Trip Advisor

There is obviously a cost to managing any operation and perhaps one of the arts of senior management is to put in place sufficient control systems without the costs becoming exorbitant. This concept applies to government as well as business. As Merryn Somerset Webb writes in this blog post (commenting on Tim Morgan's "Reform Trilogy"), undoing layers of administration from the NHS could save billions.

Over the last 50 or so years there have been serious improvements in quality management, from Deming's Total Quality Management to 6 Sigma, and the notion that improvements in quality can reduce costs by reducing defects is well founded. So care must be taken not to destroy essential management systems. But there is a concurrent idea, that customer experience is important and customers are the best people to judge it. In business, marketing departments have a host of techniques to measure customer experience. Each with their cost.

Trip Advisor offers a different way of doing this. It gets the customer to do the work of contributing to improving the system by offering an easy way for them to express their opinion. This could be applied to government services at relatively little cost.

Such a system may benefit from integration with Interactive Democracy because ID links your identification with your right to vote in an online system. It may be extended to identify you as a patient at an NHS facility at a certain time, indicating that your online opinion isn't mendacious, and giving you the right to express your opinion on-line.

Though the results of such a system may inform patient choice the more important benefit is that it will likely motivate staff to improve in all sorts of subtle ways.

Assisted Suicide

The murder charge against Kay Gilderdale for assisting her daughter's suicide has finally been dropped. Panorama did an insightful programme about it, which touched on the recent Lord's Bill and the clarification of the law by the Director of Public Prosecutions (DPP). I find it interesting that such an important Bill started in the House of Lords, which is not democratically elected and carries a religious bias in the form of 26 Bishops of the Church of England. The Church, as far as I am aware, has always been against suicide. That clarification of the law then falls to the DPP, who is appointed by the Attorney General, leads me to suspect that our elected politicians don't have the stomach for such an emotive subject. However, this poll suggests that 73% of people condone Mrs Gilderdale's actions.

For sure, this is a difficult subject and close attention must be paid to protecting vulnerable members of society. But law makers in Oregon, Switzerland, Belgium and the Netherlands have made assisted suicide legal and many other countries have laws that are less stringent than our own (please see this report). This leads me to believe that personal choice and the protection of the vulnerable aren't mutually exclusive concepts.

But this isn't just a moral/legal issue. It is also dependant upon the resources available for palliative care. Given sufficient support the NHS could remove the physical burden from caring relatives and the associated guilt patients may feel in requiring help. In short, this may remove two of the motives that we worry drive assisted suicides.

The poll results, legal cases, media interest and political avoidance suggest that it is a subject that would be well served by Interactive Democracy. Voters may even make suggestions of how to overcome some of the sticking points that the Lords found so difficult to overcome.

Technocrats

Many decisions in society require detailed knowledge and expertise and must be done by technocrats of one form or another. Consider the NICE committee that advises the NHS on the validity of new drugs (amongst many other things). Often senior doctors, they make decisions after analysing the clinical evidence and in light of the affordability of the treatment, using sophisticated metrics to compare the likelihood of providing quality of life years for patients. They make tough calls that can result in refusing patients with terminal illnesses the treatment that they need, because that money could be better spent elsewhere. The plight of these patients may tug at our heart strings.

Interactive Democracy may be used by campaigners demanding drugs that NICE have refused. They may garner much support through emotional appeals that ignore the hard hearted rational of the technocrats. Is this a bad thing?

In a democracy this should be a debate worth having. It may alter the rules that the technocrats employ to make their case by case decisions. But Interactive Democracy can not replace them; they are still an essential part of society. I don't believe that the public, through ID, could consider such complex decisions and vote frequently upon them.