Big Society or just Big Conversation?

Jerry and his girlfriend had been leading the usual chaotic lives of drug addicts when she fell pregnant. Shocked, they pulled themselves together, got on a treatment programme and found somewhere to live. With help and support the baby was born but some weeks later they used Patient Opinion to post this message to their clinic: "Me and my girlfriend have just had a baby. You think we're clean but sometimes we still slip up. We want to stop and we want to tell you. But we're afraid if we do you'll take our baby away. What's the deal?" There are several remarkable things about this posting. Firstly it's easy to forget just how new it is, for Jerry and lots of marginalised people like him, to have a public voice. If you wanted a public voice before the web then you had to get a letter published in a newspaper. Now anyone can blog, use Facebook or post clips of their consultation on YouTube. But having a voice is not the same as being heard. Facebook is great for lots of things but not so hot for interacting with the busy staff who run Ward 15. So the second remarkable thing is that the medical director of Jerry's clinic did indeed post a reply that told Jerry – and anyone else who cares to look – exactly what that clinic's policy is around protection of vulnerable children. This small act meant that Jerry and his small family stayed in touch and on treatment. Creating a platform that does this is not straightforward (at Patient Opinion it's taken us six years so far). Directing your story to just the right three or five or eight people locally who are responsible for the service you use is, relatively speaking, the easy bit even though the NHS has more than a million users per day. Finding the right incentives that help everyone from Jerry to 83 year grannies with colostomies to participate is much harder. Add the needs of busy staff who understandably will only act on patient feedback if they perceive it to be honest, well intentioned and helpful and you can see why sites like Patient Opinion have taken a while to get right. But perhaps the most remarkable thing about Jerry's posting is that it happened on his terms. His small but vital question got asked in his way, on his initiative. Democratised voice shifts power from institutions to individuals. Monolithic hierarchies are giving way to networks of connected individuals. The Big Society is Cameron's way of riding these changes. Like most politicians he is not leading but following. However, Cameron is not following political principle or ideology, he is following the new economics of the web. Cheap voice democratises participation. Being able to find 'people like me' makes it much easier and cheaper for groups to get organised. And forcing bureaucracies to hold conversations in public, because that is the place where people choose to speak, shifts power to citizens. These new economic opportunities have already turned the music, travel, broadcast and retail industries upside down. The Big Society is just one particular way of viewing how Twitter and Facebook and Flickr are already changing politics and participation. That previously excluded people like Jerry can now set the terms of these conversations does indeed make society 'bigger' – not just because the previously marginalised are now heard, but bigger in the sense of being big-hearted, more rooted in the human because more human voices are engaged in more conversations, at lower cost and with more effect than ever before. Paul Hodgkin is a GP and chief executive of Patient Opinion, a not-for-profit social enterprise