Back in March, James O’Malley wrote about the UK Government Digital Service’s (GDS) ‘One Login’ and the conceptually related Government ‘tell us once’ service. The thesis behind these services is that the Government should appear essentially monolithic from the perspective of a UK resident: information should be extensively shared across agencies, and if one updates one’s details with one agency, that update should propagate across the rest.

I agree with much of this: there is a lot to be said for simplifying interactions with Government. However, one underplayed cost is how linking data across services reduces individuals’ control over their own information. This can create murky trade-offs and unintended consequences.

To give one example: I know of a public sector organisation in the health field that went all-in on ‘one person, one record’. Superficially, this made a lot of sense, as it makes contextualisation much easier if you can see every interaction an individual has had with the organisation in a single list. _Except_… that’s not really how life works. If a journalist contacts that organisation, should that professional query really be stored alongside their personal medical data? The same applies to other professionals, say a headteacher contacting the service for advice about a pupil. Most people would have a reasonable expectation of a ‘firewall’ between personal and professional interactions, but that’s the antithesis of a ‘one person, one record’ approach. This led to a load of workarounds—appending people’s profession to their surname to create distinct ‘professional’ records, for example—that ultimately made the underlying data worse.

James cites Google as an example:

If you update your address on Gmail, you don’t need to then go and do the same thing separately on Google Maps, Google Drive and YouTube – all of those other services that are owned by the same company, and updating one will update the rest.

Yet, viewed from a different angle, this is a clear counter-example: many people have multiple Google accounts to keep their personal and professional lives separate, and they reasonably expect to update each one independently. When the Government ties all interactions to a single real-world identity, that separation becomes impossible.

‘Tell us once’ can quickly morph into ‘tell the entire state at once’—and this is often undesirable. For example, we offer free tuberculosis treatment to everyone, regardless of whether they are entitled to NHS care, because this is the best way to protect the public. This means that there will be people in the country illegally who are sharing personal information, like their address, with the NHS. If we link that data up with the Home Office, the net effect is to prevent people from accessing treatment for an infectious disease—thereby increasing risk to the public. We’ve been here before, and not that long ago.

Similarly, you might register a particular, private phone number for your interactions with services where you need a reasonable expectation of privacy—for example, if you’re reporting a safeguarding concern about a member of your family. Disaster might follow if all of your different phone numbers are thrown into a single identity—or, more likely, services find workarounds and store phone numbers in unexpected places, which exacerbates the very problem the data sharing is meant to solve. It becomes very difficult for anyone to reliably update all of their data, even within a single service.

James uses the word ‘citizens’ five times in his article. I feel a certain sense of trauma when I hear that word used in this way, borne from experience during COVID. This terminology seems to be the default within GDS. People who live in the UK but who are not citizens often have more frequent and complex contact with the Government than citizens, yet the service frequently defaults to terminology that excludes them. That feels revealing.

One would hope that the social contract is about Government giving the greatest support and most careful thought to the neediest, the most vulnerable, and the most marginalised. Yet, at least from my far-away vantage point, it often reads as though Government technology conversations begin with ‘let’s make this easier for people like me’.

So, while the direction of travel is probably right, it’s an area that needs careful thought and planning. We need to be open about the fact that ‘convenience’ often comes at the cost of personal control over data. This trade-off might sometimes be justified, but it deserves far more scrutiny than it currently receives. These kinds of changes often have unintended consequences—especially for the most vulnerable in society—and the first duty of any Government ought to be to put those very people first.

The image at the top was created with GPT-4o.

It’s been years since I left Twitter. In the end, it was a simple observation about the effect that opening the app had on my mood that made me quit:

I’d felt relaxed before I opened Twitter; now I was mildly stressed.

Since then, the arguments against what’s now called X have only mounted, and perhaps become so widely understood that they’re no longer worth rehearsing. I don’t regret deleting my account, and sometimes wonder what I ever saw in the service in the first place.

Helpfully, John Elledge’s recent New Stateman column was a good reminder of what used to be valuable about the platform. It helped me remember the excitement I used to feel back when the service felt new and fresh. I remember the excitement of posting my one and only truly viral tweet about—of all things—Opal Fruits. Elledge’s column also reminded me of James O’Malley’s essay from last December, which discussed the app’s contribution to social mobility.

I remember attending a course some years ago during which Twitter was used for discussion during the presentations. It was enormously helpful and engaging; it felt like the future. It’s impossible to imagine that happening in a constructive way nowadays, without the chat becoming hijacked by non-attendees or descending into incivility. The moment has passed.

The image at the top of this post was generated by DALL·E 3.

In 2015, along with over 1,000 other people from over 100 countries, I attended an international conference of health professionals in Geneva. One delegate gave a fascinating presentation on their country’s response to the 2014 outbreak of Ebola in West Africa.

Early in her presentation, she spoke self-deprecatingly about how her country previously hadn’t needed to develop public health guidance for high consequence infectious diseases. Instead, her agency simply looked at the guidance on the USA’s Centers for Disease Control (CDC) website, looked at the guidance on the UK’s Health Protection Agency website, and split the difference.

“There was one problem with that approach this time,” she said.

After a dramatic pause, she flashed up a screenshot of the gov.uk homepage, quipping “Good luck finding anything useful on there!”

It was a joke that brought the house down. The UK was a laughingstock; gov.uk was the punchline.

My friend James O’Malley wrote an excellent Substack post a few days ago, in which he called gov.uk “genius” and “the best thing the Tories did in office”. As always, he makes brilliant points. He knows more about technology and the web than I could ever hope to. His post is much better informed than mine and is definitely worth more of your time. Yet, my perspective differs a little from his.

I agree with many of James’s arguments: renewing a passport is miraculously easy; the site’s layout is brilliantly clear; the design principles and style guide are first-rate (though too rarely followed in practice).

But there are problems—or, if we want to be optimistic, opportunities for future development. These were evident when the service was being designed, but making passport renewal easier and putting bunting on the bank holiday page were, it seems, greater strategic priorities.

The first issue was the decision to sweep away many professional-facing websites and to collect everything on one giant gov.uk system. James links to some other people who have issues with this, but it has been a particular concern in the health field.

One major problem is that specialist-facing content is very difficult to find. I don’t see the advantage to a primarily public-facing website hosting, say, the request form that microbiology labs must use to refer gastrointestinal bacterial isolates to the national reference lab. What member of the public needs to see the form to request intrathecal antibody testing for Hepatitis C?

I know from frequent complaints that people often find it difficult to find that sort of thing on the site, even all these years after it launched. The problem is compounded where animal and human health cross: hosting content about testing birds and testing humans for influenza on a single platform is a recipe for confusion. This wasn’t true when the content was hosted on a previous website targeted quite narrowly at health professionals.

The mixing of public- and professional-facing information and the resulting unnavigability of the site became a particular problem during the COVID-19 pandemic, as already cited in evidence given to the COVID-19 enquiry. It is quite likely that professionals were, at times, taking the wrong action because they couldn’t find the right guidance among the morass of COVID-19 content that was being published daily. That’s a pretty major failing.

There are also two other significant effects of this approach.

One is that government agencies increasingly publish resources outside of gov.uk, usually partnering with non-governmental bodies to host content that would not be allowed—or be easily added to—gov.uk. I’m not going to point to specific examples for obvious reasons—if you know, you know.

Another is that a lot of content is simply not published any more, as it was deemed inappropriate to sit on a public-facing website—much of this sort of thing is no longer published online, and is therefore inaccessible to professionals and the public alike. The decision to sweep away professional-facing websites has had a chilling effect on government transparency—even while people celebrate gov.uk as a transparency success.

In 2010, when the gov.uk strategy was being developed, it was entirely foreseeable—and foreseen—that the spread of unreliable information would be an ever greater challenge.

Perhaps the single most baffling decision for gov.uk has been the choice to seemingly ignore that. This presents itself in three ways.

First: When government agencies need to give emergency messages—“there’s a big fire so close your doors and windows”, for example—these are routinely distributed via social media. If there were ever messages you’d want to present first on a stable, reliable, verified site and then syndicate elsewhere, those about public safety would seem to be at the top of the list. Instead, presumably because the gov.uk strategy didn’t account for this “user need”, the government has de facto outsourced low-level emergency messaging to Twitter. This sort of thing used to be routinely published, but doesn’t appear on gov.uk—we don’t give the public the opportunity to check facts they’ve seen on social media.

To take a really minor example: instead of this quote being published on a government domain, as it would have been before the launch of gov.uk, it’s now on a Twitter account that could have been set up by anyone. Without gov.uk, it’s likely that the quote would have been on a verifiable departmental website and linked from Twitter.

Second: Accuracy doesn’t seem to be prioritised. In the early days of the COVID-19 pandemic, there was a page about public transport on gov.uk that gave blatantly incorrect advice, suggesting that COVID-19 persisted longer on surfaces than human hands. This resulted in a deluge of questions for hospital infection specialists—and despite a chorus of complaints, the page wasn’t corrected for—literally—weeks. There is a guidance document on another topic live on gov.uk now with a persistent error in it—years after the error was first reported. If the information on gov.uk can’t be trusted to be reliable, then it undermines the whole endeavour.

Third: gov.uk doesn’t follow its own advice. In his Substack post, James celebrates the success of gov.uk Notify—a service which is routinely used to send unsolicited messages to members of the public exhorting them to click embedded links. This is not a shining example of thought-through technological prowess—it’s a tool that trains people to fall victim to scams. And, just as James says, this vision of insecurity is actively pushed across all government departments—because a failure to think in a cyber-secure way isn’t limited to a single area of government but is automatically propagated to all.

In his post, James says

To give you a sense of where it was starting from back when GDS was created, the government didn’t know how many websites it had.

In that narrow sense, I think the situation is now worse: I don’t think the government knows how many sites it ‘officially’ posts on. We’ve gone from a situation where official government content is spread over an uncountable number of accountable government websites, to one where it’s spread across countless websites which aren’t even in the government’s control. Many of them aren’t even based in the UK, and there’s no mechanism for professionals or the public to verify that the content is genuine.

Some professional content on the ‘official’ website is so difficult to find that it is likely to have caused people to come to physical harm. Factual errors in content persist for years, meaning that it’s difficult to trust the content that is on there. And some things are just not published any more, making government less transparent than it used to be.

The bits of gov.uk that work are, as James says, brilliant. But some of the strategic and cultural change that has happened around the introduction of gov.uk, partly driven by the limitations of the system, has been damaging in ways that are under-recognised. If you ask me—and there’s no reason why you should—it all needs a bit of a rethink.

The image at the top of this post was generated by DALL·E 3.

Some weeks, I think more about local journalism. This has been one of those weeks, as I’ve been thinking quite hard with my comms colleagues at work about whether and how to include public health messages in statements relating to a minor local news story. It’s sometimes a trickier call than you’d think.

When I saw James O’Malley’s most recent Substack post was about saving local news, the topic was already on my mind. He suggests that local news might be sustainably delivered through ‘paywalled newsletters’, initially supported by the BBC’s Local Democracy Reporting Service (LDRS) funds, which currently pay for local newspaper journalists.

In an instant, this would mean that many more pockets of the country once again have quality reporting in a quality publication, covering the nuts and bolts of their local democracy. And with a LDRS subsidy, it would mitigate the chicken-and-egg problem that newsletters have, of needing to sign up enough people to be viable while still paying the wages of the writers.

Over time, some newsletters might even become profitable or sustainable – like the Mill. Others may need to be subsidised for slightly longer.

But ultimately, it would stimulate an ecosystem of viable local newsletters, with the reach and distribution to serve communities with real, meaningful news – with all of the civic positive-externalities that implies: Better democracy, better accountability, and better media.

As I read this, I immediately thought this was both a brilliant and terrible idea, and I haven’t entirely managed to reconcile my thoughts on it since.

The downside is, of course, the paywall. I’m not sure that content whose accessibility is limited to a few paid subscribers really does deliver better democracy or accountability. At the very least, it’s harder to counter misinformation and disinformation that is not out in the open in the first place. I’m also not confident that it’s ethically sound to use LRDS public money to fund journalism that’s only—or at least preferentially—available to those willing to pay a subscription fee.

And yet, if a product like that existed locally, I wouldn’t hesitate to sign up, so I’m not that ethically opposed to it. Heck, I even subscribe to the apps of some local newspapers so that I can view the less ridiculous content without a deluge of advertising. And surely a sustainable future for local journalism, even if it is a little less open, is better than no local journalism at all?

It’s a quandary.

The image at the top of this post was generated by DALL·E 3.

James O’Malley opens his latest Substack post:

Twitter’s most underrated function is that it is a tool for social mobility.

After graduating into the financial crisis, I moved to London and I didn’t know anyone. My parents are not super wealthy, I went to a normal comprehensive school in the Midlands – and then to a post-1992 university. So when it came to getting a job and building a professional network, I was essentially starting from scratch.

But the one asset I did have was that I was a Twitter early adopter. Through the platform I discovered an entire professional world that would historically have been closed off to me, and as I followed journalists, politicos and other high-flyers, I was able to glimpse into their world, learn the industry gossip, identify the behind-the-scenes power-players and master the terms of art. Scrolling my timeline was like having a permanent spot at the water-cooler of London’s political and media elite.

I’ve never previously considered Twitter from the perspective of social mobility, but now that James has pointed it out, it seems obvious. Indeed, when I was active on Twitter in the early stages of my career, it helped me to make professional connections in a similar way. Public health in England is a small professional world, and as a result, it is disproportionately London-centric. Twitter helped me to make professional connections even from afar.

Yet, looking back, many of the people I made professional connections to were the—for want of a better phrase—‘extremely online’ colleagues, who were often not as influential, switched-on or expert as they thought they were.

Last week, we heard complaints at the COVID inquiry about politicians’ inability to distinguish between absolute and relative risk. Not many years ago, I did my best to explain the same to an uncomprehending prominent professional by direct message on Twitter. They may have been rarely off the telly and hugely popular on Twitter, but the conversation revealed their grasp of the basics to be a little loose. Another told me that a study they shared was significant because of a wide confidence interval, which they believed to demonstrate a very high level of confidence: an almost perfect inversion of the true meaning.

I came to learn that the people with deep knowledge and real, lasting influence tended not to be active members of the Twitterati. In my field, at least, when ‘extremely online’ people reach positions of real-world seniority, it can become somewhat fraught. Public health is a naturally complex, subtle and political field which perhaps doesn’t reward talent for brief, blunt, off-the-cuff responses. There are exceptions, of course, and I’m not inured to the irony of writing all of this in a blog post.

In politics and journalism, public engagement is the job, so naturally, excellent practitioners will often do well on social media. In these fields, Twitter is a perfect tool for social mobility, precisely as James describes. In medicine, I’m not so sure.

The image at the top of this post was generated by DALL·E 3.

James O’Malley recently wrote about status in a way that reminded me of Will Storr’s brilliant book The Status Game.¹ It made me reflect on some disparate thoughts I’ve been having recently about the role of ‘status’ in the medical profession, and especially within public health.

A little while ago, I talked with a colleague who had moved to a new role. Their former role had been equivalent to mine: actively managing local outbreaks and situations involving risks to a geographically defined population. The formal ‘status’ of the new position was no different—the pay was the same and so forth—but the day-to-day was different. The role was part of a national team broadly concerned with developing guidelines rather than having direct input into managing ongoing situations.

I knew that, like me, this person enjoyed the messily complex, ethically challenging, adrenaline-pumping world of managing ‘live’ situations, so this seemed a slightly surprising career move for them. Luckily, I knew them well enough to ask what had possessed them to take on such a different role.

My colleague told me—not quite in these terms—that they felt that the new role had a higher ‘status’: that, in their opinion, developing policy and guidance was a more ‘senior’ responsibility than managing incidents.

I know I sound desperately naive in saying this, but that floored me. I’ve been involved in developing more than my fair share of national guidance and have always seen it as a bolt-on to my ‘core’ job. I felt able to contribute to the development of this sort of thing because of my ongoing practice and experience; it wasn’t a ‘higher status’ bit of my job than, for example, chairing multiagency outbreak control teams.

I suppose I saw writing guidance as a little comparable to teaching. It is an important and worthwhile activity, but pivoting to doing it full-time seems like a career ‘jump’ into a different field, not a ‘status upgrade’ deal.

The idea that some colleagues saw this differently was quite a revelation. I think this is perhaps unique to the public health speciality: I struggle to think of anyone I know in clinical practice who has seen the leap to a job in guideline development rather than clinical practice as a ‘status increase’ in quite this way.

Status can be a funny thing: for it to hold any meaning, there has to be a socially agreed ‘ranking’ of sorts. James talks about the boost he feels when a journalist he respects engages with his work, but part of that ‘respect’ no doubt comes from a social consensus that the journalist is ‘high status’. We might be friends, but I don’t think he’d feel quite the same status boost from me blogging about his post. At the same time, as James points out, different groups have different consensuses: I strongly suspect James wouldn’t be as excited to see a complimentary post on his work from Suella Braverman as from Barack Obama, but they’re similarly statuesque figures to their particular crowds.

Even in a small field like mine, people can see status in different places. I suspect that within individuals, people recognise different things as holding status at different times in their lives and careers. At this point in my career, I would actively decline a ‘promotion’ to a management position, for example, because I value my clinical work too highly. Perhaps later in my career, I’ll value the broader influence that management positions can have.

I guess my reflection is that our own conceptions of status are even slipperier than I’d considered. I think James and Will are right to suggest that status is underestimated as a driver of behaviour, but applying that insight to understand individuals’ behaviour is more complicated than it might initially seem.

1. He also said that Succession is better than The West Wing, and without even having seen a single episode of Succession, I’m pretty sure I disagree. ↩

The image at the top of this post was generated by DALL·E 3.

A lot is often written about the need to adapt our national infrastructure, and particularly that of cities, to manage climate change. Most of what I read is about adapting cities to produce less carbon. For example, by promoting active travel over carbon-fuelled vehicles or by using heat pumps in place of carbon-fuelled central heating.

A lot of this is framed very poorly. Coverage regularly implies a choice, most frequently citing ’economic damage’ as a key barrier to implementing ecologically sound practice. It shouldn’t need saying that making our planet uninhabitable is the ultimate act of economic damage.

As my old friend James O’Malley frequently reminds us, adaptations actually have to be built to make a difference. If every option is blocked because it’s not quite eco-friendly enough, then we’re doomed to end humanity.

One aspect that seems under-discussed is how we need to adapt the built environment to cope with the climate change that is already baked-in through the damage we’ve already done. I was pleased to see an article in Le Monde yesterday about exactly this issue, looking at how Paris needs to adapt.

I think the two issues ought to be considered hand-in-hand: the super-insulated houses required to make heat-pumps work must also support passive cooling, or they will be uninhabitable in the medium term. Building better infrastructure for active travel is a must, but doing it with asphalt is a bad idea. Nice big windows to reduce reliance on powered lighting are unhelpful if they also trap heat.

I worry, though, that this complaint just puts me in the same category as those who oppose developments for not being quite ecologically friendly enough. I don’t think it’s the same complaint: building infrastructure in a way that guarantees a short lifespan can’t be good for the planet… but is it better than nothing?

My friend James O’Malley argues on his blog that 16- and 17-year-olds should be given the vote as it will help to tackle the seemingly undue attention given to old people by political parties:

By increasing the potential pool of voters at the bottom, it affects the potential electoral mathematics that the parties have to do to maximise their votes. If there are more young people who can vote, it tips the scales back towards the young. Pensioners might be reliable voters, but if there were an extra 1.6 million (ish) young people on the electoral register might be a greater motive for refocusing policies and priorities.

I’m undecided on whether 16- and 17-year olds should be allowed to vote―I see good arguments on both sides―but I think that James’s specific argument is wrong for reasons mathematic and democratic.

First, the maths. For the purposes of these back-of-the-envelope calculations, I’m using ONS projections for England (as that’s what I have at hand), defining the “youth” vote as 29-and-under,¹ and defining the “grey” vote as sixty-and-over.

Currently, the “youth” vote accounts for roughly 20% of eligible voters, versus roughly 29% for the “grey vote”. Giving the vote to 16- and 17-year olds would move these percentages to about 22% and 29%: that is to say, it wouldn’t make much difference. And the difference is lessened further by the fact that most people agree that the “youth” vote is less likely to turn out than the “grey” vote.

But, of course, the real imbalance in the “youth” versus “grey” votes isn’t in 2015. The population is ageing: the scale of the imbalance today is nothing to what the scale of the imbalance will be in the future.

If we fast-forward a couple of decades to the 2035 election, ONS projections suggest that the “youth” vote (as currently defined) would make up roughly 18% of the electorate, versus 37% of the electorate being “grey” voters. Giving 16- and 17- year-olds the vote rebalances this a titchy bit (to 20% and 36% respectively), but this difference is really so little as to be meaningless―the imbalance remains far greater than it is today.

My second problem with James’s argument is democratic. He reckons that the makeup of the electorate needs to be changed to better ‘balance’ it in age terms, because generational disputes cause problems in our country. As an example:

The old, who own property want the value of their homes to continue to increase, whilst it would be better for the young people who Ed Miliband calls “generation rent” if property prices were to fall, so that buying a house can become even a remote possibility.

But, surely, to suggest that’s a problem is profoundly undemocratic! We have decided that the best way to run our nation is by the majority electing representatives who they think will best serve their interests. The majority of the population is ageing. We shouldn’t go around thinking of ways to “fix” the result to better reflect youth interests because the youth is in the minority.

If we stick with our current form of representational democracy, then, for the foreseeable future, our politics will continue to be determined by the “grey” vote as it is the “grey” vote which makes up the largest part of the electorate. The different electoral turnouts between the generations certainly exacerbate the problem, but they are not the source of it.

Having said all of that, there is a problem here. Actually, it probably is unreasonable for the electorate to become so imbalanced: not generationally imbalanced, but gratuitously imbalanced between net financial contributors to the state and net financial users of state services. It’s hard to see how a state can function when politicians essentially only have to appeal to those who use the state’s services (especially the elderly), and have to appeal less to those who (by and large) pay for it (largely the working aged). It becomes perfectly logical for politicians to whack up tax rates or borrow with little regard for the future.

Of course, this probably won’t actually happen. It’s more likely that the “grey” vote will be effectively capped at a certain size as people work longer, as neither the state nor individuals can afford to pay for pensions which increasingly approach or exceed the length of an individual’s working life. And, of course, outrageous levels of tax and spend would provide a good incentive to improve low turnout in the younger section of the electorate, which would provide a degree of rebalance in and of itself.

On the other hand… things could get worse more quickly. We’re seeing national and international narrative opinion increasingly extending the length of childhood. We’ve already seen in the UK a major shift in legislation pushing the end of childhood (in terms of, for example, school leaving and consumption of cigarettes) from 16 to 18. There is increasing scientific evidence that key elements of development, particularly emotional development, continue until the early 20s. UNESCO considers our period of “youth” to continue until 25. The African Youth Charter considers it to continue until 35. In this context, it’s not inconceivable that a future government might choose to increase the voting age, not decrease it.

❧

To summarise: give 16- and 17-year-olds the vote if you want. But do it for good reasons, not because you want to “fix” the outcome of elections in a way that will matter little and matter for a short time. And go and read James’s post, too.

It seems almost a little wrong to select something a friend wrote for my recommended weekend read… but this is my blog, and I make the rules. So this week, I’ve selected James O’Malley’s thoughtful blog post about the hegemony of social media and the potential danger the emerging situation poses to the concept of free speech. He poses more questions than he answers, but in so-doing he made me consider restrictions on free speech from a somewhat different point of view.