This document discusses how power is shifting from hierarchies to networks in today's world. It notes that there is a balance between tyranny when power is too centralized, and chaos when power is too diffuse. It argues that we are experiencing a revolution driven by factors like ubiquitous information, increased transparency, and empowered citizens. This tends to disperse power away from organizations. However, we still need to build civic institutions that can manage diffuse power and create space for democratic action between tyranny and chaos. The document imagines what an "Occupy the NHS" movement might look like and how the NHS could creatively respond to such a challenge.

1. Why being in charge isn’t as much
fun as it used to be
In a networked world power is leaching
from hierarchies to networks
Paul Hodgkin, Patient Opinion
Twitter: @paulhodgkin
Acknowledgement and thanks to Naim Moses and his book
‘The End of Power: why being in charge isn’t what it used to be’ 2013

2. There is a sweet point between tyranny
and chaos where civil society flourishes
Political and
social stability,
economic vitality
Power completely
centralised
Tyranny
North Korea
Space for
democratic
action
Power completely
diffused
Failed state
Somalia
From: ‘The End of Power: Why Being In Charge Isn't What It
Used to Be’ Moises Naim 2013

3. We have spent 300 years building institutions that
prevent the concentration of power
Democratic and civil inventions that prevent tyranny
• Universal suffrage, rule of law, due process
• Free press
• Literate, educated population
Political and
social stability,
economic vitality
Power completely
centralised
Tyranny
North Korea
Space for
democratic
action

4. Karl Marx said that it would take a
revolution before the masses could
get their hands on the means of
production

5. But it turned out that Steve Jobs
and Bill Gates were happy to
sell us all the means of production
at a very reasonable price
… and 3D printers means this
does not just apply to digital goods

6. So now we’ve got the revolution
…..its just not the one that Marx predicted:
• Information is ubiquitous
• The cost of secrecy is rising, the cost of transparency is falling like a
stone
• The cost of collaboration is falling for the citizen but rising for
organisations
• Voice has been democratised – Blogs, Twitter, Flickr, YouTube

7. This revolution tends to disperse power.
Drivers that disperse power:
• Universal information, GPS,
• Democratised voice: blogs, Twitter, FB
• Transparency/end of privacy
• Informed, empowered populace
• Bewildered bureaucracies
Space for
democratic
action
Power completely
diffused
Failed state
Somalia

8. But we have less than 20 years
experience of these networked
drivers
We have yet to build the civic
institutions and mechanisms that
could widen the space for civil
society
?
?
Space for
democratic
action
Power completely
diffused
Failed state
Somalia

9. IMAGINE
DIFFUSE
POWER

10. What would an ‘Occupy the NHS’
movement look like?
How could the NHS react creatively
to this kind of diffuse, powerful
challenge?
What institutions do we need to
build that will mean this is an
opportunity not a threat?
See full article

11. How to Occupy the NHS –
Possible house rules
•
•
•
Never disrupt clinical care or frighten other patients
Get staff on our side – they are as stressed as you
Look after yourself
-
Use the hospital toilets and canteen – after all its our NHS
Keep warm
Go home when you’re tired, there will always be others to take your place
•
Courteously hold management to account
•
•
•
Tweet what they say using #ONNOW!
Upload your interactions with them to www.you.tube.onnow
Keep in touch nationally at www.OccupyTheNHS.org

12. Thank You (and good luck with the revolution)
Twitter: @paulhodgkin