site impaired

In March 2000, prime minister Tony Blair announced that the target for getting all government services online by 2008 would be moved forward to 2005.

Since then, government departments and agencies, local authorities and other state bodies have scrambled to meet the deadline.And as everybody in the NHS knows, chasing a single target can have perverse results.

The state has certainly put itself online. The official directory of central government websites (www. ukonline. gov. uk) has some 1,080 entries, ranging from the Apple and Pear Research Council to the zoos forum, via MI5's recruitment site. There are hundreds more local government sites.

But the take-up of such services is often poor. In December last year, Edward Leigh, chair of the Commons public accounts committee, said he was 'very disappointed at the pedestrian progress' in encouraging the use of online services. The committee found that only 11 per cent of the public has used such services, compared with 18 per cent in France and 40 per cent in Canada.

A survey published the same month, by IT consultant Hedra, found that a third of Britons with web access have visited a government website, but less than 3 per cent visit one regularly. This figure fell to zero for people over 65 and those from lower socioeconomic groups.

The National Audit Office came to the same conclusion when reporting on the government's websites in April last year. Despite 'considerable progress on basic features' in the last few years, it said that many departmental websites have not seen the growth in visitors one would expect, given the huge increase in general web use.

The report urged a focus on 'actual usage and takeup of government services' online, rather than simply on whether a service is available online or not.

The Inland Revenue is an obvious case in point. It accepted 76,000 tax returns through its website last year - 1.5 per cent of the 5 million filed through self assessment. In an August report, the public accounts committee said that at one point, four out of five efforts to file a return failed due to capacity problems with the Inland Revenue's systems.

Meanwhile, the Australian Taxation Office last year collected 562,000 returns through its website - 25.5 per cent of the 2.2 million who do their own taxes (and 95 per cent of those who have a tax accountant to do it for them). The UK service has been plagued by technical problems, whereas Australia's has a reputation for reliability.

Even with information services, government departments have failed regularly. The Environment Agency put flood-plain maps online during the floods of December 2000. The service drowned in the deluge of users. During this January's floods, the Environment Agency site sank again, though this time a skeleton service was put in place.

Web performance-measurement firm Keynote Systems found a page on the army's website that was 3,800kb in size, taking several minutes to load on a standard modem. UK country manager Andy Didcott says that average page size has fallen from 120k to 80k or less over the last 18 months.

There are bright spots. In 1999, more than a third of the UK's district, unitary, city and county councils lacked a website. This year, all councils have one, and more than a third improved their status on the Society of IT Management's annual survey of local government sites.

'There are far fewer councils that are not treating website management reasonably seriously, though a lot are not resourcing it properly, ' says Martin Greenwood, programme manager for Insight, SOCITM's research division.

He thinks councils have had an advantage over some government organisations - and particularly the NHS - when it comes to developing online services. First, in comparison to the permanent revolution in the health service, local authorities have a stable structure. Second, 'There is much more latitude and freedom to meet local needs'.Mr Greenwood says the better websites tend to be in the South East, where the web is used most.

Third, he says, councils have been able to make mistakes, compete and learn from each other.

The NHS's online presence is led by NHS Direct Online (www. nhsdirect. nhs. uk), which includes interactive guides to various complaints, allowing a certain level of self diagnosis. Despite some grumbling from GPs, NHS Direct Online is generally seen as a success, having gathered praise from the National Audit Office among others.

'A lot of money's gone into it, and It is a resource that should be exploited, ' says Mike Stone, chief executive of the Patients Association, who feels that more NHS websites should be linked to it.

Mr Didcott says that NHS Direct Online is one of the better government sites it has surveyed, with a relatively small home page (129kb) and only a small number of broken links to other pages.

AbilityNet (www. abilitynet. org. uk), a charity that advises on making sites accessible to the disabled, is also positive, though operations director David Banes says there are 'a number of actions that could be taken to make access easier and faster'. These include providing more information as audio files for those who find reading difficult.However, Mr Banes adds: 'Looking at the NHS sites, it is clear that a real effort to ensure accessibility has been made.'

At a national level, there are also sites for specific NHS organisations, advice on issues such as smoking (www. givingupsmoking. co. uk); measles, mumps and rubella (www. mmrthefacts. nhs. uk);

and the NHS gateway site (www. nhs. uk).

This allows users to search for their nearest doctor, dentist, pharmacy, optician, walk-in centre and hospital by postcode.And it gives other information such as waiting-list times and hospital star-ratings.

But for the public, that is about it. Sites provided by local organisations tend to be information only, if they exist at all (see box). This can be irritating, especially when useful things can be achieved even with a relatively simple site.

Netherfield House surgery in Seghill, an old mining village in Northumberland, uses its website (www. netherfieldhousesurgery. co. uk) to accept repeat prescriptions through an online form.

Patients can ask for prescriptions to be ready at four local pharmacies, and automatically receive an acknowledgement e-mail.

'We felt it was the communication of the future, ' says practice manager Sue Cummings, adding that it might also reduce pressure of telephone calls.

'People have said they like the fact that they can order prescriptions at work.'

However, a recent survey of 200 patients found that although 45 per cent use the web, only 10 per cent have visited the site and just 4 per cent have ordered repeat prescriptions online. 'We reckon We have got to have a big advertising drive, ' says Ms Cummings.The practice has already put notices on the back of prescriptions, as well as signs in the surgery and information in its brochure.

The site also provides e-mail addresses for practice staff.Ms Cummings says patients are using them to cancel and schedule routine appointments.

Surgeries such as Netherfield House are the exceptions. Justin Keen, a professor at Leeds University's Nuffield institute for health, feels the health service has yet to answer a basic question:

'What does the NHS want to use the web for?'

He says it could hold everyone's medical records, so they could be accessed everywhere and be controlled by the patient - but this would require sturdy security and privacy controls.

'If It is for basic communications, then It is just fine.

But what do you want to do beyond that? That is the question that hasn't been answered across the NHS as a whole.' l