Social media could transform the NHS and other public services in the same way that file-sharing changed the music industry, a conference has heard.
Growing use of tools, such as Facebook and Twitter, offered an opportunity to reinvent services, delegates heard.
The MyPublicServices event debated ways to harness these conversations, many of which are critical, to make services better and more inclusive.
If this was not done, many services would be undermined, speakers said.
"It's happened to the music and travel industries and it's going to happen to public services," said Dr Paul Hodgkin, founder of the Patient Opinion site that organised the MyPublicServices conference.
Said Dr Hodgkin: "The question is how do we cope with it in a useful and productive way and not spend decades beating each other up?"
Dr Hodgkin created Patient Opinion to capture stories about what happened to people when they got medical treatment. The site takes their criticism or praise and routes it to people in a local health authority who need to know and can, if need be, use that information to improve services.
He said that conversations about people's experiences with public services were going on all over the web and needed to be taken into account.
Dr James Munro, the director of Patient Opinion, said the web and the rising influence of social media such as Facebook, Twitter and other discussion sites was likely to force big changes in the running of programmes.
"Public services seem only to be there to give you what you need," he said. "A patient is all about being passive."
"This is about turning things upside down so the thing that looks like a deficit, your experience, becomes the gift you have to give to other people."
The conference heard from many people who had been moved by their frustration with current practices to set up a website or a service that can do something about it.
Denise Stephens created Enabled by Design in 2003 after being diagnosed with Multiple Sclerosis.
Ms Stephens said she grew increasingly frustrated with unattractive assistive technology that made her home resemble a hospital. She started Enabled By Design to share information about better designed, cheaper and more attractive alternatives.
"A lot of assistive technology is ugly and does not do the job very well," said Ms Stephens.
Talking about their experiences at MyPublicServices were projects to ensure that those in nursing homes are looked after with dignity, to help make welfare to work programmes less adversarial and a place to report experiences with police investigations.
Tom Loosemore, head of 4iP, Channel 4's Innovation fund, said he suspected that active citizens and frustrated users could become a big catalyst for change in public services.
"The design of public services around the needs of the public not the needs of the state enabled by the internet, that's the big change," he said.
"I'm not sure that the government can re-engineer itself from the inside out," he said. "It's going to take the demands of people to force it into shape."
He counselled attendees to "shout loud and force change" on local and central government.
He told conference goers: "You are the future of public services not .gov.uk."
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