The NHS is a huge organisation with over 1.3 million staff employed. This means that it can be difficult to communicate feedback, give thanks, share our experiences or highlight issues. What we need is a way to show off these messages in a concise and visible manner that’s easy for everyone to view.

Let’s use twitter to send clear feedback to the NHS!

The wall of tweets on the left shows the twitter community’s opinions and feedback on the NHS. Any tweets that mention opinionnhs.co.uk or the NHS will be displayed on this wall in real time to provide a single, clear and instant source of feedback so that the public and NHS staff can stay informed.

Treatment choice:
Whilst patient preference may sometimes be approprite, quite often (particularly in primary care), there is an accepted treatment guideline, based on the best available evidence. Perhaps its not such a good thing for patients to be able to challenge, or choose an alternative treatment, which is less effective than the clinician’s choice. Again, choice is very nice, but may not result in improved care or quality.

Also, if a patient makes a poor choice, the blame for ineffective treatment or harm is shifted somewhat to the patient themselves.
I think the best approach lies in shared-decision making, where evidence is used to inform a choice made by both the healthcare professional and patient.

NHS Choices is representative of a type of project that typifies the old paradigm of government internet projects – a big spending, centralised, top-down initiative that assumes people will come to the NHS rather than the NHS go to them. It has the hallmark of a classic managerial approach, in which expensive day-rate consultants are brought together to create a slick one-stop “solution” to healthcare information needs that are barely understood, resulting in a single ‘portal’ that offers a highly branded but not very adaptable experience.

A more forward-thinking approach, perhaps alongside the portal, would be to invest in more granular web services (the previous NHS beta Web Services seemed to provide more than those advertised on NHS Choices, but I may be wrong) and some tools for community-based organisations to use this data to help signpost services for patients. For example, some people trust their support groups or local healthcare organisations to give them good advice, so perhaps we should be thinking about offering up NHS data to those groups rather than expecting everybody will go to (and trust) the shiny central portal.

Obviously, it is easy to say and harder to do, but I am curious why a better-value, more community-minded, distributed approach was not adopted in this case.

I’m inclined to agree with Jonathon that government institutions should have a presence on the Web and perhaps more importantly I’d argue that government websites should be more than static vehicles for processing transactions and publishing information. Only a handful of agencies around the world have designed websites that invite public input, despite the fact that it would be relatively easy to do.

NHS Choices provides a useful example of how to get started and I’d like to see NHS Choices take it further by incorporating tools for digital brainstorming that would engage patients, doctors and policymakers in the process of designing a better health care system. Perhaps these brainstorming tools could operate similarly to those provided through Dell’s Ideastorm.

James rightly suggests that in some contexts non-governmental organizations can provide a neutral venue through which to foster public participation in government. I also think, however, that it’s fundamental to the health of our societies that governments strive to build a more collaborative relationship and less adversarial with the citizens they serve and represent. This suggests to me that more governments should be opening up channels for civic engagement on the Web, actually listening to what citizens say, and providing transparent feedback loops that demonstrate how input is translating into action.

There is an important role for organizations like Patient Opinion to play in this equation. Part of that role no doubt is to help keep a fire lit underneath the NHS so that it never loses the sense of urgency around the need to innovate and improve.

All your questions are good ones but can I give a bit of context. NHS Choices is part of the Government’s initiative to rationalise all its websites so it doesn’t spend more money then it needs to. It will be the home for all health information and will in time offer transactional services like emailing your GP and ordering repeat prescriptions. It also provides other functions like blogs and medical dictionaries and will soon incorporate NHS Direct’s web presence. So the DH isn’t just spending millions to create a website to gather patient opinions and help people choose. It is part of a broader initiative. You could argue all these things are duplications but our research shows that people think it is right for the NHS to have one home for reliable health information online.

As for patient opinions there is clearly room for many online avenues. I worked out on the back of a fag packet the other day that if NHS Choices managed to capture comments from just 1% of all patients attending hospitals in England in a year it would be recieving 40,000 comments a month. That would be significant enough for it to become a serious management tool. But it also shows the pool NHS Choices, Patient Opinion, RateMD and IWantgreathealth is enormous.

James Munro’s thesis, at Patient Opinion,is that people will be more comfortable placing comments on a non-government site. NHS Choices has disproved that but that’s not an argument for monopoly provision or a justification for goverment websites. Its an argument for diversity on the web. Let the public choose where they want to comment. What James and I need to do is work together and make sure all these thousands of comments are being put to good use by the NHS – that is after all our mutual goal. That’s why the NHS backed Patient Opinion. That’s why NHS Choices welcomes him putting NHS Choices comments on his site and we are exploring putting his comments on NHS Choices. Bottom line – you can never have too much comment.

When it comes to rejecting more comments I think James raises an important issue which we are looking into. But back to the original point – government websites are part of the mix and freedom of the web.

Jonathon Carr-Brown