Inside e-health on choice and consultation in the NHS

In his latest column, IT journalist Jon Hoeksma reflects on how the NHS is struggling with choice, engagement and consultation – and how the imaginative use of some simple and widely available IT could help. 



We all like to be able to choose; being able to exercise choice is one of the hallmarks of a market economy and consumer society. But enabling patients to make choices about when, where and how they receive NHS care continues to be problematic.

The real benefits of choice come when people actively choose to live healthier lifestyles, eating better, exercising more, cutting out the fags and cutting down on the booze. But the NHS struggles with choice at a more basic level.

This isn’t surprising; you can’t easily bolt a service ethos onto a monopolistic supplier. And what matters most to people at times of crisis is quality of care, which they consistently rate highly for “their” bit of the NHS.

Choice: not just a policy issue

Choice isn’t just about the latest statistics on whether patients recall being offered a choice of hospital for their first outpatient appointment. The last Ipsos MORI survey for the Department of Health found the number of patients who could recall being offered a choice had declined; but the trend is upwards. "Part of the promise of Web 2.0 social networking technologies is that they provide a way to connect people with shared interests without relying on officially-sanctioned channels."

Similarly, choice isn’t just about use of the Choose and Book appointment system. Again the trend is slowly upwards, and on the whole the system is getting better. Eventually its use will become the standard, and few will remember what the initial fuss was about.

Nor is choice about the DH purchasing services from a wider range of suppliers, such as independent diagnostic and treatment centres. When it places contracts for such services, it is making a choice centrally on behalf of patients, and NHS organisations are often directed to shift activity in line with them.

Instead, the biggest issue that members of the public face is that it remains extremely difficult to get their local NHS to listen and effectively respond to their particular preferences, concerns, complaints and questions.

Part of the promise of Web 2.0 social networking technologies, however, is that they provide a way to connect people with shared interests without needing to rely on officially-sanctioned channels.

Moving beyond info sites

When the web is mentioned in connection with choice in the NHS, the discussion tends to focus on providing patients with - limited - information on the quality of services, through the patient information portal NHS Choices.

However, Patientopinion.org already enables patients to directly share their opinions on different hospitals with them – and each other. And this is just the start; patient-sites from the US already encourage patients to name and shame individual doctors if they’ve had a bad experience.

The bottom line is that unless trusts and commissioners are genuinely responsive to the views and experiences of users – be it on dirty wards, opening hours or how services are delivered – they will struggle to identify and remedy problems and improve the care they deliver.

Looking for friends on Facebook

Another area in which the web could help is consultation. There is a long-term policy drive to rationalise hospital services by closing smaller and older units. But these local hospitals are usually the parts of the NHS that local communities love dearly and - given the choice - fight to save. "Counting how many friends a trust has on Facebook is not the most scientific measure of how good it is at engaging with the public, but it does at least show it is alive to new communications channels."

In these circumstances, public consultation can often appear to be a hollow exercise, with petitions in the local paper but discussions and meetings poorly attended. Part of the problem is that institutions to give patients a voice in the NHS are weak.

Since the abolition of Community Health Councils in 2002 by then health secretary Alan Milburn, patients have lacked statutory, independent local advocacy bodies. CHCs were replaced by Patient and Public Involvement Forums – which are now in turn being abolished.

Various initiatives have come from the government to give patients a voice – including town hall style meetings. But these have sometimes appeared cumbersome and expensive. A series of citizens' juries last month cost over £1m.

Again, social networking technologies may provide part of the answer; particularly if they can help to build a community of interest around a particular issue, or even an organization. Sometimes a good start can be made simply by making imaginative use of readily available off-the-shelf technologies.

South West Yorkshire Mental Health trust, for instance, has become the first NHS trust to launch a group on social networking website Facebook. The trust is using the group as a way of providing people with information as it bids to become a foundation trust. It is also using the site as a forum for people to contribute to discussions on mental health issues.

Wikis, email: experiment now

Maybe counting how many friends a trust has on Facebook is not the most scientific measure of how good it is at engaging with the public, but it does at least show it is alive to the communications channels favoured by a significant chunk of society.

Another Web 2.0 example is provided by the NHS in Orkney, which has created a Wiki site to better help NHS staff share information and avoid their email inboxes getting clogged up.

Despite their remit to engage with and consult the public, remarkably few NHS trust websites offer email newsletters or include interactive features such as forums or polls. These are simple, low-cost technologies that trusts can start to experiment with now.

About the author: Jon Hoeksma is technology journalist of the year, and co-founder and editor of the industry portal, E-Health insider.

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