I think the only concern with choice of treatment is that people are sometimes hypochondriacs and may not be able to reliably diagnose themselves. Having more information does help decisions though.

I’m not sure how much health data is being made available here but it is a start.

The bigger problem is that many patients will never be in a position to exercise much choice, especially if the choice is to use services which are further away. We need to develop ways of exercising collective as well as individual choice.

Hi, I’m one of the team running Patient Opinion and the author of one of the blog posts you cite. Great post!
There’s a real question here, as you suggest, about how citizen-generated feedback is best handled, and by whom. It’s an ongoing debate and we don’t have the answers, but we’re nervous of the assumption that government knows best.
We think patient and clinical trust are central issues, and also that feedback needs to prompt improvements in services.
So it is interesting to note that while Patient Opinion rejects 5% of the comments it receives, NHS Choices rejects almost 25%. And while a comment on Patient Opinion gets a response from the NHS in 65% of cases (where we have an agreement with the local service), NHS Choices gets a response in 42% of cases (for the same local services).
What does this mean? We don’t yet know, but it may be that citizens will have a less adversarial, more collaborative relationship with an independent social enterprise than with a government department.

Clearly an important topic.
The value of subsidiarity should be the basis for decision. If there are services effectively provided by the market or the nonprofit sector, no reason for government to do it. Especially because having 2 places to post feedback does not double the feedback, but creates noise. See the comments to the Uk minister blog here http://www.tom-watson.co.uk/2008/04/customer-insight-and-technology/
Yet, in most countries, we miss the richness and spread of initiatives that we have in the UK. So government action is justified. For example, in Italy, a project like fixmystreet.com has been effectively implemented by a small municipality.

Hi I’m one of the team running NHS Choices.

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

Jonathan, many thanks for answering. It’s a long time I’ve been waiting to see an explanation by NHS about this service. I still have my doubts but certainly an open and civilesed debate is needed. We are all learning our way through these innovations.

Hi, Like James I’m one of the guys behind Patient Opinion. And it’s great to be having this debate - we’ve been going 3 years and NHS Choices 15 months, so we are beginning to be able to move away from assertion-based theorising (we certainly did our share of this in the early days)and could soon be in a position to learn from the natural experiment of having 2 feedback channels available - one state-owned and part of a much wider web service and the other an independent social enterprise that just focuses on developing web-based public feedback at scale.
As suggested on a more recent posting on the Patient Opinion blog (http://www.patientopinion.org.uk/blog/post/2008/09/Should-the-state-run-feedback-sites-for-public-services.aspx), we think the time could be ripe for an independent exploration looking at a range of like-for-like figures for both sites. We have had some early conversations with the Central Office of Information who have expressed interest in supporting such a study.
We should’nt expect such a comparison to give a definitive answer about the ‘right’ way to run feedback sites - as David Osimo says, we’re all learning our way through these innovations and there is still a lot of water to go under a lot of bridges. But getting comparable data out in the open and discussing it with an independent set of people who understand what the web is really capable of, could help highlight the strengths and weaknesss of each system be it Patient Opinion, NHS Choices, IWantGreatCare, RateMD.com etc.

Thanks all for weighing-in, and thanks in particular to James and Jonathon for presenting their views on behalf of Patient Opinion and NHS Choices.

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.

Good to see this issue being aired on the Wikinomics blog, and so many useful responses. I was involved in the early stages of PO and I am a big fan of the team and what they have achieved.

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.

[...] 08:41am On the heels of the interesting conversation generated by Anthony’s post regarding Patient Opinion and it’s interaction with the National Health Service, I thought I’d point to an interesting article by the UK-based National Computing Council on [...]