If you had to choose being able to see the name of the person who sent you an email or its title which would you choose? Well the evidence is pretty clear that most of us go for the person not the title. The messenger has always been more important than the message when it comes to getting stuff into our consciousness.

This is important when it comes to writing a good response on Patient Opinion (or any other social media platform). The more personal the responder is, the more feel they feel OK about being visible as the messenger, the easier it will for the reader to hear them. So here is a great response from Epsom and St Helier

We're glad your husband's injury wasn't serious and we'll pass your kind comments on to the team, including - importantly - the 'niggle' about having to give the full medical history twice. As you'd expect, there are procedures in place for staff to check and double-check some elements of a patient's medical history, but you shouldn't need to repeat the full history in such a short space of time.

It’s good because the writer has obviously read and appreciated the original story. And it’s written in a friendly style that makes you think there is someone pretty human at the back of it.

But it could be even better. For a start the author is simply ‘Epsom and St Helier University Hospitals’ which is about as impersonal is it gets. It would be great to know who it was who was saying this stuff – not just their job title but preferably their full name. And it would be even better if we could see what they looked like so its great when people add their photographs to responses just as Jane Danforth at Nottinghamshire Healthcare Trust does .  (it’s really easy for Patient Opinion subscribers  to upload a photo to personalise their responses).

And the worst kind of response that we see? Well that’s easy - it’s the cut and paste job from someone who doesn't appear to have even read the original posting and doesn’t give any details of themselves except their job title. Even worse is where every response from the organisation is identical so that anyone scrolling through a few can immediately see that the worst kind of ‘tick boxing’ is going on.

People are pretty savvy about user feedback nowadays. They are used to reading TripAdvisor and Amazon reviews. They know that some reviews will be from when the organisation – or maybe the author - was having a bad day. They read a few and come to their judgement. But the responses – well now that's real data direct from the horses mouth itself. So judgements may be quicker and harsher -  ‘Look at this - a cut and paste job for this posting that says terrible stuff happened? How heartless can these guys be?’

 On this reading the response to a posting – especially negative ones - may be more important in shaping the public’s perception of a trust than the critical story itself.

It's interesting to see the line of what is ‘permitted’ by NHS trusts around social media shifting. Here’s the Chaos and Control blog – beautifully written by Little Feet – about how her un-named mental health trust prevented her from blogging during a recent stay as an in-patient. But what exactly was the problem that so bothered the mental health trust?

'Given that I wasn’t blogging about other patients and when specific staff were mentioned, they were anonymised, I felt this approach a bit heavy-handed. However, their argument was that patients who were more unwell than me could blog anything, regardless of the truth'

Yes, well that’s true. In a world where everyone has a public voice – i.e. can blog or tweet or post on Facebook – all sorts of people are now able to say all sorts of things about all kinds of institutions. And so? Does that make the sky fall in? No. Is it a good thing or a bad thing? Well I guess that depends on your perspective. But the one thing that is absolutely clear is that public voice shifts power to the citizen. This kind of heavy handed approach by the trust will inevitably back fire. Just ask Mubarak.

Of course some blogs and Facebook entries will be offensive, untrue or malicious (none of which is in anyway true of Chaos and Control). But on the other hand as Claire an OT who is one of our favourite NHS bloggers (@ClaireOT)  cogently argues  self expression is part of getting better, of moving up Maslow’s hierarchy. From a therapeutic point of view, all other things being equal, blogging and using social media should welcomed by mental health teams.And surely it’s all useful data – either about the staff, the service, or occasionally about the person who posts

So a blanket rule of ‘Don’t blog!’ is in our view both misplaced and impractical. What is happening here is that the NHS is (slowly!) learning the realities of the new world of social media. Most of the time social media comments should be welcomed. Sometimes they should be ignored. Occasionally something needs rebutting. For a good guide on all this take a look at the useful  US Air Force process chart on how to respond to blogs which we found on Jeremiah Owyang's great blog 

From our experience of moderating thousands of stories about mental health services we know that occasionally postings will raise issues of clinical governance – for example people expressing suicidal thoughts or threatening harm to staff. But in principle this has always happened and trusts should have procedures to deal with this.The fact that it is now happening in public on-line may be uncomfortable but does not change anything much. At root trusts need to think about whether they are exercising a legitimate duty of care - or protecting themselves.

And if Little Feet would like to use Patient Opinion as a platform to talk about her experience of services we would welcome her story.

Back in 2005 when social media was just getting going I read the Cluetrain Manifesto. It told companies in no uncertain terms about just how different the coming world of informed consumers was going to be. Cluetrain was big, famous and influential. It used this picture to illustrate the way that companies were treating their customers.

Not very Christmassy I grant you but arresting. And if you were being unkind – or had just spent too much time at the Mid Staffs inquiry – you might think that incidental roadkill is exactly how lots of people who have been harmed by the NHS end up feeling.

So our (slightly sombre) Christmas Cracker is a new version of the manifesto re-written for the NHS and updated to take account of social media. (And our thanks, acknowledgements and apologies to the great original.)

A Cluetrain Manifesto for the NHS

People using social media communicate in language that is natural, open, honest, direct, funny and often shocking. Whether explaining or complaining, joking or serious, the human voice is unmistakably genuine. It can't be faked.

On the other hand when the NHS ventures on-line it usually talks in the humourless monotone of a Comms strategy, and the your-call-is-important-to-us busy signal. Same old tone, same old evasions. No wonder people are beginning to lose respect for a health service unable or unwilling to speak as they do.

But learning to speak in a human voice is not some trick. Trusts and Health Boards will not convince us they are human with lip service about "listening to customers." They will only sound human when they empower real human beings to speak on their behalf. This isn’t difficult – some health organisations are already doing it really well.

Twelve Propositions for the NHS in 2012

1. Social media means that the networks surrounding health services are getting smarter, more informed, more organized. Participation in these networks changes people fundamentally.
2. There are no secrets in this new world. Combine open data with democratised voice and whether the news is good or bad, everyone will know it.
3. With a billion people on Face Book the NHS’s attempts at patient engagement and empowerment look increasingly out of touch with reality.
4. The hard-to-reach aren’t 'out there' – they are alive and well and working in the NHS.
5. The NHS is having two conversations. One with itself. The other with everyone else. In most cases, neither conversation is going very well. Almost invariably, the cause of failure can be traced to obsolete notions of command and control.
6. Front-line staff - who make the wheels of the NHS turn each day - want to join these public conversations directly in their own voices, not in platitudes written by the Director of Comms.

Meanwhile what people are thinking online goes something like this:

7. The people we’d really like to talk to on-line are the nurses and doctors who look after us. But you always hide them behind a corporate smokescreen that prevents anyone taking responsibility for the words that come out of their mouths. Don’t you trust them? Or is it us you don’t trust?

8. We already know some people who work for you. They're pretty cool online. Do you have any more like that you're hiding? Can they come out and play? When we have questions we turn to each other for answers. If you didn't have such a tight rein on "your people" maybe they'd be among the people we'd turn to.

9. We’d be delighted if the NHS joined us in this new world of social media. But it's our world. Take your shoes off at the door, start talking human! Even at their worst, our on-line conversations about your services are more interesting than all that corporate flim-flam you’ve been shoving at us since Mrs Thatcher's time.

10. We've got some ideas for you too: some new tools, stuff that will make your services better, and your staff happier. For free, right now. Got a minute?  

11. We'd like it if you got what's going on here. That would be really nice. But it would be a big mistake to think we're holding our breath. We have better things to do than worry about whether you'll change in time to get all this. Health care is important but it’s only a small part of our lives. It seems to be all of yours. Think about it: who needs whom? 

12. To the NHS these networked conversations may appear confused, may sound confusing. But we are organizing faster than you. We have better tools, more new ideas, no rules to slow us down. We are waking up and linking to each other. We are watching.

But we are not waiting.                                                                                                         

                                                                                      Happy Christmas!

So GPs don’t like on-line feedback. At least that’s what a report in yesterday's Observer said. At Patient Opinion we were particularly interested in this as we are just beginning to pilot how the PO system could be used with ‘consenting’ Clinical Commissioning Groups (CCGs) who have asked us to put their GP services on the system as well as using us to inform their commissioning decisions.

The article was based on figures released by NHS Choices which showed that over the last 2 years 28,000 people have posted comments about their general practice via the NHS Choices service. Some 2,000 of these were not published because they did not meet the editorial policy whilst the same number – 2,000 – of responses from staff had to be withdrawn because they were deemed to increase rather than decrease disagreement between the parties.

From our point of view both figures are extraordinarily large. At Patient Opinion we would expect to have to removed very many fewer stories (around 3 per 10,000 stories) due to swearing, profanity or racist comments. And whilst we don’t prohibit NHS responses, and certainly recognise that in many instances they are woefully inadequate, ones that are aggressive enough to make us think about asking them to be taken down are vanishingly rare.

So what is going on? An obvious answer is that general practice is just starting out on its learning curve about how to handle negative comments on line. But perhaps it is also the case that practices feel more strongly precisely because they sit in their communities and the relationship with patients is – or at least feels – different to them? And last but not least GPs of course have long had trhe option to ‘throw patients off the list’ as a last resort. So maybe this lowers the threshold for them being less courteous on-line.

Interestingly the very early results from our pilot with practices although showing many positive stories also has a significant number of negative ones – accompanied by some very good, sensible responses. So maybe another key variable is when websites are explicit about working with professionals rather than doing to them, as perhaps NHS Choices does

So the CQC find that in one in five hospitals the care of the elderly is poor. No surprise there given the stories we are often told on Patient Opinion. So will the Health and Social care Bill that squeaked through the Lords yesterday make any difference?

If we set aside all the organisational turmoil of making the changes (a big set aside I grant you) will the reforms once fully in place make any difference?

Our guess here at Patient Opinion is sadly, probably not. We don’t doubt the sincerity of the Secretary of State in wanting to put the patient squarely at the centre of things but the NHS still wants to do this on its own terms. Look at its behaviour – even in the way it seeks to put patients centre stage – it’s still deeply focused on its own needs: You answer the questions that we put in our questionnaires. We look at the results and if you’re lucky you might see the occasional change.

Nothing wrong with this except it is the NHS itself and its own needs that are taking centre stage, not the patients’. Out there people want be part of a conversation as they are on FaceBook and Twitter and they really don’t see themselves as feedback fodder any more.

So what would make a difference to how we care for elderly people? Saying ‘Lessons will be learnt’ is no longer adequate. Indeed after so many inquires and debacles the next politician who says this kind of thing (no matter if it is true) is likely to be lynched by the media.

What we need to do is to make the desire to listen a reality, and for the first time ever we can move beyond platitudes and start to do this in ways that give the patient’s side of the conversation real power. The next time there is something like the CQC report telling us of yet another dreary failure, the response from Andrew Lansley should now be: ‘You’re right. We messed up. We know we need to listen. And we understand that you may not trust us to right now. So we want you to tell us what you think of the NHS, good and bad, in public, confidentially via independent sites like Patient Opinion. And we guarantee to reply, in public to every single story.’

Now that really would signal a sea-change in the scale, transparency and power of the patient voice.