Patient Opinion has officially arrived in Scotland! Though, with 179 stories about Scottish NHS services on the site so far – people have already been finding their way to us to talk about Scottish health services. Now it’s my job to help the Scottish NHS health services to hear what’s being said.  

My previous role was in mental health service user involvement.  It was a great privilege when people felt able to share their stories with me and amazing to witness the impact their stories had on those delivering services. We all get so busy it’s easy to forget the seemingly small things that matter so much.

First and foremost, Patient Opinion is a place where people can speak about their experience of NHS services.    We will be looking to raise awareness of the website in a whole host of ways: talking to local community groups, contacting national charities, employing social media like Twitter.

Crucially, for the next twelve months we are going to be working in partnership with the NHS Scotland Better Together Programme to help NHS services in Scotland to hear what people are saying on Patient Opinion and to help make a difference with those stories. 

Several health boards are already getting involved in different ways: Dumfries and Galloway, Forth Valley, Scottish Ambulance Service, Golden Jubilee Hospital and the number is growing every week.    Some hope to use Patient Opinion in specific areas of their service, eg Neurology, to start with and take it from there.   

It’s great to be part of the Patient Opinion team.  As their first worker based in Scotland I am a new beastie to them and so far they have understood every word! Or so it appears! Though I haven’t unleashed the full range of my Scots vocabulary on them yet!

  This is me!

All at PO are delighted to welcome our newest team member - Gina Alexander. Gina's role is that of the Engagement and Support Officer for Scotland and Gina will responsible for driving forward the joint pilot scheme between Patient Opinion and NHS Scotland.

The Pilot is part of the NHS Scotland "Better Together Programme" which is all about ensuring Service Improvements as a result of engagement with the Public. the main PO site carries further details here>>>

Prime Minister David Cameron will today make a major speech on the future of healthcare in the United Kingdom in which he will suggest that the NHS must reform or the country as a whole will suffer. The Coalition have announced a radical shakeup of healthcare within the UK and have pledged increased health budgets, at a time when most departments face a cut, to enable these reforms to be put into practice.

"We have fallen behind the rest of Europe. We are more likely to die of cancer or heart disease. We shouldn't be aiming for second best."  Claiming that the UK has fallen behind other European nations in terms of standards and achievements the PM asserts that the NHS currently has little incentive to improve and that the new reforms will do more than simply re-badge the service, which was a feature of the last administration.

He has also dismissed claims that the reforms are too much, too soon suggesting that there is an appetite for reform within the medical profession.

Later this week ministers will publish legislation to changes the health service. Within this there are plans to scrap PCT's (Primary Care Trusts) and health authorities and that power over decisions and financial control will be handed to GP consortiums. The Government will present the Bill as a milestone in its reform agenda, but some experts have cast doubt that doctors' will be willing or able to take on new responsibilities. Mr Cameron counters however by saying that 141 GP consortiums – covering half of the country – have now volunteered to pilot the reforms.

Later in the year, the Government will publish a White Paper on yet more reforms calling for an injection of third party expertise outlining ambitious plans for charities, private companies and community groups to fund, run and in some cases even own some public services. The move is designed to break up the public sector's traditional monopoly on running services, new rules will dictate that in future a fixed proportion of services must be provided by "non-state providers". All of this harks back to Mr Cameron's "Big Society" concept. A concept that calls upon individuals and communities take more responsibility requiring the state to do less.

Patient Opinion have been at the forefront of this type of concept for the last five years - Patient Opinion is a not for profit Social Enterprise and our ethos is all about enabling patients to share their experiences of health care, and by doing so help other patients, and perhaps even change the NHS. Since our launch in 2005 we have received and collated over 45,000 patient stories and as a result of this have enabled subscribing bodies to receive feedback on their services. Some might say that we were already ahead of the government on the need for supporting the NHS from outside the state sector! To learn more about us click here

We were really pleased to hear Andrew Stott, the government's director of digital engagement, talking at the Talk About Local 2009 conference in Stoke over the weekend.

Not only a clear sense of what engagement means and what the web can offer, but a mention for Patient Opinion too. Nice! 

We quite often get stories that you would think demand instant action - for example Why was my dad left lying naked on the bed? or patients being able to see others urinating. But then nothing happens. In part this is because managers and staff see such things as regrettable rather than important. Sure, it shouldn’t have happened but nobody died and the real thing to get sorted is to make sure Mrs. Jones in Bed 5 doesn’t breach the 4 hour waiting target.

But in part it is because web-based feedback is so low-friction. For the first time comments are beginning to arrive at the speed of light (or at least the speed that we at Patient Opinion can handle them!) whilst the system designed to receive them moves with all the urgency of a sloth with toothache. The web makes transactions faster and reduces the transaction costs for citizens but it does not reduce the costs of responding for organisations nearly as much. In short web 2.0 is citizen-centric not organization-centric.  Faced with this the  temptation for organisations is to simply cut and paste formulaic replies. This plugs the managerial dyke but does nothing for the citizen or the service.  

From the point of view of service provider – any service provider, NHS or commercial, health or otherwise – this problem can only get worse as more and more people use the web to tell you what they think of you . Two outcomes are then possible. If most web-based feedback is ignored then citizens will tire of giving it and the flow will cease. Alternatively at least some organizations will re-organise themselves and really begin to listen and act on what their customers are saying. Organisations that are driven by sales and profits are likely to be more responsive but what will make public sector organisations responsive short of turning them all into profit centres and losing all the other, wider benefits of them being a public service?

Part of the answer here lies in seeing web-based feedback as lighter, less ponderous than more traditional feedback.  Citizens do this already of course – conversations on the web are just that: fast, transient, informal chatter.  But it’s hard for organisations – especially health service ones who are addicted to the iron cage of bureaucratic rationality (also known as systems, procedures and protocols). For them it’s as if all your life you’ve been building a zoo where all the animals are safely contained and ordered and know when it’s their feeding time and then suddenly you find your job is to play in a jazz band –and to do it fast, hip and on the public stage of web where everyone can see you.

The real answer to this conundrum may lie with front line staff who know in their hearts that real care, great care, always involves as much fluidity and creativity as it does protocols and procedures. Getting things right, giving personal care, has always been about relationships and relationships are perpetually in motion, conditional, responsive each to the other.

So the lessons for us is to try and get the stories on Patient Opinion directed to front line staff rather than middle managers.  And that front-line staff should be empowered to listen, respond and change as a result of these dialogues. In this model web-based feedback becomes a way to nudge, remind and renew the professional heart that has currently been obscured by 15 years of systematising, evidence-based care. Conversations with patients and families after the event, about what could have been better, then become the multiple, systematic drivers of better care. And the web-based exchanges that trigger these thousands of micro improvements can  be summed into reputational measures that rank wards and departments and hospitals for their actual, public, proven ability to listen and learn from those they serve.    Now that's what Lord Darzi would really like.