I recently had the privilege of being in a teleconference with Mike Alverson, the CEO of Kaiser Permenante, one of the biggest integrated providers of health care in the States.

One of the interesting things he said was that Kaiser now divided health care into 4 settings:

• - Staffed beds. This includes hospitals and residential settings
• - Ambulatory care by which they mean clinics, out patients, pharmacies etc
• - Domiciliary settings where the patient is looked after in their own beds
• - The web – email and skype consultations, telemedicine, appointment booking, shared decision making and other information aids and your own personal EPR

This made me stop for lots of reasons. Of course! The web *is* a major setting for health care. And one that is rapidly evolving and effecting the other three. And - just like PO - the web is an intrinsically egalitarian place to do health business.

All this is not just happening in California where Kaiser is based. Whether it is giving feedback about what happened to you via Patient Opinion, booking your own appointment on Choose and Book, using your own EPR via Patients Know Best, or exploring patient-founded sites like MoodScope, the web is already becoming a major place for patients across the UK.

I began as an intern at Patient Opinion three weeks ago and have learnt a lot working alongside Kate Ebbutt, learning how the organisation works and how our old friends, Facebook, Twitter and Blogging can help to redesign the way patients interact and gain feedback from their health services. Since starting, I have found myself straying from the entertainment section, to now searching the society and health section of the Guardian website, hoping to find out more about how a health service I always took for granted actually works.

Patient Opinion has told me that patient interaction and feedback is essential to improve services. But I’m interested in why this works. Right now, the NHS is owned by all of us – we feel pride in it (as the #welovethenhs campaign last year showed) and we want it to be great. I can’t imagine wanting to share my story, hoping to make shopping at Tesco better – but somehow it works for the NHS. We feel ownership, and that ownership makes us want to help the NHS. If the health service becomes more commercial – would we still feel that way?

The NHS Reforms have quickly become a real interest for me.The Health and Social Care Bill has fast become one of the most contentious pieces of legislation in British history. Their main proposals seem sensible; to create an independent central NHS Board which keeps an eye on spending across the country, to promote patient choice, and to reduce NHS administration costs. According to proposals, funding and commissioning local health services for patients will no longer be handled by Primary Care Trusts; instead they will be overseen by groups of GPs. However, as this is a new skill for them, GPs will need help – and this help often comes in the form of private consultancy and management companies. The concern is that this will encourage more privatisation and commercial competition.

Criticism of these changes stems from the fear that new reforms would enhance private investment, at the cost of patient welfare. Competition has become the most controversial NHS proposal by the coalition. It is fantastic for business, where it drives quality, but can the NHS be regarded as a business in which competition will flourish? As Doctor Sohom Das remarks, ‘One only has to look at the outcome of the privatization of rail services - dire quality and ever inflating fares’.

I personally feel that it is us, you and me, who make our health services great. Our engagement with the services, sharing our experiences and working collectively to make a difference is key. The question is: would we still feel like this about an NHS that expects us to act as customers, not citizens?

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.

If you havn't yet seen it, our director James Munro wrote a great peice for The Guardian this morning. It's a gentle but optimistic warning about the problems the Government might encounter as they bring in a ratings system for care homes. Worth a read, even if we do say so ourselves.

James' peice for The Guardian - "Beware of the pitfalls of rating care homes" (15/12/2011)

"In times of change the learners will inherit the earth while the knowers will find themselves beautifully equipped to deal with a world that no longer exists."- Eric Hoffer