NHS Choices

“Healthcare 2010: Challenges and opportunities – a view from NHS Choices” was a joint presentation by Helen Rowntree (Director of Strategy & Innovation) and Robyn Glen (Social Marketing & Digital Media Consultant).

NHS choices is a Department of Health programme established in 2007 that represents online presence of the NHS, which seeks to provide “reliable and comprehensive health information” and lead the “information revolution in health care in England”.

Key elements of the website include:

> A Health A-Z (an encyclopedia of over 800 conditions and treatments)
> “Live Well” – magazine style content promoting healthy living messages
> Guide to more than 800 prescription medicines
> Multimedia content – interactive tools and videos
> Service information – over 40 directories of services
> Service comparison tools or ‘scorecards’ for hospitals and GPs
> A commenting facility – that is being rolled out to all NHS services

The service is currently accessed by approximately 7 million visitors per month and responses to online “pop-up” surveys show that whilst most users are members of the public as many as 15% report that they access the site for “professional purposes”, 74% are repeat visitors, 80% of respondents are satisfied, 85% say they would recommend the website to a friend and 90% say they would use the site again.

Helen then explained why mobile is integral to the NHS choices offering:

> Helps NHS choices to communicate with the 15 million adults in England who do not have access to the Internet
> offers an “immediate channel” to support effective service delivery
> cost effectiveness.
> “Personal nature of mobile devices ideal for health centric themes”

Before outlining where they feel the specific opportunities lie in improving access services, uptake of screening, vaccinations and appointments, long-term conditions self-monitoring and behaviour change.

Helen then completely contradicted her first statements with an explanation of how NHS choices are delivering Health services via “mobile and digital widgets”.

To my mind this is completely missing the focus. Patients who are able to use these iPhone applications are most definitely not amongst those 15 million adults in England who do not have access to the Internet. If you are under the same misconceptions about how to reach a mobile audience please read this piece by Tomi Ahonen in which he outlines why it makes no sense to be developing for iPhone first.

To my mind this is a complete waste of limited public resources. Not only does the App Store already contain hundreds of free quit smoking, drink tracker and fitness applications but this public investment is also impeding private sector mHealth developers in the UK as they try to develop new business opportunities. A similar scenario happened as a result of the BBC Online service competing against online start-ups and long-term effects of this are well documented in the Independent Review of BBC Online P46-51. With the UK having a well established reputation as a healthcare innovator I’m surprised the UK Enterprise boards aren’t up in arms about the threat presented by this tax payer funded competitor.

We then got an overview of the NHS choices health services that are already available via mobile:

> a free SMS service available on 64746 which enables patients to find their nearest “smoking service”, Doctor or dentist, get appointment reminders and track their BMI and alcohol units.
> The website NHS choices which is available through the “Direct Gov Platform”
> Mobile applications on iPhone, although they do have plans to support other devices and app stores soon
> Bespoke mobile services for local healthcare providers such as “stop smoking”, “sexual health” or “patient feedback” services

We where then given details of a case study conducted at the Princess Alexandra Hospital NHS trust, which asked the patient “how was your hospital experience?”

Before trying to engage them in a somewhat bizarre set of text message exchanges that required the patient to send the word “PAH” to the short code 64746.

Wouldn’t it have been easier to just enable the already well advertised hospital number to receive SMS? Then they could have simply written “have something to say? Let us know by sending a text to 01279 444455”

Bizarrely, views patients submitted were then “moderated” before being displayed on the http://www.nhs.uk website and the organisation’s “profile page”. What this means is anybody’s guess but I have a few concerns because this isn’t made totally clear in the campaign poster and nor is it obvious who does the moderation and for what purpose (eg. is it to ensure patient data that could reveal their identity isn’t posted? Is it to ensure staff members aren’t identified? Is it designed to make the organisation look good/bad?). Checking out several on the NHS choices website and it is evident that there are posts that reveal patients first and family names and in several cases these include rare names which would make it easy to identify patients and the treatments they had received. From the screen shots I have taken (but would not be willing to share publicly) it is clear that they have created a patient privacy time bomb.

In the report following the trial of these “SMS technologies” we got some insight into how ineffective these poorly designed systems are proving for patients. Whilst the strap lines may have been encouraging eg:

“UCLH saw a 100% rise in feedback across the pilot period”

In reality this meant a total of 18 people actually bothered to engage with the free text message service.

“Around half of all users completed the survey in full”

In reality, this meant that half of the users were probably so bored with the tedious design of the service that they didn’t even bother replying to free messages from the hospital that they wanted to share feedback with.

When you factor in the fact that UCLH employs some 6000 staff and provides over half a million appointments a year I think it’s safe to say Simon Cowell is not going to be taking SMS engagement lessons from NHS Choices!

The second case study is ongoing in the Lincolnshire area is trying to look at how real-time waiting time information can encourage appropriate use of acute care services by “improving the spread of citizens across bricks and mortar facilities” (I promise I’m not making this up!).

Amazingly, the service is been promoted to “anyone with an urgent care issue” and requires them to text the word “waiting” to 64746 to get “real-time wait info and advice on your mobile”

I don’t know about you but I can’t fail to see the humour in this nonsense:

The service was also designed to offer a “downloadable desktop application” so that “more detailed info and advice” could be accessed by “mothers of young children/carers” with urgent care issues.

This sounds like one of the most ill considered initiatives I’ve ever heard of. We are talking about children and carer dependent patients who are reliant on the judgement of a carer who deems their condition to be in need of “urgent care” yet is being advised to download a desktop application to their PC.

Thinking this was as bad as it could get. I was amazed to find that this case study also involved broadcasting live images from security cameras installed within Lincolnshire healthcare facilities and walk in clinics:

On learning how limited NHS healthcare resources were being spent further reducing patients rights to privacy I had to hold my tongue as the presenters informed us of the importance to avoid fashions/fads and the need to “create solutions that adhere to the principle of ‘graceful degradation’ e.g. basic functionality should be accessible to all

An incredible lesson coming from an organisation that has so clearly started with the development of an iPhone application as it apparently strives to reach those “15 million people in the UK who don’t have access to the Internet”.

As a final point, NHS Choices recommended developers “pre-empt questions around confidentiality of patient data and NHS systems integration” by considering whether “your solution meets security and compliance criteria as defined by Connecting For Health”, “N3 integration will be prerequisite for delivery”, “you will need to hold on to or process patient data and how this will be managed”, and “Patient Management systems such as EMIS/System 1 will need to work with you to deliver your solution”

I never thought a healthcare provider would ever be involved in the live broadcasting of images of their waiting-room patients. Thanks to the help of NHS Choices, Lincolnshire NHS Trust have been the first to do this. Amazingly the people involved in this still feel they have lessons to give others on patient confidentiality.

Isn’t it about time that they stopped trying to rearrange the chairs on a sinking ship and tried to add value to patients lives by enabling them to engage with interactive services? As the new coalition party takes a closer look at the return on investment its getting for it’s healthcare spend maybe it’s time for NHS Choices to start giving patients what they want and stopped tip toeing around trying to stay popular?

This blog post is part of a series of mHealth reviews from the 2nd Mobile Healthcare Industry Summit 2010. Click here to get the full review.

About David Doherty

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5 Responses to NHS Choices

  1. Pingback: Department of Health Spokesman: “We are happy to work with the BMA to understand their concerns” « 3G Doctor Blog

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  3. Pingback: Where’s the evidence that patient ratings on the NHS Choices website is driving up standards? « mHealth Insight: the blog of 3G Doctor

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