Evidence: NHS Direct doesn’t understand Privacy, Social Networks or Mobile

I mentioned yesterday that the Department of Health had suprised me with their interest in popularity contests but it wasn’t very clear if they understood the privacy issues that abound. This interview “NHS Direct considers targeted ads on Facebook and Twitter” by Ben Whitelaw in the Guardian however clears it up nicely.


The telephone and online advice service is considering paying social media services for targeted advertising… …Roger Donald, acting associate director of multi-channel for the organisation, told the Smart Healthcare Live conference that it may opt to pay to direct Facebook and Twitter users to NHS Direct’s services, including its health symptom checkers, despite the ethical issues surrounding it… …If I write on my status that I’m feeling a bit ill and I’ve got a cold or flu, there’s a possibility that we could serve an advert for our cold and flu symptom checker,” said Donald. “We think that’s quite a powerful way of driving traffic to our services. Whether it’s right or not is another question… …It’s whether or not we start mining things like Twitter and Facebook for mentions of illness and patients who aren’t feeling particularly well. I’m not sure if it’s right and justified – I’m sure we’ll find out in the future

I’ve written before at length about my thoughts on non-medical staff in the NHS collecting information about patients that is gleamed by snooping into their personal communications and the efforts of NHS Choices to broadcast on the internet live CCTV images from busy clinic waiting rooms but this one has me lost for words.

Donald added that there are also issues over the security of personal information in social media services. “As you go through one of our symptom checkers, you’re giving us some fairly personal information about yourself and we haven’t yet been successful in getting Facebook to agree that they won’t that information for their own benefit,” he said. “They tell us verbally that they won’t but at the same time they’re not prepared to put pen to paper and actually commit to that. It’s going to make that interesting for us

In case you’re not aware FaceBook has a business model based on matching advertisers to people who will click on their adverts. If you reveal information within FaceBook that information (and probably other bits of information) will be shared with advertising partners who may (read: probably will) also consolidate this information with other sources of data that they (and partners) have collected relating to you.

Social Networks

NHS Direct, which provides services including a national advice phone service, online advice and out of hours support for GPs and dental services, established a presence on Twitter in 2008, and now has more than 9,000 followers. During the 2009 swine flu pandemic, one of its tweets reached 40,000 people after it was retweeted (forwarded) by followers… …To gain more followers, NHS Direct sends tweets mentioning trending topics (those which are most popular with Twitter users), runs funny tweets that are more likely to be retweeted and posts messages such as ‘Good morning Twitter’ to illicit responses

Numbers: Let’s have a look at these numbers. This morning @nhsdirect has 9,525 “followers” and is “following” 8,735 other accounts. Taking just one of these “followers” to make my point: @newyorkpsychic (but you knew it was going to be that one didn’t you ;)) has 86,075 followers. Is it right to say that last time he retweeted a @NHSDirect post it “reached 86,000 people”?

Unfortunately not. Because lots of the tweets are missed, reach people on other continents to whom they are completely irrelevant, are completely ignored or are recieved by accounts that aren’t actually “people” eg. in the case of @newyorkpsychic it’s a US company offering psychic services.

Value: In healthcare the focus on value seems to be everywhere but for some reason NHS Direct social media activities seem to have rules of their own. I find it highly likely that that every single person who read one of these tweets already knew that there was a swine flu pandemic – probably because someone told them, they watched the news, listened to the radio etc. While I’m clutching at straws to see the value for money for healthcare budgets to be invested in reminding the already informed the idea of sending out “funny” messages really highlights the absolute waste that’s involved in these efforts – particularly when you look at how poorly performing some of patient services are.

Here’s a fun video made by a good friend of mine that should make you laugh were it not for the fact that over at Riverside House there are probably people with government health budgets that are actually having conversations like this…


Whilst Roger Donald revealed some juicy iPhone App stats (180k downloads of their free app in 2 weeks) it doesn’t in the least surprise me that he hasn’t revealed how much advertising budget they committed to this or any details of how many of these were by customers are located in Britain (note: no.1 market for iPhone apps is the USA, no.2 market is China – where free apps are a very big hit) or if customers actually used them or are still using them.

But make the jump to the comments and a reply from “NHSPatient” highlights the complete lack of insight into the mobile user experience that has resulted from the misdirected Smartphone focused strategy being taken at NHS Direct:

If NHS Direct is keen on drawing the social-media and mobile-phone using community into its services it has to do something about its voice telephone service. Whilst there are some landline users who escape paying the premium charges properly associated with calling a 0845 number, this does not apply to mobile callers. In the worst case for commonly used mobile providers, callers pay a premium of 41p a minute when calling 0845 4647 over the cost of calling a “Geographic Rate” number. All 03 numbers are treated as “Geographic Rate” and therefore included in (generally unlimited) landline calling packages from contract mobiles. With PAYG, the rates are always considerably less. 0345 4647 has been set up and is ready for use by NHS Direct as an alternative. There is no need for the expense of a complete number change – NHS DIRECT MUST SWITCH ON THE 0345 4647 ALTERNATIVE NOW!!

I’ve been explaining to Directors at NHS Direct this issue for years and unlike the twitter and facebook strategies I feel this is actually something that is affecting patients today. Many of these patients don’t have fancy smartphones and access to appstores and are most in need of a telephone helpline service especially in these recessionary times where low income homes are increasingly “mobile only” as they cut the cord in a bid to make cost savings.

About David Doherty

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1 Response to Evidence: NHS Direct doesn’t understand Privacy, Social Networks or Mobile

  1. Pingback: How long before an insurer refuses to cover a patient who shared their opinion online? « mHealth Insight: the blog of 3G Doctor

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