Five Wicked Digital Health Issues – Jonathon Carr-Brown, Managing Director, NHS Choices

, NHS Choices Beta

I’ve got a short speaking slot at the Health and Social Care Expo in Manchester on Monday. I’ll be on the NHS England stand at 11.30am and I thought I’d give you a preview of what I will be discussing.

I was tempted to describe the journey NHS Choices is going on, but I thought it might be more interesting to share the five main issues we are grappling with.

In shorthand terms, these issues are:

1. Creation v Curation
2. Comprehensive v Selective
3. National provision v Private provision
4. Local v National
5. Consumer v User

Allow me to elaborate.

1. Creation v Curation – Do we continue to write most of our health, social care and lifestyle content in house or do we pull in content from other sources? Maybe, for example, from organisations accredited with the Information Standard. Sounds good. Or does it?

The evidence we have from consumers is that they come to NHS Choices because they want the NHS view. Brand and choice is as important in content as it is with services.

The provision of health information is about reassurance and guidance. NHS Choices has 20% of a massive UK health information market. Patterns of user behaviour suggest people want to read the NHS stuff and the Cancer UK and Macmillan stuff and be reassured it is all broadly saying the same thing.

Curation also presents production questions, policy issues and clinical sign-off questions, to say nothing of questions around payment. My view is that we need to produce slightly less, link slightly more, and curate a bit to effectively tackle the long tail of around 3,000 rare conditions we haven’t even touched. Does that make sense?

2. Comprehensive v Selective – This is a debate we have covering both written content and data. We cover over 1,000 treatments and conditions and more than 800 quality metrics. And we have contrasting research which states that users want more content and fewer metrics.

The threshold for metrics appears to be seven on any given service. But the perceived wisdom is that the publication of every scrap of data will drive quality. We believe that conflates the quality and choice debate unhelpfully.

Quality is driven by openness, choice is driven by a small number of useable and useful comparators. Our approach is to create views of the world. An accountability view with every metric you can possibly want, and a user view with fewer indicators that gives the public a yardstick. Is that the right approach?

3. National v Private – There are many potential digital health markets struggling to emerge at the moment. The main stumbling block for most is the creation of a sustainable business model. Or put simply, who is going to pay for the service?

Commenting on personal health records are the ones I’m closest to. We have made a decision not to enter the personal health records arena but we are equally clear that we are going to stay in the commenting business. And the distinction we make is that commenting is a right. Whereas a digital personal health record is adding additional value to a right. Is that a coherent stance?

4. Local v National – There are more than 5,000 websites in the NHS. Many, such as NHS Trust and GP websites, have legitimacy; others you have to question.

Local information is important but the best and most cost-effective way of raising awareness of “local” information is to put it on a site which is easy to find via a Google search (other search engines are available). And the creation of local sites dealing with health campaigns or conditions aren’t sustainable and don’t represent value for money.

We feel it is imperative that local councils and the wider NHS realise that NHS Choices is a massive marketing tool they can use to drive local populations to the information they need.

5. Consumer v User – This is an emerging and fascinating theme in NHS Choices research. Simply, we have research showing that users of the NHS don’t see themselves as consumers. We see this particularly in the field of commenting.

People who are happy to comment on a hotel just wouldn’t consider commenting on a hospital experience. Should we be worried about this? Is it just a question of time? Or are we missing something fundamental about the relationship between health, the NHS and people’s perception of the service?

Well there you go, a few scattered thoughts for discussion on Monday.


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