Published: 15/01/2004, Volume II4, No. 5888 Page 8 9

To channel grassroots feedback and help volunteers with their responsibilities, CPPIH has developed a website with a difference. Alan Staunton reports

In December, the Department of Healthsponsored Commission for Patient and Public Involvement in Health launched 575 local forums so the public voice could be heard in the NHS decision-making process.

The replacements for community health councils are intended to supply commissioners and trusts with 'grassroots' feedback from local communities, both on their performance and on their priorities.

Information sharing is at the heart of the project, so it is not surprising the commission has set up a dedicated IT system to help the forums' voluntary members perform their duties.

Called a knowledge management system, its primary purpose is to help forum members share their experiences with other members, local NHS bodies and with CPPIH, says communications and knowledge management director David Orchard.

The system is accessed through a password-protected website, or 'portal', on the internet. But it is not an ordinary website, says Mr Orchard. 'The information on the site is going to be changing all the time, so we can't just fix a structure like on a conventional website, ' he says. 'It is more a series of two-way interactivities being conducted on many aspects of what is, itself, the fairly complex topic of health.'

Behind the portal, CPPIH has installed specialised software that manages the structure of the information on the site and allows it to be presented in an appropriate way. It also provides a high degree of personalisation, tailoring the presentation for the individual visitor's role, interests and characteristics.

Despite this, Mr Orchard is keen to ensure the site can be accessed pretty much irrespective of the technology that people have. A home PC or public library machine with a browser less than two or three years old should work on the site, he says.

'It doesn't use Javascript, and it runs on Macs as well as PCs.We are paying attention to make sure it runs for all sorts of people, since one of our main goals is to encourage a wide range of diversity among users, for example partially sighted people or those who prefer to read material in other languages.'

There are likely to be up to 10,000 forum members and they will not receive any training - so ease of use is critical.

CPPIH's own 'knowledge managers' have set up a range of topics into which people can place their contributions. These are organised hierarchically, rather like the popular Usenet discussion groups carried by many internet service providers. Toplevel topics are, for example, factors affecting health in the local community. CPPIH is keen to promote discussion on topical themes where decisions are imminent - a current example being water fluoridation.

The software is supplied by Reading-based firm ATG, and has already been successful on several commercial public websites, such as the Royal Mail's. The same system is also used inside the so-called 'forum support organisations' and by CPPIH itself, giving 'a completely open and transparent environment across the whole network', says Mr Orchard.

Moreover, in spring 2004 CPPIH will start to open the system up to the general public.This will allow NHS users to see what activities and discussions are going on in their local forum and to contribute to them.

Eventually, hundreds of thousands of people are expected to use the system.

But Mr Orchard concedes the path may be a bumpy one. 'We are still finding our way - not so much because of the technology but because there are not many examples of how to manage information in this type of government-funded public involvement project.We want to surface the public voice, but we need to tread carefully until we understand how we can manage it.'

One especially awkward issue is freedom of speech.

'It is an interesting challenge of democracy - that people will say what they want, ' says Mr Orchard.This could, of course, include libellous, commercial or other undesirable contributions.

'We need to find manageable ways to deal with things that fall outside the bounds of acceptability, while still allowing voices to surface without editing them, ' says Mr Orchard. So CPPIH will be providing advice to forum members, helping them understand the implications of the material they put on the site.

As a back-up - and to deal with less compliant elements in the general public - CPPIH's knowledge managers will have to moderate the discussions and remove potentially illegal material - while being careful not to impose an 'official view' on the discussions. It will be a difficult balance to strike.