Do you want to be a 'fan' of your local trust, or Alan Johnson's friend? With Facebook you can. Stuart Shepherd looks at how NHS organisations are using Web 2.0 to connect with patients

Did you know I am friends with health secretary Alan Johnson and health minister Lord Darzi? Oh and their colleagues Ivan Lewis, Ben Bradshaw and Dawn Primarolo? Like more than 400 other people I am also a Facebook friend of Manchester primary care trust.

It's great though. Sometimes they send me little messages to let me know where they are, what they are doing or what's on their mind.

The world of social networking websites can be a confusing one. People, even organisations, are not necessarily what they seem and identities, both corporate and personal, can be appropriated, as recent headlines have testified.

A widely reported libel hearing came about because of false Facebook profiles being created for businessman Matthew Firsht by a former associate. The case highlighted a number of important points - that while false profiles are an abuse of Facebook's terms, setting one up is relatively easy and it can be very difficult to trace who is doing it.

Facebook, which was set up in 2004, is one of the most popular online social networks and the place where I have been making contact with my new pals. As well as playing host to personal profiles - such as that of Lord Darzi - the website is also home to all kinds of membership groups, many of them open to anyone who cares to join. As a "business solution" Facebook also offers what it calls pages, where companies and organisations - and NHS trusts - can keep individuals or "fans" who sign up to the regularly updated page. This can generate interactive stories that Facebook claims will drive increasingly more traffic to the page.

Ostensibly the NHS has a presence on many of these Facebook features, with Lord Darzi's profile a confirmed bona fide. To a point, that is. The line from the Department of Health is that the profile was created for use as one of several channels for engaging with as many members of the public and NHS staff as possible during the next stage review. Effectively it has since been has superseded by the Our NHS website.

However Lord Darzi - or whoever it is at his office who manages his profile - is still making new Facebook friends and people are posting a mix of personal and promotional messages on his "wall". Taking his profile at face value, as any member of the public who is a "friend" would do, it is also worth noting that according to his "pages" section Lord Darzi is a supporter of Respect MP George Galloway.

The purpose of a Facebook profile can also be a vehicle for displaying the more personal side of life in public office. If so health secretary Alan Johnson uses it to good effect.

"Alan is taking his excellent staff out for a very liquid lunch," he told his friends - of whom there are nearly 900 - late last month, having left the Facebook group "No state funeral for Thatcher" just a few days earlier. The DH confirms that the profiles (look for the UK Parliament network) are genuine, but are run by constituency Labour Party staff, not members of any department team.

His "friend" and mine Ben Bradshaw (naturally, both are also chums with Lord Darzi) told his "friends" that on the day speculation about David Miliband's possible leadership push started to gather momentum he himself was "thinking" - about what, he wouldn't say.

Mistaken identities

On closer inspection of a number of NHS trusts pages however, things are not what they seem. A number of groups have been set up on Facebook using an organisation's name without authority and even in some cases without their knowledge.

"Well you have told me something I didn't know," says Pat Stone, press and publications manager at Southend University Hospital foundation trust, on hearing that there is a Facebook group using the hospital's name.

The Southend group has 247 members and appears to have been set up primarily as a social network for people working at the hospital, although it describes itself as a "business-employment and work" group. The official air this lends it is underlined by the use of the NHS logo.

Fortunately for the Essex trust, the Facebook group does not use the trust's full official name (it leaves off 'foundation trust') so the trust could still develop its own authorised group.

For now such an option is not open to University Hospital of South Manchester foundation trust. A Facebook group using the trust's full and official name has already been created. Identifying itself as a "professional organisation" the description of the trust reads as if it comes from the foundation trust website, for which there is a link. Its administrator is not a member of the South Manchester communications team and as trust communication officer Rachel Blenkinsop confirms, Facebook currently plays no part in its formal marketing strategy.

At just 30 the membership numbers are small and there is little activity within the group. And although in late 2007 a Facebook user placed a message asking if this was the first foundation trust Facebook group, there is no sign of any reply yet.

New connections

A few trusts though have taken the initiative, seeking to exploit the marketing and communications possibilities that social network websites can offer.

"With the arrival of resources like NHS Choices we were aware of the drive to provide information and increase interactivity with users of our services," says Countess of Chester Hospital foundation trust marketing and communications officer Andrew Duggan.

"An important objective for us at the moment is engaging with younger people; our staff, patients and [foundation trust] members of the future. Obviously one of the main marketing and promotional tools that now reaches that group, traditionally difficult to engage with, is Facebook, so we saw it as an opportunity."

Mr Duggan has prepared and presented papers for the trust's board demonstrating the potential benefits of using online social networking and other media tools to connect with a wide variety of stakeholders. He also launched the trust's Facebook group.

A press release marking its launch emphasised the opportunity to get information about the hospital and its services and "the chance toƒ take part in discussions relating to the trust, allowing everyone to have their say... and contribute to the way the trust develops in the future".

To date the official Facebook group, with Mr Duggan as administrator, has 247 members. It hosts videos including those of the trust's cleaning services, a look at its fertility treatment services and a "welcome to the trust" tour, information on trust events and photos. Its discussion boards engage with users, asking them for their opinions of the trust and whether they would like to work there. It also includes a link to NHS Jobs.

"We are aware of potential for negative comment and feedback within social networking and I knew there was already a 'Countess of Chester Hospital - best/worst hospital ever!' Facebook group before we produced our page," adds Mr Duggan. "However if 20 people were all raising the same concern about an area or aspect of our work then I would say that's legitimate and a good indication of how effective this kind of communication tool can be."

Manchester PCT, meanwhile, is leading a bit of a Facebook double-life. As well as a dedicated PCT profile, that you have to become friends with to see, there is an NHS Manchester Facebook page.

"More than ever," says PCT head of communications Tim Seamans, "we need to think about new ways of engaging with and getting messages across to local people, using new media to approach them in familiar and comfortable e-environments. When we officially launch the page in September the content will reflect all the interactive and multimedia and interactive elements of our website such as videos, blogs and discussion forums.

"In terms of detail, though, I doubt you would ever see as much on Facebook as there is on the website. This is more like a taster for an audience that wouldn't usually go to our web pages."

"To have a Facebook page - which is visible to everyone, can be found via a search engine and may have limitless and automatically accepted numbers of fans to whom you can send updates - we first needed a profile page," says PCT web manager Irene Barnard. "You can only name a page once, so we had to plan for September when ours changes to NHS Manchester."

If Facebook seems slow to catch on among NHS organisations, what is becoming increasingly popular is the use of video on trusts' own websites. But how many will follow in the footsteps of South Norfolk council, which recently placed a promotional trailer for its vacant chief executive's post on YouTube?

Northern Lincolnshire and Goole Hospitals foundation trust might not have been advertising any specific posts as such but its six-minute YouTube broadcast sets out to portray it as an employer and location of choice. As well as a commentary and accompanying visuals extolling some of what might be the under-appreciated virtues of the area, in a manner local tourist boards would be hard pressed to beat, there is a supporting cast of clinicians who talk about the positive attributes of the trust and the development opportunities they have enjoyed.

"A number of our clients, such as Whittington Hospital trust, have also been making films to support their foundation status application," says Adam Brichto of Brickwall Films, producers of the Northern Lincolnshire video. "They have used the format not just to explain the process to the public via YouTube and their own sites, but to celebrate and promote their achievements as well."

Rather than go down the YouTube route for now, however, the Whittington chose to take part in an NHS Choices project offering a number of trusts the opportunity to place short promotional videos within their provider profiles. These films were set to launch in mid-August to coincide with the launch of new provider profile platforms giving increased levels of information on services, greater interactivity with trust websites and the chance for all healthcare organisations to upload their own similarly formatted films.

"We were looking for a means to showcase our new buildings and dispel outdated perceptions," says West Middlesex University Hospital trust chief executive Tara Donnelly of its decision to take part in the NHS Choices videos pilot.

"Until now the template for the provider profile has been quite restrictive, with room for just one photograph. We were delighted to bring things to life in a video and got some pro bono creative support from a leading advertising agency. We targeted the areas where we are planning market growth - maternity and surgery - while getting some core messages across in an entertaining and effective way."

But take-up of the project remains small. And it remains to be seen if trusts will start advertising services, infection control rates and jobs on YouTube.

Web 2.0 explained

Web 2.0 is the catch-all term used to describe the online trend for sharing and user-generated content, in which the internet gives users the tools to create and distribute their own information rather than just consume. The results - Wikipedia, Google Maps, blogging, social networking and Flickr among countless others - are changing the way we interact with each other and use the media.

Facebook is a privately owned free-to-access social networking site. It allows its 90 million registered users - 8.5 million in the UK - to find and exchange news, messages, photos and virtual gifts with established and new friends across a number of networks formed around location, workplace, university and so on.

Several features within Facebook - groups, pages - also allow individuals, businesses or organisations to create and administer interactive profiles for promoting products, brands, even NHS trusts, through "word-of-mouth marketing" to supporters or fans.

Other social network sites popular in the UK include Bebo (more popular with teenagers than Facebook) and MySpace.

YouTube is a website that allows people to upload and share video clips. In January 2008 it had almost 79 million users and more than three billion viewings.

YouTube users can group their material within their own "channel" type - not-for-profit, reporter, musician and so on.

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