The NHS spends close to £100m a year on thousands of websites that are often hard to find, badly designed and not wanted by the public, according to government reports leaked to HSJ.

NHS brand undermined by online confusion

NHS brand undermined by online confusion

NHS brand undermined by online confusion

The NHS Digital Communications Review, published internally by the Department of Health in June, says there are 2,873 NHS websites in use.

The question is raised why these sites were developed in the first instance

Research for the DH review, also leaked to HSJ, found that - despite the huge number of sites - the public “struggled to locate the NHS online with a Google search”. When they did find it, “the scale and depth of information on offer was daunting to many”.

The research, carried out by communications agency Precedent, states there are “over 2,000 NHS organisations all trying to get the attention of the public”. It identified 4,121 NHS websites - but noted that more than 1,000 are no longer accessible.

The research report says around 30 per cent of the “live” sites had “at least one notable deficit in standards”, including confusing navigation and/or poor quality content.

“GP surgeries were the weakest of all the website types in the sparse offering of features and functionality,” it says.

Sites maintained by primary care trusts, foundation trusts and strategic health authorities received “almost no recognition” from the public.

“The question is raised why these sites were developed in the first instance - ie due to a genuine need or if they were developed without evidence, on a perceived need only,” it says.

On accessibility, it found: “Some basic web standards were not followed… vulnerable members of the public are often not being properly catered for.”

Only half the websites provided email addresses. “The NHS is not making itself easy to do business with,” it says.

The research report also found: “It is possible that where problems are found across the [NHS digital] estate, the confidence of the public in the NHS brand may be diminished, especially in the current climate where the public have high expectations and demands online.”

Interviews with users revealed the public wanted to see “one NHS” online. “The public expected NHS websites to represent the ‘one NHS’ that they see providing their treatment.”

The Precedent research attempted to assess the cost of NHS sites but not many organisations could or were willing to provide information when asked.

The report estimates the cost of running the sites “could be as high as £86m per year”. However, the figures do not include set-up costs and therefore “underestimate the overall total spend”.

There was also very little information about the use of NHS websites. Precedent stated: “The very fact that collecting basic cost and usage data was problematic underlines an accountability and performance management gap.”

The DH concluded “web management is still a relatively immature service area in the NHS”.

The Precedent research also discovered that Google listed 56 million pages within the nhs.uk domain. The vast majority are likely to be hidden to the public and the research concludes that their purpose is unclear.

A DH spokeswoman told HSJ: “As the recent white paper said, the government intends to bring about an NHS information revolution to give people access to comprehensive, trustworthy and easy to understand information from a range of sources on conditions, treatments, lifestyle choices and how to look after their own and their family’s health.

“The department will set out how it intends to achieve this with the launch of an information strategy in the autumn.”

Confusion reigns: the research report on the state of the digital estate

“A total of 4,121 [NHS] websites were reviewed. This is a huge number of individual sites for a single organisation and creates huge challenges in terms of maintaining quality, focus and relevance.”

“The ownership of NHS websites was often unclear, with the review process indicating that even trained researchers found it difficult to identify the purpose and ownership of sites.”

“The public are confused by the diversity of sites and content. They think of the NHS as one institution and expect the web presence to reflect this.”

“Poor navigation was found throughout the NHS estate but public-facing websites such as those from GPs and PCTs were most commonly to blame.”

“GP surgeries have by far and away the poorest sites, in that they have the largest percentage of problems identified. GP sites [also] failed to provide the means to allow interaction with users.”

“The public find that the NHS does not always feature in Google search results for many health-related terms. What this means is that people are often drawn to resources from Wikipedia, the charity sector, NetDoctor and Patient UK, for example, rather the NHS.”

“It is possible that where problems are found across the estate, the confidence of the public in the NHS brand may be diminished, especially in the current climate, in which the public have high [online] expectations.”

“From the limited data received, it is clear that the NHS has little in the way of central mechanisms to track the costs and usage of all NHS websites.”

“The majority of returns on these [website traffic] measures informed us organisations were not equipped or used to reporting on these measures.”

Summary of nhs.uk websites

4,121 Total nhs.uk websites

2,000 Approximate “active” sites

287,300 Estimated pages accessible

56 million Pages indexed by Google

30 per cent Number of sites that exhibited at least one “notable deficit in standards” (poor quality content, lack of NHS branding, poor navigation, “not authoritative” or out of date content)

50.3 per cent Sites that include email address

188 Responses to researchers’ request for usage and cost data (of 4,121 sites)

33 per cent Sites that include accessibility statement

11 per cent Show no sign of NHS branding

£12,000-£30,000 Estimated average cost per site

51,000 Estimated average annual unique users per site

400,000 Estimated average annual visits to site