Andrew Lansley’s “information revolution” looks like it will be a boost for NHS Choices. Has the time come for it to fully play a role in improving health?
The white paper promise is of a plentiful supply of performance data to help patients exert more choice and control over their care. Big central government portals like NHS Choices clash with the government’s Big Society vision. But perhaps if NHS Choices can help the local NHS engage the public with the right data and information in the right context, then the website may have an important future role whatever the brand name.
What’s important are the components that make NHS Choices useful to the public: high quality health advice, an A to Z of conditions and treatments, a local services finder and trust comparison tools.
It’s hard to imagine a world without these components available to facilitate choice, but improvements need to be made to make sure the system really gets used by the public and health professionals alike.
While data may help inform decision making it can alienate those without a clear understanding of what it means. Our research and King’s Fund studies suggest that some of public will use comparative data, but many are put-off by it and expect their doctor to make a recommendation based on this information and their professional opinion. Just look at the way NHS Choices presents infection data for St Bartholomew’s Hospital in London: “The organisation running this hospital had 0.85 Clostridium difficile infections for every 1,000 bed days for people aged 65 and over, staying in hospital for three or more days”.
Of course numeric data is not enough. The most appealing measures of performance are the stories of what others have experienced. On NHS Choices, patient feedback about hospitals and GP services has still to gain momentum, but the plans to survey patient opinion more often may help to create a more complete and rounded set of data that people actually find useful.
With 80,000 pages locked away on the web, printing off NHS Choices material is a simple but effective way to get the right information in front of the public in digestible form. GPs and primary care staff are well placed to do this as part of the consultation process and in so-doing endorse and authenticate the information they hand over. However, when printed health information is provided by GPs, it is often Patient UK outputs from EMIS, the most widely used record system. Why isn’t NHS branded information part of these systems?
While most GPs are aware of NHS Choices, very few actually use it with their patients. Several reports, the most recent of which was from Imperial College London’s department of primary care, have called for better marketing to GPs and other practice staff.
However, it is still unclear why GPs are not yet engaging with NHS Choices as the definitive NHS information and data set. Certainly, GPs need to get involved in the creation and management of the content so that they own and understand the provenance of what they see. And of the hundreds of NHS Choices videos, more could be hosted by GPs or primary care teams.
Our research suggests that the public trusts and relies on what is said by their GP and other health professionals more than internet resources they have to find and read themselves. We have also found that most patients still do not think of the NHS as an information provider. GPs are in an ever stronger position to move perceptions on by referring their patients to NHS Choices – it’s the only reliable public NHS site there is.
If all those pages of NHS Choices information are to survive, they will need to be distributed to whatever the new local NHS looks like. PCT websites struggled to find a public purpose largely because PCTs are not understood by the public and their sites cannot be easily found. NHS Choices has not been precious about its content and is keen to syndicate content and data and functionality. Local authorities may have a role here but are not the natural home for health information either. Finding flexible ways to package the components of NHS Choices data into consumable bite size pieces is less of a challenge than finding the right local setting to deliver them.
While these improvements to the existing NHS Choices offer are needed, we should also expect a set of new online tools to be tabled in the forthcoming Information Review. These may include booking GP appointments, management of health records and communications with clinicians. Quite a revolution, but none of this can succeed without the close involvement of GPs and patients in design process.
Michael Guida is a strategist at Precedent.