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Can I eat that lettuce? Voice, Digital, Public Health England and NHS Citizen

October 25, 2015


lettuce blog

Here are 3 small stories about voice and digital. A lot of organisations use digital as a tool to connect with the public. Much of it is ‘broadcasting’ sending messages out, but some also try to to use it enable dialogue and voice.

The first story – can I eat that lettuce?

This story is really just a bit of fun. I was walking past Leeds City Hall and saw that they had turned their flower beds over to vegetables – they looked great! Two people were looking at them and one of them picked a radish to eat and said to me “do you think I am allowed to do this?” I had no idea and tweeted the council with a picture – this is what happened:

Screen Shot 2015-10-24 at 17.15.26


I think the response from the council was great – whoever was managing their account responded quickly, answered the question AND used the request to point me in the direction of their allotment service – clever!

Story two – the Mental Health Champion

Those of you who read this blog regularly will know that I have been involved for years as a trustee of a Citizen Advice Bureau and have a particular interest in improving access to welfare rights for people with mental health problems. I am concerned that there is not consistent provision across the country for this small but vulnerable group of people who are 4 times more likely to be in problematic debt than the general population.

So when Kevin Fenton (National Director for Health and Wellbeing for Public Health England) wrote on his blog saying that he was going to be the organisations champion for mental health I left a comment calling for more action on welfare rights for people with severe mental illness and pointed at the evidence this is what happened:

Screen Shot 2015-10-24 at 17.20.42


Again, I think the response from PHE was good and since then I have had a conversation with Gregor Henderson and I am hopeful that with the Centre for Mental Health and others we can make some progress on this issue.

Story three – NHS Citizen

One of the ways that twitter is used is to have a ‘tweet chat’ basically a conversation over twitter usually for an hour. So when I spotted that NHS Citizen the engagement arm of NHS England were having a tweet chat on mental health – I joined with the aim of lobbying with regard to the same issue – welfare rights and psychosis. This is what happened:

Screen Shot 2015-10-24 at 17.19.20

The response here was not so helpful. As you can see the person running the tweet chat referred me to the NHS Citizen portal. As I understand it this is a mechanism that allows members of the public to raise issues – champion them virtually, gather supporters in the hope that by so doing a particular issue will rise to the top and be considered by NHS England at its Assembly.

While in theory this sounds good in practice I am less convinced for a number of reasons:

  • It assumes that issues have not already been debated and considered in the real world – so risks adding another layer of bureaucracy
  • Surely we don’t need to take all issues through this process – some should be dealt by engaging with appropriate officers
  • It makes debate less public taking it into a controlled and managed space – you have to go on to the portal to find out what is going on
  • I think it aims to bring a co-produced democratic approach to this sorting – but its a bit of a delusion  as it does not attract very many people (see the comment from Simon Landau above) issues are considered by a very small number of digitally literate individuals. Look at the global rank of the NHS Citizen Site (the national engagement website for the NHS) compared to that of a local Clinical Commissioning Group! – not good! Also, see this screenshot taken on the 24th of October 2015 – look at the number of people involved in each issue – the best I found was 70 odd – not in this screenshot.

Screen Shot 2015-10-24 at 21.29.39

What this experience made me think about.

NHS England has invested large amounts of money in an extensive ‘digital democracy architecture’, neither Public Health England nor Leeds City Council have – yet my experience with both of these was more productive.

If you are going to have a mechanism for dialogue with the public make sure that:

  • the people running the engagement are well informed and using engagement as an opportunity to progress action rather than referring to another place where the member of the public has to start all over again
  • the mechanism needs to be simple to use and easy to join

Most fundamentally – theoretically correct and apparently rational models of engagement can actually stifle dialogue and democracy – it should all be more fluid and less managed than this!

There is a broader issue, some private sector companies have a twitter feed that is a key tool for dialogue with the public – from rail companies to Waitrose etc. Public Sector organisations have by and large not gone down this route – there are exceptions like the Leeds City Council example above.

I wonder if NHS England were instead to invest in some empowered staff to manage their public twitter account whether they would actually have much stronger engagement than the complex architecture of NHS Citizen?

Rather than tidying up the dialogue, organisations need to change their behaviour and culture to be more inclusive of the diversity and complexity of conversations

What do you think?

7 Comments leave one →
  1. Mike Pedler permalink
    October 26, 2015 08:42

    Good questioning Mark

    As you say “NHS Citizen” has some way to go before catching up with Leeds CC – although I remind myself that MH is somewhat more complex than radishes!

  2. October 27, 2015 12:55

    Thanks Mike – good to hear from. You are right of course with regard to the complexity of mental health. I think though that part of the challenge is not creating a system that assumes that dialogue has to be about getting access to the sledgehammer – many issues don’t require this – they can be addressed more effectively at a much lower level in organisations. Indeed, a public dialogue can empower middle ranking managers to take the action they have been desperate to progress. I think that my Public Health England story is an example of this. One of my problems with the NHS England commissioned NHS Citizen model is that it almost assumes that the only dialogue worth having is between the lobbyists and the top people in the organisation – in most cases that is not and should not be necessary.

  3. October 28, 2015 12:38

    Hi Mark
    It’s Camilla Child from the Tavistock Institute here – we met last year and more recently on Twitter. As you probably remember I am one of the people working on NHS Citizen, in particular thinking about how to support people across the whole system actively engage (citizens and health professionals) and what needs to change to make that happen. So I read your blog with real interest and would like to thank you for talking so constructively about something we haven’t done well.

    You’re right when you say that organisations need to open up their channels and engage there. Both the positive examples you give are about staff responding swiftly and giving an answer. You also mentioned our response to a question – and I just wanted to offer a bit of background if I can.

    In July we started a new forum, NHS Citizen Gather, which is part of the mechanism we are building for bringing issues to the NHS England Board. Issues are raised and discussed both in the forum but also in other places (events, and other conversations online). These discussions are brought together in the forum by moderators and then selected – via citizen jury – for a twice-yearly Assembly. There, members of the Board and citizens work on the issues so that they can understand how progress can be made by NHS England.
    Back in September we held one of a series of Twitter chats on mental health, which you joined. Our aim with the chats was to bring a discussion that was already happening on Gather to a wider audience, so they could contribute too. The points made by people joining the chat would be fed in by our moderators to the Gather forum and become part of conversations that could go to the Board or other parts of NHS England. This is an important part of our strategy, particularly when NHS Citizen remains a work in progress and is in its very early stages of implementation.

    I’ve looked back at the Twitter conversation. You have asked what NHS England’s view is about funding for welfare rights and debt services for people with psychosis in NHS Trusts. We’ve said we’re not sure we can answer that – and it would be better directed to NHS England (whom we’ve @mentioned). Further to this we’ve mentioned the work that the CAB does.

    You’ve expressed surprise that we can’t get to people in NHS England for you and then after that, I think unwisely, we’ve suggested you share thoughts on the Gather forum.
    I think we’ve got a couple of things wrong. The first is I don’t think we’ve been clear enough about what the purpose of the Twitter chat is and how it fits into what we’re doing. We’ve compounded this by not responding and replying in a way that reflects this.

    More broadly, I think we need to be clearer and better at telling people what our relationship is to NHS England (i.e. what NHS Citizen can and can’t do). We have been commissioned to build a space and manage a form of participation in NHS England decision-making. We are not a direct conduit to different parts of NHS England. However, I couldn’t agree more with you that issues should be addressed effectively at different levels of organisations. The intention for NHS Citizen has always been to make sure everyone with an interest, personal and professional, in the NHS, can take part so that issues can be taken up with the right people when they are raised. Not all issues should go to the Board. We have always known that the conversations will be stronger if everyone – citizens, patients and of course staff and other health professionals – who has insight is able to contribute openly and without prejudice so that multiple perspectives are present and so that solutions can be co-produced. At the moment, NHS England staff, in the main, haven’t joined the conversations directly on Gather (online, or face to face) or elsewhere online. So right now the only route for dialogue with NHS England that we can offer is through the process I’ve described.

    The NHS Citizen strategy is that by connecting conversations and supporting them so that they can contribute directly to solutions for the NHS, it will enable NHS England to go a lot further in the future than simply being more engaged. Ultimately this should be about the organisation being able to make sense of and be responsive to the valuable insights, opinions and challenges that you and many others are able to make to build a better health service.

    Ultimately, we have the same immediate goals – but we’re trying to address a decision-making issue, which is: what happens to good engagement?

    Thanks again for calling us out on these points – it’s hugely appreciated and I hope we can continue this conversation and continue to learn from you.

    • October 28, 2015 13:37

      As someone who is active in public engagement around health and care (I manage the operational delivery of two local Healthwatch organisations) I find this debate fascinating and stimulating. There is clearly more all partners can do. Three things come to mind as areas we could interestingly try to find solutions around:

      1. It’s very difficult to say anything deep in Tweet chat as the medium is designed for short messages. Many people access Twitter from mobile devices so pointing to web based stuff is likely to see a fair number of people with valuable things to say fall by the wayside. This is compounded by adding tags – these reduce the amount of space in the Tweet to say anything meaningful.

      2. I’m not sure in a digital age it’s realistic for use to tell people what the purpose of a Tweet chat is. People will use it how they want to and it’s our role to do the best we can with what they say. That said, some guidance on how contributors can help us to be most effective could be useful.

      3. A huge number of NHS decisions are made at a more local level than BHS England. This will increase with more delegated Primary Care Commissioning and the pace at which the devolution agenda is developing. The user of health and care services shouldn’t need to know which specific mechanism to use or organisation to contact to tell their story, ask their question or give their views. We need to get better at joining ourselves up.

      I’m not sure what the solutions are but I’m happy to be part of a conversation that tries to explore some of them…


      • October 28, 2015 14:12

        Pete – first, anyone calling themselves “onnorthernrail” has attention immediately. Second, thanks for your response – really helpful contribution to the discussion – Mark

  4. Francesco Palma permalink
    June 11, 2016 12:47

    Just found this site to-day, As of 25/05/2016 the NHS Citizen gather space has been shut for comments with immediate effect. The five issues discussed at the 2015 Citizen’s Assembly has not received a response from the NHS England Board as yet, with only one issue ( Gender Identify Services) being acted on from the 2014 Citizen Assembly out of the 5 issues presented.

    NHS England does not have a long track history of involvement/Participation and if the development of STP Plans from the 44 ‘footprints’ are anything to go from then the requirements of Involvement(duty) to involve patients and public as set out in the Health and Social Care Act 2012 has not been understood by the CCG’s and by NHS England.

    You say that;

    the people running the engagement are well informed and using engagement as an opportunity to progress action rather than referring to another place where the member of the public has to start all over again’

    Here lies the problem with Gather space, the moderators were not experienced in the issues posted, if were able to moderate for inappropriate comments.

    • June 12, 2016 10:27

      Thanks for the update Francesco – interesting! It looks like NHS England have taken an executive decision to shut things down for a while – without talking about it on ‘Gather’ first – which says it all really!

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