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


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:


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:


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:

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:

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:

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?

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