Patient Opinion is your favourite band. Is NHS England the big record company? (Updated)

The Guardian this morning reports that NHS England will be setting up a “TripAdvisor”-style site to capture people’s feedback.

This has a number of implications in lots of different directions, but the one I wanted to briefly comment on is what this says about how markets arise in public services and are then distorted.

In social care, there were 44 care comparison sites at the last count. This “market response” presumably arose because there was a gap in the market: people weren’t getting the information they needed to make judgments about where is/isn’t a good care provider.

In the context of the NHS, and though not exactly equivalent to a comparison site, Patient Opinion has been doing a tremendous job over the last 7 years or so of enabling people to share their experiences of NHS services, aggregating that feedback and supporting NHS organisations to use this information to improve services.

Patient Opinion is a bit like* that really good band only you and a few people know about (a “few” being a relative term, here).

Patient Opinion needed to be created (and was done so very well indeed) because there was a gap in the market. It was an innovator at a time when no one else, including the NHS, was doing feedback particularly well.

Since today’s Guardian effectively says that NHS England is going to replicate Patient Opinion, it could be argued that Patient Opinion’s job is done. When the NHS adopts your idea, you’ve gone mainstream. It’s like EMI signing (or taking over) the band you love, and now all of your other friends and the general public will be listening to the band only you and your friends knew about.

But is this right? Is the presence of government here – in the form of the bizarrely-centralised-though-not-really-centralised NHS – a constructive or distorting market force?

I posed this question to myself when looking at social care comparison sites:

Is it appropriate to think that social care information / comparison sites should be centrally-led, guided more by a visible hand from government rather than by an invisible hand? Or is it ok for information about social care to be provided through the continued emergence of a demand-driven market, reflecting what we see in the film streaming and price comparison businesses around us?

@pubstrat has highlighted the same question using many other examples, such as MyPolice, fishing licenses and Patient Opinion itself, using the metaphor of government as elephant and others as small(er) creatures. He concludes:

I don’t, on the whole, think that government is obliged to leave the field completely clear for others where its own services and information are concerned. But I do think that the asymmetry of power and voice obliges it to take great care where it places its [elephant] feet.

In this case, my initial answer (with explanatory brackets for tortured simile purposes) is that there has to be joint work between NHS England (EMI) and Patient Opinion (your favourite band) to make the most of both unique characteristics they could bring to the question of feedback (your band’s music). NHS England brings scale, significant credibility and brand; Patient Opinion brings the platform, the independence and the learning/innovation of the last 7 years.

If both can work together, then the good music of feedback can be taken to the masses whilst maintaining its integrity. If not, we might end up with another Robbie Williams.

I really hope NHS England / EMI takes the opportunity to work with Patient Opinion.

*I generally don’t like argument by analogy, but make an exception here. Please don’t get too hung up on the band / record company thing.

Update (2 December): Paul Hodgkin of Patient Opinion has written an excellent post here on the topic, and @georgejulian has brought her characteristic “no bullshit” approach to the issue here. Both posts well worth reading.


The Right to Request, third party organisations and adding value

I’ve read the summary of NAO’s interesting report about the Right to Request programme, which supports NHS staff to apply to form a social enterprise to supply services under contract to PCTs.

There are a number of interesting points highlighted in the report, which I note (in no particular order or logic) below:

  • Employee-owned social enterprises have been spun out to provide services to PCTs since 2008, i.e. prior to the Coalition Government coming to power (para 1).
  • Government policy is to “support social enterprises and mutuals spinning out from parts of the public sector” (para 4). This is presumably about much more than the government encouraging the setting up of social enterprises and mutuals as a means to an end, which means that government recognises the added value that such organisations can and do add to the health economy.
  • One of the first benefits identified by employee-led social enterprises is of reduced staff absence rates (para 7). I don’t know why, but this always seems to be one of the first measures of success identified by such organisations.
  • The Right to Request programme has worked well through having a centrally-run support unit within DH, and that the objectives of the RtR programme are aligned with the wider objectives of the DH (para 9).

By far the most interesting point is raised in paragraph 10:

PCTs approved proposals for spinning out social enterprises where enterprises promised more benefits than the alternatives but did not generally contract for them to deliver these additional benefits.

For me this is part of a wider point relating more generally to third party delivery of services. If, as public bodies and third party organisations (be they private, voluntary or social enterprise sector) wish and claim, third party organisations deliver added value beyond that provided by a “traditional” service, then that added value must be articulated, contracted for, captured and assessed.

I absolutely think it is the case third parties add value; they must continue to drive themselves to demonstrate – both qualitatively and quantitatively – this added value they provide.

In its report, the NAO has taken the view that PCTs and government needs to demonstrate this value; though I agree to an extent, I’d take the view that PCTs and government need to create the space in which third party organisations can demonstrate the added value they create.