As if by magic, after my blog post yesterday on patient complaints, today sees the release of a National Audit Office report catchily titled Feeding back? Learning from complaints handling in health and social care.

So what does it say? In a nutshell (and I quote):

There is, in particular, confusion as to how to access and navigate the complaints system; lack of public confidence in the system; concern over the time taken to respond to complaints; a failure to find a sustainable and effective independent resolution stage; and limited sharing of lessons within and across NHS bodies.

Among other highlights, the NAO found that:

• only five per cent of people who were dissatisfied about the NHS went on to make a formal complaint
• few trusts capture and report data on complaints in a systematic way
• a fifth of complainants reaching the Healthcare Commission stage simply wanted "an apology or recognition of the event"
• only one third of complainants considered that the organisations they had complained about had demonstrated that lessons had been learned as a result
• in many cases trusts had genuinely learned from complaints but did not tell the complainant

Hmmm... all this feels entirely consistent with yesterday's conclusions. Can Patient Opinion help with all of this? Yes, I think we can.

The NHS is institutionally attuned to the big things – what’s coming down from the big beast in Whitehall or the latest missive from the Chief Executive. This stacks up into institutional agendas that focus on things like Should we be shutting the casualty unit? Do we need another Consultant surgeon? How are we going to implement the Darzi report?

And when that isn’t occupying the operational brain space then it’s all the middle range stuff – how do we reduce the number of expensive bank nurses? When is the next data return due? How do we implement the latest policy on C difficile?

But the experience of the patient is made up of the micro – Was I washed gently? Did I feel included in my care? Was the place clean? Was it too noisy to sleep at night? Such things are visible to professionals who hopefully care a lot about getting them right, but they are more or less invisible to the institution except when they result in a complaint.

Patient Opinion takes thousands of these comments about micro aspects of care and makes them more visible. But what happens then? Well often not a lot. Being focused on the strategic or the middle-range must-do’s means that busy staff all too often see patient feedback as something that just highlights irritating blemishes. At best its something to add to the already over-long To Do list. At worst something that can be easily ignored.

So how can Patient Opinion turn blemishes into blossoms? How can patient comments help set a thousand flowers blooming? Well the answer here is more than the technology. The latest guidance about how government should use Web 2.0 says that people should be prepared to respond quickly, listen and act. Which as Dan Herman points out on wikinomics blogs is great advice.

But our experience on Patient Opinion is that the only people who aren’t caught in the cross fire of conflicting incentives here are the patients. So the trick is using their energy, enthusiasm, and ideas to drive micro change hundreds of times across the NHS. One early example is allowing people to comment on how the trust has responded – see what one less than pleased punter thinks of the hospital's response to their posting.

No one thought that thousands of people would step up to the mark and help create Wikipedia. Or that there were millions of people just waiting for an on-line auction site. The trick is to find ways to galvanise people’s real enthusiasm for the NHS into a process that involves staff and causes thousands or service improvements to blossom. A good analogy perhaps as creating this culture is probably more like gardening than meeting policy targets or implementing Lord Darzi’s report. Slow, gentle persistent work to get the conditions right. And resisting the temptation to pull everything up by the roots once a day to see how they are doing.

There's a lot of talk around about using technology to improve healthcare - making more information available, giving patients a voice, helping them manage their care by making patient records accessible online, and it's thowing up some real key issues.  Empowering patients to have more knowledge about their conditions, more information about the services they receive, to have more choice, appears to a step in the right direction, but what about the implications?  A lot of the issues are around power and who is in control - the public has access to more information than ever before, and this all works against the paternalistic model of care.

We are starting to see a real power struggle, between those who have traditionally controlled healthcare (clinicians, GPs) and those receiving it.  For a number of years there's been a recognition that expert patients, those with a good understanding of their condition, visit their GP less often - in 2005 the Department of Health launched the Expert Patient Initiative.  At the time only 21% of doctors were in favour of this approach to supporting those with long term conditions like diabetes, arthritis and Parkinson's, there's still a considerable number out there who think patients "do not have wisdom but follow prejudice, hearsay, and urban mythology" (Ray Jones).

Patients are being encouraged by the government to take control of their care, the internet has supported a new phenomenon, patient opinion leaders, and expert patients are becoming more and more common, as this post in HSJ indicates "People with chronic conditions are sharing their stories with each other, not just for emotional support, but for the clinical knowledge they gain in an online community." (Jane Sarasohn-Kahn of the think tank THINK-Health and author of a report on health 2.0).

This power struggle is becoming a major issue in the US.  According to Dr. Robert Lamberts, an internal medicine physician and medical blogger in America “Doctors used to be the only source for information on medical problems and what to do, but now our knowledge is demystified.”  “When patients come in with preconceived ideas about what we should do, they do get perturbed at us for not listening. I do my best to explain why I do what I do, but some people are not satisfied until we do what they want.”

Sharing information is driving the shift in power.  Patients have a voice and have access to others stories about their care, but is anyone really listening to them?  Here's the real issue - technology is just an enabler, it supports change and improvement and innovation, but it can't make it happen.  Without the ability for people to make it happen, it won't.  Throwing money at technology is not the answer.  Technology can only go so far, it needs a real, adult conversation between patient and doctor and the ability of staff to make changes without being stuck in a bureaucratic loop.  Patients are changing and starting to take control, those working in the NHS need, in my humble opinion, to release some.

Today saw the publication of Health Minister Lord Darzi’s report High Quality Care for All, containing “ambitious plans" to raise the quality of healthcare for patients right across the NHS.

According to the NHS site Our NHS, Our Future, “High Quality Care For All sets a new foundation for a health service that empowers staff and gives patients choice. It ensures that health care will be personalised and fair, include the most effective treatments within a safe system, and help patients to stay healthy.”

So far, responses to the report have varied.  In response to the recommendation that hospitals are to be fined or rewarded with financial bonuses of up to 5% of a hospital’s budget based on what patients think of the quality of their care, a post by Tom Reynolds on the very enlightening blog Random Acts of Reality notes that "Giving patients choice is a fine idea in principle, but for many of the patients that I deal with they just don't have the knowledge to make an informed choice on their treatment.”

Careworld.net, a blog aiming to “highlight the inadequacies, the poor decision making, the hypocrisy and their consequences”, points out that the reports is “silent on the issue of the NHS top down highly bureaucratic structure…” noting that  “this is an important opportunity missed.”

The Jobbing Doctor, whilst acknowledging that dissection of the review over 2-3 weeks is in order, describes it as “a sagging souffle” and “a hugely disappointing review.”  In my considered opinion, whatever the responses to the review, it at least has identified that staff must be empowered to make real changes, and so effectively address ever increasing expectations from a public who are constantly being told that the NHS is to be led by them.

The challenge now is to turn Lord Darzi's vision into reality, in a notoriously slow moving and heavily bureaucratic NHS.  Practically speaking, Patient Opinion aligns well with Darzi's key recommendations, providing support to staff by demonstrating exactly what it is patients want and need, based on their experiences, suggestions and comments and providing support to patients by helping them make informed choices about their care.

As it’s been a great week for recognition (we’re finalists in the UK Catalysts awards and the New Statesman New Media awards), maybe we can forgive Lord Darzi for choosing to mention NHS Choices but forgetting to mention Patient Opinion in his plans for a high quality NHS.

Last month, Patient Opinion’s own James Munro attended NESTA’s flagship conference The Innovation Edge.  NESTA supports innovation across the UK, and have generous in providing their enthusiasm, time, expertise and funding in support of Patient Opinion’s expansion to cover mental health services across England.

James was interviewed at the event, where he spoke about Patient Opinion and more specifically, the mental health pilot with the 5 Boroughs Partnership NHS Trust in Warrington. When asked about the potential difficulties which can be experienced in making changes in a monolithic bureaucracy like the NHS, James noted that sometimes improvements at ward level were easier than making wider organisational changes.  My experiences support this – the closer you get to the frontline, the more you are likely to make a difference to patient care.

The video contains some really key messages about what Patient Opinion is doing, and emphasises that improving care should start with the patients and users of the NHS

From time to time (well, about every half an hour) we sit around the PO office throwing around ideas about how our site needs to develop now. What's the next leap forwards?

One idea that comes up a lot goes something like: "Wouldn't it be great if people could use the site to find other people who face the same challenges/have the same condition/live nearby/use the same hospital?"

And it is a great idea. And I suppose, because of the enormous myFace hype, everyone thinks everything has to be a social network.

But the last time we had this conversation, I realised something: that doesn't really excite me. I can see how helpful it can be to find other "people like me" and support one another. But somehow, I don't want to build one myself.

What did excite me was when we went to the HQ of Which? in London a few months ago. In their reception they have a big slogan on the wall that says something like "The aim of Which? is to make consumers as powerful as the organisations they have to deal with".

Now that does excite me. For me, the aim of Patient Opinion is to help the voices of patients and service users become as powerful as those of NHS organisations. After all, it is our NHS, and it means a lot to us.