I recently had the privilege of being in a teleconference with Mike Alverson, the CEO of Kaiser Permenante, one of the biggest integrated providers of health care in the States.

One of the interesting things he said was that Kaiser now divided health care into 4 settings:

• - Staffed beds. This includes hospitals and residential settings
• - Ambulatory care by which they mean clinics, out patients, pharmacies etc
• - Domiciliary settings where the patient is looked after in their own beds
• - The web – email and skype consultations, telemedicine, appointment booking, shared decision making and other information aids and your own personal EPR

This made me stop for lots of reasons. Of course! The web *is* a major setting for health care. And one that is rapidly evolving and effecting the other three. And - just like PO - the web is an intrinsically egalitarian place to do health business.

All this is not just happening in California where Kaiser is based. Whether it is giving feedback about what happened to you via Patient Opinion, booking your own appointment on Choose and Book, using your own EPR via Patients Know Best, or exploring patient-founded sites like MoodScope, the web is already becoming a major place for patients across the UK.

During my regular mid week date with One Born Every Minute last week, there was a moment that got me thinking about what part love plays in health care.

Shortly after giving birth to a baby boy, one of the new mums seemed flustered when the attending midwife reached over and embraced her with a kiss on the cheek, telling her that she was proud of her. It was intimate, warm and loving and not something I've seen happen during any other labour featured on the show. It’s certainly not something you'd expect from other health care professionals, a kiss and a cuddle from the surgeon who'd just removed your kidney stones would be fairly unusual.

This may not fit with everyone's definition of love, but in my interpretation it is without doubt a loving and affectionate gesture and behaviour that falls outside of the standard role of the midwife. I’m sure it’s more a reflection of the midwives personality than the circumstances, but it got me thinking about the part that love has to play in health care.

People often talk about their professional personas and how much they differ from the personalities they express outside of work. Acting 'professionally' has connotations of suppressing the softer side of your character and portraying a more corporate, task focussed demeanour. But in a world where teachers are warned that hugging a crying child who has fallen in the play ground is acting outside of 'professional boundaries', are we forgetting how important it is to be human at work?

In the report we released this time last year, it couldn't have been more conclusive that the attitudes of staff and a lack of care and compassion were the most frequent causes for complaint or concern for patients of our health service. The same is true for compliments; what people are most thankful for when receiving health care is feeling like the staff cared about them.

So people certainly notice and appreciate kindness, affection and loving behaviour but is there any evidence to suggest that this has any impact on health outcomes?

The King's Fund Point of Care programme(2009) noted that:

'Research evidence suggests that compassion affects the effectiveness of treatment. For example, patients who are treated by a compassionate caregiver tend to share more information about their symptoms and concerns, which in turn yields more accurate understanding and diagnoses (Epstein et al, 2005).

'In addition, since anxiety and fear delay healing (Cole-King and Harding, 2001), and compassionate behaviour reduces patient anxiety (Gilbert and Procter, 2006), it seems likely that compassionate care can have positive effects on patients' rate of recovery and ability to heal.'

It's clear that experiencing compassionate care, and in this context love, from health care staff matters enormously to patients, both in shaping their impression of health services and in their recovery.

For staff, showing compassion to people at their most unwell or vulnerable is often at the heart of their motivation for joining the NHS. It's my impression from reading the stories we receive that the majority of staff are striving to show patients the affection and kindness that makes all the difference, but that staffing issues sometimes get in the way. So how can we help to ensure staff always feel comfortable and capable of delivering this level of care?

The King's fund paper goes on to suggest that:

'In the practical circumstances in which staff caring for patients feel under pressure, and experience themselves as having very little time, it is often difficult to do just that one thing for the patient that makes her or him feel cared for. Enabling staff to feel and be compassionate towards patients in their care, at all times, requires action on multiple levels.

One of the most powerful resources that healthcare professionals consistently cite is patients' stories.

Every day here at Patient Opinion we continue to make available stories from patients that detail how it feels when compassion is lacking and what truly compassionate care looks like. I'm reminded of a beautiful quote from a story we received some time ago which recorded a moment between a member of care staff and the author's nan:

'One day I heard one of the staff, Tracy, talking to my nan as they were bathing her. Tracy was lovely with her and so caring and sensitive - I can't imagine it's easy to bathe a grown person. Tears came to my eyes, I was touched by the care and respect demonstrated. No one knew I was close to the bathroom door and could overhear what was being said, this wasn't a demonstration put on for my benefit.'

Thinking back to the midwife on One Born Every Minute, her attitude, warmth and willingness to give a little bit of herself makes me hopeful. The interaction between her and the new mum on the bed depicted everything that I know to be the right way to treat a person and I'm reassured to see that either in line with or in spite of policy, treating a patient with love prevails.

So the CQC find that in one in five hospitals the care of the elderly is poor. No surprise there given the stories we are often told on Patient Opinion. So will the Health and Social care Bill that squeaked through the Lords yesterday make any difference?

If we set aside all the organisational turmoil of making the changes (a big set aside I grant you) will the reforms once fully in place make any difference?

Our guess here at Patient Opinion is sadly, probably not. We don’t doubt the sincerity of the Secretary of State in wanting to put the patient squarely at the centre of things but the NHS still wants to do this on its own terms. Look at its behaviour – even in the way it seeks to put patients centre stage – it’s still deeply focused on its own needs: You answer the questions that we put in our questionnaires. We look at the results and if you’re lucky you might see the occasional change.

Nothing wrong with this except it is the NHS itself and its own needs that are taking centre stage, not the patients’. Out there people want be part of a conversation as they are on FaceBook and Twitter and they really don’t see themselves as feedback fodder any more.

So what would make a difference to how we care for elderly people? Saying ‘Lessons will be learnt’ is no longer adequate. Indeed after so many inquires and debacles the next politician who says this kind of thing (no matter if it is true) is likely to be lynched by the media.

What we need to do is to make the desire to listen a reality, and for the first time ever we can move beyond platitudes and start to do this in ways that give the patient’s side of the conversation real power. The next time there is something like the CQC report telling us of yet another dreary failure, the response from Andrew Lansley should now be: ‘You’re right. We messed up. We know we need to listen. And we understand that you may not trust us to right now. So we want you to tell us what you think of the NHS, good and bad, in public, confidentially via independent sites like Patient Opinion. And we guarantee to reply, in public to every single story.’

Now that really would signal a sea-change in the scale, transparency and power of the patient voice.

Years ago, in fact until very recently, Saturday Night Live probably meant a show from the London Palladium or a well known US TV show, not anymore. On Oct 1st Saturday Night on Radio 5 Live meant from a busy A&E Department at the Royal Edward Albert in Wigan. The Stephen Nolan show which transmits from 10pm Friday to Sunday inserted their man for comment and opinion real time.

Given the nature of our business I wasn't going to pass up the opportunity to listen to the show to see what transpired - afterall this was what we are about and are trying to achieve - feedback and comment on NHS services and this promised to be straight from the horses mouth.

The show even inserted a reporter to Wigan town centre, I assume to interview drunks as they were being taken to A&E.

"I'm surprised" purred Nolan, his surprise wasn't that people were arriving at A&E but three at arrived with Cardiac Arrest within an hour. He reported live as one was taken from the Ambulance and being wheeled into A&E. "We're machines that can break down at anytime" and then "It's like a conveyor belt" Thankfully the Ward Sister interjected with the fact that getting three heart attack cases in such a short space of time was extremely rare.

However at this point Nolan raised possibly one of the best points of the entire show, some people arrive for an ingrowing toenail and resources are taken away from the treatment of higher importance cases to deal with more frivolous injuries or those that are self inflicted. We all buy into the NHS and want our bit out of it when we feel we need it.

A motorbike accident victim wished it was more like casualty - "You see 3 million doctors on casualty doing nothing" on being told he'd wouldn't be dealt with for 3 hours or so. "I wish I could be seen a bit quicker ... I just want to be seen" The reason for his wait of course, perhaps unknown to him, was that three more high priority heart attack victims were ahead of him in the queue.

Sadly just after this interaction, it was announced that the man wheeled from the Ambulance with a Cardiac Arrest had died. The Ward sister sounded genuinely choked and I suppose it brought home even more so the priorities the NHS faces. Treat a man whom had crashed his motorbike and was frustrated at being told he had a three hour wait or try to save a mans life?

Over 23 million people use A&E in the UK annually for varying reasons, sometimes sports injuries, but around 20% of cases involved alcohol in some way. The programme was on air until 1am and I didn't listen to it to the very end but it continued to interview patients, managers, staff and relatives of the people in that A&E, it confirmed several things, that I probably already knew: 1/ - I have always said at the emergency end of the NHS it can rarely be bettered. 2/ - Sometimes we have no idea whom might be ahead of us in the queue to be seen but we all think we are the most urgent priority that the NHS faces. Perhaps communication could be better at times to put us in our place a bit more.

But finally above all else at 3/ - We all want to have our say on the NHS so why don't we?

For the remainder of this week the show can be heard by visiting the Five Live Website or via a direct link here

I have just had my first experience of the NHS Scotland Event - it was a surprising couple of days!  With a load of NHS Scotland bigwigs in the same auditorium I expected to hear about the 'challenging financial climate', that we should 'do more with less', and the key would be 'improvement', 'measurement', 'productivity'...and I wasn't disappointed: they were all there with bells on!

However, 'compassion', 'care', and 'empathy' also featured prominently, perhaps even more so - what a relief!  Were there even lessons to be learned from the Disney Corporation?  Will we ever call patients 'guests'?

It shouldn't be so surprising but it was reassuring that senior health service staff and government officials are placing these fundamental values front and centre.  As so many Patient Opinion stories, convey, the absence of these values can make the difference between a good experience and a bad one, aside from any clinical intervention.

I came away remembering a quote from the film, 'Patch Adams', "treat the disease, you'll win some, you'll lose some.  Treat the person, you'll always win."

It's a great sentiment; it's been around a few years now!  However, not sure if it can quite compete with the Acting Director of NHS Scotland quoting Lady Gaga!  Apparently, the NHS is Scotland is "on the Edge of Glory"?  How exciting!