Digital Engagement

Department of Health

April 2010

E-Communications & Publishing

Communications Directorate
Skipton House
 Digital engagement

Table of contents

page
1. Executive Summary..................................................................................................................3

2. Digital engagement: opportunities and tools..........................................................................3

3. The context of digital engagement for DH ..............................................................................5

4. Digital engagement: DH’s strategic objectives ........................................................................6

5. Why engage digitally at all? .....................................................................................................6

6. How to make the decision to engage in digital channels ........................................................6

7. Why is a Departmental approach to digital engagement necessary?.....................................7

8. Relationship to other initiatives...............................................................................................9

9. Defining a digital engagement approach.................................................................................9

10. When and where to engage ..................................................................................................11

11. Implementation considerations.............................................................................................12

12. Evaluation ..............................................................................................................................12

Annex 1: Digital engagement in relation to social media .....................................................................14

Annex 2: Example initiatives .................................................................................................................15

Annex 3: Implementation guidance ......................................................................................................18

Annex 4: a Framework for Digital Engagement in DH...........................................................................20

Annex 5: Glossary of terms ...................................................................................................................21

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1. Executive Summary
1.1. This document describes digital engagement (DE) and social media1, sets out the context
and background to their use in the Department of Health, and develops a framework for
the future development of digital engagement. DE already exists within the Department,
has been used with varying degrees of success, and is going to become more prevalent
with changing demographics and emerging technologies.

1.2. DE brings new opportunities to engage audiences in their health and healthcare in better
(and often cheaper) ways – and allows more to be achieved with engagement enabled by
digital technologies, usually in combination with other media.

1.3. In addition, the outside world is engaging with DH (and topics relevant to DH) in digital
channels in any case, using blogs2, comments on media sites, social networks and more.
Having an approach and supporting materials to respond to this is important.

1.4. The document presents criteria that can be used to assess whether, and how, DE may
deliver benefits, along with guidance on terminology, strategic principles, operational
practice, and examples of use. Annexes include a detailed Glossary of Terms, and further
guidance on the application of DE in practice.

1.5. A simple set of strategic priorities forms the heart of the document. The relationship
other relevant strategies and initiatives across government, and within DH, is described in
this paper.

1.6. The document focuses on engagement in the context of digital communications. The
term ‘digital’ is also used to describe other technology applications, such as informatics,
technology for remote monitoring and patient self-service, and many other examples.
These uses of the term ‘digital’ are not within the scope of this document.

1.7. This document is owned by the e-Communications and Publishing team (ECP) within the
Communications Directorate, and is hosted online, via a Quickr (“Digital Engagement”). It
forms the Department’s contribution to the Permanent Secretary, Government
Communications’ objective of an approach to Digital Engagement in place for all
departments by the end of March 2010.

2. Digital engagement: opportunities and tools

2.1. The capability to digitally engage already exists. Active discussions are happening in social
media. Comment ‘threads’ exist in forums and blogs. Fan pages, groups, forums and lists
already exist in relation to particular audiences. The common characteristic of these
examples of engagement is that they involve conversations. Engagement moves
communication beyond the transmitting of information in one direction or other, and
into conversational territory, where information flows faster and more fluidly. Annex 2
provides some examples of DH experience in these areas.

1
The relationship between these terms is discussed in more detail at Annex 1.
2
This and other terms are described in the Glossary at Annex 5.

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2.2. Digital engagement is relevant to DH policy leads, campaign managers, marketers,

commissioning policymakers, internal communicators, press officers and in most other
areas of Departmental activity.

2.3. DH has a range of its own channels available to support digital engagement, including:
§ an external ‘corporate’ website: http://dh.gov.uk
§ a public-facing website, NHS Choices: http://nhs.uk
§ Delphi, the Department’s intranet: http://delphi.dh.gov.uk/delphi/index.htm
§ Commslink, an internet-based network restricted to communications professionals
across the NHS: http://www.nhscommslink.nhs.uk/
§ a YouTube channel for video content: http://www.youtube.com/departmentofhealth
(as does NHS Choices: http://www.youtube.com/nhschoices) – each channel having a
different content focus
§ a Flickr stream: http://www.flickr.com/photos/departmentofhealth/
§ several Twitter accounts: one for the Department as a whole
http://twitter.com/dhgovuk; others with specific objectives, styles and content
§ its own presence within other public-facing sites, such as the Care and Support
content within Directgov
§ Facebook pages for relating to different policy areas and campaigns
§ a Civil Wiki page: http://wiki.gsi.gov.uk/index.php/Department_of_Health
§ the capability to host blogs on its internet and intranet sites, with features such as
commenting and moderation available
§ online member communities and forums – as an example, the Social Marketers’
network, sponsored by DH (http://socialmarketers.net)

DH also has the ability to engage in other channels outside its own control, where there is
value to be gained from doing so. It is a rich and complex environment.

2.4. To give a sense of scale to these channels, the following tables shows examples of metrics
associated with them.

Channel Example metric

DH website (dh.gov.uk) 850k visitors/month

NHS Choices website (nhs.uk) 9m visitors/month

Delphi, the DH intranet 170 pages updated/month

Commslink 3,700 users

YouTube DH channel: 322 subscribers ;

156,000 views

Flickr 189,903 views

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Channel Example metric

Facebook Example: HPV page has 2,500+ fans

Twitter @dhgovuk – 2364 followers

3. The context of digital engagement for DH

3.1. Before considering digital engagement in more detail, the characteristics of DH’s
communications context are worth noting:

3.2. Widespread general interest: health matters are of interest and relevance to a wide
audience, with many individuals ready to engage. This differs from, for example,
international trade, science or agricultural policy matters. Everyone is a healthcare
stakeholder.

3.3. Diverse audiences: DH audiences include managers, medical professionals, other

government departments, the general public, media, social care stakeholders, patients,
special interest groups and its own staff. Different audiences also have different
capabilities to engage, and some use intermediaries to do so. This wide variety means
that this overall approach to digital engagement is necessarily set out at a high level.

3.4. Overlaps between health practitioner and patient interest: whilst the principal focus of
some communication activity may be on healthcare professionals, the nature of health
issues means that it is always likely that this information will be consumed by a lay
audience to some extent. Further complication occurs where communications are
intentionally targeted at mixed lay and specialist audiences, and where they are delivered
through intermediaries.

3.5. Existing areas of interest: from healthcare consumers to healthcare professional groups
to the pharmaceutical industry – strong networks and online forums of interest already
exist (‘parents’ is a good example). These groups are better versed in engaging digitally
than government. As with large organisations generally, government has some catching
up to do in practising effective digital engagement.

3.6. Fast-moving, unpredictable and high-impact content areas: issues ranging from new
diseases (such as pandemic flu), to treatment concerns, to health scares (real or
perceived), can frequently appear with a combination of little notice, high public interest,
and potentially high impact on health outcomes. Emergency communications as a whole
are an area of both challenge and opportunity for digital engagement. The real-time
potential of digital communication to be flexible and responsive in real-time can be very
well suited to emergency situations. An example might be the healthcare implications of
a major terrorist attack requiring rapid communication with a broad, geographically
dispersed audience.

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4. Digital engagement: DH’s strategic objectives

4.1. We will use DH-hosted tools and channels, as well as external channels, to listen and
respond to our audiences, and to give them opportunities to interact with us and each
other online, where there is benefit from doing this.

4.2. We will ensure, through evaluation, that our digital communications are effective and
maximise the use of DH communications resources.

4.3. We expect a consistent set of operational principles (described in detail in this

document) to be adopted and applied to the practice of digital engagement, and for
this to become seen as a core communication skill rather than a specialist discipline.

4.4. We expect digital engagement (and the use of digital communications generally) to
become seen as part of overall communications planning in all media. Digital
engagement does not have to represent a revolutionary change – it is a natural
extension of, and support to, engagement in other channels.

5. Why engage digitally at all?

5.1. Digital engagement is a strategic choice, rather than a “box to be ticked” as part of
communications planning. It serves in two broad contexts:

5.2. Firstly, digital engagement offers the opportunity for planned interaction with new,
specific audiences, using channels that enable feedback and responsiveness to an extent
unachievable using traditional media. Changing patterns of channel use in certain
demographics – in favour of digital channels – mean that digital engagement
opportunities are continuing to increase over time.

5.3. Secondly, digital engagement around public services happens, whether planned or not.
Peer-to-peer networking, the creation of interest groups, and the ability of social
networks to spread messages virally and quickly are all examples of digital engagement.
By not participating, DH misses opportunities to counter misleading information, to
influence debate or to interact with audience sectors who increasingly view digital
channels as their native environment. Issues that surface in digital channels can readily
cross over to more traditional media at speed, giving widespread attention to matters
previously of only niche interest.

5.4. An approach to digital engagement does not start from the presumption that “more
openness is always better” or “digital engagement is the answer to every problem”.
Neither should it dictate how specific areas of communication could be conducted. This
will be a factor of objective, audience, content and media. Instead it reflects
opportunities and risks of digital engagement as an enabler of better communication, and
provides how to proceed where it is advantageous.

6. How to make the decision to engage in digital channels

6.1. Digital engagement is not currently a standard part of communication planning in DH.
Current DH practice, experience and expertise vary widely across directorates. Nor, for
reasons set out in this paper, should it necessarily feature in all communications

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planning. However, the disposition of audiences to engage in digital channels does show
a general increasing trend, and DH will and should become more active in its practice.
Some examples of DH digital engagement can be found at Annex 2.

6.2. Indications that digital engagement should form part of the communications mix include:
§ An understanding of the audience. In terms of its demographic – is it young, old,
technology-literate?
§ An understanding of the platforms that are being used – do they have a particular
culture or pre-existing user community? A recent government crowdsourcing of
images used Flickr; falling foul of Flickr’s active professional photography community
who reacted to the seeming ‘amateurisation’ of their market.
§ An opportunity to co-create. Is the subject being communicated one where
representation, creation and amendment can genuinely be offered?
§ A need for openness and scrutiny. Is the historical or broader context of the topic
such that openness and engagement may be particularly appropriate? (A non-DH
example would be the crowdsourcing of ideas for a new approach to MPs expense
processes).
§ An appetite for some level of risk. Digital engagement can offer the unexpected.
Platforms that aren’t under direct control always have the potential to be used for
purposes that weren’t predicted.
§ Ability to think laterally: some of the most successful digital engagement has come
about by taking an indirect approach to a topic. Leicester City Council achieved a very
high level of engagement on Facebook by operating a ‘fan page’ for Leicester as a city
– rather than the Council as an organisation. Similar, a current DH example about
social care recruitment is exploring whether its Facebook page could focus on more
general recruitment conversations, rather than just solely on social care as a theme.
§ Resource availability: from staff with the right skills, to enough time to cope with the
work arising from engagement, to a commitment of resource for the whole life of a
period of engagement. Communicators at all levels (and the policy teams they work
with) need to be aware of the principles of digital engagement – not just those at the
front line of communication.

6.3. If most of the conditions in 6.2 can be met, these provide good indications that
proceeding with digital engagement will have value.

7. Why is a Departmental approach to digital engagement

necessary?
7.1. Digital engagement, particularly that involving social media, changes the way we
communicate. It is:
§ Far more widely distributed: all those involved, whether as public service providers or
as users, have the potential to publish on a very wide scale
§ Direct: digital engagement has the potential (for better or worse) to redefine
intermediation in communication – often removing intermediaries entirely, but also
creating new challenges for those without access to digital services
§ Real-time in nature: feedback and reactions are often immediate

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§ Unpredictable: events and conversations frequently cross between channels in

unexpected ways – e.g. a face-to-face experience may lead to a user-generated video
being uploaded to a blog, whose comments then become the subject of a traditional
media news story. In 2009, the story of a London Underground worker who abused a
passenger was on the front pages of national newspapers the day after he was caught
on another passenger’s video camera and the content uploaded to social networks.
§ Viral: social media are capable of transmitting onward messages at very great speed,
reaching an exponentially increasing audience; if things go wrong, they can go very
wrong, very quickly; and cross channels in doing so, often into traditional mass media.
The story of a death initially (and incorrectly) thought to be linked to HPV vaccination
reached a large audience very quickly through the passing on of links to the story
through social media.
§ Complementary to traditional media: DE can often deliver most benefits when used in
association with traditional media
§ New: not yet embedded into ways of thinking or working; meaning that some
mistakes are inevitable, and a great deal of duplicated learning may occur
§ Increasingly popular: as a personal preference for a communication channel
§ Inverted: in the relationship between the experience and expertise of practitioners:
more junior officials may be more skilled in the use of social media than those more
experienced and senior in a policy area

7.2. All these factors combine to make DE complex, requiring sound underpinning principles.
DE does not provide a solution to every problem. Traditional communications – and the
expertise accrued in using them – have a very strong role to play. But the increasing
potential of DE, whether as an intended part of communications, or as a consequence of
other events, means that an appreciation of DE is now an essential part of policy
planning.

7.3. As an example of this, Eurostar service failures in December 2009 exposed the lack of a
digital engagement approach. Eurostar had a social media policy – based on using social
media to deliver marketing messages. But in the event of an operational crisis, the
resulting storm of negative feedback showed that digital engagement is now an essential
consideration for any organisation facing a large public audience.

7.4. Any long-term digital engagement approach carries a significant caveat – the
technologies and media involved change rapidly. In the early years of public participation
on the internet it was easier to track and manage engagement – monitoring a few
significant forums and blogs, and having an understanding of the most popular social
networks, was achievable without a large commitment of resources.

7.5. At the start of 2010 this landscape is showing signs of change. As ever, the ‘popular’
networks and forums are in flux, but there are new strategic issues at play with the rise of
geolocation – where the place where data was generated (or which it references) is at
least as important as its content – and utilities which make it easier to participate in
numerous channels at the same time. Cross-platform identity services also support
engagement between parties in which content can cross easily between media and
platforms. For example, a Facebook log-in can now be used to register on other sites,
meaning that content can be created and those sites, and automatically update pages in

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Facebook at the same time. This makes monitoring and management of online activity
more difficult.

8. Relationship to other initiatives

8.1. The Power of Information Taskforce was commissioned in 2008 by the Cabinet Office,
and reported in 2009 with a series of recommendations on digital engagement3.This
document is an extension of that guidance, tailored for the Department of Health,
bearing in mind the Department’s priorities and role.

8.2. This document covers the business use of social media for digital engagement – not the
use of social media in a personal capacity. The Cabinet Office has published guidelines for
civil servants using social media through the Central Office of Information (COI)4.

8.3. The overall cross-government engagement strategy, as set out by Cabinet Office and
documented by COI, sets out to:
Communicate where people are present
§ Put information in the places where people go already
§ Participate where people are present, particularly through forums, wikis and blogging
§ Deliver access to online services where people go
Create better user experiences for government services
§ Enable people to find the information and online services they require by having fewer
communication channels and focusing them around audience needs
§ Bring relevant information together into one place on government sites rather than
across several sites, saving users time and effort
§ Create a consistent high-quality experience through a dedicated set of standards
Enable non-governmental bodies to reuse information
§ Help non-governmental bodies to build new services by structuring information so
that they can combine public data with private data
§ Avoid replicating what is already being undertaken by non-governmental bodies

These general objectives have been used to develop more specific principles relevant to
the work of the Department, set out in section 9.3 below.

9. Defining a digital engagement approach

An identifiable relationship to overall organisational strategy

9.1. For Department of Health, this means an alignment of DE to the overall strategic
objectives of:
§ Better health and well-being for all: helping people stay healthy and well;
empowering people to live independently; and tackling health inequalities.

3
http://poit.cabinetoffice.gov.uk/poit/
4
http://www.coi.gov.uk/guidance.php?page=264

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§ Better care for all: the best possible health and social care that offers safe and
effective care, when and where people need it; and empowering people in their
choices.
§ Better value for all: delivering affordable, efficient and sustainable services;
contributing to the wider economy and the nation.
...and values:
§ We value people: We care about people and put their health and well-being at the
heart of everything we do.
§ We value purpose: We focus our actions and decisions on achieving our shared goals.
§ We value working together: We work together as one department and with our
partners and stakeholders.
§ We value accountability: We take responsibility and are open to challenge.

9.2. Good digital engagement must demonstrate relevance and contribution to the delivery of
these objectives, and be practised in line with these values.

Underpinning strategic principles

9.3. As important as the relationship to organisational strategy are the principles that support
all engagement in practice, strategic and tactical:
a. Set objectives for all planned engagement activities, and be clear in the desired
outcomes from unplanned, responsive activities.
b. Build a business case quickly and adjust it in the light of experience – it may not be
right first time. Build in agility to the process of developing the business case – quick
turnaround may be more useful than a perfectly-formed product.
c. Be consistent: across different channels, over time, and across topics/campaigns/
themes.
d. Have a recognisable tone of voice.
e. Be realistic about where and to what extent DH can engage on a particular issue: if
content is taken and embedded in thousands of third-party sites, all of which could
then feature follow-up comments and discussions, it will be unrealistic to interact in
all of them.
f. Be clear about the audience being engaged, and why. Engagement works best when
a community’s character and needs are understood, and particularly if it has been pre-
engaged in other channels (including non-digital).
g. Leaving is harder than arriving – if you have to close a channel, plan the exit carefully.
For example, a Twitter channel set up as part of an overall campaign may have an
intentionally fixed lifespan. Prepare for its closure so that those involved in
conversations aren’t taken by surprise. Above all, don’t abandon a channel and leave
it publicly visible and unattended.
h. Similarly, co-production sets a tone for future activity. Once audiences have
experienced co-production in a particular policy area, it may be hard to revert to
previous approaches.

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i. Remember the effectiveness of DE as complementary to traditional media – plan

digital activities as part of an overall approach.
j. Follow the code for civil service online participation.
k. Don’t think of the channel first and then try to find a use for it.
l. Ensure that channels are accessible and suited to the needs and capabilities of those
engaging in them.
m. Prepare for the unexpected – run scenarios to test DE. Be creative in: “what could
happen if...” thinking.
n. Measure and evaluate engagement activities.
o. Be prepared to rethink established metrics and role of existing assets, notably web
sites. Engagement involves being where the conversation is, not necessarily bringing
others to a destination.
p. The best place for engagement may not be DH’s place.
q. The best organisation to lead co-production may not be DH. For example, a third
sector partner may provide a more effective setting.
r. Be aware of the skills required: beginning DE without them is likely to fail
s. Approvals processes and timescales from non-digital channels are unlikely to be
suitable for DE
t. Take risks – if nothing ever goes wrong, it may be a sign that genuine DE is lacking
u. Don’t ignore digital engagement, whether planned or not – it won’t go away

10. When and where to engage

10.1. This refers to active choices of channels as well as decisions made in response to
feedback from monitoring and listening.

10.2. There are three basic approaches available in planning where to engage; approaches
which can be used in combination:
§ On one’s own channels – “bringing the conversation to you”
§ On other sites – “taking the conversation to where the audience is, and where
conversations are happening anyway”
§ Through allowing content to be used elsewhere – providing the ingredients for
engagement to take place, anywhere; e.g. allowing content assets to be embedded in
third-party blogs

10.3. An example of using these approaches in combination would be the hosting of a web
content where direct feedback can be left, also containing embedded video content (i.e.
content appearing in the site itself), which can either be viewed in situ or by linking back
to an external video hosting site (such as youtube.com). The content is also made
available for other, non-government, sites to take and use, allowing further engagement
to take place on those sites.

10.4. Such an approach has benefits and drawbacks. By offering content in numerous settings,
different audiences and communities can be reached. However, there is a corresponding

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increase in the workload required to monitor, and especially, participate in, the
numerous conversations that ensue. Effective use of monitoring tools, such as a social
media dashboard, can offset this to some extent.

11. Implementation considerations

11.1. Resourcing: one of the most significant strategic issues to consider is the impact on
traditional resourcing models that DE may bring. Large-scale interaction, 24 hours a day,
on hundreds of sites covering dozens of topic areas may be possible in theory. But this is
unlikely to be achievable with realistic resources.

11.2. Instead, engagement opportunities can be prioritised: in a recent exercise, ECP worked
with the QIPP team to review 40 recent stories, in digital channels, mentioning topics
which might have relevance to the QIPP agenda. The stories were reviewed for the
degree of relevance to QIPP, and the impact which the topic might have on the delivery
of QIPP’s objectives. This led to a balanced choice for each story on whether engagement
was appropriate, and if so, in what channel.

11.3. The use of social media is becoming better understood. More is known about the nature
of building communities, managing interaction and reacting to the unforeseen. Social
media tools are, by and large, free of up-front costs, although they do of course incur
significant amounts of management time in their establishment and operation.

11.4. As DE continues to grow in volume – which seems likely – so the use of smarter
resourcing approaches should be explored. For example, rather than having a dedicated
social media manager for each project it should be possible to deliver operational
economies by specialising and sharing such skills across a number of projects.

11.5. Quantifying resourcing for digital engagement requires the establishment of clear
engagement goals and monitoring frequencies. Passive monitoring can be conducted
with very little resource, once initial tools have been set up, but once response has been
entered into, an ongoing resource commitment needs to be established. For planning
purposes it may be useful to distinguish between ‘set-up’ resource (establishing a
strategy, choosing platforms, preparing content, building a community or network) and
‘operating’ resource – listening, responding, escalating.

11.6. Accessibility: in both the technical sense (provision for users of different capabilities) and
the network sense (any form of connection to digital platforms such as the Internet). It is
not the role of an approach to DE to define future infrastructure provisions, but clearly
we must bear in mind the realities of access when planning for digital engagement.

12. Evaluation
12.1. Given the resources that digital engagement can consume, evaluating its effectiveness is
essential. However, its evaluation is complex. There is a temptation to focus on
intermediate metrics (number of ‘followers’ or subscribers, the size of audience that will
have seen online content, the number of blog posts and comments generated etc.) rather
than tangible outcomes. Yet tangible outcomes may only be indirectly attributable to
digital engagement, such is the nature of influence.

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12.2. Tools fit for the evaluation of digital engagement are required: this may mean the design
of ‘dashboards’ (suites of tools which show evidence of performance in a number of
areas, together in one place). Examples of these already exist in central government, and
have been developed by ECP to suit particular DH requirements. As well as measuring
obvious metrics such as frequency and extent of coverage, tools also exist which can
track ‘sentiment’ – the tone and context of online commentary on a particular topic.

12.3. This document does not propose a single evaluation methodology to span all instances of
DE across the Department. Given the range of communication and engagement activities
such a methodology would be unlikely to exist in practice. However, the setting of
objectives (and corresponding measures) suitable for each example of DE, and the
periodic review of progress against them (with swift corrective or fine-tuning action taken
where necessary) are essential.

12.4. As a minimum, evaluation should include:

§ a core set of ‘hard’ measures, including numbers of subscribers, estimates of audience
reach, and volumes of content generated;
§ sentiment analysis (some degree of sampling is inevitable) as evidence of audience
perceptions of engagement; and
§ assessment of overall achievement of campaign or policy goals, where engagement
has played a part.

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Annex 1: Digital engagement in relation to social media

Although these topics are related, and often interchanged, they have different meanings. Digital
engagement is defined as:
Digital engagement: the use of interactive techniques to improve service
delivery and information provision via digital technologies (the internet,
mobile telephones and digital television) [defn: COI]

The Cabinet Office commissioned the 2009 Power of Information5 report, which described three
categories of digital engagement in practice:
§ Helping people online where they seek help
§ Innovating and co-creating with citizens online
§ Opening up online dialogue

Interactivity and improvement are important here. In contrast to “digital communication” – the use
of any digital channel or technique to communicate – DE must6 have this two-way element of
interaction (for example between service provider and service user). Merely publishing information
in a digital format, or presenting an electronic transaction without any ability to provide comment or
feedback, does not constitute DE.

In addition, DE may well facilitate engagement within peer communities. An example might be to
provide a space for carers to share their experiences and advice with each other, rather than
offering ‘top-down’ guidance. Social media can be used to provide such spaces.

Social media refers to particular digital technologies that are frequently associated with, and very
suitable for, digital engagement.
Social media: digital tools that permit people and organisations to interact
freely with low (or no) barriers to entering a conversation

Social media is less concerned with broadcasting messages to mass audiences; and more about
engaging specific groups in some depth, building strong and ongoing relationships between people
and a brand, campaign or policy.

Digital engagement refers to a general philosophy of operating; social media are a particular set of
tools that enable this.

5
http://www.cabinetoffice.gov.uk/reports/power_of_information.aspx
6
There is arguably a wider definition of engagement, based on the consequences of even one-way
communication. However, that would equate digital engagement with all digital activity, and detract from the
focus on interaction that is the purpose of this paper.

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Annex 2: Example initiatives

Examples from across DH

Response to pandemic flu, 2009

A programme of engagement across several digital channels. A Twitter channel provided regular
updates on breaking news items and other content. A protocol was also developed between the
major public-facing government websites to use the pandemic flu Twitter account to amplify their
respective significant messages.

Monitoring and listening played an important role. By understanding the conversations that were
happening in digital channels, content could be tailored to meet particular concerns, or to clarify
points where needed. Although DH decided not to interact directly with the public through digital
media, its use for listening to conversations, sentiment and concerns demonstrated engagement
because content was created or changed as a result.

Other digital engagement took place through the use of video content (NHS Choices posted
commentable content on its YouTube channel) and some content was also hosted on DH’s YouTube
channel (non commentable at that time). A paid search management strategy was put in place to
ensure the prominence of appropriate links relevant to pandemic flu search queries.

NHS Choices also supported commenting on its news articles. Generally these conversations were
self-moderating; with users directing users to correct information sources if they were in doubt. A
general policy of not interfering in user commentary was observed. Email subscriptions for updates
were also supported by NHS Choices.

HPV Vaccination, 2009/10

The HPV vaccination campaign used a mixture of traditional and digital media. Traditional
promotional media and paid web search were supported by web content giving further information
on the vaccination programme. A notable engagement feature was the ability to register for
reminders (sent by text message) to help make sure that vaccinations occurred at the right time. This
was a novel use of a digital channel (the mobile phone) to reach an audience group for whom this
was particularly appropriate.

The HPV use of social media (Facebook: http://facebook.com/hpvtogether) to support other

channels has also shown some excellent practice. The theme of the page is not: “become a fan of
HPV vaccination” – it has instead featured attractive content for girls and young women on lifestyle
and leisure interests. By sharing content that has value to this community, the community engages,
develops and – almost as a by-product – becomes conducive to receiving, sharing and discussing
messages about the vaccination programme. The Facebook group has over 2,500 fans, and has been
used to organise events such as the “Girls Night in” which was signed up to by nearly 8,000 people.

Big Care Debate, 2009/10

One of the largest, multi-channel digital engagement exercises, this included an email list that could
be signed-up to, a Facebook page, a Twitter account and latterly, an exercise to encourage the public
to submit photos related to care, for display and potential inclusion in the forthcoming White Paper.
Supporting web content for the engagement channels was created as a subdomain of Directgov.

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The Facebook page attracted informed and active contributors, and built up a following.
Contribution from DH to discussions on the page was relatively limited in volume and frequency
compared to that generated by the public, with the effect of allowing a small number of vocal
contributors to dominate discussions.

Webinars/webchats (various dates)

DH has conducted several webchats, hosted in different ways: in a government channel (the No10
web chat platform); via the media (using the Guardian’s webchat services); and with the third sector
(using Mumsnet and Carers.org as webchat platforms). Typically the format centres on a prominent
individual (the Chief Medical Officer, senior official or minister, typically) providing either a briefing,
with follow-up comments and participation, or a straight question-and-answer format.

In a recent example (Feb 2010) Phil Hope chaired a web question-and-answer session for around an
hour taking questions on the topic of care and support. The full transcript of the webchat is available
at http://www.number10.gov.uk/Page22420. The moderator took direct questions about the
engagement exercise (in addition to questions for the minister) and provided personal responses via
email – a very positive indication of engagement.

Examples from across government

The New Opportunities online consultation

(www.hmg.gov.uk/newopportunities.aspx) provides access to the New Opportunities White Paper
and seeks opinion on how the UK can draw on the opportunities offered by the global economy.
The site is a primary source of information that encourages users to engage in discussions in other
locations before submitting their comments.

The Sustainable Development Commission website

(www.sd-commission.org.uk/pages/sd-panel.html) The Sustainable Development Commission has
recruited a 500-strong panel of multi-discipline stakeholders to which it can pose regular
consultation questions.

Number 10 webchats
(www.number10.gov.uk/news/webchats) allow the general public to direct questions at the people
who make decisions that affect their lives. They are a cost-effective and engaging way of involving
the public in government processes, and embed good content.

The Communities and Local Government discussion forums

(http://haveyoursay.communities.gov.uk/ forums/) enable users to debate issues that are relevant
to their local community through the Department’s own social media channels. They are a low-cost
way of gathering public opinion and placing the views of the public at the heart of policy-making
processes.

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The Listening to Students blog

(http://talk.dius.gov.uk/blogs/studentlistening/) provides the Department for Innovation,
Universities and Skills (DIUS) with an opportunity to post information that will engage university
students in government decisions. The Department’s dedicated social media unit creates technical
solutions, policy and communications. The student listening blog is a good example of the way in
which DIUS creates dedicated spaces for key stakeholders using low-cost social media.

RAF careers promotion

(www.bebo.com/theroyalairforce) has benefited from social media activity. Its Bebo page
successfully exploits the network effect by giving users highly engaging content that they want to
talk about and share with others. To do this they allowed frontline staff to tell their own stories
using video and chat.

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Annex 3: Implementation guidance

Recommended practice

More detailed guidance on digital engagement by channel:

§ Social networking sites (e.g. Facebook)
– Consider creating pages related to the targeted topic (as opposed to being based on its
direct theme); some creativity of approach can help in attracting broader audiences and
building a more active community. Examples include the “Girls Night In” events within
the HPV group, and an approach to social care recruitment which focuses on more
general issues of career choice – not just around social care.
– One of the most sensitive areas is the boundary between personal and business persona
for staff participating in the Facebook environment – staff should always engage as DH
officials when participating on official business on social network platforms.
§ Web campaigns
– Give consideration to the need for new content – developing existing content on public-
facing government sites (e.g. NHS Choices or Directgov)
– Look for opportunities to make content available to other platforms (including non-
government) in addition to developing content on government sites
§ Consultation channels
– Ask for proportionate personal information, indicating how it will be used
– Make it clear what (minimal) information is required from those engaging, and what is
optional. Barriers to participation should be as low as possible.
§ Forums
– Decide on moderation approach (pre-publication, post-publication or none) based on
the context of the forum membership, topic area and discussions. Moderation helps
reduce the risk of off-topic or offensive content being submitted, and can be used to
prevent on-forum conflict between users, but it can also introduces costs and delays to
publication, and can be seen by some users as a form of censorship.
– Assess forum usage as proportion of available audience, check for domination by a
small, vocal community, and consider mitigating actions. As an example, if a profession
has several thousand members, but only a handful are participating in a forum, explore
ways to broaden the appeal, either by seeding different topics for discussion or by
publicising the forum to a wider audience.
§ Blogs (including microblogging)
– DH policy is that no officials will blog in a personal capacity. Any channels that are
operated must respect this; an example of a way to achieve this might be the use of a
range of external contributors to write posts based on specific topics, as a featured
theme relevant to a particular policy area. Once begun, blogs should be regularly
updated.

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– Allow blog comments; decide on moderation approach (pre- post- or none) based on
context, but a blog with no comment facility represents generally poor practice (and is
effectively no more than web page publication).
– Cross-promote the blog or microblog in other channels.
– Use a personal touch, but don’t make it all about one person’s activities. Exploration of
related themes, or asking questions of the channel’s audience, can be useful ways to
broaden the content and value of posts.
– More detailed guidance is available from the e-Communications and Publishing team.
No new blogging or microblogging channels should be set up without the involvement of
ECP.

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Annex 4: a Framework for Digital Engagement in DH

It may be useful to recap this digital engagement framework in a “6 P” mnemonic form:

Purpose
Is there a clear purpose for digitally engaging?

Principles
Have the principles within this document been reviewed before firm plans and commitments are
made?

People
Are the resources in place to support digital engagement? Is the community with whom engagement
is proposed well-understood? Are other communities that may become engaged also understood

Place
Where to engage: on a DH platform, on other platforms (government and non-government), via
supersites, or using a combination of these?

Practice
Are the guidance notes within this paper being applied to the operation of digital engagement? Has
additional guidance been sought – from the eCommunications and Publishing team and from peers –
where necessary?

Protection
Has due care been given to risk, reputational protection and potential policy impacts of digitally
engaging? The eCommunications and Publishing team provide advice and expert guidance in this
area.

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Annex 5: Glossary of terms

Term Definition

Blog Derived from “Web log” – originally a regularly-updated journal on

which visitors could leave comments. Now generally used for a site
(or section of a larger site) where text-based content can be
created in the form of short articles, almost always open for
comments to be posted. These comments may be subject to some
degree of moderation.

Campaign site Website created in association with a specific campaign; usually

for a defined period of time; may include facilities to receive user
feedback and present an opportunity for engagement.

Commentable document A facility for hosting a document under review, usually divided into
manageable sections, and permitting comments to be left for the
author – and to permit dialogue between commenters. Combines
some of the features of a wiki for collaborative working, but
retaining an initial document structure throughout. Has been used
on a number of government policy documents made available for
digital consultation. One tool that delivers this functionality
(implemented on the WordPress platform) is known as
Commentariat. Example at:
http://interactive.bis.gov.uk/lowcarbon

Consultation channel Any channel used as part of the policy formation process whether
in the gathering of ideas, discussion of concepts with stakeholders,
or in hosting content as part of a formal consultation process. The
content may be commentable (see above), hosted as a wiki for
collaborative editing, or simply be displayed publicly with
comment invited through email or other direct channels.

Content-based networking e.g. YouTube, Vimeo, Flickr, TripAdvisor – sites based on content of
sites a certain type (e.g. video, images, reviews) with a strong element
of user feedback, user-generated content (UGC) and elements of
social networking (e.g. ability to create groups, forums, favourites,
peer-to-peer relationships etc.)

Crowdsourcing The use of digital (or other) media to allow the contribution of
information or ideas from a wide range of people, usually around a
topic, a question, or a request for innovative suggestions.

Dashboard Dashboard: a utility that searches and aggregates information

from many channels across the internet, and displays it all in one
place, in real time, for management, monitoring or consumption
purposes. Example: www.netvibes.com/socialcare

Data feed Automatic generation of content (usually from a website) so that it

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Term Definition
can be read elsewhere, or integrated into other channels. A feed
might be updated, for example, every time a new blog post or
comment is created, allowing the content to be read elsewhere by
a subscriber to that feed.

Feeds are also useful for automating information flows between

websites, so that a change in one place can be reflected in another
site without the need for manual intervention. Updated disease
statistics would be a good example of such a feed.

Digital communications Communications using digital media (aka digital channels): the
internet, mobile telephony or digital television technologies –
including platforms operating using these technologies.

Digital engagement The use of interactive techniques to improve service delivery and
information provision via digital media technology.

Email subscription Although not ‘social’ in terms of community formation and peer-
to-peer interaction, allowing users to register email addresses to
receive personal(ised) updates represents a form of digital
engagement. Digital tools build a two-way relationship: the user
receiving content, and also experiencing some sense of being part
of a community, even as information recipient.

Forum Area for registered members to discuss specific topics. Can form
part of a wider overall site. Characterised by a core user base
making multiple contributions and often sharing relationships or
culture. Forum content may or not be moderated.

Geolocation The tagging of content with attributes relating to a physical place.

Typically this will be either the place where the content was
created, or a place to which it refers.

Group A type of forum generated by users within a social networking or

similar type of site. Shares many of the characteristics of a forum,
but can be more volatile. Members (who are a subset of the
members of a larger form or social network) will typically interact
for a shorter period of time, usually around a specific single issue.
Creation of fan pages (or similar designations) also effectively
forms a Group.

Metadata Information about information. Often invisible to the user,

metadata allows content to be classified, structured and sorted.
Tags represent a use of metadata.

Microblogging e.g. Twitter, Identi.ca, Yammer (the latter within corporate

environments). Member communities sharing short message
content, openly and by direct peer-to-peer message. Highly
flexible in their use, and prone to rapid escalation of issues:

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Term Definition
creation of “a Twittermob”.

Moderation Editorial judgement over user-generated online content.

Numerous varieties exist, from moderation by peers or by the site
owner/author, to outsourced arrangements where professional
moderators assess and process comments on a larger scale.

Post To publish content to a blog, micro-blog, forum or website, either

as a new topic or as a comment on existing content. Also, as a
noun, to describe the content posted (synonymous with ‘blog
post’, ‘forum post’ etc.).

Platform Infrastructure within a digital channel allowing content to be

hosted, applications to be run, or interactions between users
managed, within an overall structure. An example might include
youtube.com – a platform for video hosting and interaction, or the
iPhone as a mobile telephony platform capable of running a
variety of different applications installed at the choice of the user.

Private social networking site A social network intended for a specific community of interest.
Offers similar features to an open social networking site, but
almost always sets conditions and controls over entry and
participation. E.g. sites set up using Ning.

User-generated content Any content provided by users, rather than the owners of an
online environment. May or may not be moderated (see above)

User feedback A specific type of user-generated content: that created as a

response to provided informational content. Can take the form of
freeform text comments, ‘votes’, likes/dislikes, or more detailed
survey-type information.

Social bookmarking
A method by which people can store, organize, search and share
articles, blog posts and other information. There are many
different libraries, each with their own bookmark, including Digg,
de.lici.ous and Reddit. Increasingly, posting content links as tweets
or to Facebook profiles provides a common form of bookmarking.
Eg. the DH website supports the sharing of content through social
bookmarking:
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_115988

Social marketing The use of marketing techniques to achieve desired social

outcomes (e.g. behaviour change). May or may not involve the use
of social media. Included here to avoid confusion with social media
marketing.

Social media Digital tools that permit people and organisations to interact freely
with low (or no) barriers to entering a conversation.

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Term Definition

Social media marketing The use of social media to promote a particular cause or product.
May or may not have social marketing implications. Included here
to avoid confusion with social marketing.

Social networking site A website offering general-purpose networking features to all who
may want to join. Facebook dominates the adult market; Bebo has
a focus on a younger/teenage audience; MySpace is now focused
on music/video content and may be regarded as a content-based
networking site, albeit one with a high membership.

Tags Keywords (or similar indexing information) describing online

content that allow other users to search for relevant material.

Twitter The best known of the micro-blogging platforms. Users contribute

short messages, either on the twitter.com website, or using a
number of third-party ‘client’ applications: whatever the route,
interaction happens in a consistent and open way. Terms include:
Tweet: to post content (short messages up to 140 characters long)
Re-tweet: to republish another’s post. Good for spreading
messages widely, or adding commentary to them
Hashtags: words or phrases preceded by ‘#’. This allows them to
be grouped together and easily searched.

Webchat (or Webinar) A structured discussion using instant messaging

Example: http://webchat.number10.gov.uk

Wiki An open collaboration environment in which users may freely (or

with some controls) create and modify content as a community.
The best known example is Wikipedia, where an open community
collaborates to create an encyclopaedia, but wikis can be used for
tasks as varied as communal creation of a policy document, or
managing the names and interests of attendees to an event.

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