There are currently over 1,500 organisations consuming content from the NHS website. Our syndication service allows these third-party partners to integrate our clinically approved content and service information through free application programming interfaces (APIs) or widgets.

It is estimated that 14% of UK households now have voice-activated speakers. Whether or not you believe predictions that 50% of searches will be by voice by 2020, this is a significant market – and is particularly significant for health information. Using websites can be hard for people with literacy difficulties and accessibility needs. Voice-activated devices offer one way, for some people, of getting around these problems. So, this is an important new opportunity for us – but one that we have approached carefully.

Members of our syndication team went to NHS Expo 2017 to talk to people about the API offer from the NHS website. We met members of the Amazon Alexa team at the event and found there was mutual interest in exploring this further.

We had previously looked at how to build a ‘skill’, the equivalent of an app which individual users can enable on their Alexa speaker. We could have developed a skill ourselves, without a close partnership with Amazon, but the contact at Expo developed into a chance to take advantage of their expertise in creating content for voice. By adding our content to Alexa’s core knowledge base, it could be used for all relevant questions not requiring a user to enable a skill in advance. This is key when you consider the challenge of reaching those who are not actively engaging in their own health.

There were a lot of complexities to address before we got to where we are now, and we frequently reviewed and discussed concerns with colleagues. When working with any organisation, especially commercial entities, we are aware that they have different priorities to the NHS and we, as a nation and as NHS staff, are very protective of our health system’s non-commercial ethos. This makes it a sensitive area to operate in, but, fundamentally, we are happy that Amazon wants to be able to offer trusted health information to answer questions from Alexa users. Our priority is to allow people to use their preferred channels to answer basic health questions.

We offer a free API of NHS website content to anyone building digital products and services. While free of charge, there are specific terms about reporting and branding, plus partners must undertake to make no changes whatsoever to our content.

But we recognise that a voice platform has specific demands. A bullet list doesn’t work well on voice and you don’t have access to colours and positioning to help your users navigate high priority content. We have worked with Amazon to find an approach that allows only essential alterations for voice-specific content based on a core approach. We have stuck to the fundamental principle of not agreeing a way of working with Amazon that we would not be willing to consider with any single partner – large or small. We have been careful about data, commercialisation, privacy and liability, and we have spent months working with knowledgeable colleagues to get it right.

It might be helpful to capture some of the key themes that are coming through from feedback so far, and to reflect conversations we have had about mitigating these.