Select Committee on Health Written Evidence

Memorandum by Patient Opinion (PS 10)



    1.  Patients have a strong interest in safety but their insights and suggestions are consistently under-used.

    2.  To remedy this the NHS needs to develop

    —  tools that enable easy feedback

    —  incentives that result in patient insights being translated into appropriate improvements.

    3.  Patient Opinion is an independent social enterprise that is currently working on a scalable web-based platform that facilitates these two aims.

  1.  In some ways patients have the most intense interest in patient safety of anyone in the health care system. Despite this the views of patients about how to improve safety remain a largely untapped resource.

  2.  For the last 3 years Patient Opinion has been working to let patients, carers, service users and staff feedback their experience of receiving and giving care across the UK health service. Whilst Patient Opinion focuses on all aspects of care not just safety it is clear to us that such tools could be used to great effect to improve safety

  3.  However at present the vast majority of stories posted on the Patient Opinion website with suggestions for improvement are ignored. In large part this is because busy staff have neither the tools nor the incentives to act on patient feedback that is not in the form of a complaint or that does not comply with the bureaucratic systems set up by Trusts and the NHS to deal with comments and suggestions made by patients and carers.

  4.  By contrast organisations focus much effort on

    —  Large scale issues—for instance if we shut the A&E department will the ITU still be safe?

    —  Medium-level management issues—for instance how can we improve safety by decreasing our reliance on bank nurses?

    —  By contrast patient suggestions are typically about the micro. For example why were the floors always wet in the toilets on ward 23 or why was my dad lying naked on his bed one day when I arrived to visit him?

  5.  Such patient insights and questions are often ignored because they do not fit with:

    —  Other, understandable, managerial pressures like hitting the 18 week target or keeping in budget.

    —  They are invisible and inaccessible to senior management, Board and commissioners.

    —  Such things can be seen as a one-off or "not my business" or the province of another person or team who are unlikely to welcome their defects being pointed out.

    —  as things stand at present correcting hundreds of little things can be hard, unrewarding work involving many different departments

  6.  However the micro aspects of how patients are treated are crucial to care and to safety. If washing is not done with attention to dignity falls are more likely. If feeding vulnerable people is not seen as important patients are more likely to become malnourished. If gentleness is not systematically valued, then subtle forms of abuse can flourish.

  7.  Currently there are few incentives for professionals or managers to use to patient feedback to improve safety. As a result a small but significant number of patients who are:

    —  passionate about improving just these aspects of care

    —  often posses highly relevant skills

    —  are often time rich and eager to give something back to the NHS

    —  are for the first time relatively easy to identify on a large scale are ignored, and the opportunity to really put patients and carers at the centre of the NHS is lost

  8.  We believe that tools such as Patient Opinion can be used to develop "patient-led" safety initiatives that could identify and correct hundreds of micro-aspects of care across the NHS. These are often the things that really matter to patients and carers. Attention to these micro, but all important, aspects of care, will improve patient safety, ensure that the dignity of patients is respected and upheld and build more positive inclusive relationships between care providers and those receiving care.

  9.  Whilst such tools are not yet fully developed it is likely that they will play a major part in improve safety over the next few years. We would be happy to give further details of what such tools might look like and the development process that Patient Opinion is engaged on.

Dr Paul Hodgkin

Chief Executive

September 2008



  1.  Patient Opinion is an independent website founded in 2005 by Paul Hodgkin a GP in Sheffield. It is a social enterprise and is free for any member of the public to use. It generates income via subscriptions from more than 50 NHS organisations who use its service to monitor, analyse and respond to patient comments.

  A range of other organisations also use the system including over 30 patient organisations, LINks, and 6 MPs.

  2.  Patient Opinion currently displays more than 9,000 stories and a similar number of ratings; receives around 1 million page views per month; and covers all hospitals, mental health trusts, hospices and covers the whole of the UK except Scotland which will be added by November 08.

  3.  For some examples of patient comments relating to safety and trust responses see:—a very critical posting plus response that shows how many trusts do not know how to use patient feedback to improve safety—posting with 2 responses that demonstrate a different approach to feedback.

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