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
4. By contrast organisations focus much
Large scale issuesfor instance
if we shut the A&E department will the ITU still be safe?
Medium-level management issuesfor
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
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
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
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
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
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:
very critical posting plus response that shows how many trusts
do not know how to use patient feedback to improve safety
with 2 responses that demonstrate a different approach to feedback.