More consistency is needed in how the NHS handles online feedback, say Dean Russell and colleagues

The growth of sites such as, and NHS Choices gives patients the ability to provide feedback or help them find care. Such open collaboration seems like a great opportunity for patients and the NHS to work together to improve healthcare through better communication. However, there is a risk this new approach is backfiring on the NHS, with patients unsure where to complain and with the service seemingly unclear what to do with the feedback.

The challenge for the NHS is to understand the concept of measuring how people feel

With so much visibility, it is not surprising this method of communication is gaining importance with the public, health managers and politicians alike. As a sign of the times, the Department of Health’s dignity ambassador Sir Michael Parkinson recently urged patients, relatives and carers to use internet reviews and ratings to blow the whistle on inadequate elderly care.

The official channels are still the most popular for specific service areas. For example, patient advice and liaison services continue to be the main source of comments and feedback for acute trusts.

Yet this is not the case across all areas of the NHS, and when it comes to local health provision it can be confusing for the public.

In fact, it could be argued there are too many options online to provide feedback, creating a paradox of choice.

This is complicated further by many sites using branding that makes them look like official counterparts of the NHS; and by many real NHS sites trying not look like NHS sites.

The health service also needs to be crystal clear about where it directs patients for feedback, and this needs to go deep into the organisation - from GPs to nurses and administration staff. Frontline people need to welcome online patient feedback and to know where to direct patients. But how many get to read the feedback from these sites? These professionals get few chances to be updated about the latest online activities.

Patients want answers

Patients do not care about internal processes, time constraints or even the authority of the feedback sites they use. They want answers and responses, and unless the entirety of the NHS is clear where they need to provide it and what is going to happen to it, the general public will just see the whole process as a red herring and switch off from providing this valuable feedback.

These are not new problems. The NHS could learn from local authorities, which have found solutions to customer relationship and service challenges, from managing library services to reporting potholes.

More consistency across different services might also benefit the public in other ways.

Imagine if all NHS feedback sites had a consistent core of quantitative measures, for example ratings for cleanliness or friendliness, that were used across the UK. Such a consistent baseline measure would make it easy to produce simple dashboards showing the realtime results for individual healthcare organisations.

If this were extended across all public services, it would be a powerful tool and allow for a like-for-like comparison and give greater insight into both expectations and results.

The challenge for the NHS is to understand the concept of measuring how people feel. The annual Care Quality Commission health check measures clinical and financial performance data but this is given significant prominence over how people feel about their care. The NHS needs to identify clear metrics for this and understand how to communicate the information back to the public in a sensible manner.

The problem for the NHS is not whether it will get feedback, or even how much, it is in working out what to do with it.

Dean Russell, Michael Guida and Ann-Sophia Virtala are digital strategists at Precedent.

Top tips for managing and using patient feedback

  • Centralise The NHS should provide one official rating service which uses both qualitative and quantitative ratings
  • Promote Make sure all patients are aware of the service. Promote and inform on GP noticeboards, hospitals, etc, and make sure staff are talking about it too
  • Monitor and moderate Channel appropriate resources to monitor the feedback and to moderate it
  • Respond Allow for rated institutions to respond to specific complaints and provide guidance on how best to do this
  • Address Show that the feedback matters and is taken seriously and that criticised institutions take it on board and improve