An information revolution is promised as patients vent their spleen via health websites. Daloni Carlisle finds out how you can use their opinions to improve services

Prime minister Gordon Brown hit the headlines in March when he called for an “information revolution” enabling the public to give eBay-style feedback on public services - including the NHS.

“We spend an awful lot of time and money helping doctors and nurses to improve care. We can spend a fraction of that helping patients to make the biggest change to services we have ever seen.”

While this might have been news to the public, it has been an item on senior health service managers’ agenda for some time. Improving the patient experience is one of the five key priorities of the 2009-10 operating framework, which says: “The opportunity to have real-time feedback on patients’ experience gives providers and commissioners an unprecedented opportunity to respond to changes and improve the patient experience.”

There are already a number of providers working in the market, each with a slightly different model. Broadly, though, they all offer web based tools where patients can describe and rate their experiences. This is fed back to the NHS, either as simple alerts or after some number crunching.

NHS Choices, which attracts 5.7 million users a month, or 10.8 per cent of traffic to UK health websites, is undoubtedly the largest. It already has a patient feedback tool where people can leave comments about their hospital experience and this summer will launch a new service to rate GP services.

Smaller, independent players include, which collects patients’ experience of services. It is a not-for-profit social enterprise set up by a GP and last summer it meshed its content with NHS Choices so that feedback on both sites is combined.

Clear vision

Some are commercial operations. Dr Foster Intelligence, part owned by the NHS and approved by the framework for procuring external support for commissioners, offers Patient Experience Tracker to NHS providers (see box, opposite). It has worked with some large trusts, such as Homerton University Hospital foundation trust in London.

Then there is www.iWantGreat, which describes itself as a small entrepreneurial company and asks patients to rate individual doctors. It currently has contracts with four primary care trusts and two NHS trusts to collate patient feedback on their doctors. All these providers claim that tracking patient experience can help improve services.

Neil Bacon, founder of iWantGreatCare, recently told a seminar convened by Microsoft (whose technology drives many of these web based tools): “Healthcare can be improved by harnessing the voice of patients.”

He added: “We spend an awful lot of time and money helping doctors and nurses to improve care. We can spend a fraction of that helping patients to make the biggest change to services we have ever seen.”

Dr Bacon’s experience over the last six months is that 90 per cent of feedback so far has been positive. This may change as patients learn to trust feedback systems and certainly NHS Choices is chock full of negative comments.

Patient experience

But how do you turn patient experience into service improvement? James Munro, director of research at, says this is a question that trusts are rightly asking.

“Fundamentally this [measuring patient feedback] is about better services and one of the things we have learned is that it is not enough simply to stick feedback on a website,” he says. “You need a clear vision about how feedback turns into change and we have been spending a lot of time thinking about how you do that.”

He is not convinced that eBay-style rating is the way to go: does anyone’s level of care really go up because someone on a website has said they are not doing something well?

This is not the only question PCTs and provider trusts will have about real-time patient feedback. Important points that need exploring before signing on the dotted line with a provider include:

  • What are the feedback mechanisms?
  • How can patients be sure their identities will not be revealed?
  • How are comments moderated?

This is the beginning of a journey that is likely to change patient care in unforeseen ways. It will be up to the NHS to get the best out of the new technologies now on offer.

Are you using patient feedback to drive service improvement? Email your examples and ideas to


Patient Experience Tracker

Listen carefully

  • Real-time patient experience can improve services
  • The technology to develop this exists and is in use
  • Commissioners and providers need to invest in systems
  • They need to be clear about what they want from systems
  • They need to consider how to turn feedback into service improvement

How Salford embraced pets and pals

At Salford Royal foundation trust, patient comments are used to resolve individual issues and identify themes, says Steven Jones, the trust’s patient advice and liaison service (PALS) manager.

A comments and suggestions scheme uses the trust’s website and comments boxes throughout the trust. The feedback goes to PALS, which contacts people with concerns straight away and, if appropriate, gives advice on making a formal complaint.

Mr Jones adds: “Even if it’s a simple suggestion, we acknowledge everything that comes through. We then take it to the person who can really do something about that comment.”

The patient is informed once an improvement has been made.

Staff are encouraged through their training on customer care to refer patients directly to PALS. Some patients drop in after an appointment and inpatients get a visit from PALS staff.

The trust’s communications assistant monitors comments made on the NHS Choices website. Compliments are passed to the relevant team, and if an individual concern is raised, PALS will liaise with the specific department to find a response for the patient.

In some wards, Salford has trialled Dr Foster’s Patient Experience Tracker, a handheld device that asks questions and provides instant feedback. PET is being used to ask questions about areas of concern raised in the annual inpatient survey.

Dr Foster’s tips for harnessing feedback

  • A dedicated project manager and ward-level project leads are key to driving successful patient experience projects
  • Before introducing it, promote the idea of collecting patient feedback as a way of making informed service improvement decisions
  • Test questions you would like to use to get feedback on a few patients to ensure they understand them
  • Include questions that address trust-wide issues - these can be used for benchmarking - and questions that are ward specific
  • Display posters to inform patients and staff of the actions taken as a result of their feedback. Patients will feel confident that the trust is listening