by Lisa Trigg
In the recent White Paper Caring for our Future, the government announced its intention to support comparison websites which assist users in choosing providers in England. With the popularity of websites such as TripAdvisor, it seems like an obvious solution to solving the problems of limited information in the social care sector. This has already been applied with some success in health care with NHS Choices and other independent websites. However, a new PSSRU discussion paper Using Online Reviews in Social Care explores the potential challenges involved in setting up this type of website for provider quality in the social care sector.
The opportunity for health care users to post reviews of doctors and hospitals has been the subject of some debate in the medical profession (Trigg 2011). Much of the discussion centres on whether patients can be competent reviewers of complex medical care and the extent to which they will use the internet to post malicious comments on what they perceive as inadequate care, for example, where doctors have refused to issue prescriptions. Despite these objections, NHS Choices has a facility which allows feedback to be posted on hospitals, GPs and dentists. The site has received 85,000 comments on various services over the last three years (NHS Choices 2011). Services such as www.iwantgreatcare.org and www.patientopinion.org.uk also allow patients to provide reviews on both clinicians and hospitals. Research on the insight of patients is mixed – while a recent study identified a relationship between patient ratings and clinical quality (Greaves et al. 2012), other research suggests that patient feedback tends to be more useful for the non-technical aspects of care (Chang et al. 2006).
For social care, at least at first glance, the opportunity to use online reviews appears less controversial, at least for personal care. It seems comparatively safe to assert that a user of social care can form a more comprehensive view of how well their provider is performing. For example, a user – or their carer – can form views on the extent to which they were treated with dignity and respect, and whether the service fully met their needs. The idea of publishing feedback from users is gaining ground – as well as the development in England, the Australian government has recently announced plans for a government-run comparison website, My Aged Care.
However, this application faces a number of issues in the social care sector. To begin with, it might prove difficult to deliver user feedback in sufficient volumes for users to gain an accurate picture of the service. For example, for older people in the residential care sector, with the average length of stay at approximately 1.6 years (Forder and Fernandez 2011), there is simply not enough turnover of residents to generate a large number of reviews – from either residents or carers. Add to this the fact that many residents are living with dementia, and may not have the mental capacity or skills to post feedback on the internet. For those users or carers who can generate reviews, the threat of reprisal for already fragile or vulnerable users may be too great.
The new discussion paper Using Online Reviews in Social Care attempts to document the range of challenges for using online reviews in social care. It discusses the barriers for generating reviews in the sector, as well as the potential difficulties for information-seekers and for providers who might be interested in using reviews to address quality issues. The paper stresses the importance of consolidating information into a single site, facilitating peer-to-peer contact (that is putting potential users and their carers in contact with current users and carers), and also the opportunity to gather information from professionals – or even collect feedback from users and carers for publication. This is the approach taken in the Netherlands and Sweden, where both users and carers are surveyed on a regular basis, with the results published on central websites (on www.kiesbeter.nl and www.aldreguiden.se respectively).
While the benefits of providing information on providers to social care users are undeniable, the strategy for collecting and delivering appropriate data and feedback needs careful thought and planning to ensure that the effort behind these initiatives is not wasted.
Chang JT, Hays RD, Shekelle PG, MaClean CH, Solomon DH, Reuben DB, Roth CP, Kamberg CJ, Adams J, Young RT, Wenger NS (2006) Patients’ global ratings of their health care are not associated with the technical quality of their care, Annals of Internal Medicine, 144, 665-72.
Forder J, Fernandez J (2011) Length of Stay in Care Homes. A report commissioned by BUPA, Personal Social Services Research Unit, London.
Greaves F, Pape UJ, King D, Darzi A, Majeed A, Wachter RM, Millett C (2012) Associations between web-based patient ratings and objective measures of hospital quality, Archives of Internal Medicine, 172, 5, 435-436.
NHS Choices (2011) Improving Health, Improving Lives, NHS Choices Annual Report 2011, NHS, London.
Trigg L (2012) Using Online Reviews in Social Care, PSSRU Discussion Paper 2836, Personal Social Services Research Unit, London.
Trigg L (2011) Patients’ opinions of health care providers for supporting choice and quality improvement, Journal of Health Services Research & Policy, 16, 102-107.
Age UK Guest Blog: Using Online Reviews to Choose Care Homes by Lisa Trigg, 25 July 2012.