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A matter of opinion

Annie Gunner Logan

At the CCPS Membership meeting just before Christmas, the good folk from the online feedback platform for the NHS – Patient Opinion – came along to tell us about their plans to develop a Scottish version of the social care offshoot Care Opinion.

We heard a detailed presentation covering the processes through which comments submitted to the site are considered, moderated and posted, and the ways in which service providers are consulted and involved. This is not, we were assured, a ‘TripAdvisor’-style ratings site for the care industry: rather, it’s a tool that providers can use to improve their services.

Careful thought had clearly been given to some of the key differences between a feedback site focusing on health care – where provision is free at the point of use and delivered directly by the public sector – and social care – where services can come with hefty charges, and delivery is the business of a multitude of public, private and voluntary organisations.

What hadn’t been sufficiently recognised, from the perspective of the care providers in the room, was the fact that they operate in a market environment, and that the opinions posted on the site might have a significant impact and influence on choices made within that market.

Specifically, questions were raised about the extent to which local authorities and, increasingly, individuals with their own purchasing power under self-directed support are likely to use Care Opinion to ‘shop around’, whether or not it was designed for that purpose.  In that context, providers were keen to find out whether and how Patient Opinion is able to guarantee that the feedback posted on its site is authentic.

Clarity on this question has become all the more urgent during the past fortnight, since an investigation by Newsnight revealed that a considerable proportion of posts on the NHS Choices site, which includes a lot of material syndicated from Patient Opinion, turn out to have been submitted not by patients, but by staff.

The NHS internal market (in Scotland, at least) is long gone, and the principle of user choice has nowhere near the same force in the health service as it does in social care. But if even NHS workers feel under pressure to ‘big up’ their services online, posing as patients, then how much greater will be the pressure on social care workers?

More worryingly, we know that TripAdvisor, Amazon and similar sites have been plagued not only by glowing reviews that turn out to be bogus and self-aggrandising, but by malicious postings from envious competitors and rivals intended to deter customers and damage reputations.

I’m not suggesting that Patient Opinion, Care Opinion, Good Care Guide or any of the other online services that will surely spring up shortly on a screen near you are chock-full of phony baloney, and ought to be banned or taken down. I’m sure that they have a place, a function and a value as an additional feedback mechanism to be used alongside providers’ own arrangements – which are themselves increasingly sophisticated – together with inspection reports, independent evaluations, complaints records and all the rest.

But I do think that providers, authorities and individual purchasers should, whether posting or browsing on these sites, remain alive to the ways in which markets drive behaviours and, as a consequence, keep an open mind about the matter of authenticity.

Doubly so, when it comes to inspectors: for the Care Inspectorate has already announced that it intends to become a ‘public interest body’ in respect of Care Opinion, meaning that certain reviews will, under certain circumstances, be referred to and investigated by the Care Inspectorate complaints team.

Let’s hope that the first part of any investigation will relate to the reliability of the review. Disobliging comments on Tripadvisor may land a business in all sorts of trouble, but are highly unlikely to trigger a formal intervention by a statutory regulator with substantial enforcement powers. Care Opinion, welcome to our world.