Fiona Barr

Whatever the merits of NHS league tables and star ratings for hospital care, there is one thing they can never tell you – how each of the millions of individuals treated in hospital every year felt about their experience.

To fill that gap Dr Paul Hodgkin, a Sheffield GP, has harnessed the latest in "social software" to deliver the oldest kind of performance report, word of mouth.


Patient Opinion, an online service launched nationally in January after a four month pilot in south Yorkshire, offers patients the opportunity to report their experiences and rate the hospital where they have been treated on everything from standard of medical care and standard of nursing care to punctuality, cleanliness and parking,

Dr Hodgkin says he was motivated to set up the service after seeing how individual feedback worked on sites like eBay and Amazon.

He told EHI Primary Care: "I looked at eBay and saw how the whole system runs on the reputation of those who take part in it and I thought it would be fantastic for the NHS if we could use technology to do something similar. I also thought that if we didn’t do it from within the NHS and with NHS values someone else would come in and try and make a profit out of it – which wouldn’t be right."


The site works by inviting patients to submit their ‘stories’ on their hospital care through the website and to rate the hopsital against seven criteria. Patients need only submit their email address, a first name or nickname and their postcode. All stories are then reviewed by the Patient Opinion team before being placed on the site.

Dr Hodgkin says: "We have set the bar pretty low in terms of how much personal information people need to put in as we thought asking for too much information would put people off, particularly elderly people. We accept the positive stories on face value and try and verify the critical posts."

Patients or relatives and friends who come to the site looking for information can then search by postcode, hopsital or condition to find out what other people’s experiences have been. The site uses data feed from to allow patients to call up hospitals within a defined radius of their postcode and also includes links to NHS star ratings and other NHS sources of information about that hospital.

The site will narrow down to speciality and site, although not to particular teams within that specialty, and patients searching for information can also use lay terms which the site autmatically converts into the appropriate medical term.

Opinions submitted to the site are relayed to the hospitals concerns with ‘thank you’s passed on directly to the individuals mentioned.

Accurate feedback

Dr Hodgkin says NHS managers have always struggled to get accurate feedback about the services provided in hopsitals and are enthusiastic about the Patient Opinion model. He adds: "At the moment patients are able to rate services through from ‘very poor’ but it was interesting that when we had a meeting with NHS managers recently they wanted ‘very poor’ to be changed to ‘unacceptable’ rather than having everything smudge into an average."

Six months in, the pattern has been that approximately 50% of reports praise the NHS or say thank you to staff while about 30% to 40% of posts are critical of the service they have received.

For example, ‘Bernadette’ writes: "Last summer I had surgery at Grimsby hospital for acid reflux. I cannot praise the people who cared for me enough. My post operative recovery was slow as I needed to slowly introduce solid food into my diet. Everyone was very patient with me and there was never a mention of my being discharged until I felt ready to go home. i would never have any worries aabout being admitted again. well done everyone."

A more critical report from "Brian G" reads: "My wife had a couple of heart attacks, which culminated in a serious heart operation. First diagnosed in Louth County hospital where we have nothing but praise for the service, cleanliness, food excellent, staff superb. Onto Grimsby Princess Diana Hospital: clinical service excellent, staff less pleasant, food not so good, cleanliness not top notch.

"Onto Hull Castle Hill, this was where the operation was done. Facilities poor, cleanliness poor, she caught the dreaded MRSA. Staff a mixed bag: some very good, some poor. Food AWFUL. "

Dr Hodgkin is keen that the site should not be seen as "a stick to beat NHS staff with" and says those taking part are encouraged to make constructive suggestions about how care could be improved rather than just reporting bad experiences – although he says the team also tries to keep editing to a minimum.

He added: "We try to keep negative posting as grounded in what actually happened as possible and what could be done better."

Dr Hodgkin first had the idea for the site about three years ago but it was the advent of the Choice agenda that helped him to receive pump-priming funding, which was given in April last year from the Department of Health and South Yorkshire Strategic Health Authority after a tendering process. That money will run out in April and from then on the site will be reliant on subscriptions from trusts.


The team of five people that runs Patient Opinion is led by Dr Hodgkin, who works three days a week for the service. A PCT commissioning manager and a director of health services research is involved as well.

The site offers trusts who subscribe the chance to receive RSS feeds of opinions. These are submitted directly to the manager running the department concerned. Trusts are also offered their own interface to respond to postings and ratings.

So far the team has only approached trusts in south Yorkshire and Dr Hodgkin says that five trusts and PCTs have so far signed agreements to take the service. Fees start at £5,000 a year for hospitals for various levels of subscription.

The website itself was built by Headshift, a social software internet consultancy. The company says it has used patient weblogs, RSS feeds and a custom developed social tagging system learned from the informal language used by patients to allow users to search without using medical and healthcare terminology. It says Patient Opinion is also the first major online application to achieve real-time web service integration with

Livio Hughes, Headshift director, added: "Patient Opinion is just the beginning. When you understand the shared, user-generated value that such a service starts to generate,it is easy to think of many other ways in which patients can help each other get the best use out of limited NHS resources, whilst taking more control of their own care."

The site’s survival will depend on how many trusts it can get to sign up for the information but also, crucially, on how many opinions it can generate to make the site useful to those trusts. It is early days yet and so far around 150 opinions have been submitted but Dr Hodgkin says the team are well aware of the challenge ahead.

Social enterprise

Patient Opinion has been set up as a ‘social enterprise’ which means that any surplus generated by the site will be ploughed back into the NHS, overseen by a series of stakeholder shareowners from within the NHS whose votes are needed for any future funding decisions.

Possible plans for the future include adding mental health and the private sector and also extending ocvering to the other three home countries. Primary care is not included in the service and is likely to remain outside its scope, according to Dr Hodgkin, because much smaller patient populations mean confidentaility would be harder to maintain and patient viewpoints less representative with for example four narge trusts in south Yorkshire but 225 individual practices.

Dr Hodgkin believes that with the possibilities now offered by technology, if he had not had the idea for Patient Opinion someone else would have done, and sooner rather than later.

He adds: "If people don’t like a service they have a choice of ‘exit’ and ‘voice’. Choice is improving ‘exit’, and I hope Patient Opinion will be a new and powerful way of improving patients’ voice."


Patient Opinion