NHS online patient feedback reviews open to abuse
Neil Churchill, director of patient experience for NHS England: "The issue here is transparency"
The NHS has removed all but one of 653 patient reviews of a healthcare trust from its website, after BBC Newsnight found the system was open to abuse.
Newsnight found that last year, 49% of patient reviews - 105 of 216 - about Nottinghamshire Healthcare Trust on NHS Choices had come from staff accounts.
Some 47% of those from staff accounts did not declare a conflict of interest.
Staff often help patients to post reviews, but the trust acknowledged it needed to be clearer who wrote them.
The reviews were originally posted to independent feedback website Patient Opinion, but syndicated to appear on the NHS Choices website.
Most of the reviews posted without staff declaring a conflict of interest were from staff accounts that had declared themselves on other occasions when posting on behalf of patients.
Any data that notes when a staff member has posted is automatically stripped out on NHS Choices.
'Open and honest'A spokesman for Nottinghamshire Healthcare NHS Trust said: "We acknowledge that postings need to be clearer about who is writing them and we are working on a solution for this, internally and with Patient Opinion.
"We have created a public website so that anyone can see what is being said about our services because we want to be open and honest about the feedback we receive."
Patient Opinion said it supported trusts to help people with mental health problems, learning difficulties, the elderly, or those without internet access to post reviews.
"We absolutely accept that it must be clear to everyone when a story has been added by staff, on behalf of a patient or carer. We have updated our site so that we can now show this correctly for past and future stories."
However, it added that it had no reason to doubt the legitimacy of reviews posted by staff.
'Seriously let down'The single review left on NHS Choices about the trust, which was not syndicated from Patient Opinion, has the title "seriously let down" and awards one star out of five.
The anonymous review, posted last year, reads: "I have been let down by the service at every opportunity, when I was at my most desperate."
The removal of the trust's reviews from NHS Choices comes as NHS England prepares to roll out its own patient feedback site, Care Connect.
The issue of potential system abuse is not unique to Nottinghamshire, but the trust was frequently flagged up during the Newsnight investigation.
Analysis of 7,333 reviews submitted to Patient Opinion last year found that 6% had been posted from computers connected to the NHS's "secure" computer network.
Reviews linked to NHS computer networks were critical of a trust or hospital in one in 10 cases, compared with one in four across all reviews.
Data released to Newsnight also showed that six of the most recent 100 reviews submitted to Care Connect originated from hospital computer networks.
Sixteen reviews posted to Care Connect from computers connected to the NHS network had an average score of 4.8 out of five stars, compared with the overall average of 3.7 out of five stars.
'Skewing results'The NHS is currently piloting Care Connect across 18 healthcare trusts.
The system was due to be rolled out across the country by the end of the year, but the NHS has since dropped that ambition.
Care Connect will enable patients to submit reviews of care both online and by traditional means, and to leave a star-rating of hospitals against criteria such as "cleanliness" and "involvement in decision making".
Gary Walker, a former United Lincolnshire Hospitals Trust chief executive, who became an NHS whistleblower, told Newsnight: "Your data has already shown that staff in the NHS are reporting data - that's wrong - and the data they're reporting is skewing the results and that has to be wrong, so it's making the data the public sees almost meaningless.
"The original plan behind all of this was to try and improve the quality of services. I don't think that's being achieved at the moment."
Patient Opinion already gives reviewers the option to indicate that they are NHS staff, a family member, carer, friend or volunteer but Care Connect does not.
'Leading the world'Neil Churchill, director of patient experience for NHS England, told Newsnight that the "vast majority" of comments on Patient Opinion were coming from patients, carers or their families.
He said the NHS was "leading the world in the use of patient feedback".
"We can't guarantee that all reviews are coming from patients and families but we are very sure that the vast majority are," he insisted.
He said what happened in Nottinghamshire was a "very interesting experiment" to help "vulnerable patients to have a voice".
He added: "These reviews were coming from learning disabilities services, they were coming from secure hospitals, they were coming from older people in mental health wards and what staff were doing was writing up their feedback for them and posting them on Patient Opinion."
You can see more on this report on BBC Newsnight on Tuesday 18 March at 22:30 GMT on BBC Two, or later via the Newsnight website or BBC iPlayer.
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