A BBC report has uncovered that nearly half of the reviews for a single NHS trust on NHS Choices were submitted from the trust's own computers. The reviews had been provided by Patient Opinion, which gathers online comments and stories about providers of both health and social care and also publishes them on its own website.
Patient Opinion has since defended the publication of the stories, explaining that the intention of the website is not to provide TripAdvisor type reviews, but to assist the NHS in improving quality and responsiveness.
However, with the expansion of personal budgets in social care and the introduction of personal health budgets this year, patients and service users, and their families and carers, will increasingly be involved in making decisions about care providers. How do we make sure that any reviews they find online are genuine?
The trouble with fake reviews
The phenomenon of "fake" online reviews has its own term, "astroturfing", where information is artificially presented as if it comes from grassroots consumers. A recent example is where 19 companies managed to secure reviews for a yogurt shop in New York. Unbeknown to them, the shop was entirely fictitious and was part of a sting operation by the Attorney General.
In Australia, the government has recognised the risks of fake reviews and has issued guidelines for providers. And it is already taking action, writing to 40 businesses last month to address suspicious review activity.
In the UK and elsewhere, to improve the trustworthiness and credibility of reviews, organisations (including the Consumers' Association) are turning to specialist review sites like Feefo and Reevoo to help with collecting feedback from reviewers who can be verified as being genuine customers.
Regardless of what information on performance might tell them, people are likely to pay more attention to personal reviews and testimonials, so it is important that they are trustworthy and genuine. Participants in one study were asked whether, in the event of having angina, they would choose to have balloon angioplasty or cardiac bypass surgery. All of them were given the percentages for a favourable outcome from each procedure and some were also given patient testimonials. Even where the number of good testimonials matched the clinical outcomes information, participants who received testimonials were less likely to choose the more effective option.
People also prefer to know what other users and carers think. When asked what information they might prefer when choosing a care home, older people and their carers in a recent study were most interested in information from residents and their relatives, more so than the views of the regulator or measures of clinical care or the financial health of the provider.
Caring about health and social care reviews
It is important to remember that searching for information on care providers hasn't caught on to the same extent as for other types of reviews. Even in the highly marketised health care system in the US, people spend about the same amount of time researching the purchase of a new fridge as a doctor or hospital. And while the use of online reviews in general is increasing, the number of people consulting reviews for health care is much lower and seems to be unchanging.
For people who do seek information online, these are worrying signs that they might be looking in the wrong places. One survey in the US found that 44% of participants said that the website Yelp was the most trustworthy source of online reviews of doctors. Yet Yelp filters about 25% of the reviews it receives as they look suspicious, and admits that its system is not foolproof.
How to fix it?
It would be helpful to learn from the experiences of other sectors and to introduce better processes to verify the sources of feedback. It is also important to recognise the incentives which may exist for gaming the system. For example, for private care providers this might mean posting positive reviews in order to attract business (or posting negative reviews about other providers). Or it might involve generating positive reviews where provider payments are linked to patient experience indicators.
It would be cynical to suggest that all care providers and care review websites will encourage or condone the posting of misleading reviews. However, the experience from other sectors tells us that the practice is becoming widespread. When we are asking people to make important and far-reaching decisions regarding their health and quality of life, then we have a duty of care to make sure that the information we provide is reliable and accurate. After all, it cannot be acceptable that a review about a steam iron or a laptop computer is more trustworthy than a review about the experience of major surgery or about a care home where a frail parent will live for the rest of their lives.