On 18 February 2012, an online database of almost 60,000 eldercare and childcare services in England was launched to considerable public fanfare. Known as the Good Care Guide it operates in a similar way to TripAdvisor, allowing families using childcare or adult care services to find and rate care providers. Three days into its launch the GCG website stated that, “Good Care Guide is proving a big hit with families. We have had over 30,000 visits to the site since it went public on 18 February and hundreds of reviews are flooding in.” There is little doubt that the Good Care Guide aims to fill a perceived gap in the care market. It has even been lauded by the Care Services Minister, Paul Burstow, as being one of a number of sites to “shine a light on bad practice.”
It is difficult to disagree with the principle of giving the user of care services an opportunity to comment on their experiences of the quality of care. The principal regulators in the sector, the Care Quality Commission in relation to adult provision and Ofsted for children’s provision have a variety of mechanisms to capture the views of users of services, including during inspections and via online submissions. The comments of service users feature in inspection reports and can have a direct bearing on the “ratings” awarded by those regulators. A feature of the risk assessment processes of CQC is that the views of users of services, as for all forms of qualitative data, must be carefully evaluated in terms of the source of the information, the degree to which it is specific and objective in nature and whether it relates to events which were recent at the time the data was provided. There are, therefore, checks and balances built into the regulator’s systems aimed at distinguishing genuine concerns expressed by users of services or other members of the public from those of a malicious or unsubstantiated nature.
It is not clear what checks and balances are operated by the business operators of the Good Care Guide prior to disclosing the comments of members of the public. The terms and conditions on the Good Care Guide website state that “GCG endeavours to ensure the accuracy of all content of the Website. However, this cannot be guaranteed and GCG liabilities are excluded and/or limited…The content of the website is provided for information purposes only and you should not rely upon it in making or refraining from making any decision or in taking or refraining from taking any action.” In practice, people are going to rely on ratings on the website, particularly if they are negative. There is a link to the relevant official inspection report for each service but one might question how painstaking an analysis someone will undertake if a service is star rated as “bad” on the Good Care Guide website. The terms and conditions also state that they will only accept postings from users but it is apparent that they are accepting comments not only from relatives of service users, which is understandable, but also members of staff. There is a real risk that aggrieved former members of staff (or current members of staff who are subject to disciplinary processes) will post malicious and unfounded comments on the website.
We have already seen postings on the Good Care Guide website that are potentially defamatory of care providers with unsubstantiated, general and anonymous comments being expressed. There is a real risk that some members of the public will post false and negative comments about a care service for whatever motive, and star-rate a service poorly in terms of quality of care, facilities/environment and value for money. Services are being rated as “bad” on the basis of a single posting. One such service we know of was fully compliant with all the CQC essential standards. Clearly the business operators of the website anticipate that false statements will be posted. A press release issued by one of the organisations that set up the website – United for All Ages – states “Good Care Guide has built in robust processes to ensure that only users of care comment and providers can challenge false statements.”
Providers can subscribe to the website for a fee of £60.00 per care service per year to enable alerts to be sent to them when a positive or negative review is posted. If all services were to subscribe to the Good Care Guide that would generate a multi-million pound business for the operator of the website, a private company limited by shares. The subscription enables providers to report there own comments on a posting which are subject to some form of verification process. There is an issue about the fairness of a reporting system that only alerts providers of negative postings if they have subscribed for a fee and even then only after the posting has been made, by which time damage to the business may have occurred. In addition, by subscribing to the service, the website operator states that you are bound by its terms and condition which includes an exclusion for “all and any losses, liabilities, claims, damages, expenses or costs (whether arising as a consequence of negligence or otherwise) arising in connection with… the inaccuracy, incompleteness or tardiness of any information supplied through the service.” So you pay for the privilege of receiving alerts about already published negative postings, while signing away any legal rights. One might question whether this is fair, enforceable or value for money. An alternative will be to set up a system of regular monitoring undertaken by the registered manager for the particular service.
What the business operators of the Good Care Guide say is that they can remove negative comments from their website pending an investigation. If it is felt that untrue, exaggerated or unsubstantiated comments have been posted about a service, then the affected provider should consider making a challenge as quickly as possible. It will be important to take charge of the process at the outset. We successfully challenged a posting in the first few days of the operation of the website on behalf of a care home client. The Good Care Guide removed the posting pending an investigation.
Providers should also encourage users of services who are positive about their care to post comments on the website otherwise one or more negative comments can have a devastating impact on the rating of the business. This process could link in with surveys of service users’ views undertaken by providers. Consideration ought to be given to how providers can assist service users in posting positive comments. For instance, it might be sensible to engage a media relations firm to lead on the process.
What is clear is that this is a new source of information about care services which providers will need to be especially vigilant about if they are to protect the reputation and commercial interests of their businesses from false statements and unfair ratings. The risk is that it becomes another forum for criticising care services with little moderation of content and no obvious means of accountability if rights are waived away by providers.