For many people the NHS is like marmite, but whether we love it or hate it, we all end up using it one day, one way or another.

Students are one of the most outspoken, actionable social groups around, so when asking a number of them for their opinions on health services – an outspoken answer was what I got.

It has been an interesting few days hearing student’s thoughts on their health services. Below is a film the students I met, sharing their views – but not everyone was happy to be filmed, and as you’ll read below, there were quite a range of views!

International students, on the whole told me that they thought the NHS was great. When asked why, they mostly replied, ‘because it is free and available to all’. Interesting, a majority of the international students I spoke to also felt open minded to the idea of reforms and privatisation of the NHS.

In comparison, British students were a little more sceptical. But, overall they also agreed that the NHS was a great thing, although they did say that there are improvements to be made – all of which can be done with the help of patient feedback.

Elizabeth Etheridge who is studying French at the University of Sheffield, told me how her Nan had recently been in hospital but she felt the only reason ‘things were being done quickly’ was because her mum ‘knew the right people and could pull a few strings’. However, when speaking of the University health service, she could not speak highly enough, ‘fantastically well run, great service and really pleasant doctors.’

Interestingly, when I asked her about her thoughts on Patient Opinion, she said, ‘I’ve never heard of it but I think it’s a great idea. Change always starts from the bottom.’

One group of students I have been eager to speak to are medical students. Fortunately, I did manage to speak to a few outside the University Information Commons on Wednesday.

Although they didn’t wish to be filmed or be directly quoted, they did speak to me and pass on some really intriguing information. One male student who was in his fourth year of medicine told me of how he was intending to leave the field before he had even started because of ‘all of the bureaucracy’. His course mate told me she would be sticking with it but was sceptical of her future as she said, ‘the NHS isn’t what it used to be’. She also told me how all the medical students she knew were in uproar over the current proposed changes.

Speaking with students about their experiences of health services and their thoughts on the NHS, has made me see that students do care about their services and would like to see change. What is more important I think now, is that a site such as Patient Opinion try and expand its reach to students. Students are the next generation and with their strong political ideologies and desire for change, their work and interaction with PO could be surprisingly influential.

In my final week with PO I will be looking at student health services and our experiences of them. As a student, going to university can be a stressful time and thinking about registering and dealing with a new health centre is just another issue to add to the pile. From registering, to getting used to a new GP, it can all be a bit of a whirlwind. I want students to share their stories and experiences of their health services.

Over the week, I will be looking at a variety of issues, from how international students see the NHS and their experiences, to speaking with medical students about why they choose what has become such a controversial career path and asking how they feel about being publicly rated just as a hotel is on Trip Advisor. I will be speaking to the students of Sheffield and asking for their opinion on health services, ‘warts ‘n’ all’.

Equipped with a camera, charm and insightful questions I will pool together student’s experiences of the NHS and health services.

Follow my daily updates and look out for my overall findings on Monday.

Two weeks ago we held a very lively North of England stakeholder event in Sheffield. And, in the course of what was a very stimulating and enjoyable day, there was one brief exchange between a speaker and a participant which really made me think.

Jane Danforth, involvement manager at Nottinghamshire Healthcare NHS Trust, was speaking about the impact of Patient Opinion in the trust. And Helen Forrester, the manager of B50, one of the trust's adult mental health inpatient wards, talked about how using Patient Opinion had changed the culture of her ward. (Their slides are available.)

One of the participants asked how many stories the trust received through Patient Opinion. Jane pointed to the figure on the slide - "259".

"Oh, so 259 per month?"

"No", said Jane. "259 since we started."

The questioner - and one or two others - looked rather taken aback.

And that was the moment the proverbial light bulb above my head went on. That was exactly the point: it wasn't that Helen had seen significant changes in her ward culture despite there being only 259 stories across the trust. It was that just 259 stories (and many fewer specifically about ward B50) on a public web site had been enough to help her change the culture in important ways. That was all it took.

Of course, everyone (including me) is used to thinking that we need thousands of responses to surveys to tell us anything reliable. But here were worthwhile changes in culture and practice in the wake of a much smaller number of stories.

The point was underlined later in the day, when Steve Eastwood, a commissioner of drug and alcohol services in the North West, talked about how the stories they had received through Patient Opinion were helping them commission better services. (Slides available.)

How many stories? 78.

So there's the question: how many stories is enough? And, of course, we know the answer: enough for what?

It all depends on what you want to achieve. What are your objectives? Why do you want to hear the experiences of patients and carers?

If your objective is to measure (as it so often is in the NHS, where "listening" and "measuring" seem to be used almost interchangeably), and compare those measures between times or places, then yes, you will need a lot of responses to gain the precision and certainty you need.

But if your objective is to change culture, empower patients, prompt staff reflection, or improve services, then on the evidence of Jane, Helen and Steve it seems that a very much smaller number of stories - coupled with an understanding of how to use them - may be more than enough.

At last, I'm starting to understand why we talk about the power of stories.

Good to have some evidence about what we’ve long suspected – that patients know what they’re talking about when it comes to the quality of hospital services. Researchers at Imperial College have shown that hospitals that  rated highly by patients on public feedback sites are indeed better that those that are rated badly by them.

Not surprising but very worthwhile to have the academic evidence. Thanks to everyone at Imperial who did the hard work.

Hi, my name is Jane Danforth. I work as an Involvement Officer for Nottinghamshire Healthcare NHS Trust. It’s a huge integrated mental health, learning disability and community health services organisation covering Local and Forensic services, Community Health services and Offender Healthcare. It’s my first time writing a blog on the Patient Opinion site. I hope you will find it interesting.

I’m really lucky to work in an organisation that supports an Involvement team with two Involvement Centres. It’s true to say I am blessed with great support from the top of our organisation; Professor Mike Cooke CBE (our CEO) my manager and also from Trust colleagues and Patient Opinion (PO)

How can I describe the PO team and what they offer to us? Well, for one, ‘real time’ feedback is starting to change the way we do things in the Trust. 2011 has been the best year for us yet. We were named as Pioneers of the Month for PO last year and we held the record for the fastest posting and response times of any Trust! We get Facebook and Twitter posts about us leading the way for patient feedback and it’s made my job so enjoyable. It has done our Trust the world of good and given us a platform to prove that our ‘Positive’ brand is not rhetoric and spin. PO has made a difference and offered value for money to the organisation. People say how much they like it and find it a great way to share how they feel about our services and what they would like to see get better.

Open and honest feedback sometimes means you have to take a deep breath and think hard about how you are going to respond to stories that are not always complimentary. The support of a great Communications Team makes all the difference. Julie Grant, Head of Communications is my sounding board and someone I can go to when challenges arise. Equally Sam Eagling, managing PALS and Complaints (Service Liaison) helps complete the circle of communication. I know that between us we can help to make things happen and people posting on the site get their voices heard. Things actually can change for the better and we have seen it happen ‘before our very eyes’!

I’m really pleased to say that the majority of our feedback is complimentary. I know staff get a real lift from postings that praise what they do and when we can’t always do what people ask, we can at least explain why some things are the way they are. I really believe it can stop people taking things further when issues arise and over next year we are going to try and evaluate this.

Our involvement volunteers take on many different roles. This year and in 2012 we will continue carrying the Olympic torch for PO.

Our PO Champions are making a difference using a ‘pass it on’ philosophy. Champions are made up of service users, carers, families and staff including Governors. For everyone they tell about PO they encourage others to tell someone else. Word of mouth is a powerful marketing tool, if you are good you can get always get better and positive feedback is a massive motivator. Equally when feedback is not good you have to listen and work together to resolve issues.

Next month I am going to tell you more about our iPad pilot. We launched a trial across the Trust in Local and Forensic services and believe me it’s been an exciting time! To be honest, It has increased my workload initially but it’s also given me such a buzz when I can see staff becoming responders and our youngest ever posting was from a 10 year old using our child and adolescent mental health services and in case you are wondering? Yes it was positive!

In January, we will be looking forward to the year ahead. My manager Paul Sanguinazzi, Head of Involvement, is keen that we really focus on getting a seamless reporting system that pulls together all our feedback in the Trust.

Other Trusts have started to ask me how we work with online feedback and I look forward to February 9th where we have been invited to speak at the regional PO event in Sheffield about how we have made it work for us in Nottinghamshire Healthcare.

And finally, I would like to share with you a letter of thanks that was given to me at the beginning of the week from a patient who was being discharged. This posting made my year: A letter of thanks for the staff on Ward B2