New data from the NHS Friends and Family survey, which asks patients whether they would recommend  A&E and inpatient wards to their nearest and dearest based on their own experience, has been released today.

The survey, which will grow into the most comprehensive ever undertaken, covers around 4,500 NHS wards and 144 A&E services. It allows hospital trusts to gain real time feedback on their services down to individual ward level and increases the transparency of NHS data to drive up choice and quality.

The Test was first announced by the Prime Minister in January 2012 and means that patients will now have a real voice in deciding whether their care is good enough or not – and hospitals will be able to take swift action to make any necessary improvements.

The Friends and Family Test was introduced in April this year and this release of information covers the first three months of the survey.  There are wide variations in numbers of respondents which affect overall scores but highlights include:

• Over the first three months, over 400,000 NHS patients completed the survey.
• Specialist hospitals tended to have higher scores for inpatient services.
• The Friends and Family Test scores are available at Trust, hospital, speciality and ward level.
• In June 36 wards out of 4,500 across the country scored an overall negative figure, down from 66 in April.
• For A&E in June, just one service received a negative score.
• Inpatient data was submitted by all 157 Acute NHS trusts as well as Independent sector providers, and A&E data by all 144 providers of relevant A&E services.
• A&E service scores ranged from 100 to minus 13, with the top ten Trusts landing between 100 and 79. (FFT scoring ranges between +100 and -100).
• The scores for inpatients ranged from 100 to 43.
• There has been a steady increase in the numbers of respondents each month, increasing from 108,000 in April to 160,000 in June, with a total of 404,657 responses gathered for the quarter April to June 2013.
• The Care Quality Commission will also use the data as part of its new surveillance system when assessing risks at hospitals, together with other data such as mortality rates and never events.
• The England-wide response rate for both inpatient and A&E surveys was 13.1 per cent.
• Public and patients can find easily searchable data for the Friends and Family Test for June 2013 from 0930 today on the NHS website.

Tim Kelsey, NHS England’s National Director for Patients and Information, said: “This is the boldest move yet to promote real openness in the NHS and to concentrate our focus on improvement in care. For a year, a pilot has been running in the Midlands and East region of the NHS in which more than a third of a million people have given their feedback. Frontline staff have been quick to embrace this data as a tool to change things for the better.

“At the heart of Robert Francis’s report into the tragedy at Stafford hospital was one basic message: to ensure the NHS delivers high quality care for all, we need transparency of the patient and carer experience. It is the absence of this transparency that often allows poor care to go undetected.

“Friends and Family Test is a major step forward for patients and for the quality of their care. Direct patient and citizen feedback is vital to improving the services the NHS provides. Trusts can concentrate their focus on improvement with this information.

“From this first publication, we can see a significant and real variation in the quality of customer service across the NHS. There are home truths here and everyone will expect those Trusts who have large numbers of their patients choosing not to recommend their services to respond as quickly as possible

“It is important, however, this early data is treated carefully. Low response rates can have a dramatically disproportionate impact on scores.

“As more and more patients respond, the data will become more and more robust. Just as important is the additional information given around the chosen score, as this can identify the care, the staff, the processes that make a real difference to patients.”

The Friends and Family Test is based on one simple question, ‘How likely are you to recommend our ward/A&E department to your friends and family if they needed similar care or treatment?’ Patients are presented with six responses ranging from ‘extremely likely’ through to ‘extremely unlikely’.

Organisations are encouraged to ask follow-up questions at the same time to find out more details that can help drive improvements. The number and wording of the follow-up questions is determined locally but tend be similar to “Please can you tell us the main reason for the score you have given?”

The tables below provide the key findings of the data:

The Friends and Family Test will be rolled out across other NHS services, with maternity services going live from October this year. NHS England is committed to introducing the Friends and Family Test to General Practice and community and mental health services by the end of December 2014 and to the rest of NHS funded services by the end of March 2015.

Where can I find the data?

Details of the Friends and Family Test data for June 2013 can be found from 0930 today on the NHS website. The FFT data for April, May and June for all Trusts will be published simultaneously and can be found within the statistics page of the NHS England website. Data for Independent Service Providers, which are private sector providers who also deliver some services on behalf of the NHS, has also been published.

Public and patients can find easily searchable data for the Friends and Family Test for June 2013 from 0930 today on the NHS website.

How are the scores calculated?

The scores are calculated by analysing responses and categorising them into promoters, detractors and neutral (passive) responses. The proportion of responses that are promoters and the proportion that are detractors are calculated and the proportion of detractors is then subtracted from the proportion of promoters to provide an overall ‘net promoter’ score.

Those that say they are ‘extremely likely’ are counted as promoters. ‘Likely’ is neutral, ‘neither unlikely nor likely’, ‘unlikely’ and ‘extremely unlikely’ are all counted as detractors.

When looking at the scores for individual trusts it is important to look at what lies behind the overall score.  The score should not be looked at in isolation; both the response rate, that is what percentage of people responded and the total number of responses, should be looked at to gauge how representative the overall score may or may not be.

For example, Trust A may have scored 100 but it could be based on only 5 responses out of 1,000 patients who received services, so its score only represents a small percentage of its users. Trust B may have also scored 100 taken from a relatively small number of overall responses, say 50, but this is out of 100 patients and so can be said to be more representative.

The NHS already collects a large amount of data on patient experience but one of the challenges of the existing survey programme has been that the gap between data collection and reporting has been relatively long. One of the key benefits of the Friends and Family Test is that the data is produced in a timely manner so hospitals and other providers of services can act upon it quickly.

Some hospitals which have achieved a low FFT response rate in Quarter 1 of 2013/14 (less than 15%) will not earn the maximum Commissioning for Quality and Innovation (CQUIN) funding available. However, NHS England is clarifying its guidance to commissioners and providers on the Friends and Family Test CQUIN to ensure that, where a hospital does miss the Quarter 1 response rate target, the CQUIN scheme still provides a financial incentive for the hospital to achieve an improved response rate by the end of the year.