Making the most of feedback

Around 1.2 million responses are submitted every month to the Friends and Family Test. It’s all about continuous improvement and, in that spirit, NHS England is now looking at ways to improve the effectiveness of the FFT itself, as NHS England’s Director for Experience, Participation and Equalities explains:

NHS England first launched the Friends and Family Test in inpatients services in 2013.

Over the next two years it was rolled out across other healthcare services as it gathered momentum in the uptake from patients and, in that time, this quick and easy feedback tool that anyone can take part in has already amassed more than 43 million responses.

The addition of insight from “real time” feedback to what we learn annually from a suite of national surveys has made the NHS a world leader at listening to patients.

Asking all providers to take part in the initiative has brought a change in the way most see patient feedback: not just as ‘nice to have’ but as an integral way to address quality challenges at a time of growing demand.

In an earlier review of how the initiative was working in hospitals, 88 per cent of the 95 trusts who took part said the FFT was working well and 78 per cent thought it had increased their emphasis on patient experience.

In the same review, a member of a patient discussion group commented: “I remember hearing a doctor referring to a patient as ‘the appendix’.  You wouldn’t hear this kind of thing anymore.  There is much more focus on patients as individuals.”

We know from the NHS Staff Survey that 51 per cent of NHS staff use patient feedback for improvement in their own services and teams. That’s likely to come from the FFT, as patient surveys, whilst important for producing robust and comparable data, take longer to produce and don’t necessarily provide information about those services / teams and certainly not at a similar scale and frequency.

The data is a useful way for national agencies such as NHS England, NHS Improvement and the Care Quality Commission to “take the pulse” of local service quality and to assess the ongoing impact of national policies and investments on patients.  It’s not just about central monitoring though. Local data about every trust and primary care practice is available for public scrutiny through publication, fresh off the press every month, on NHS Choices and it also helps commissioners of healthcare to understand how their local services are doing.

Much more than that though, the comments that many people add to their ratings of the service – detail which is retained locally – is a rich seam of information to see what’s working well and where things can be improved.  On my travels round the country, I see countless examples of the FFT delivering genuine change that benefits patients and services alike.

Take, for example, the Think Drink initiative at Nottingham University Hospitals NHS Trust, where feedback drove a rethink on the decades-old norms around pre-operative fasting.  It reduced the time patients go without food or drink from an average of more than nine hours to around three. Indications are that, not only are patients happier and more comfortable, but they also appear to be recovering faster from their operations. It’s hoped that these faster recoveries will translate into faster discharge and the freeing up of further hospital beds, which benefits everyone. (See further examples on our YouTube channel.)

The FFT has not been without its problems and criticisms but, overall, we feel it has raised the bar, helping patients influence decisions large and small and lifting the morale of staff. NHS leaders are committed to its retention and they share our ambition for the FFT to fulfil its potential and be as effective as it can be in driving service improvement.

Although we’ve tackled many specific issues to smooth its implementation on the front line, we know there are still elements that don’t work well enough.  For this reason, our Insight & Feedback Team are launching a project to take the FFT’s evolution to the next stage and refresh the guidance by April 2019.

In particular, we aim to:

  • Consider whether we should change the wording of the FFT question so that it works better across all healthcare settings.
  • Support services to make the most of what it can give them.
  • Remove the burden in meeting some of the specifics in the guidance (such as the 48-hour rule for acute trusts and the fixed “touchpoints” across maternity care).
  • Support the best possible use of the data and increase the value of it.

Several work-streams are being set up to deliver this work and there will be plenty of opportunities for healthcare professionals, patients, voluntary organisations and representative bodies to feed into the improvement project during 2018.

We are particularly keen to hear views on the following questions:

What’s the one thing you would change about the FFT? What currently works well about the FFT in your organisation and why? When are staff most engaged with it? When does it make the most difference and lead to improvements and what are the things that block that from happening? We hear from trusts and practices that it’s useful to ask additional questions after the FFT question. Is this the case for you? We think there may be merit in maintaining flexibility in how you can conduct the FFT in terms of whether it’s on paper, by text, by email and so on – would you agree?

If you want to be part of the conversation, feel free to get in touch at

Dr Neil Churchill

Neil is Director for People and Communities at NHS England, having joined the NHS after a 25-year career in the voluntary sector. His work includes understanding people’s experiences of the NHS, involving people and communities in decision-making and leading change to improve the quality and equality of care. He has a particular focus on strengthening partnerships with unpaid carers, volunteers and the voluntary sector.

Neil has previously been a non-executive director for the NHS in the South of England, is a member of the Strategy Board for the Beryl Institute and Chair of Care for the Carers in East Sussex. He is himself an unpaid carer. Neil tweets as @neilgchurchill


  1. Danielle hibbert says:

    My mother was waiting for a knee replacement operation, she received a phone call to say, this is a courtesy call to check you are okay for your operation next week? She hadn’t received the letter for the operation that had been sent 3/4 weeks earlier. She was unable to accept the date (for the following week)as we needed time to arrange things as she is elderly and lives on her own. I hope the slot for the operation was used by someone else. I’m shocked as in this day an age we rely on posting letters, surely email or text would be more efficient and cheaper. I can’t believe there is no confirmation process in place other than a call the week before. I wonder how many operations don’t happen because of this process and how much this costs the NHS?. The eventual operation was fantastically carried out by a team of fantastic people both the surgeon and the fantastic nurses.

    • NHS England says:

      Thank you for sharing your experience. This is exactly the kind of feedback that the Friends and Family Test is there for as it’s a tool for local service improvement. Your comments would be really useful for the trust concerned so they can consider whether they could avoid such difficulties in the future. You could also write direct to the patient experience team at the hospital and, in cases where something goes seriously wrong, there is the option to make a complaint. We’re glad to hear though that the clinical services went well when your mother did have her operation and we wish her well.

      Kind Regards
      NHS England

  2. Karen Pengelly says:

    Not an FFT reply but relating to feedback. My 18 year old son, still in full time education has repeatedly been asked to complete a GP Patient Survey. He has no idea, has never voluntarily engaged with any public service in his life, that’s what parents do on their behalf.

    My experience of local GP services are: when my husband suffered a coronary a few years ago, he couldn’t even get through to the doctors to make an appt, he walked himself over there. No weekend service at all, rarely appointments same day, limited opening hours, rarely see the same GP twice, usually have to book 2 weeks in advance. Hard to plan an unexpected illness…

    Please stop asking teenagers what their views on GP services are, they generally won’t have a clue – one could be lead to believe that you don’t want honest or thorough answers.

    Front line staff, as ever, superb, helpful and engaging, maybe do less consulting, commit the budget to service enhancement and use common sense instead?

  3. Pauline says:

    Apart from the six monthly surveys is there a monthly survey that staff can partake in to boost their teams? I am a student currently doing a research on team engagement in the NHS

    • NHS England says:

      Thanks for your interest in how NHS staff give feedback. At a national level there are two ways that this happens. First, there is an annual survey which looks at NHS staff experience in detail around many issues such as staff engagement, discrimination and the quality of care staff are able to provide. About a third of the NHS workforce took part last year. You can read about the most recent findings. You might also be interested to know that the 2017 survey is due to be published on 6 March.

      In addition, the Staff Friends and Family is a continuous opportunity for staff in NHS trusts to comment on whether they would recommend their workplace and the services it provides to the people they care about. The data from the Staff FFT is published quarterly and you can find fuller details about the initiative elsewhere on our website.

      In addition, many trusts conduct work individually to give their staff a say in how services can be improved. You might want to take a look at a short video illustrating how staff feedback works in a particular award-winning trust.

      Staff experience and feedback is a really important thing to focus on as we know that there are very strong links between this and the quality of care that patients receive, as was outlined by one of our blogs.

      Kind Regards
      NHS England