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 england.insight-queries@nhs.net.