The Friends and Family Test – proof of success through action

Since the publication of this blog Tim Kelsey has left NHS England.

The Friends and Family Test (FFT) was one of the many responsibilities NHS England inherited from the Department of Health when it came into being on 1 April 2013.

Since day one, we have not looked back, rolling out data from A&E, inpatient and maternity services from every Trust in the country.

In his report Robert Francis told us that it is when the small things are ignored, that these little indignities lead to tragedy. We have listened to that and taken action. More than 1.8 million individual pieces of patient feedback have been collated in our first year and, more importantly, frontline staff have been able to react to the comments and views from patients to make immediate, clear, dynamic and demonstrable improvements to services.

This may seem innocuous, trivial even, in terms of a step forward – but listening to patients and then acting on what they tell us is key to following the recommendations of Francis and vital to taking a more caring and compassionate NHS forward.

FFT has quickly built into the biggest assessment of patient opinion ever conducted by the NHS or any health service in the world and represents a major step towards our commitment to openness and transparency.

The Friends and Family Test data is a vital tool for driving improvement in services. The purpose is not just to listen to what patients are telling us, but to act on what they tell us.

It has transformed the way we listen to patients. It’s about accountability, about improvement and about customer satisfaction. The Friends and Family Test is a key part of the solution to driving up standards in our hospitals and maternity units.

In gathering the feedback we have given hundreds of thousands of people the chance to have their say. The feedback we have received has been impressive and Trusts have acted swiftly upon it.

Examples of improvements as a result of NHS staff acting on the feedback are wide and varied, from hospitals ensuring patients do not feel isolated, to improving the food they receive.

The University Hospitals Coventry and Warwickshire NHS Trust received FFT maternity feedback raising issues over the new birth centre’s discharge process and visiting times for partners.

As a result staff have worked to speed up the discharge process and changed visiting times so partners can now stay on the ward at night.

FFT has become a living, breathing daily poll of what the NHS is doing well and, on occasions, not so well. Proof of it in action has been seen across the country and some of the best examples of FFT in action include:

  • A patient who uses a wheelchair telling Hull and East Yorkshire Hospitals NHS Trust the mirrors in the bathrooms were too high. The Trust installed full length mirrors.
  • And mums giving birth in the mornings said they were missing out on breakfast. Following feedback through FFT, mealtimes were made more flexible. The Trust has also introduced a trolley service for patients who were too ill to go to the shop to get a newspaper.
  • The Mid Staffs NHS Foundation Trust brought in soft-closing bins for inpatient areas as a response to patients feeding back that noisy bins kept them awake at night.
  • A similar ‘Quiet Protocol’ to help patients sleep well at night was introduced at Sandwell and West Birmingham Hospitals NHS Trust after it received FFT feedback about disturbed nights.
  • Ipswich Hospital reacted to FFT calls from bereaved families for free car park exit tickets, after they raised the huge costs they faced on leaving hospital after spending time at the bedside of a dying relative.
  • The Royal Wolverhampton NHS Trust introduced medication cards for patients who are off the ward during drug rounds to alert them that their medication is waiting to be dispensed.
  • Meanwhile, the Lister Hospital in the East and North Herts NHS Trust acted promptly to FFT feedback which suggested that staff on the cancer ward didn’t always introduce themselves to patients. All healthcare professionals have been reminded of the importance of introducing themselves to patients. And its gynaecology ward has introduced a silent patient call alarm system at night to avoid disturbing other patients.

To prove that nothing is too big or small in terms of staff reacting to FFT feedback, you only need look at the efforts of staff at Chesterfield Royal Hospital where patients said they were getting peckish between the 6pm dinner and the 7am breakfast. It promptly led to snacks being offered at supper time around the wards.

And you either love it or hate it, but Marmite wasn’t on the breakfast menu at Chesterfield with patients being offered only jam or marmalade. But after receiving FFT feedback, Marmite is now among the breakfast jars.

It just goes to show that the Friends and Family Test can lead to real change and improve the patient experience of the services we provide – from things as diverse as better access to doctors and nurses, to having a jar of Marmite on the breakfast tray.


  • NHS FFT was implemented for inpatients and A&E from 1 April 2013.
  • The first national publication, covering inpatient and A&E services, was on 30 July 2013 covering the first quarter’s data. Since then, inpatients and A&E data has been published monthly.
  • The FFT in maternity services was launched on 1 October 2013. The first national publication of maternity services data, covering the first quarter’s results was on 30 January.
  • The FFT for NHS staff will be launched from 1 April. All staff working within the organisation during each reporting period will have the opportunity to provide their feedback, which will include two simple questions:
  • How likely are you to recommend <this organisation> to friends and family if they needed care or treatment?
  • How likely are you to recommend <this organisation> to friends and family as a place to work?
  • NHS England is committed to introducing the NHS FFT 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.
  • The NHS Friends and Family Test has already enabled over 1.5million people to have their say since April 2013, giving vital feedback that will help shape and improve services going forward.
  • The NHS Friends and Family Test is based on a simple question that ensures that local hospitals and the public get regular, up-to-date feedback on what patients think about their services.
  • The NHS FFT focuses on collecting the data in real time, or as close to it as is possible, so results can be acted upon quickly without a time-lag from data collection to publication of the results. This allows staff to act quickly on the results and importantly to assess whether these actions have made a real difference to the patient experience.
  • By using the results from the NHS Friends and Family Test and the supplementary insight it generates, NHS employees – from ‘Ward to Board’ – will be informed and empowered to understand, celebrate and build on what’s working well in their area, whilst also tackling areas of weak performance.

Tim Kelsey was previously National Director for Patients and Information, since the publication of these blogs he has left NHS England.

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  1. Brendan Young says:

    I have recently been involved in the design of a Stroke Pathway Friends and Family Test as a patient representative within a CCG Stroke Strategy Group.
    I believe that the spread of FFT across the NHS will help improve the caring culture and bring home to patients, staff and NHS Leaders that they must operate like a real world organisation recognising that customer responsiveness is essential to improve the service and maintain the goodwill of these customers (not forgetting the internal customers…the staff)
    Both small and larger incremental improvements can be generated by FFT. Equally importantly the FFT ensures that patients and the public become involved with the NHS and the staff who deliver the services……thus engendering a spirit of joint responsibility for the patients’ health and service improvement.
    I would suggest that this culture of shared responsibility together with customer responsiveness could become a foundation for integrated care across the NHS and with partnerships….with patients, the public and politicians all becoming genuine stakeholders.
    Brendan Young patient representative West Midlands Clinical Senate Council

  2. Richard Caulfield says:


    This all makes the F&FT seem very good and lovely, but do we really need F&FT to do this? Yes there should be ‘customer’ insight and feedback mechanisms, but they should be more sophisticated than F&FT.

    Now with targets to up number of responses and payment driven by whether responses are good or bad will encourage the wrong behaviour. If F&FT is going to be meaningful, surely we need to understand what has been fed back and what has happened as a result: not simply measure if x% of patients responded and y% report a positive experience: we should be interested in how those that didn’t have a good experience were responded to.

    i could go on but just to say I visited a hospital the other day as part of a ‘mock’ inspection and asked a number of patients the F&FT questions: they were all bemused why you would ask the F&F question in a hospital and one said ‘No’ – and when pressed why said ‘it’s too far away’.

    Let the F&FT be part of encouraging a feedback/response culture inside the NHS but please move away from essentially a payments by results method with it – it is inappropriate and will have unintended consequences

  3. John Gooderham says:

    I welcome all this. But what about outpatients and day cases, which seem to have been overlooked so far?. Being a volunteer driver for a community transport organisation, I’m very aware that most outpatients get a goodish experience. I get the impression, however, that when things start to go wrong they go from bad to worse. Examples of poor outpatient experience include: having difficulty in making appointments; having appointments cancelled at short notice; having x-rays ordered only after having seen a doctor; having to wait for long after the scheduled appointment etc. Examples of poor day case experiences include block bookings for clinics, and – the most appalling of all – having operations cancelled twice at short notice, with no guarantee of a next date being early, unless the patient went private at the same NHS hospital unde the same surgeon. I’m also an elected patients governor at a local FT, so I’ve raised these concerns there.