Times and questions may be a-changing

The NHS Friends and Family Test (FFT) is currently under review to see how it can be improved as a tool for improvement.  NHS England’s Director for Experience, Participation and Equalities explains how the work is progressing and what the next steps will be:

After more than six months of intense discussions, rigorous testing and robust research as part of our project to improve the FFT we are nearly ready to prepare a set of options and recommendations for NHS England’s leaders to consider.

The proposals will focus on whether to change the mandatory FFT question, which currently asks how likely people are to recommend the NHS service they have used to their friends and family; or to current mandatory time limits for feedback invitations applied to A&E, inpatients and maternity touchpoints.

I mentioned in my previous blog about the project a year ago that we were aware of several issues creating practical challenges on the ground and limiting the FFT’s usefulness as a tool for improvement. The project has explored evidence of this to consider whether any elements should change to make the FFT the best tool it can be for driving improvement activity at local level.

Since then, there have been hundreds of interactions with healthcare professionals, patients and the public to explore the options.

We’ve found some interesting things:

  • Most concerns about the FFT were about the wording of the mandatory question so we are assessing whether it would be helpful to change the wording;
  • While the question itself helps produce a national FFT “score”, there is potential for it to do more to prompt people to give free-text comments to explain their rating and say what worked or could be better;
  • Sites that tested a shortlist of potential alternative questions told us that the alternative wording they tested resulted in fewer staff having to explain what it was about to patients, or patients commenting on the question in their comments – meaning they got richer feedback – so those benefits will need to be weighed against those of current arrangements;
  • There is no overwhelming consensus around what a “better” question looks like… but we have a shortlist for comparison and the findings of formal research, which has just been completed, will reveal more about the pros and cons of all the options;
  • There is still a tendency to use FFT to understand performance in comparison with other trusts, but we know the data from FFT is not comparable so it’s unfair to teams to use it in this way;
  • The emphasis on “doing” FFT has led to a focus on collecting more and more data at the expense of acting on the feedback to make improvements.

We’ve explored, with maternity specialists and people with lived experience, the viability of letting women and their families being able to give feedback anytime in their “journey” through maternity services – something that an earlier piece of Ipsos MORI research with women identified as desirable – rather than at only the mandatory stages we set out in our original guidance in 2014.

So far, the project team has engaged with almost 1,300 individual stakeholders outside NHS England through an array of working groups, surveys, regular updates, and workshops, along with numerous webinars and several tailored presentations. Additionally, formal research by Ipsos MORI has involved:

  • 35 interviews with providers, commissioners and stakeholders
  • Face-to-face focus groups involving around 40 patients
  • Online focus groups around 25 healthcare professionals
  • Almost 40 cognitive interviews with patients.
  • Several online discussion sessions with groups of NHS staff.

This engagement has added real value. One point which comes up consistently is that it’s important to patients, and people working in the health system, to make sure that feedback is listened to.

The FFT can be a powerful way to involve and empower staff throughout the organisation in improving patient experience; using it, for example, to understand what it is that’s holding up discharge; how teams can be more joined up; or which little things could be fixed to benefit patients.

Used as part of a cohesive patient focussed quality improvement strategy, the ease with which patients can tell us what’s working and what’s not working could be a game changer. What we’ve learned will help us produce some useful good practice on this, regardless of whether we make changes to the FFT question or timings.

In the early weeks of 2019, the project team is busy bringing together all this information to evaluate all options.  We intend to publish revised guidance by April but we will begin sharing details of any changes before that, along with our position on transitional arrangements if needed.

We can’t give certainty at this point about what will be decided but we can guarantee that any recommendations will be evidenced and will have been shaped by the people who use the FFT. We are certain that we will be able to help provide a new focus on using the tool to drive improvement.

Keep in touch with progress via the project development web page or sign up for our monthly project update by writing to

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

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