Keeping the Friends and Family Test going during COVID-19

Trust/Practice: University Hospitals Plymouth NHS Trust.


University Hospitals Plymouth NHS Trust was keen to continue using the Friends and Family Test (FFT) throughout the pandemic, even though data submission was suspended. They considered it essential to maintain a measure of the quality of patient experience, especially given the pause on other feedback mechanisms, and were concerned once stopped it might be hard to restart.

In the early response to the pandemic FFT collection reduced, and some wards assumed that it had stopped. The patient experience team therefore decided to use the introduction of the new guidance from 1 July, to refresh the FFT, promote its use with staff, and make it work more simply and consistently across the trust.

They decided to continue to collect FFT feedback and use statistical process control (SPC) charts to monitor change over time across the trust, and at ward and department levels. During April and May, FFT scores breached upper and lower process limits for the first time, reflecting an enhanced gratitude effect.

Like other providers, the trust increased the numbers of iPads available to patients, partly to support them communicating with family and friends, but also to enable them to give feedback. They continue to receive most feedback by paper forms; these are quarantined for three days, and volunteers continue to input these remotely. Ward staff received guidance on how to set up Zoom calls and the importance of cleaning iPads between uses.

The new simplified FFT forms allow people to leave their details if they are happy to be contacted to discuss their experiences further. The patient experience team follows these up whether they are concerns or thanks to a member of staff or team,.


While the trust is not overly concerned about response rates, it does monitor them locally to ensure they don’t drop too low. In the early days of the pandemic rates  reduced from about 5,000 to 1,000 per month and have risen since moving to the new guidance at the start of July.

The trust’s patient experience team compiles a monthly high-level patient experience report, and shares comments and response rates with wards. Wards also look at their own data on the feedback IT system.

The FFT responses during this time have highlighted:

  • an enhanced gratitude effect
  • assurance of positive patient experience during periods of rapid change
  • patients said they felt safe because of organisation and staff responses to COVID-19, personal protective equipment (PPE) use, social distancing, signage, etc.
  • some concerns about people not social distancing
  • early concerns about staff wearing or not wearing PPE and
  • issues with communication, particularly between relatives and clinical teams.

Using FFT, the trust was able to identify and take measures to address concerns around:

  • visiting restrictions
  • communication between patients, families and clinical teams
  • discharge and anxieties about people going home to households with people shielding.

The positive feedback has been really important for staff morale, particularly during the time when staff were redeployed, and with ward moves.

Feedback collected through FFT has highlighted that, while much work has been done with COVID-19 patients, there appeared to be a reduced focus on feedback from non-COVID-19 patients. This led to the trust carrying out some patient experience interviews with non-COVID patients to explore their experiences in more detail.

Once we were able to show how useful the data was, people were really on board and there was a real hunger for that – people have missed having some of that data.