In 2018 NHS England carried out a project to improve some areas of the way the Friends and Family Test works across the country, with the ambition of making the FFT a more effective tool for gathering patient feedback that helps to drive local improvements in healthcare services.

This work drove policy changes, set out in our publication of revised FFT Guidance in September 2019, and the changes took effect from 1 April 2020.

While wanting to listen to views on how to improve this tool, there was never any question of stopping it. Stakeholders continue to say that it adds valuable insight to their other activity to understand patient experience.

The 2023 national NHS Staff Survey tells us that 70.55% agree that their organisation acts on concerns raised by patients and service users. Much of this feedback will come from the Friends and Family Test and we know that many providers share their FFT findings and patient comments with staff at ward level.

This focus on patient experience provides an opportunity for improvement in big ways and small ways. We have seen many examples over the years, from initiatives for quieter wards at night and improving the dining experience through to initiatives to dramatically reduce patient fasting times before operations.

Since the beginnings of the FFT, providers and commissioners have made and shared observations on how to improve FFT. Many changes have been made, or gaps filled, over the years since the FFT was originally launched; by 2018 it had run for 5 years and a focused review on what could be improved felt timely.

The development project centred on:

• exploring a more effective question that worked better for patients
• supporting services to make the most of what FFT could give them as a local service improvement tool
• removing the burden in meeting some of the specifics in the original guidance (such as the 48 hour rule for acute trusts and the fixed ‘touchpoints’ across maternity care)
• supporting the best possible use of the data

During the project, particularly over the summer and autumn of 2018, there were opportunities for healthcare professionals, patients, voluntary organisations and representative bodies to feed in and the emerging options were tested in healthcare settings with a range of stakeholders. In all, more than 1300 people engaged in the process. The project included independent research consisting of interviews with NHS staff and members of the public, as well as cognitive testing of FFT question wording options to replace the original one.

If you want to contact the project team about the 2018 redevelopment project, please email them at england.insight-queries@nhs.net. Please clearly mark your email subject ‘FFT project’.

Outcome of the project

The revised guidance for implementing the Friends and Family Test was published in September 2019 and is now in effect.

The policy changes were announced in autumn 2019 with an email to all trust chief executives, to senior accountable officers of all CCGs in England and to primary care professional bodies.

We are grateful to the many stakeholders who shared their views on the future of the FFT and how it could be a more useful improvement tool, particularly the healthcare professionals and patient representatives who took part in events, webinars, surveys and working groups over the course of the past year and those who commented on draft guidance to advise on its clarity and completeness.

The main changes were that:

• all providers use a new FFT mandatory question and 6 new response options
• we removed mandatory timescales where some services were previously required to seek feedback from users within a specific period – this affected A&E services, inpatients and maternity – to allow more local flexibility and enable people to give feedback at any time, in line with other services
• we placed greater emphasis on use of the FFT feedback to drive improvement
• we advanced exploring new, more flexible, arrangements for ambulance services where the FFT has proved difficult to implement in practice

Our Frequently Asked Questions are reviewed regularly. If you have additional questions, please email the FFT Helpdesk. The FFT Helpdesk is unable to process feedback received directly from patients about their healthcare experience. If you wish to give feedback on your care, please get in touch with the provider directly to ask about your FFT.

We also updated promotional resources to support implementation of the revised FFT. The FFT Communications Resources page provides more detail.