Friends and Family Test development project 2018-19

NHS England is carrying out a project to improve some areas of the way the Friends and Family Test works across the country. The work will result in publications of refreshed FFT Guidance by April 2019.

Outline proposals for the work were given the green light by Chief Executive Simon Stevens in the autumn and also supported by the Department of Health.

The ambition is to ensure the FFT can be a more effective tool in gathering patient feedback that helps to drive local improvements in healthcare services.

It is more than three years since the two-year rollout of the FFT across NHS-funded services was completed. Since then patients have consistently been contributing about 1.2 million pieces of feedback every month, demonstrating the appetite of members of the public to tell staff what they are doing well and where improvements can be made, particularly where they give comments on their experience in addition to their rating.

On average, nine out of ten people say they would recommend the service they used to their friends and family.

The national NHS Staff Survey tells us that more than half of NHS staff currently use patient feedback in improvement work in their own services and teams. Much of this will come from the Friends and Family Test as 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 and projects to enhance end-of-life care for both dying patients and their loved ones:

Think Drink – How patient feedback reduced patient fasting times before surgery

How feedback is helping to improve End of Life Care

We believe it has been particularly valuable in the following ways:

  • Putting patient experience on the map where previously it hadn’t been
  • Giving everyone a voice in a way the national surveys don’t
  • Supporting staff in reinforcing the good job they do
  • Giving staff evidence on where changes need to be made
  • Providing swifter and more granular data than the surveys, which is particularly important at a time of major change such as in primary care at the moment.

We don’t want to lose those benefits so it’s not an option to stop.

However, since the beginnings of the FFT, providers and commissioners have pointed out the aspects of the initiative that do not work so well. Many changes have been made, or gaps filled, but we feel that the experience of using the FFT across all settings over the past three years now highlights a number of key areas where it could be more effective.

These are:

  • Explore a more effective question
  • Supporting services to make the most of what it can give them as a local service improvement tool
  • Removing 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)
  • Supporting the best possible use of the data.

During the project, particularly over the summer and autumn of 2018, there will be opportunities for healthcare professionals, patients, voluntary organisations and representative bodies to feed in and emerging new policy will be tested in healthcare settings.

If you want to put forward any views on the work, or be involved, you can contact the project team at Please clearly mark you email title “FFT project”.

Latest news from the project

Stakeholder surveys

The project team has gathered the views of NHS service providers, commissioners and FFT suppliers about how the Friends and Family Test could be improved.  These surveys closed recently and responses are currently being used to help shape the direction of the project and inform discussions in the working groups looking at the wording of the question and the timing of feedback requests.

Other areas of the survey responses will help to decide what needs to be included in revised guidance, for publication in spring 2019.

Thank you to everyone who took part.

Working groups

The project team is continuing to hold regular meetings of working groups to inform decisions about changes to current FFT ways of working. These are made up of volunteers from across NHS organisations, along with a number of patients and people with lived experience.

Separate discussions have been held with interested patients and patient representatives and with maternity stakeholders to further inform this work.

Webinars for commissioners were held on 15 and 18 October and a workshop for FFT suppliers was held on 11 October. If you missed these and would like details of the presentations, please get in touch.

Testing and research

A number of healthcare providers volunteered to test some of the emerging options to see how well they work for them and for patients. As testing ends, sites are submitting their findings on either ‘the question’ or ‘timing’ elements proposed for FFT. The information will be discussed with the working groups to help inform recommendations on changes to the current guidance on the mandatory question and timing requirements.

A formal piece of research involving cognitive testing of emerging question options with a sample of patients and staff is due to run with volunteer involvement through the autumn.

If you have any questions about this work, please contact the project team, using ‘FFT project’ in the title, by emailing