Friends and Family Test development project 2018-19

NHS England has been carrying out a project to improve some areas of the way the Friends and Family Test works across the country, with a view to publishing refreshed FFT Guidance over the next few months.

Outline proposals for the work were initially given the green light by Chief Executive Simon Stevens and 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 almost four 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.

There have been more than 60 million pieces of patient feedback from the Friends and Family Test. 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 the Friends and Family Test 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 felt that the experience of using the FFT across all settings over the past four years highlighted a number of key areas where it could be more effective.

These have centred on:

  • Exploring 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 were opportunities for healthcare professionals, patients, voluntary organisations and representative bodies to feed in and the emerging options were be tested in healthcare settings and a range of stakeholders.  In all, more than 1300 people have been engaged in the process.

If you want to contact the project team, please email them at Please clearly mark you email title “FFT project”.

Latest news from the project

Changes to Friends and Family Test policy have been announced, following the FFT Development Project.

Revised guidance, which is currently being prepared, is likely to be published in September and this will detail the changes for implementing the FFT from 1 April 2020.

The changes announced mean that:

  • There will be a new FFT mandatory question and six new response options;
  • We will remove mandatory timescales where some services are currently required to seek feedback from users within a specific period, which affects 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 will be putting greater emphasis on use of the FFT feedback to drive improvement;
  • We’ll be exploring new, more flexible, arrangements for ambulance services where the FFT has proved difficult to implement in practice.

The changes were announced in an email to all trust chief executives, to senior accountable officers of all CCGs in England and to primary care professional bodies, with a request to cascade them to appropriate people.

For queries about the announcement, please contact the FFT Helpdesk on