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

Most of the work which will inform revised guidance on the Friends and Family Test has now been completed. The final phase, formal research work by Ipsos MORI, is now well underway.  They have completed 35 interviews with providers, commissioners and other stakeholders and have run a series of focus groups involving 40 patients.

They are currently completing online focus groups with around 25 healthcare professionals, focussing on a shortlist of possible replacement questions for the current mandatory one, and they are finalising in-depth cognitive testing of these questions with around 40 patients.

The research report will be looked at alongside all the findings from the other elements of the project – surveys, workshops, working group discussions, literature review and live testing within trusts – to help inform recommendations for potential changes to the FFT guidance.  These recommendations will be submitted to NHS England’s Chief Executive Simon Stevens in early 2019 and we will begin communicating the outcomes soon after decisions have been finalised.

We will allow plenty of time for people to make necessary changes to their systems to reflect the revised guidance, but we know that some services may want to apply any changes relatively quickly, so we are considering the practicalities of a transitional period so that services can “switch over” to compliance with the revised guidance at a point that works best for them within that period.

Useful discussions with representatives of the NHS Youth Forum were held in November and there was a webinar with our working groups to update them on the findings of the testing phase.