Friends and Family Test development project 2018-19

NHS England recently 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.

Whilst 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 national NHS Staff Survey tells us that almost six in ten NHS staff think patient feedback is used to inform decisions. 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 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 didn’t want to lose those benefits so it was never an option to stop.

However, since the beginnings of the FFT, providers and commissioners had pointed out the aspects of the initiative that could be better. Many changes have been made, or gaps filled, over the years since the FFT was originally launched, but we felt that the experience of using the FFT across all settings over the past five years highlighted a number of key areas where it could be more effective.

These centred on:

  • Exploring a more effective question that works better for patients
  • 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 tested in healthcare settings with a range of stakeholders. In all, more than 1300 people engaged in the process.

At a later stage, we will be publishing a report on the project to explain in detail how it was carried out. We will also publish a report from Ipsos MORI on a strand of formal research commissioned to support this work. The research included 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, please email them at england.insight-queries@nhs.net. Please clearly mark you email title “FFT project”.

Latest news from the project

The revised guidance for implementing the Friends and Family Test was published in September 2019 and is now in effect.  However, implementation has been affected by the response to the coronavirus.  Further information on what we are asking providers to do at this time is provided in our Frequently Asked Questions.

The policy changes were announced last autumn 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 changes announced mean that:

  • All providers are now using a new FFT mandatory question and six new response options;
  • We have removed mandatory timescales where some services are currently required to seek feedback from users within a specific period – which 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 have placed greater emphasis on use of the FFT feedback to drive improvement;
  • We are now well advanced in 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.

Because of the changes to the FFT, we have published .

We have recently finished reviewing and updating promotional resources to support implementation of the revised FFT.  The FFT Communications Resources page provides more detail.

If you would like a receive email updates about this work, you can join our mailing list for the FFT Update. Just email your request to the project team at england.insight-queries@nhs.net.