NHS England and Improvement has provided the following high-level advice about reducing burden and releasing capacity to manage the COVID-19 pandemic:
- Community services: “Cease data submission and collection with immediate effect”
- Primary care: “Practices will not be required to report to commissioners about FFT results”
- Acute providers: “Stop reporting requirement to NHS England and NHS Improvement”
The measures are intended to allow for staff resources to be diverted towards more immediate priorities during the COVID-19 pandemic.
To support those measures, we are temporarily suspending the submission of FFT data to NHS England and Improvement from all settings until further notice. You do not need to keep a count of responses collected during the suspension.
There will be no penalties for not complying with any part of the FFT guidance during this period.
We also advise you to stop using methods of feedback collection that may pose an increased risk of infection to either staff or patients (for example feedback cards or ipads/tablets).
The requirement to implement the changes we were introducing from 1 April is postponed but the requirements to collect FFT feedback at specific times in general and acute inpatients, A&E and maternity services are now removed, as is the requirement to collect FFT feedback in ambulance see and treat services. See questions below for more detail.
We will provide more advice about adopting the new question and timing requirements in due course. If you have already made the changes that is fine and if you still plan to make changes over the coming months, that is also fine. The submission templates will be changed to the new fields at the time that submission becomes required again.
It would be helpful if you could let us know if you are delaying making the changes by emailing email@example.com.
It remains as important as ever to continue listening to patients and enabling them to raise concerns about the services they are using. Patients may still want to give feedback about their experience, and it is important they still have this opportunity. FFT could still be a route for them to do this, as can PALS, or other collections that may be ongoing at this time but you should avoid any methods that have a risk of infection such as feedback cards or tablets.
Any feedback collected may be useful locally, but there will be no national submission until further advice is published later in the year.
We remain fully committed to all NHS providers collecting and using patient feedback to improve the quality of services as we set out in the revised guidance published in September 2019 and the contractual requirement to implement the FFT will remain in place.
We will advise people when to restart submitting FFT data later in the year. We will allow a period for people to make the necessary preparations before implementation. Information will be placed on our FFT webpages and we will send out an update to people on our FFT Update mailing list when we have more information. If you are not already on the list to receive the monthly FFT Update, please email us at: firstname.lastname@example.org. You can also ask to be added to the list to receive our more general monthly Insight Update if you wish.
The main changes are intended to improve the FFT by:
- making the wording of the mandatory question and standard response scale more effective in collecting good quality feedback. The new question has been tested with staff and patients to make sure it is accessible, and
- making it easier for patients to give feedback by changing the timing requirements in A&E, general and acute inpatients and maternity settings, bringing them into line with other settings.
Full details of the changes are in the new FFT guidance.
NHS England offers support by providing a range of promotional resources. These range from films – both animated introductions to the FFT and examples of how it is working in some healthcare services – to a range of posters and leaflets suitable for different services.
You can find more than 50 FFT promotional resources on the Health Publications website. To view a list of what’s available, type FFT into the search box on the top right of the screen then scroll through the list. If you register on the site, you will be able to download any of them and order print copies of some of them.
We have also published a set of case studies that show good practice in carrying out the FFT, making it accessible to a range of service users and using the feedback.
You can contact the NHS England and NHS Improvement Insight and Feedback Team via our email address: email@example.com if you have any queries about the FFT or the changes we are introducing.
We provide translations of the new standard FFT question and response options in the following languages: Urdu; Turkish; Spanish; Somali; Russian; Romanian; Punjabi; Portuguese; Polish; Japanese; Italian; Gujarati; German; French; Farsi; Chinese (traditional); Chinese (simplified); Bengali; Arabic; Albanian.
The new mandatory standard question is:
“Thinking about [setting]…
Overall, how was your experience of our service?”
And the response scale to use is:
- Very good
- Neither good nor poor
- Very poor
- Don’t know
Providers should choose the most appropriate one of the following, or something similar, to describe the setting or experience being asked about:
- your GP practice
- your stay in the hospital
- your dental practice
- your recent visit to A&E
- this maternity service
- our antenatal service
- our labour ward
- our birthing unit
- our homebirth service
- our postnatal ward
- our postnatal community service
- your recent appointment
- your recent visit
- our recent visit
- the service we provide
The new question has been cognitively tested to make it as widely accessible as possible. However, providers are encouraged to add text or graphics to the question to make it easier for patients to respond where appropriate. NHS England provides examples of easy read, British Sign Language and foreign language versions but providers should also feel free to develop their own. We would be happy to receive examples and make them available online to other providers.
In the past, we agreed that the standard question and response options could be difficult for some people to understand, and we have provided guidance on how to amend the question to make it simpler and easier.
We think that the new question and response scale make it much easier for most people to respond without needing to simplify it further. We are keen, therefore, that providers use the wording and the response options we have set out in the guidance – these have been cognitively tested with a wide range of people that use services and we are confident that they are much more accessible than the old question and response options.
Having said that, we do acknowledge that not everyone has the same cognitive ability and some people may still find it difficult to respond to the question as it stands. That is why we have said in the guidance that locally providers can add any supplementary wording and graphics to the question that they need to, to help people understand what they are being asked to do. The most important thing is to enable people to give feedback if they want to.
We have made examples of easy read-designs available for people that want to use them. These are not mandatory, and providers should feel free to design their own versions, using the standard question wording, if they prefer to do so.
We know that the free-text feedback is the most important part of the FFT. The requirement to ask at least one free-text question alongside the mandatory question is not changing.
Providers are encouraged to use free-text questions that work for them and their patients, for example seeking feedback on something that has been identified as needing further examination.
During our development project, we tested several free-text questions. We found the following pair of questions were well understood and encouraged good quality feedback:
- Please can you tell us why you gave your answer?
- Please tell us about anything that we could have done better
Providers can use these questions if they choose to.
We recently updated our FFT related case studies, including examples of how the free-text data is used to identify opportunities for improvements.
While it’s not mandatory to collect demographic information, we think it can be useful for: identifying whether there are any demographic groups that are not engaging through the FFT, and may therefore require an alternative approach; and whether any demographic groups are reporting better or worse experiences than others.
If you do collect demographic information you should think about collecting the most useful for you and the demographic make up of your patients.
We recognise that there are ongoing debates about the best way to collect and record sex or gender information, and at this stage we are not able to make a firm recommendation on how to word the question or the response options. However, we have used the following question and response options on our downloadable cards for use in primary care settings:
Prefer not to say
Prefer to self-describe [ ]
Providers can use this, or develop their own versions if they want to collect this data.
We have removed the “at discharge or within 48 hours” requirement.
Our view is that patients should be able to give feedback when they want to rather than only at the point where they are discharged. This change will bring these settings into line with other settings. It will make it possible for long-term inpatients to give feedback during their time within the hospital; and will allow patients more time to reflect on their experience before giving feedback if they need it.
Providers should make the FFT available to any patients who want to give feedback during their time within the hospital and after they have left. Providers can still offer the FFT at a specific time if they want to – they can set their own timescales to do so, they do not have to set a specified time limit.
We know that the timing of seeking feedback makes a difference. For example, when patients are asked immediately after attending A&E, they may be more likely to respond and have a clear memory of their experience, but the response may be more thoughtful and balanced if the patient has had more time, say a couple of weeks, to reflect. Feedback collected during an inpatient stay may be affected by gratitude bias or concerns about the impact on their care if they make criticisms but if patients want to give feedback they should be able to.
We have removed the four touchpoints requirement in maternity services, so that people can give feedback at any time during or after their pregnancy.
The changes bring maternity services into line with other settings and make it easier for people to give feedback when they want to, so that
- they don’t have to wait until the 36th week if they want to give feedback about something that happens earlier; and
- they can have more time to reflect before they give feedback on their birth experience.
Providers will still be able to ask proactively at locally determined times (for example at routine scans) if they choose to do so but should be careful to give people enough time to recover from childbirth before asking them for feedback.
It will need to be clear to the staff and patients which part of the pathway the feedback relates to so that the feedback can reach the relevant staff. Therefore, we will continue to relate the feedback to the four pathway stages (pregnancy, birth, postnatal ward and postnatal community) – each pathway stage has its own “framing text” (for example: “Thinking about our antenatal service…”), and data will still be submitted to the centre in line with the same four pathway stages.
The changes will mean that, for the three settings that we have previously published response rates, this is no longer possible because there is no limit on how often a patient or service user can give feedback. We will continue to publish data that gives an indication of how effectively the FFT is being implemented, in line with all other settings.
Providers are not required to proactively ask patients to give feedback at times specified in the guidance, but they should ensure that patients know that if they want to use the FFT to give feedback they can.
Providers can use any collection methodology that meets the requirements, for example they can use SMS texts, a webpage, pen and paper, tablets and so forth, but should ensure that all patients can find a way to give feedback if they want to – so the provider may wish to use a combination of methods. To be inclusive, the provider might want to have feedback forms on the reception desk as well as send an SMS message to patients that have had an appointment.
If the provider finds it useful, it can continue to carry out a routine collection at a time that suits them and their patients, for example, at discharge, at some given time post discharge, or at specific appointments.
We know that in the case of ambulance services there can be practical difficulties in making the FFT work, but we want to ensure that patient experience information continues to be collected and used to improve the quality of the service. We have, therefore, changed the requirements in relation to ambulance services. Instead of seeking feedback through the FFT, we have worked with ambulance leads to develop an alternative approach for see and treat care.
Where an ambulance service provider does not want to continue to use the FFT they will be able to sign up to an alternative method of collecting patient experience information.
We are not removing the FFT requirement for patient transport services.
The FFT is a continuous feedback tool, designed to be quick and easy for patients to use and for staff to implement and collect. It is not intended to provide data that can be used to compare different organisations.
Unlike the national surveys:
- All people who use services should be able to use the FFT to give feedback if they want to. There is no sampling of patients and no requirements around response numbers or rates.
- There is no single method of collecting data. Providers can use any method that works for them and the people that use their services.
The published data is not subjected to routine analytical processes and is not:
- case-mix adjusted to reflect the different kinds of treatment patients are receiving in different providers; or
- adjusted to reflect demographic characteristics (such as age, ethnicity, or gender).
Using the FFT data to compare providers can have a detrimental effect on how it is collected and used. Providers would, understandably, focus on trying to get a high score (for example by being selective in which patients are asked to give feedback) rather than collecting good quality feedback and using it to identify good practice and opportunities for improvement.
The new guidance encourages providers and commissioners to focus on what the feedback is telling them and how it can be used to make improvements.
The national requirements related to response rate were removed in April 2015 to discourage of a disproportionate focus on achieving very high response rates which led to providers thinking about the FFT as a tick-box exercise.
We know that collecting too many responses can be overwhelming for the provider; it can be resource intensive just managing the volume of responses; and it can be difficult to analyse free-text feedback effectively.
Commissioners will want to see that a reasonable amount of feedback is being collected, but what is reasonable will vary from setting to setting. We encourage commissioners to focus more on: seeking assurance that providers are giving their patients the opportunity to give feedback and are then using the feedback to identify good practice and opportunities to improve.
The monthly numbers we publish include data that can help commissioners get an overview of how the provider is doing in gathering patient experience insight, in the context of the number of people using the service. The numbers are not a performance measure – and from April 2020 we will not be calculating ‘response rates’.