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 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.
We understand that teams will need time to plan for the changes and make any necessary adjustments. The new arrangements will be implemented from 1 April 2020, which means the first data using the new question would be submitted in May for publication in June 2020.
Depending on the method you use to collect your FFT responses, it may not be practical for you to switch from the old question to the new question overnight on the day before transition. You can make preparations and change to the new question a few days earlier so that you are fully ready to start on the first day.
It’s also possible that for some time after the new question is in place you will receive responses to the old question. Data collected using the old question can still be used locally but should not be submitted to NHS England and NHS Improvement under the new response options. If you are significantly affected by this, you may want to make your commissioner and your Board aware.
The submission system will change to the new response options in time to submit the first month’s data. The new time series will start with that data, but we will include a caveat when we publish the national data that makes it clear that that month’s data is likely to be affected by the changeover and may not reflect the total number of responses collected.
NHS England currently 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.
We will be reviewing and updating these as necessary to fit with the revised guidance. As a temporary measure to help kickstart the new-look FFT, we will make available some supplies of feedback forms for use in primary care and all services will be able to download templates for local printing. These will all be made available in good time before the start date for implementing the revised guidance.
We have 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: firstname.lastname@example.org if you have any queries about the FFT or the changes we are introducing.
We are intending to 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.
If you know you will need translations of the new standard question into a different language, please let us know which languages you need via the FFT Helpdesk, email@example.com.
The new mandatory standard question will be:
“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 will provide 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 current 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 current 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 will be making examples of easy read-designs available over the next few months, for people that want to use them. These will not be 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.
We are changing 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 are removing the four touchpoints requirement in maternity services, so that women will be able to give feedback at any time during their pregnancy.
The changes bring maternity services into line with other settings and make it easier for women to give feedback when they want to, so that
- women don’t have to wait until the 36th week if they want to give feedback about something that happens earlier; and
- women 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 women 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 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 will not be 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 are, therefore, changing 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’.