Frequently Asked Questions

Download a copy of the Frequently asked questions

Fundamentals of Staff FFT

Development of Staff FFT

Implementing Staff FFT

Reporting Staff FFT results

Using Staff FFT results

Staff FFT and other staff engagement tools

Data protection and the Electronic Staff Record


Fundamentals of Staff FFT

What is Staff FFT?          

Staff FFT is a feedback tool for staff, predominantly for local improvement work; consisting of 2 questions (with options to give free text feedback for each) through which organisations can take a temperature check of how staff are feeling. It is a quicker feedback mechanism than the existing NHS annual staff survey, and at its best will enable staff to voice their concerns (on a regular basis if they wish to) and for organisations to respond.

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What is Staff FFT for?

Recent research has evidenced a link between levels of staff engagement and quality of patient experience. The introduction of staff FFT represents a commitment at a national level to amplify and strengthen the voice of people working in the NHS and to promote positive listening and learning cultures (as per Francis and Berwick), which will further support service improvement.

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What exactly is the requirement?

Organisations should ensure that as a minimum, all staff are given the opportunity to participate in staff FFT once a year. Organisations can choose which cohorts of staff participate at what point over the course of the year (in Q1, Q2 and Q4) or could give all staff the opportunity in each quarter. The results should then be reported centrally in Q1, Q2, and Q4.

Organisations should ask 2 questions as follows (giving a free text comments box after each question):

“We would like you to think about your recent experience of working in <the organisation>.

  • How likely are you to recommend <this organisation> to friends and family if they needed care or treatment?
  • How likely are you to recommend <this organisation> to friends and family as a place to work?”

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Which organisations have to implement Staff FFT?

The staff FFT guidance makes clear that at this stage, only NHS Trusts need to implement staff FFT.

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Is it a contractual requirement?               

The provision to undertake staff FFT is listed in the NHS standard Contract under Schedule 6G in the Particulars.

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Can we ask all of our staff to do staff FFT in one quarter?

No, we have set out a flexible approach to the Staff FFT, but it is a requirement that Staff FFT data is collected in three quarters (Q1, Q2 and Q4).

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Can we include Staff FFT in our full/census internal staff survey?

You may of course include the Staff FFT questions in your internal staff survey – but this will only meet the requirement for Staff FFT if it is collected in line with the national guidance and is collected in three quarters (Q1, Q2 and Q4).

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Can we just do staff FFT once a year (and speak to a handful of staff in the other quarters)?

The guidance makes it clear that there should be a quarterly collection and assessment of staff feedback. Organisations may choose which staff to include each quarter, but it is important that a sufficient proportion of staff are included to allow for a quarterly publication of trust data.  Organisations should use the quarterly results to make meaningful service and quality improvements within the organisation, and ensure that the quarterly data can be used to assess trends and track progress over the course of the year.  NHS England will also publish the results for quarters 1, 2 and 4. Don’t forget that staff FFT can be used as part of existing quarterly engagement activities.

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Development of Staff FFT

Who have you worked with to develop staff FFT?

We have worked with representatives from provider trusts, staff side representatives, NHS Employers and academic experts in staff engagement. We also sent our draft guidance to all HR directors before Christmas so that they could give us feedback on the proposed approach.

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Has Staff FFT been tested?

We have tested staff FFT in four sites; looking at suitability of question wording, response volumes and question order.

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What were the findings of the testing?

The testing found that there were no significant concerns with the wording of the question – generally people understood the question and that there was no perceived order effect.

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How much will Staff FFT cost?

The precise detail of this will largely be determined by the approach decided by a provider. Staff FFT could be delivered through an in house solution or by a third party supplier. It could be carried out using postcards or tablets (plus other mechanisms). Organisations asking staff FFT of all staff each quarter may incur more cost than a provider adopting a sample approach, but again this will depend on the method used. We will be gathering information on all the approaches that organisations adopt for the implementation of staff FFT.

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Implementing Staff FFT

How should Staff FFT be implemented?

It’s really up to organisations, who could choose to adopt a similar methodology to the patient FFT, or incorporate this into their existing staff engagement plans, if appropriate.

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Can a 3rd party supplier be used?

Yes

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What are the pros and cons of using a 3rd party supplier?

There are multiple considerations to bear in mind – cost, resource, technical capability both in terms of survey methods and of free text analysis, ability to maintain an anonymous or confidential collection, use of existing supplier for patient FFT. Each of these considerations is likely to have a different impact on each organisation.

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Can we use different methods of collection for different staff groups?

Yes

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How frequently do we have to ask the question?           

The minimum number of times staff should be invited to respond to the staff FFT questions is once in a financial year. If organisations want to ask the question more frequently, they can.

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Who should we include in Staff FFT?

One of the fundamental principles of staff FFT is that everyone who works in a setting delivering NHS services (a hospital, a clinic) or who is employed by an NHS Trust, should be included. They may not be directly employed by the Trust (for example they could be bank, agency or hotel services staff) but the principle of inclusivity remains.

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Should we include our volunteers in staff FFT?

This is a local decision, but given the amount of time and dedication given by volunteers to delivering care, we would encourage organisations to seek input from volunteers as part of staff FFT.

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How many people should be asked each time we do Staff FFT?

There is no required number of staff who should be answering staff FFT questions in a quarter, but it is important that a sufficient proportion of staff are included each quarter to allow for a meaningful quarterly publication of trust data.  Each organisation might want to chunk up their staff differently, according to what works best for them to support local improvement work. Depending on how the staff FFT is being implemented, it might be easier to include everyone each time, or to have a mixture of approaches, where the staff FFT is open for all to complete if they wish, with a particular emphasis on hearing from certain groups of staff at certain times.

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Should we focus on certain staff groups?

One of the principles of staff FFT is that it is available for all staff working in or for an organisation and all should have equal opportunity to participate. If, as part of local improvement work, an organisation wants to ask particular questions (in addition to staff FFT) of certain groups, or wants to focus on certain groups first as part of a phased approach, that is fine; equally, if data points to a need to carry out a more robust investigation in certain areas (as outlined in the Equality and Diversity System), that is also acceptable.

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Is Staff FFT confidential?             

Staff participating in staff FFT should be re-assured that their responses will be handled confidentially. Organisations may choose to implement Staff FFT in a way that best suits staff and the needs of the organisation to support local improvement, but they are obliged by law to honour any statements they make about anonymity or confidentiality.

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Do we need to collect protected characteristics?            

Whilst this isn’t compulsory, it is best practice to understand which cohorts of respondents are giving which messages, in order for local improvement work to be effective. Organisations can choose how they can best gather this information but are obliged by law to honour any statements they make about anonymity or confidentiality as part of that collection.

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Can we use protected characteristics data from ESR to fulfil this?

Where Trusts are utilising data from the Electronic Staff Record (ESR) to obtain equality and diversity data for Friends and Family Test responses, every member of staff must be informed that their response will be linked in this way.  Prior to staff FFT being implemented for the first time, Trusts must provide open and transparent documentation to every member of staff detailing how ESR data will be used. The Caldicott Guardian within the Trust will be required to sign off that the solution for staff FFT meets the requirements of the Data Protection Act (1998) and the NHS Code of Practice on Confidentiality (2003).  There is no requirement for the Caldicott Guardian to provide this assurance in cases where Trusts are only utilising ESR data to identify a sample of staff to undertake Staff FFT.

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A previous version of the guidance said we’d have to capture staff grouping – is this still the case?

In order to use the responses that come through staff FFT, it will probably be helpful to understand where, in a general sense, they have come from – e.g. from a particular department or professional group perhaps. This delineation will be up to organisations, and we will not collect this extra level of detail at a national level, as it’s highly likely that there will be a variety of ways in which organisations tackle this.

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Does Staff FFT include NSH Foundation Trusts?

Yes, Staff FFT does include NHS Foundation Trusts.

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Reporting Staff FFT results

What data has to be reported nationally and how often?            

Organisations should submit their FFT data to Unify following Q1, Q2 and Q4. The data should consist of the number of and type of responses to each question, and the number of responses per mode. The staff FFT guidance (section 4) gives more detail.

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The Unify collection template looks pretty complicated. Why is it like this?      

Part of the really useful analysis that can be done on the data is to look at the relationship between staff feeling positive about their workplace and staff feeling positive about the care their organisation provides. In order to do this, the data needs to be submitted in a way which represents this linkage. The design of the collection template is as simple as it could be in order to enable this analysis to take place.

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Do we have to submit the number of people who were included in staff FFT per quarter?

No, this isn’t needed, but the number of responses will obviously be included. We will not be publishing response rates for staff FFT, but we will publish the number of responses along with established and existing data on workforce numbers, in order to get a sense of the size of an organisation and the proportion of staff using the staff FFT.

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We are planning to collect staff FFT data in Q3 –how do I report this so that it feeds into our national data?      

The results from Q3 should be included in the submission for Q4.

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Using Staff FFT results

Where should the results be published?

Locally, organisations can publish the results where they feel most appropriate. If an organisation is considering publishing free text, consideration should be given to how respondent confidentiality or anonymity can be maintained.

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How will results be presented?

We will not be presenting results nationally until August; until that time we will work with the findings of the patient FFT review (which has been considering this and other issues) and other stakeholders to consider how best to present the data.

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What will be published nationally?       

Our intention is to publish the results from staff FFT (presentation decisions pending) and also the number of responses per Trust. The detail of the breakdowns of responses for both questions will be available on the NHS England website.

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How will results be used?

It is not the intention that the results should be used to performance manage organisations, nor compare organisations to each other. Results should be used locally to identify areas for improvement and develop associated action plans in partnership with staff side representation.

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Staff FFT and other staff engagement tools

Does staff FFT have to be used on its own?

No, not if there are existing staff engagement mechanisms used on a quarterly basis to which the staff FFT questions could be included. If an organisation wants to do this, the FFT questions should be positioned first in the larger survey.

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How is it different from staff survey?

The NHS staff survey is a well-established survey mechanism, from which official statistics are generated. Responses from all organisations are weighted accordingly, in order to give national figures which take account of response bias. Data from the staff survey can also be cut in different ways, allowing for analysis in different areas, for example, protected characteristics, staff grouping, organisation type etc. In comparison, staff FFT is a different feedback tool; where the staff survey can be slow, staff FFT is fast; where the staff survey is structured, staff FFT finds its value in free text comment; staff survey is unbiased and representative in its sampling; staff FFT is inclusive in its approach, which may sometimes mean it is not wholly representative of all staff, but represents the views of those who participated; the staff survey is annual; staff FFT is an ongoing feedback tool. Given that they are different approaches, we will use the results from staff FFT in a different way from the results of the staff survey.

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Is staff FFT instead of the staff survey?

No – they are complementary staff feedback tools and in NHS trusts, both should be used.

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Do we have to do staff FFT in Q3 if we’re doing staff survey?    

No – there is no requirement to do staff FFT if an organisation is doing the NHS staff survey in Q3.

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Data protection and the Electronic Staff Record

The guidance states that we must provide open and transparent documentation to every member of staff detailing how ESR data will be used. Does this mean we have to write to every member of staff?

No – it is not a requirement that you have write to every member of staff. This information could be made available on the intranet, or actively communicated through a staff newsletter/bulletin, or on payslip information, for example. It could also be included on an electronic survey tool, by asking the participant to agree for their data to be used in this way prior to proceeding with FFT. For further advice, please contact your Information Governance Manager.

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I am only using ESR to draw up a sample/contact list, do I still need to provide open and transparent documentation to every member of staff?               

Yes – because staff FFT is primarily about gathering feedback about the quality of services, it is beyond the scope of the original purpose of the ESR. For further advice, please contact your Information Governance Manager.

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Why does the guidance refer to the Caldicott Guardian and not the Senior Information Risk Owner (SIRO)? 

The guidance states that the Caldicott Guardian within the organisation is required to sign off the solution for Staff FFT, where organisations are using the ESR to link staff FFT responses to equality and diversity data. NHS England recognises that in some organisations the responsibility for confidentiality and data assurance is distributed between the Caldicott Guardian supported by the Information Asset Owners within the organisation. In these circumstances, the relevant Information Asset Owner (who must be of sufficient seniority to discharge their responsibilities) for staff data may sign off the solution for Staff FFT, and provide assurance to the Caldicott Guardian that the data collection meets the requirements of the Data Protection Act (1998) and the duty of confidentiality owed. As outlined within the Information Governance Toolkit, Information Assets Owners (IAOs) are responsible for providing assurance about the information assets within their remit. This assurance is for the management of information risks (to the SIRO) and for confidentiality and data protection (to the Caldicott Guardian).

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The guidance states that “Consent to contact staff via email/telephone/SMS is required”.  Why?

Staff email addresses and telephone numbers, will be, in most cases, taken from the ESR. Under the Data Protection Act such data can only be used for a “compatible purpose”.  As Staff FFT is primarily about providing feedback on the quality of services, it is not deemed a “compatible purpose” with ESR.  It isn’t a requirement to write to every member of staff, to seek consent, but information should be made available to all staff about how the data is being used, i.e. on the intranet, or actively communicated through a staff newsletter/bulletin, or on payslip information, for example. Organisations must have in place a mechanism to deal with staff objections to this use of the ESR for this purpose.

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