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Helen Ryan: 'NHS Choices has skewed the results of a simple survey'


We are a good hospital and our patients overwhelmingly recommend us, so why did the Family and Friends Test results place us among the worst trusts in the country? asks Helen Ryan

The Friends and Family Test concept is very simple: ask every patient in every hospital if they would recommend the service they have just experienced to a friend or family. It’s not difficult, a bit blunt as an instrument maybe, but worth doing.

I think the test is useful when used in conjunction with other sources of patient feedback. However, it shouldn’t be headline news on its own as it is a simple, limited tool that is a small piece of the jigsaw.

There has been a great deal of time, effort and media attention leading up to the test’s implementation in April this year. And this meant the publication of the first set of national results in July had fanfares and headlines guaranteed.

“Unfortunately, we had not factored in how the data would be “interpreted” by NHS Choices. This turned our good results into very bad results indeed”

I am the director of nursing at Yeovil District Hospital Foundation Trust in Somerset. We have an organisational culture called iCARE, which is held up as an example of good practice for staff and patient engagement, so the Friends and Family Test should have presented us with no problems.

We committed fully to the task of getting a good level of response to the survey from our inpatients. The lower benchmark was 15% and, with maximum effort from staff, we were getting up around the 40% mark, which was excellent.

As we were calculating our own results, we knew we were getting very positive endorsement (95%) from our patients. While we were not complacent, we were quietly confident - and why not?

Unfortunately, we had not factored in how the data would be “interpreted” by NHS Choices. This turned our good results into very bad results indeed.

The first main issue is the use of a net promoter score (NPS). This is basically a calculation applied to the survey figures that gives a single number score rather than percentages. Applying NPS methodology to the Friends and Family Test has been controversial and it certainly could be blamed for muddying the waters.

Putting that to one side, every NHS provider now has an NPS against their results and ours was 66 for June, which - apparently in NPS world - is a good score.

The second key issue is that the list of hospitals with their NPS scores are given to NHS Choices so it can display a rating for each organisation.

Now NHS Choices is wedded to its methodology of providing an indication of how one organisation performs relative to another. Everyone goes on a list, with the top 20% rated as “among the best”, the middle 60% as “OK” and bottom 20% as “among the worst”, complete with a cautionary warning red exclamation mark.

My view is that NHS Choices was caught out by the fact that a high proportion of trusts scored very well. This meant the bottom 20% had many trusts like ours, which had good scores, but it still rigidly stuck to its chosen format. And so our Friends and Family Test bombshell was dropped.

The local paper displayed the alarming headline that the survey placed us among the worst trusts in the country. BBC radio interviews followed. Patients and our local population were justifiably alarmed and staff were angry and disillusioned.
We are a good hospital and our patients overwhelmingly recommend us, so my question is: why did the NHS over complicate a simple survey and end up misrepresenting the results?

The opportunity of celebrating a legitimate good news story that might restore some confidence in the NHS as well as recognise the hard work of our staff has been squandered and frankly, in my opinion, that’s indefensible.

Helen Ryan is director of nursing and clinical governance at Yeovil District Hospital Foundation Trust


Readers' comments (5)

  • michael stone

    Although I don't like the simplicity of the current version of the F&F test (I much prefer narrative feedback, which is harder to 'score' but much more informative about why something was thought good or bad), I myself would have just listed the hospitals and their actual scores.

    But surely Helen's hospital would still, have been in the bottom 20%, but without a label. If I see only 5 ratings, and they are 9,9,8,7,7 then I see no stand outs at all, but the scores of 7 are the least good: but if I see 8,8, 7, 5, 1 then I would wonder what was going on, at the '1'.

    But with this particular test, personally I'm not convinced that a score of 8 would definitely indicate better real-world performance than a score of 7, which is a different issue !

    If Helen is arguing that you should never use comparative indicators, then I would ask, without comparative indicators, how can the less good identify, and try to learn from, the better ?

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  • MS it is not about you and your personal preferences!

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  • Helen,

    I can imagine you seeing the newspapers and reading the headlines...

    People outside the NHS will simply see Yeovil Trust doing very badly and they won't know how the scoring was calculated.
    They will believe this scoring is accurate because its official.

    What is the NPS? Is the formula for this explained on the NHS website clearly for all to see?

    One problem is the NHS is truly awful at advertising itself to the public. Take iCare.
    Have you told the public how good it is?
    Have you told the public how good your hospitals really are?

    Take Nurses. Nobody really knows how
    complex vocation Nursing is and Nurses never complain or demonstrate or organise themselves and tell the public, everybody walks all over them.

    Tell the public directly how good your hospitals are and bypass NHS Choices.
    Tell your staff I support them.
    Tell your staff the most important people of all - your patients are getting better with smiles and laughter and love and they support you.

    And what am I doing?
    I am writing a play about Nursing


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  • No sympathy Helen; I'm afraid that those who live by the soundbite, nonsensical poll and survey die by them.

    Hospitals aren't hotels or shops or health spars and why the upper echelons believe that anyone in their right mind would recommend a hospital stay is beyond me.

    Good hospitals with excellent standards of care don't need to concern themselves with results of flawed Friends and Family surveys... If you're a good hospital, the community will know.

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  • focus of resources where they are needed seems to be deviated from direct patient care onto masses of silly schemes (typical of general management who do not understand the very serious and expert knowledge, skills and work of clinicians and patients' needs) and must cost a considerable amount of money which could be far better spent. they are like a flash in the pan which last a short while, are found to be unpopular and found not to work until someone thinks up the next daft idea.

    when are clinicians going to be permitted to return to concentrate full time on the jobs they have been trained at a very expert level to actually carry out?

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