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Negative review sparks overhaul of NHS patient feedback system


NHS England is to change how the friends and family test is implemented and presented after a major review concluded it cannot be used as a “single measure” for the quality of care across the health service as originally intended.

The review − published a year on from when the test was rolled out nationally − found the new measure of patient experience was “widely misunderstood” by staff and the public, and raised concerns about the data being “gamed”.

Under the current friends and family test, patients are asked a standard question (see box, below) which they can answer as “extremely likely”; “likely”; “neither likely nor unlikely”; “unlikely”; “extremely unlikely”; or “don’t know”.

As well as recording the answers to this question, new guidance issued yesterday said trusts will also be mandated to collect free text comments from patients. They will have to start doing this from April 2015.

However, the new guidance also said that token systems − where patients are able to give a score by dropping a token into a box − will not be permitted after April 2015 because they have to be collected separately from follow up comments. This means scores and comments cannot be linked.

In addition, the guidance confirmed that trusts must collect data from all inpatient services including day cases from April.

The friends and family question

“We would like you to think about your experience in the ward where you spent the most time during this stay. How likely are you to recommend our ward to friends and family if they needed similar care or treatment?

Meanwhile, NHS England has committed to publish the results from the test on the NHS England and NHS Choices websites “in a more transparent format which both patients and staff will find easier to understand and use”, according to its guidance.

“The number of responses will also be published alongside the data to indicate the levels of participation in the friends and family test within that organisation. The date of this change will be confirmed through the monthly publication,” it added.

The proposed changes follow an NHS England review which concluded the test score − calculated using a net promoter score scores the ranges from 100 through to -100 − was “widely misunderstood” by staff, patients and the media.  

The review said: “It is very clear that the current FFT score that is produced from the collected data is widely misunderstood and does not lend itself to clear communication.”

The guidance said it was developing “analyses” to help identify when test data had been “gamed”.

Prime minister David Cameron announced in July last year that friends and family would be “single measure that looks at the quality of care across the country.”

“With the friends and family test, we now have a single measure that looks at the quality of care across the country,” he said at the time.

However, NHS providers have long raised concerns about the test’s suitability as a comparative tool, and NHS England admitted last November that the test could not be considered a “statistical measure”. 

From December this year, the test will be rolled out to GP practices, and from January 2015, to mental health and community services.

It will further be extended from April 2015 to NHS dental practices and patient transport services as well, covering acute hospitals outpatients and day cases.

The guidance set out the key uses for the friends and family test as:

  • Gathering useful feedback from people who use services that can be fed directly to the staff that provide their care, in a simple format, in near real time;
  • Providing a broad measure of patient experience that can be used alongside other data to inform patient choice; and
  • Identifying areas where improvements can be made so practical action can be taken.

Source: NHS England’s friends and family test guidance July 2014


Readers' comments (5)

  • michael stone

    'trusts will also be mandated to collect free text comments from patients.'

    GOOD - a 'like' or 'dislike' without an accompanying 'why' (in other words, without the 'free text explanatory comments') is often near-to-useless !!!

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  • michael stone

    Just downloaded the report - the report makes the same point:

    'In particular, some trusts do not currently ask the follow-up question about why a patient gave a particular response, which necessarily limits the extent to which staff will understand what they are doing well and what needs to be addressed and improved.'

    Is that because those trusts don't 'get the logic', and it is simple as logic goes - or, cynically, because they have some sort of objection to patient feedback, I wonder ?

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  • Most Trusts use additional measures besides the FFT in isolation. The FFT is an indicator.

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  • Please remember the guideline
    "Providing a broad measure of patient experience that can be used alongside other data to inform patient choice"
    The FFT is not the single measure

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  • Simon Rowland

    This is great news for patients as it will make the feedback useful to Hospitals.

    We have been providing free-text analysis as part of our ViewPoint friends and family test and patient experience solutions, since the implementation of the FFT. Happy to help others.

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