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'Staff don’t need another stick to be beaten with'


We all love a listing. Many a weekend away now starts with a click on TripAdvisor to pick the hottest hotels and the coolest cafes.

But transfer this idea to the NHS, as the Friends and Family Test has done, and I am not sure it gives a full picture of how well a department or trust can meet the patient’s needs. In fact, many argue scoring hospitals in this way has proved counterproductive.

Originally, net promoter scores (the basis for the Friends and Family Tests) were introduced to measure the success of private sector services. It was deemed useful to compare the customer service of, say, one high street bank with another. But there are all sorts of variable factors involved in a visit to, say, an accident and emergency department - how unwell the patient feels, how busy the department is, whether there has been a major incident and so on.

I am not saying these variables should not be measured. Far from it - they can be a useful indicator. But we should remember those who score the trusts are self-selecting and so can skew the figures.

This week, Yeovil District Hospital claimed its Friends and Family Test results (see page 2) had been misrepresented by the quintile method adopted by NHS Choices, which takes out the lower 20% of trusts and categorises them as being among the worst in the country. Even though - as in the case of Yeovil - 95% of its respondents would recommend the trust to friends and family.

The data is also flawed because it does not take into account the volume or percentage of respondents. Many trusts surveyed under 5% of patients and gained a higher ranking than those who provided scores with a greater proportion (and volume) of responses. So some of the numbers are not robust behind the rankings. Some trusts have nearly 400, while some don’t even manage 100. It seems the latter doesn’t give enough of a statistically sound base to draw conclusions from or comparisons with. And yet NHS Choices is.

Trusts are used to being measured against targets and filtering out the findings to help them improve performance. However, this test has been given such a high profile by the prime minister that the public have been encouraged to put a huge amount of faith in it.

The test has some merit. However, without a commentary, the results can be misleading to the public and demoralising to staff.

What NHS staff don’t need is another stick to be beaten with.

If NHS England wants to publish these test results, it should do so responsibly, with respect for those hardworking staff and hospitals whose reputations could be ruined by the data.

Jenni Middleton, editor Follow me on Twitter @nursingtimesed


Readers' comments (16)

  • Good point about the statistics
    Thank you

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  • In private industry, if a company does not listen to and provide what the customer wants, they go out of business. Customer surveys are a fact of business.
    The NHS should also always listen to their customers, and respond.
    Is the inward-looking culture too concerned with the effects on staff, instead of hearing the views of the people for who the NHS is intended ie. the patient
    Patients, and their views, are important - they are the customer!!

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  • Patients are not customers and using customer satisfaction tools that work in private industry is clumsy and a pointless waste of time. It will not help the vulnerable elderly being treated badly and is far too easy to skew. Surely it would be far better for health services to have a visible figure who is in charge and who will not only listen to complaints but will set and maintain standards and instill pride in the work force so we can concentrate on patient care not on satisfying the relatively narrow parameters any question asks. It's a sad fact we are spending so much time getting patients to comment on services and therefore less on patient care. This is the same mentality that has people wanting to know how to pass an exam rather than learning about something and being able to demonstrate that learning had taken place.

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  • I wonder how they are going to do this in my field of work, Severe and enduring mental illness? Some of the people I see, their attitude to me can change by the hour, ranging from me being their best friend to their worst enemy. Hopefully they will do the survey when they are in a good mood

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  • tinkerbell

    there has to be a middle ground where everybody has a voice, staff and patients. If it is the latest vogue to call them 'customers' or whatever, the principle remains the same. We want to know that whilst that patient, customer, human being was in our care they felt cared for and weren't just passive recipients of care who were uninvolved in the process. After all we are there for the patients they are not there for us.

    Because hospitals are so huge, each department speciality should take responsibility for their feedback and this should not be sought by the nurse providing the care but someone other who also has an investment in that department e.g., the ward manager.

    The survey should be kept brief and simple so everyone can understand the questions being asked, because we need to walk before we can run.

    It seems as usual something has been rushed through without giving it much thought and does not properly reflect the amount of good care that is being provided. Departments that are providing excellent care should be highlighted and other departments that are not meeting standards can be compared to those that are and the question that should come out of that should be 'why not?'. Is it due to low staffing, culture, etc., and then once you have established the problem work towards a solution.

    Everything gets so terribly complicated by the bureaucracy of the NHS which is probably one of its biggest problems.

    As someone at work recently said we should use the KISS approach. Keep it simple stupid.

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  • a patient who had poor experiences of the NHS stated in a comment in the telegraph today that managers are concerned by what is reported and not what actually happened to the patients.

    I feel this is a valid point which applies in some areas and worth bringing to attention of the NT readership.


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  • Hmm!
    I may have misinterpreted the NMC new proposals about re validation but isn't this one of the items they were proposing ???
    Quite often nurses still have to act as the patients interpreters after the visit from the doctors STILL

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  • tinkerbell

    The Friends and Family Test is based on one simple question, ‘How likely are you to recommend our ward/A&E department to your friends and family if they needed similar care or treatment?’ Patients are presented with six responses ranging from ‘extremely likely’ through to ‘extremely unlikely’.

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  • michael stone

    Tink, this is out-of-place but I'm trying to 'catch up with you'.

    I am planning to use your earlier comment (below) in my 'stuff', because I really like it and it is very short, very clear and blindingly correct. And your final sentence can be linked with some of the Neuberger LCP Review's comments quite neatly. I will of course attribute it to Tinkerbell and NT, but would you like to be described as a Mental Health Nurse, or as a mental nurse, or as something else ? 'As a pixie' isn't acceptable, as it would reduce the 'gravitas' of the quote.

    Cheers, Mike

    As a 'simpleton'(George's expression with which I agree) all I can say is that if I am in excruciating pain without any hope of making a recovery as I have a terminal illness then I would like as much pain relief as I can have to relieve my pain even if it kills me.

    If I have the potential of making a recovery then I would want as much pain relief as I can tolerate without it killing me.

    I would certainly hope that if that situation occurs I will not have a team unsure of what to do debating it whilst I scream out in pain 'for Gods sake somebody please help me'.

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  • tinkerbell

    michael stone | 8-Sep-2013 2:09 pm

    You must be psychotic because I was only thinking about you today and wondering if there was a way you could make your writings more clear and concise or bullet point them so they are easier on the eye and get to the heart of the matter more precisely without losing the attention of the reader. Don't get me wrong I realise you are passionate but just wondered if there was a way to bring it all together more concisely.

    By all means you are welcome to use it but I would rather not be described as a 'mental nurse' but a mental health nurse even if I am a pixie.

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