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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)

  • tinkerbell

    P.S. Mike if you are sending it to any members of government could you throw in a few choice swear words for me and tell them that I think they are a bunch of ******* clowns who couldn't organise a whatsit in a whatsit. Many thanks.

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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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  • michael stone

    tinkerbell | 8-Sep-2013 4:07 pm

    Thanks Tink, as it happens I prefer 'short and pithy': but have you tried to explain to people who have written a 20-page guide about Advance Decisions, that the fact that an ADRT refusing a life-sustaining treatment must be written to be valid, does NOT mean 'that a verbal refusal of CPR is not legally binding' ?!

    I would prefer guidance that curt through the 'crap of the caveats' - so I would prefer guidance to be written more like this:

    'If CPR might be clinically successful, the decision-making rule is this:

    For CPR, the rule is that if a clinician is aware of information which would persuade a reasonable person, that the
    patient would have refused CPR for the CPA in question, had the patient somehow been able to consider the issues relevant to his CPR decision during a CPA and also to indicate his refusal, then the clinician must not attempt CPR. If a clinician attempts CPR, and a third party believes the clinician should have concluded that the patient would have refused resuscitation had the patient been capable of doing so during the CPA, then the clinician is running a risk of prosecution for assault.

    If the clinician is not reasonably persuaded that the patient would have refused CPR, then CPR should be attempted.'

    And, the even simpler compresion of things like this:

    '‘Good care’ is care that the patient would have considered to have been good, if somehow he/she could retrospectively
    express a view. It is that simple - behaviour that the patient objects to, and non-communication that leads to huge conflict and resentment and anger, isn‘t normally ’good care‘.'

    But, sadly, clinical guidance isn't currently being written in that style: I need to work through 'the technical argument' if I'm arguing the case with guidance writers (especially the ones who don't seem to properly understand the law).

    How guidance should be written, is an interesting debate - what is obvious, is that at present it isn't good enough, and it isn't 'correct' for some issues, either.

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  • michael stone

    PS to Tink:

    I don't like being described as psychotic - I prefer being described as mad, which is both more accurate and more ambiguous !

    And my stuff doesn't go to the Goverment: I've already included your bit in something which will wing its way to Bee Wee, and I did describe you as a Mental Health Nurse.

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  • michael stone

    tinkerbell | 8-Sep-2013 4:07 pm

    Tink, are my comments at:

    more to your taste, style-wise ? I think I've put some rather nice ones, in there ?

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  • tinkerbell

    michael stone | 9-Sep-2013 3:54 pm

    thanks Mike, will take a look.

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