Critics question whether “friends and family” test in NHS is fit for prime minister’s purpose

BMJ 2013; 346 doi: (Published 07 January 2013) Cite this as: BMJ 2013;346:f83
  1. Zosia Kmietowicz
  1. 1BMJ

The BMA and the NHS Alliance have questioned the value of the latest idea from the prime minister for all general practitioners in England to undergo the “friends and family” test as a way to root out services that offer unacceptable standards of care.

Last May the government announced that hospitals in England would be subject to the test from this April after a recommendation from the Nursing Quality Care Forum, which was set up last January after a number of high profile cases of poor care in the NHS.1

But on 4 January David Cameron said that the test, in which patients and staff are asked whether they would recommend a service to a loved one, should be extended to GP surgeries, district nursing services, and community hospitals.

Cameron, who has been championing greater compassion in care for the past year,2 said that there was still “a long way to go to raise standards across the NHS and get rid of those cases of poor and completely unacceptable care that blight some hospitals and homes.”

The health secretary for England, Jeremy Hunt, said, “The new friends and family test will shine a light on standards of care throughout the system and help expose the shocking examples of poor care that have been coming to light much earlier.”

However, the BMA and others have raised concerns about whether the test would be suitable for detecting substandard services.

Mark Porter, chairman of council of the BMA, said, “Doctors and the NHS, generally, welcome feedback from patients and their families. However, the friends and family test that has been piloted so far is based on a model developed to test satisfaction with consumer products. We would like to see a full evaluation of the pilot before it is rolled out more widely, as there may be better ways of getting useful information from patients in a form that allows the NHS to improve services.”

Michael Dixon, chairman of the NHS Alliance, and Brian Fisher, its lead on patient and public involvement, said that they had long supported the need to take account of patients’ experiences of the NHS, including in general practice. But the friends and family test was not the right mechanism, they said, because it did not allow patients to explain why their experience was good or bad.

They said in a statement, “There are already methods available to deliver feedback, and the friends and family test won’t add anything new, or tell patients what they want and need to know.”

Cameron also announced that new minimum standards of training for care staff would be published within weeks. Access to training to provide support for people with dementia would also be available to all NHS and social care staff, while every ward would have a “dementia champion” and every NHS organisation a dementia nursing expert. A £50m (€61m; $80m) incentive scheme would be available in 2013-14 to improve care of people with dementia.

All hospitals would also be urged to introduce hour by hour nursing care rounds. So far nine in 10 hospitals have done so, the Department of Health said.


Cite this as: BMJ 2013;346:f83


  • Observations: You can’t mandate compassion (BMJ 2012;345:e8509, doi:10.1136/bmj.e8509)


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