Intended for healthcare professionals

Rapid response to:


Friends and family test should no longer be mandatory

BMJ 2018; 360 doi: (Published 29 January 2018) Cite this as: BMJ 2018;360:k367

Rapid Response:

Re: Friends and family test should no longer be mandatory

Firstly, thank you to the authors, all hugely respected in their fields, for being bold enough to write this article which reflects the views of and discussions with many practitioners in the field of patient experience, including myself. On a personal level, I have known Jocelyn Cornwell for more years than I'd care to remember, going back to the 90s and my time working at the College of Health, founded by Michael Young, Lord Young of Dartington, an early pioneer of consumer and patient rights and founder, amongst other things, of the Consumer's Association. We were championing and training NHS staff in how to run focus groups well before Tony Blair discovered them!

Reflecting on the impact of the Friends and Family Test at King's, I still hold the view that the introduction of the Friends and Family Test, took our eyes off the prize and sent us off course; it was a distraction and a very expensive one at that.

At King's we've a long history of openly seeking patient views, introducing our own inpatient survey way back in 2004, probably one of the earliest trusts to do so. We asked patients a comprehensive set of questions covering their patient journey with us. It took a bit of time, but there was great buy in from staff and we achieved real and sustainable improvement and the survey results really mattered to our staff. We regularly hit our 50% response rate target for our inpatient survey - now we are struggling to hit 30%. Back in the day we even asked patients if they would recommend King's. However, we made a decision to drop that question as it didn't provide useful data. Over time, we extended our surveys into outpatients and day surgery/day case. I admit that the launch of the Friends and Family Test (FFT) in 2013 meant we had to quickly launch feedback in A&E and that was a good thing. However, the focus placed on trusts to achieve volume over quality through the early FFT CQUINs had a negative impact. I agree with other responders to this article - the focus on response rates was wrong and has had a lasting negative impact. As a social scientist, I fully appreciate the need for robust data but, with an A&E that sees upwards of 350 people a day at only one or our sites, we don't need a 20% response rate to understand what's important to our patients. What we need is time an resource to action change.

At King's, there is a strong desire to be up with the best in terms of our FFT performance, which is right- we want to provide an excellent patient experience and our target is to be in the top 10% nationally measured by FFT. However, as others have stated, the key value of FFT is not in that percentage recommendation rate, but in the follow up comment /s - that is where the meat is. We are lucky enough to work with a supplier (and yes, we pay, but not as much as many!) who provides invaluable insight and analysis of the FFT free text comments. This to me is the only real value of FFT. However, I don't think we need FFT to get this qualitative feedback. We've always asked patients to give us their comments through surveys, interviews, discussion groups and regular patient stories to the Board. Personally, I think that the time I input into developing our programme of patient stories to the Board of Directors and into our wider listening programme, is more valuable than the time spent on managing the 'beast' that is FFT. Perhaps I am old school but, to me, one powerful story is worth more than a thousand FFT ratings. This is not to negate the importance of performance data but it can't stand alone.

I have to say, that the views I have expressed in this response are my own but do reflect many at King's and many of my colleagues in the field. I fully appreciate that the birth of FFT was, for some trusts, the first real catalyst to seek patient feedback on a regular basis and that has to be a good thing. For us at King's, it was a bit of a distraction from what we were already doing rather successfully, and a huge drain on resources.

Not a single one of us I am sure doubts the importance of listening to our patients and their families - that is a done deal. However, please give us some freedom to listen without the constraints of a mandatory Friends and Family Test.

Competing interests: No competing interests

30 January 2018
Jessica M Bush
Head of Engagement and Patient Experience, King's College Hospital NHS Foundation Trust
King's College Hospital, Denmark Hill, London SE5 9RS