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

Thank you for your article. It is good to see this topic being discussed. Raising awareness of patient experience is a positive!

I fully understand, support, encourage and facilitate people feeding back on their care. Without really listening, how can we properly understand what is important to others, how do we know what we do well and how do we understand where we can improve? Feedback is essential to providing high quality care and experience in our NHS. I encourage and support staff to ask for feedback for the rich insight it gives and in most cases, the positive comments we receive which can motivate and support staff in their roles. Exactly how we do this is up for discussion.

We do need to collect data and information to be able to improve and without measurement you cannot track and monitor improvements. It is right and proper that NHS England ensure that organisations are collecting feedback. All successful organisations across the world will have implemented changes to their services based on evidence which has generally been collected from their consumers. We cannot meet the health needs of the population based on assumption. The Friends and Family Test (FFT) is the recognised measure mandated for the NHS, but is it fit for this purpose? This is something that a number of my colleagues have been discussing for some time.

Each month NHS organisations input FFT ‘numbers’ of how many patients responded and recommend the organisation into a data repository who are then ranked and compared. This allows NHS England and other organisations to understand which hospitals are achieving a higher response and recommendation rate. With this information we can learn and share best practise. Is it appropriate though to look at the response rate for a small specialist hospital compared to large general hospitals with numerous services? Emergency Departments for example can find it challenging to achieve high response rate for the FFT. The number of FFT cards received may not reflect the high quality service received and satisfaction of patients. There must be some middle ground where we can gain rich insight without ‘penalising’ for low responses.

The methods in which the data is captured are variable and are dependent on local organisations so cannot be compared ‘like for like’. It would simply not be feasible for all NHS organisations to allocate budget to having a bank of telephone operators proactively calling patients to measure their experience which is a solution commonly used in private sector organisations. Do the comparisons matter, should we just be ensuring we collect feedback AND improve by listening to that feedback?

The free text we gain from the FFT is very valuable and we should not lose this from our feedback mechanism. I often see FFT responses of 'not recommending' a service which then follows with comments in the 'free text' box giving a ‘glowing commentary’ about how good the service was, how kind the staff were and how safe a patient feels. This does not align.

I would suggest we should take the best from the FFT, learn from how it has been embedded into organisations and also really listen to staff that have 'issues' with the FFT. There are better ways to elicit feedback, capturing the emotional aspects of healthcare that are very meaningful to a good experience. We should focus on person centred outcomes and look for measures that we can co-design with patients. The hard numbers give just half the picture and the drive to increase the responses to me is missing the point somewhat. We MUST collect insight and use it the best of our ability. Gaining feedback should not just be about the ‘numbers’, it should be about the quality of what we get and in a manner which suits the patient. It would be excellent if we are able to flex the way we gain feedback, learning from each other, sharing best practice and still ensuring we are fulfilling our responsibilities of the NHS Constitution by asking for and using feedback.

In summary, we need to listen to feedback from OUR organisations, from NHS staff and continually improve by acting what we hear.

Please note these are my personal views / comments and not those of the organisation I work for.

Competing interests: No competing interests

31 January 2018
Michaela Tait
Patient Experience & Engagement Manager
Milton Keynes University Hospital NHS Trust
Milton Keynes