Trusts to be rewarded for friends and family test success

13 November, 2012 | By Ben Clover

For all the talk of easing top-down control of trusts, the mandate mentions some levers that could hit providers.

The most significant of these is that hospitals with good scores under the friends and family test “will be financially rewarded”.

Read an in-depth analysis of the friends and family test

It is not clear if the financial “reward” will be under the existing Commissioning for Quality and Innovation (CQUIN) payments system or a different arrangement in the NHS standard contract between trusts and commissioners.

There are two versions of this test, one asking staff in the annual staff survey whether they would recommend the trust to a friend or family member, and one asking the same question of patients.

The latter system has already been trialled in the NHS Midlands and East strategic health authority cluster, where the response from hospitals has been mixed, with some dramatic fluctuations in trust performance.

The mandate confirmed the patient friends and family test would be rolled out to all acute hospital inpatients and A&E patients from April 2013 and, from October, “women who have used maternity services”.

It said it must then be introduced “as rapidly as possible” for all NHS services – although it is not clear if this will include NHS-funded care in the private or charitable sector.

A Department of Health spokeswoman said it would be for the commissioning board to decide exactly how the financial reward would be allocated.

The commissioning board will also have considerable power over many hospital trusts with its £12bn budget for specialised services, which commissioning board chair Malcolm Grant yesterday said would include chemotherapy.

The document issued this morning mentions “providing equally good access to care seven days a week” but only sets an objective to improve this “where possible”.

The mandate also formalises Andrew Lansley’s “four tests” for reconfiguration.

It said: “The commissioning board’s objective is to ensure that proposed changes meet four tests”, and sets out near identical wording to Mr Lansley’s, saying: “There should be clarity about the clinical evidence base underpinning the proposals, they must have the support of the commissioning GPs involved, they must genuinely promote choice for their patients and the process must have genuinely engaged the public, patients, and local authorities.”

Professor Grant told a conference in Manchester the mandate was intended to “get away from the Bevan culture of the Tredegar bedpan” - referring to a speech by the first secretary of state for health that the reverbarations from even a small care failing should be heard by central government.

He said: “Responsibility has to be taken at the point where resources are applied”, but added patients would be protected by the NHS constitution.

Readers' comments (11)

Anonymous | 13-Nov-2012 1:17 pm
I can't wait to read that CEO have been telling their staff that if they reply positively to staff surveys that there will be more money to spend ! What next.... Brownie points for cleaning patients shoes !
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Anonymous | 13-Nov-2012 1:21 pm
To Anon 1:17 - this already happens in my area of (non-NHS) healthcare: large retail pharmacy chains have for many years rewarded branches for positive scores and the ensuing fiddling and pressure to get them is well recognised
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Anonymous | 13-Nov-2012 1:32 pm
It's just weasel words. An objective to improve 'where possible' is hardly an objective. As a patient I would rather be protected by knowing I was going to be treated by someone who was good at their job and enjoyed doing it rather than someone who was average at best, completely demoralised after years of constant change and couldn't care less about me as an individual other than to ask me if I would recomend them to my friends or family.
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emph-asis | 13-Nov-2012 1:57 pm
Perhaps a lever that makes all staff think about the patient satisfaction is not a bad thing? I am happy to reward my staff for a job well done; the challenge is finding a reliable and independent way of measuring it.
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Anonymous | 13-Nov-2012 2:06 pm
Given the wide resource discrepancies between acute providers that already exists this is likely to reward those who already have and further disadvantage the 'have not's'
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Insideperspective | 13-Nov-2012 3:53 pm
Surely the idea of a PBR/ patient choice system is that those trusts delivering better quality to patients will receive more tariff as a result of (at the margin) patients preferentially choosing them.

As commentators have already said, the results can be rigged more easily than the 1967 Russian general election - anyone can fill in paper forms or log in and do so, even when they havent been patients.

To provide additional financial incentives shows a fundamental failure to understand the basics of market economics.
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Anonymous | 13-Nov-2012 3:55 pm
Has anyone audited or validated how Hinchingbrooke shot up the NPS rankings? Is this a genuine result, or could it have been rigged?
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Phil Addison | 13-Nov-2012 6:33 pm
Hinchingbrooke now is not top it is down to number 12.

http://www.strategicprojectseoe.co.uk/uploads/files/September%20Screenshots_v%201.pdf

I am doing research into the test and timing so when and who you ask (as with other feedback) is very important. All feedback is subject to gaming!

*By the way as part of my research we have developed free software for NHS www.make-feedback.com.
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Anonymous | 14-Nov-2012 2:19 pm
Surely the DH has a statistician to advise them?
He/she will know that unless there is 100% patient and staff compliance in sending this sort of data in, (or a statistically sound sampling system) the results will be meaningless. Any self-selecting basis for non-compliance by patients or staff will immediately invalidate the results.
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Even if it were appropriate to award money for "quality", surely it would be better to give the money to the worst Trusts, to help them improve. If not the DH will be responsible for increasing inequality, not decreasing it.
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Jim Thompson | 3-Jan-2013 2:11 pm
The Information Governance issues will determine that only professional systems will be acceptable to gather and ensure the data sits in the correct place with the correct security.

Paper methods are a good backup, but by their nature, suit only a simple tick box for the FFT question and not any comments - (being too expensive to process)
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Stuart Mathieson | 3-Jan-2013 3:25 pm
Agree Jim that professional systems are needed but paper still has by far the greatest reach. Patients won't enter powerful comments on devices in clinical settings and often need to confer with relatives & carers back home. Secure confidential feedback can be routinely collected from paper economically with the right system - See http://tinyurl.com/arjslvb
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