NHS Choices has been accused of “misleading” and “confusing” patients in its presentation of the results of the friends and family test.

Salford FF test

Performance against the controversial test is displayed on the NHS Choices profile pages of every acute hospital.

While hospitals with the highest 20 per cent of scores receive a big green tick against the measure, organisations in the bottom fifth have their position denoted by a large red exclamation mark and the words “among the worst”.

This is despite all but two of the lowest ranking trusts scoring above 50 for inpatient care. Results this high would be considered excellent in other industries that use friends and family-style “net promoter scores” to track customer satisfaction.

Performance in accident and emergency was weaker, with all of the bottom fifth scoring below 50. However, under net promoter methodology, in which the number of “detractors” is subtracted from that of “promoters”, any positive score is generally considered to be good. In July, only Barnet and Chase Farm Hospitals Trust and Medway Foundation Trust scored below zero.

The calculation of who is in the bottom fifth does not take account of variations in response rates. Trusts are expected to survey at least 15 per cent of patients, however some had quizzed just 6 per cent of inpatients and less than 1 per cent of A&E patients.

Yeovil Foundation Trust was rated “among the worst” on its inpatient scores in June, despite surveying almost 40 per cent of its inpatients and only six saying they would be unlikely or extremely unlikely to recommend the hospital.

The Western Gazette ran a story declaring the trust was “among the worst NHS trusts in the country” based on the NHS Choices presentation.

Yeovil FT director of nursing Helen Ryan told HSJ the trust had been pleased with its results – which equated to 95 per cent of patients recommending the trust – and had been “caught out” by the way NHS Choices had interpreted it.  

“NHS Choices has got completely the wrong way of displaying the friends and family results,” she said. “They say they have to present relative performance but in their effort to give people a choice they’re giving people misleading information which could worry patients unnecessarily.

“The interpretation of these results has been a devastating blow to a really good hospital which has good results. I continue to be baffled that the NHS can’t take the opportunity of saying well done to itself for doing a good job.”

Ms Ryan has raised the issue with NHS Choices and NHS England but there has been no change to how July’s results, published today, were presented.

Other trusts ranked among the bottom fifth in the test include Salford Royal Foundation Trust, widely regarded as high quality organisation, and Heart of England Foundation Trust.

Dr Mark Newbold, Heart of England chief executive and chair of the NHS Confederation’s Hospitals Forum, told HSJ he liked the test and found it useful for identifying issues and making improvements.

However, he questioned whether the test results were comparable, due to the variation in methods trusts used to collect the data.

“Even a relatively small change to the way you collect data can have a big impact on the result,” he said.

A Picker Institute analysis of the first nationwide set of friends and family results found average scores were six points higher at organisations which collected the results on paper or postcard compared to those which used an electronic tablet.

Mark Platt, Royal College of Nursing policy advisor on patient and public involvement, told HSJ the way NHS Choices presented the information was “likely to be confusing” for patients.

He said: “In terms of supporting patients to make an informed choice I’m not sure the NHS Choices approach is very helpful. The real benefit of the friends and family test is that it helps organisations to see where there are problems that need further investigation.”

NHS Choices editorial and data standards are set by the Clinical Information Advisory Group, which is chaired by NHS England medical director Sir Bruce Keogh. The website uses the ticks and exclamation mark system to display a range of data about trust performance, including the patient survey and whether trusts are meeting CQC standards.

In a joint statement NHS England and NHS Choices said testing of the exclamation mark system indicated users of NHS Choices “interpreted the Red exclamation mark as a ‘warning’ about an aspect of performance, and not, for example, an alarm that an organisation is somehow dangerous.”

A spokeswoman said: “To ensure we learn from the experience of using FFT, NHS England is committed to reviewing the operation of the Friends and Family Test once we have collected 6 months of data. As part of this review we will be seeking views from Trusts and patients on how best to present the data.”