Trusts “consistently” raised concerns about using the controversial friends and family test in accident and emergency departments, according to research commissioned by the NHS and obtained by HSJ.

The audit of 162 trusts by consultancy Fr3dom Health was carried out in February and March, as they were preparing to use the patient satisfaction survey.

It found all were ready to roll it out in April, as required under national guidance, but said trusts had highlighted concerns about the viability of its use in A&E.

Two summary reports by the consultancy (see attached) were released in response to a request under the Freedom of Information Act. One of the reports says: “From a trust point of view the main concern remains the ability to manage the friends and family test in A&E environments.

“While this is probably not a surprise the consistency with which this comes through is [a surprise].”

The work was commissioned in February by the strategic projects team of the now abolished East of England strategic health authority, which pioneered the friends and family test.

NHS England, which is now overseeing use of the test, said in response to the reports this week that trusts had returned data for A&Es for April.

However, managers and professionals assisting organisations to implement the test have also told HSJ of particular concern about its use in A&E.

They told HSJ some A&E departments were struggling to reach the 15 per cent response rate required by national guidance because of the more chaotic environment and range of patients seen in A&E. 

Poor A&E waiting times performance in much of the country in recent months (see right) suggests there has been significant pressure on the services.

One senior source closely following trusts’ progress in implementing the friends and family test told HSJ: “Hardly anyone is getting near the 15 per cent required response rate for A&E. It doesn’t give any real guide to quality either.

“They [the DH and NHS England] should scrap it all together [for A&E].”

Failure to reach the required response rate could mean trusts lose income, because the test is one of four commissioning for quality and innovation targets in contract guidance for 2013-14.

The CQUIN 2013-14 guidance says: “Providers will need to achieve a baseline response rate of at least 15% and by Q4 a response rate that is both (a) higher than the response rate for Q1 and (b) 20% or over.”

The Fr3dom Health reports also said more than a third of trusts were not following guidance in how they “framed” – or presented – the test question. They said some were still finalising their approach to it.

They also show trusts are using a wide range of methods to gather their data.

The single most popular was “to ask patients to complete a paper survey”, while others are using other methods including tablets, text messaging and phone calls.

A range of staff are handing out the surveys with most opting to use nurses and ward support. Some are using volunteers and small number clinicians and managers.

A NHS England spokeswoman told HSJ: “While the report does raise concerns about the management of [the test] in A&E environments, its conclusion that that trusts were ready to deliver the [the test] has been shown to be accurate as 100 per cent of A&E and acute overnight departments submitted a return covering the first month.”

A Department of Health spokeswoman said: “NHS organisations have worked hard to implement the test. As the report shows they have been successful, with 100 per cent of trusts submitting data - this deserves credit.”