NHS England is to change how the friends and family test is implemented and presented after a major review concluded it cannot be used as a “single measure” for the quality of care across the health service as originally intended.

The review - published a year on from when the test was rolled out nationally - found the new metric was “widely misunderstood” by staff and the public, and raised concerns about the data being “gamed”.

New guidance issued alongside the review said from April 2015 trusts will be mandated to collect free text comments from patients and should collect demographic variables alongside the test data.

Under the current friends and family test, patients are asked a standard question (see box, below) which they can answer as “extremely likely”; “likely”; “neither likely nor unlikely”; “unlikely”; “extremely unlikely”; or “don’t know”.

The new guidance also said that token systems - where patients are able to give a score by dropping a token into a box - will not be permitted after April 2015 because they have to be collected separately from follow up comments. This means scores and comments cannot be linked.

The guidance also confirmed trusts must collect data from all inpatient services including day cases from April.

The friends and family question

“We would like you to think about your experience in the ward where you spent the most time during this stay. How likely are you to recommend our ward to friends and family if they needed similar care or treatment?

NHS England has also committed to publish the results from the test on the NHS England and NHS Choices websites “in a more transparent format which both patients and staff will find easier to understand and use”, according to its guidance.

“The number of responses will also be published alongside the data to indicate the levels of participation in the friends and family test within that organisation. The date of this change will be confirmed through the monthly publication,” it added.

The proposed changes follow an NHS England review which concluded the test score - calculated using the net promoter score - was “widely misunderstood” by staff, patients and the media.  

The review said: “It is very clear that the current FFT score that is produced from the collected data is widely misunderstood and does not lend itself to clear communication.”

The guidance said it was developing “analyses” to help identify when test data had been “gamed”.

Prime minister David Cameron announced in July last year that friends and family would be “a single measure that looks at the quality of care across the country”.

“I am determined to give patients a far greater voice within the NHS as a way of highlighting the best and worst of care within our hospitals,” he said at the time.

“With the friends and family test, we now have a single measure that looks at the quality of care across the country.

“I want the NHS to put patient satisfaction at the heart of what they do and expect action to be taken at hospitals where patients and staff say standards are not good enough.”

However, NHS providers have long raised concerns about the test’s suitability as a comparative tool, and NHS England admitted last November that the test could not be considered a “statistical measure”.  

From December this year, the test will be rolled out to GP practices, and from January 2015, to mental health and community services.

It will further be extended from April 2015 to NHS dental practices and patient transport services as well, covering acute hospitals outpatients and day cases.

The guidance set out the key uses for the friends and family test as:

  • Gathering useful feedback from people who use services that can be fed directly to the staff that provide their care, in a simple format, in near real time;
  • Providing a broad measure of patient experience that can be used alongside other data to inform patient choice; and
  • Identifying areas where improvements can be made so practical action can be taken.

Source: NHS England’s friends and family test guidance July 2014