Significant variation between trusts in the response rates to the friends and family survey has sparked fresh concern about the test’s validity following publication of the first national results on Tuesday.  

However, analysis revealed a “moderate correlation” with last year’s NHS’s annual inpatient survey, providing a boost for the controversial measure which has been consistently criticised for lacking statistical rigour.

The results cover feedback from over 400,000 patients who completed the test, which asks respondents if they would recommend a hospital to their friends and family, between April and June.

Data was collected from in-patients and accident and emergency departments.

However, A&E response rates averaged just 8 per cent, much lower than the 15 per cent NHS England targeted.  

Nearly a quarter of inpatients completed the survey nationally, although trust performance varied markedly.

East Kent Hospitals University Foundation Trust managed to collect responses from just 1 per cent of patients while the Royal National Hospital For Rheumatic Diseases Foundation Trust had a response rate of 81 per cent.

Specialist hospitals scored far better than their general counterparts in the inpatient survey, making up the top 11 trust scores.

Friends and family average scores

Friends and family average scores

The Royal Marsden Foundation Trust topped the table with an average net promoter score of 95 over the three-month period. Barking, Havering and Redbridge University Hospitals Trust came last, scoring 40.  

However, initial analysis of the results undertaken by the Picker Institute found a “moderate correlation” between trusts’ performance on the friends and family test and last year’s in-patient survey.

Chris Graham, its director of research and policy, told HSJ: “We have found a stronger correlation than we might have expected.

“The June data is less strong in terms of correlation but the data over the quarter shows a moderate correlation.”

Mr Graham gave caveats around the data, stating the huge variety in responses rates could harm the data’s validity.

The institute stressed its analysis was preliminary. It also advised against compiling league tables of trusts’ performance.

NHS England national director for patients and information Tim Kelsey told HSJ there were correlations between the data and other measures. He stated that when inpatient and A&E scores were combined eight of the bottom 10 trusts were already under scrutiny from regulators.

Tim Kelsey

Tim Kelsey

Mr Kelsey said response rates would improve as trusts and patients got used to the test.

There remains significant opposition to the test. Critics cite opportunities for trusts to “game” results and lack of statistical rigour as major concerns.

Jocelyn Cornwell, director of the Point of Care Foundation, a charity seeking better experiences for patients, said: “The way in which the data is collected varies widely and is open to gaming.

“Also, the information provided is not meaningful. We know patients are more likely to be positive when they’re in hospital than when they’re at home.”

Top five trusts, including specialist trustsScoreResponse rate (%)
The Royal Marsden FT9533
The Robert Jones and Agnes Hunt Orthopaedic Hospital FT9228
Liverpool Heart and Chest FT9135
Clatterbridge Cancer Centre FT9140
Papworth Hospital FT9031


Bottom five trusts, including specialist trustsScore Response rate (%)
North Middlesex University Hospital5222
Surrey and Sussex Healthcare5219
Cambridge University Hospitals FT5127
Royal Free London FT518
Barking, Havering and Redbridge University Hospitals4036


The 14 Keogh review trustsScore Response rate (%)
Buckinghamshire Healthcare829
Burton Hospitals FT8030
George Eliot Hospital7919
Northern Lincolnshire and Goole Hospitals FT7810
Colchester Hospital University FT7638
Sherwood Forest Hospitals FT7523
Blackpool Teaching Hospitals FT7326
The Dudley Group FT7226
Tameside Hospital FT6827
East Lancashire Hospitals6858
United Lincolnshire Hospitals6528
Basildon and Thurrock University Hospitals5826
North Cumbria University Hospitals5513
Medway FT5531


Top five non-specialist trustsScoreResponse rate (%)
West Suffolk FT8534
Frimley Park Hospital FT8319
Hinchingbrooke Health Care8260
Buckinghamshire Healthcare829
Worcestershire Acute Hospitals8127

Source: NHS England