• Key ‘friends and family’ question dropped
  • Timing restrictions relaxed
  • Patients Association says reforms suggest original test was a failure

NHS providers will no longer be required to ask patients whether they would recommend their service to “friends and family”, and rules on when they must ask mandatory experience questions will be lifted, NHS England has decided.

Under plans set out in a letter to NHS chief executives earlier this month, from next April, there will be no requirement to ask the so-called “friends and family” question. 

Instead, NHSE is proposing a new mandatory national patient experience question – “overall, how was your experience of our service?” – with six possible answers, which have not yet been set out. Further guidance is to follow later in the year.

There will no longer be a mandatory question about whether the patient or service user would recommend the service. This is the core element of the controversial “friends and family test” introduced six years ago, which some saw as a powerful lever for patients and source of mass feedback, and others argued was seriously flawed.

In addition, current strict limits on when patients should be asked for their feedback will be relaxed. At present, in acute settings or emergency departments, patients must be asked the question within 48 hours of discharge; while, in maternity settings, patients are asked several questions at specific care points such as during antenatal care, at discharge from the birth suite, and at discharge from a postnatal ward.

From April, across accident and emergency, maternity and inpatient services, patients must be free to give feedback at any time, “though providers may also still prompt feedback at a stage that suits them”.

NHSE said the changes were designed to ensure the test “can be a more effective tool in gathering patient feedback that helps to drive local improvements in healthcare services”. 

The letter from Neil Churchill, director of experience, participation and equalities, said there would be a new “universal mandatory question – successfully tested with a broad range of people, including children down to the age of eight – that asks, in the context of each service, ’overall, how was your experience of our service?’”.

The Patients Association told HSJ the changes appeared to suggest the original test had been deemed a failure and questioned whether this was a missed opportunity to create a better feedback system.

In his letter, Mr Churchill said the changes would increase flexibility. He said: “We believe that continuous feedback from patients can play a key role in monitoring and delivering high quality care.

“The changes to the FFT are all about helping services and commissioners to use it as more than a quantitative measure of collection and move towards more active use of the feedback, alongside other patient experience data, to drive quality improvements.”

Ambulance services will be given alternative options to be set out in coming weeks.

Rachel Power, chief executive of the Patients Association, said: “This change essentially seems to abandon the original ‘friends and family’ concept in favour of a general feedback questionnaire. If so, NHS England would seem to have declared the friends and family test a failure – which may or may not be fair, but they should be publishing their evidence for that in some detail.

“Could this be a missed opportunity to introduce a substantially different mechanism for getting essential patient feedback into the NHS? Might the NHS do better to concentrate its efforts on capturing spontaneous, unprompted feedback, in moments when patients are genuinely grateful, or genuinely upset? With so little information on the rationale for this change, it’s hard to say.

“We would also like to see more detail on how the feedback will be used to improve services, which is the crucial thing, and which NHS England’s letter refers to only briefly.”

NHSE has published details of the “development project” which led to the changes, but not published a review or report on its decision. It has said it is planning to publish further guidance and advice on the new approach later this year.

According to NHS England, patients submit around 1.2 million pieces of feedback every month via the friends and family test.

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