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Friends and Family Test: what it means for NHS

This news article was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Following the recent announcement by the Prime Minister of a ‘Friends and Family Test’ to be implemented in the NHS, in response to recommendations…

Following the recent announcement by the Prime Minister of a ‘Friends and Family Test’ to be implemented in the NHS, in response to recommendations by the Nursing Care Quality Forum, the Department of Health has issued more information about the test.

What it means for the NHS

  • Introduction of a standard Friends and Family Test question in acute inpatient wards and A&E departments from April 2013.
  • Reporting of standardised data at national level by Trust, based on a standard question.
  • Coverage of all acute inpatient wards (with limited exceptions).
  • Inclusion of and reporting from A&E.
  • Ward-level data based on the above to be published from April 2013.
  • The approach to implementation will be refined over the coming months through co-production with the NHS and other key stakeholders such as the NHS Confederation, Monitor, Foundation Trust Network, and Commissioners.

The Friends and Family Test (FFT) is an easy-to-understand question that will be asked of patients about the care they received.

It’s being introduced because we want NHS organisations to obtain regular and timely feedback from patients about the care provided in the NHS, take ownership of the results and act on the feedback.

This isn’t a new concept for the NHS: many hospitals are already getting regular feedback from patients and acting on it to improve services; some hospitals are using a simple question about overall experience of care as part of their patient feedback activity.

What will the question be?

We want the public to be able to compare hospitals. To enable comparability we expect to have to ask hospitals to ask the same question and use similar methods.

We will work with the NHS over the coming months to develop the most appropriate question and method, building on the learning already available in many parts of the NHS.

It is important that the question we use is meaningful for patients, can discriminate reliably between good and poor services and drive improvements.

Will it be introduced in every NHS setting?

All providers of acute inpatient services, and A&E departments will be required to ask their patients the simple question.

Will it be asked in every acute inpatient ward?

The expectation will be that FFT will be implemented in all acute inpatient wards; there will be a few exceptions such as Intensive Care Units where it may be inappropriate to seek feedback from patients.

When will the friends and family test be introduced?

We will be requiring all providers of NHS funded acute inpatient services and A&E departments to deliver this from April 2013 and this will be a requirement in standard contracts.

Ward-level data and A&E department data based on this question will be published from April 2013.

Does the NHS need to stop/change current feedback activities right away?

The NHS should already be working towards meeting the requirements of the Operating Framework this year to actively seek out, respond positively and improve services in line with patient feedback. This activity is important, and should continue.

The development work the Department is doing with the NHS, SHA clusters and others such as the NHS Confederation and Foundation Trust Network, will result in a standard question being rolled out from April 2013. Trusts should be mindful of this when planning their patient experience work.

What feedback tools will you expect the NHS to use to ask the question?

It is important to keep costs to a minimum so we will be working with providers and commissioners to determine the most cost effective method - but we will require an approach to enable patients to compare Trusts on a like-for-like basis .

Developing real-time patient feedback systems has been an expectation in the Operating Framework since 2008. Wherever possible NHS organisations will want to build on mechanisms already implemented eg existing real time feedback systems and surveys.

It is important that the question is asked of a sufficiently large sample size in each setting, in order to get statistical significance to enable comparability over time.

What support will DH give to SHAs and the NHS in rolling this out?

The approach to FFT implementation will be refined over the coming months as we work with the NHS and other key stakeholders, with further details being available in the autumn.

Many parts of the NHS are already very active in getting feedback from patients and using it to improve services. We will learn from their experience and work with SHA colleagues, providers and commissioners to help develop a common approach and standard question.

Where will the results be published?

Ward-level data will be published from April 2013 on a locally determined basis. Providers and commissioners will be able to load up their Friends and Family score via the local profiles which already exist on NHS Choices.

We will be working closely with SHA colleagues and provider/commissioner organisations to determine other viable options for national publication of results.

Will results be comparable across the country?

Hospital level data will be comparable - patients will be able to rate hospitals and see which have improved or got worse. Due to the difference in size of hospitals, there may not be strict comparability across all wards or hospitals immediately as it will take some time to build up statistically significant data.

How many people will be asked the question?

This will depend on the size of the organisation. It will be important that enough patients are asked the question so that the results are meaningful and representative so therefore we will not be setting central quotas.

How much flexibility is there over what is implemented?

To achieve a step change and allow publication of data from April 2013 there will naturally need to be some standardisation of approach. We will work with SHA colleagues, providers and commissioners to establish this. Many parts of the NHS have already developed good practice that can be drawn from.

Has an impact assessment been made of the policy in line with guidance?

This is not a new burden - many organisations already ask their patients for feedback, and this has been an expectation in the Operating Framework for several years. We are however working closely with SHA clusters on the detail of implementation and how to maximise its effectiveness in improving services and informing patient choice.

Further information

An initial meeting with SHA cluster colleagues is happening in early June to begin working through the details outlined above. We will provide an update via SHAs following this meeting. In autumn we will issue further updates on progress with the work underway with the NHS and other stakeholders on standardising the question and overall approach.