Despite its flaws, the Friends and Family Test allows patients to give valuable feedback, writes Erin Dean
Would you let your family stay here?
SUMMARY
Patient feedback through the Friends and Family Test is to become standard in all NHS England settings by the end of the year. The test – which involves asking patients if they would recommend the service they are receiving to family or friends – was announced in January 2013 by prime minister David Cameron, who said it would act as a ‘flashing light’ to identify failing trusts. It has been established in all acute and emergency departments for the past 18 months, and began in maternity services last October. By the end of the year, the test will be widespread in GP, community and mental health services (see box). A review into the Friends and Family Test (FFT) commissioned by NHS England and published in July said the test has had a positive impact on patient services. Eighty five per cent of trusts reported it is being used to improve patient experience. In particular, The Friends and Family Test – a simple survey asking patients if they would recommend the health service they have received – is being amended in response to criticism that it unfairly condemned services on the basis of unreliable data. Despite its flaws, improvements have been introduced in response to feedback from the test. Author Erin Dean is a freelance journalist 22 september 10 :: vol 29 no 2 :: 2014
the open-ended follow-up question is proving a rich source of patient views. Actions prompted by the FFT include measures to improve cleanliness, provide warmer water in showers and better quality meals. The review recommended some fundamental changes to the test. When the first FFT results were published last year for acute and A&E services, critics highlighted the variation between trusts in the way responses are collected, the injustice of condemning some services on the basis of one or a handful of patient responses, and basic flaws in test design, with the questions too open to interpretation. Some concerns were upheld in the review, and are reflected in NHS England’s new guidance (tinyurl.com/ofc83yb) on implementing the test, which was issued last month. The NHS England changes include altering how the score of the FFT is worked out. It is currently calculated by subtracting the proportion of patients who are ‘Extremely unlikely,’ ‘Unlikely’ or ‘Neither likely nor unlikely’ to recommend, from those who are ‘Extremely likely’. Three alternatives have been recommended. NHS England guidance has yet to decide on the model that will be used. NHS England is also tackling the variation in how responses are collected, in particular, by banning
a method where patients indicate their response using tokens. There must also now be a mandatory follow-up question, and there are three suggested ways of phrasing this in the NHS England guidance.
More reliable
RCN policy adviser Mark Platt says the changes will improve the test. ‘We have been critical of the FFT before, and of its simplistic approach, and we welcome these changes, which will make it more reliable and rigorous.’ He adds: ‘The greatest thing about the FFT is that it is close to real-time data for staff.’ Rachel Reeves, principal research fellow in the school of health and social care at the University of Greenwich, says that there are still much better sources of information
NURSING STANDARD
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ISTOCKPHOTO
How the test will apply to mental health services
available on the quality of care, such as the Care Quality Commission’s annual inpatient survey. ‘The FFT is still a poorly-designed survey, which gathers poor quality data,’ she adds. ‘If trusts are taking notice of patients’ comments to make changes, that could be a good thing but there is a high risk the comments selected for action are those which staff find the easiest to deal with, rather than those which patients would prioritise.’ One of the examples of improvement highlighted by NHS England is that Mid Staffordshire NHS Foundation Trust brought in soft-closing bins in response to patients saying noisy bins were keeping them awake at night. ‘Noise at night is far from being the biggest problem at Mid Staffs,’
NURSING STANDARD
says Dr Reeves. ‘The 2013 national inpatient survey data shows that, on that particular question [on noise], they were in the top 20 per cent of trusts nationally. However, they were in the bottom 20 per cent on 20 other questions, including questions about getting adequate pain relief, being involved in decisions about their care and waiting for a bed once they were in hospital. ‘The FFT encourages the NHS to focus on quick and easy fixes, at the expense of dealing with more difficult issues that are more important to patients.’
Positive changes
At Hillingdon Hospitals NHS Foundation Trust in west London, the FFT has led to a number of positive changes, including the
NHS England is changing the way patient feedback is collected
Mental health services will be among the last services to be covered by the Friends and Family Test (FFT) at the end of this year, along with GP and community services. NHS England guidance stresses that assumptions should not be made about service users’ willingness or ability to respond to the test. All groups should be asked, including patients with dementia, learning disabilities and children, as long as a clinician does not think asking will cause distress. RCN mental health adviser Ian Hulatt points out that asking patients who have been sectioned how likely they are to recommend a service is not going to be easy. ‘The context of the result of the FFT is important, such as the percentage of respondents who have been detained. But feedback is important, and while people have criticised it, it is a quick indicator.’ launch of a ‘comfort at night’ project to create a more restful environment, and measures to ensure patients with Parkinson’s receive their medication on time. Bev Hall, Hillingdon’s deputy director of nursing, admits that she was sceptical about the FFT when it was introduced. ‘I felt it was a political move, but it has definitely led to improvements. We have focused on what patients have been telling us in the follow-up question. Often it is the very small things that patients write about, such as staff introducing themselves. ‘The other thing we have picked up is how patients notice and comment on the behaviour of staff towards other patients, such as the patience of staff when caring for people with dementia’ NS
september 10 :: vol 29 no 2 :: 2014 23
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Would you let your family stay here?
SUMMARY
Patient feedback through the Friends and Family Test is to become standard in all NHS England settings by the end of the year. The test – which involves asking patients if they would recommend the service they are receiving to family or friends – was announced in January 2013 by prime minister David Cameron, who said it would act as a ‘flashing light’ to identify failing trusts. It has been established in all acute and emergency departments for the past 18 months, and began in maternity services last October. By the end of the year, the test will be widespread in GP, community and mental health services (see box). A review into the Friends and Family Test (FFT) commissioned by NHS England and published in July said the test has had a positive impact on patient services. Eighty five per cent of trusts reported it is being used to improve patient experience. In particular, The Friends and Family Test – a simple survey asking patients if they would recommend the health service they have received – is being amended in response to criticism that it unfairly condemned services on the basis of unreliable data. Despite its flaws, improvements have been introduced in response to feedback from the test. Author Erin Dean is a freelance journalist 22 september 10 :: vol 29 no 2 :: 2014
the open-ended follow-up question is proving a rich source of patient views. Actions prompted by the FFT include measures to improve cleanliness, provide warmer water in showers and better quality meals. The review recommended some fundamental changes to the test. When the first FFT results were published last year for acute and A&E services, critics highlighted the variation between trusts in the way responses are collected, the injustice of condemning some services on the basis of one or a handful of patient responses, and basic flaws in test design, with the questions too open to interpretation. Some concerns were upheld in the review, and are reflected in NHS England’s new guidance (tinyurl.com/ofc83yb) on implementing the test, which was issued last month. The NHS England changes include altering how the score of the FFT is worked out. It is currently calculated by subtracting the proportion of patients who are ‘Extremely unlikely,’ ‘Unlikely’ or ‘Neither likely nor unlikely’ to recommend, from those who are ‘Extremely likely’. Three alternatives have been recommended. NHS England guidance has yet to decide on the model that will be used. NHS England is also tackling the variation in how responses are collected, in particular, by banning
a method where patients indicate their response using tokens. There must also now be a mandatory follow-up question, and there are three suggested ways of phrasing this in the NHS England guidance.
More reliable
RCN policy adviser Mark Platt says the changes will improve the test. ‘We have been critical of the FFT before, and of its simplistic approach, and we welcome these changes, which will make it more reliable and rigorous.’ He adds: ‘The greatest thing about the FFT is that it is close to real-time data for staff.’ Rachel Reeves, principal research fellow in the school of health and social care at the University of Greenwich, says that there are still much better sources of information
NURSING STANDARD
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 22, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
ISTOCKPHOTO
How the test will apply to mental health services
available on the quality of care, such as the Care Quality Commission’s annual inpatient survey. ‘The FFT is still a poorly-designed survey, which gathers poor quality data,’ she adds. ‘If trusts are taking notice of patients’ comments to make changes, that could be a good thing but there is a high risk the comments selected for action are those which staff find the easiest to deal with, rather than those which patients would prioritise.’ One of the examples of improvement highlighted by NHS England is that Mid Staffordshire NHS Foundation Trust brought in soft-closing bins in response to patients saying noisy bins were keeping them awake at night. ‘Noise at night is far from being the biggest problem at Mid Staffs,’
NURSING STANDARD
says Dr Reeves. ‘The 2013 national inpatient survey data shows that, on that particular question [on noise], they were in the top 20 per cent of trusts nationally. However, they were in the bottom 20 per cent on 20 other questions, including questions about getting adequate pain relief, being involved in decisions about their care and waiting for a bed once they were in hospital. ‘The FFT encourages the NHS to focus on quick and easy fixes, at the expense of dealing with more difficult issues that are more important to patients.’
Positive changes
At Hillingdon Hospitals NHS Foundation Trust in west London, the FFT has led to a number of positive changes, including the
NHS England is changing the way patient feedback is collected
Mental health services will be among the last services to be covered by the Friends and Family Test (FFT) at the end of this year, along with GP and community services. NHS England guidance stresses that assumptions should not be made about service users’ willingness or ability to respond to the test. All groups should be asked, including patients with dementia, learning disabilities and children, as long as a clinician does not think asking will cause distress. RCN mental health adviser Ian Hulatt points out that asking patients who have been sectioned how likely they are to recommend a service is not going to be easy. ‘The context of the result of the FFT is important, such as the percentage of respondents who have been detained. But feedback is important, and while people have criticised it, it is a quick indicator.’ launch of a ‘comfort at night’ project to create a more restful environment, and measures to ensure patients with Parkinson’s receive their medication on time. Bev Hall, Hillingdon’s deputy director of nursing, admits that she was sceptical about the FFT when it was introduced. ‘I felt it was a political move, but it has definitely led to improvements. We have focused on what patients have been telling us in the follow-up question. Often it is the very small things that patients write about, such as staff introducing themselves. ‘The other thing we have picked up is how patients notice and comment on the behaviour of staff towards other patients, such as the patience of staff when caring for people with dementia’ NS
september 10 :: vol 29 no 2 :: 2014 23
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