The Friends and Family Test: How is it working?

Recently I came across a blog Times and questions may be a-changing by Dr Neil Churchill, Director for Experience, Participation and Equalities at NHS England. In it he describes the current review of the Friends and Family Test (FFT). As some of you may know the FFT was launched in April 2013. The purpose of the tool was to provide the opportunity for patients and service users to provide feedback about their care experience, good or bad, and to comment on whether they would recommend the service to their friends and family. The current review is looking at whether the tool could use more effective questions and how it could be better used to drive improvements, as it was originally intended. The blog describes the methods used within the review to engage the public and staff alike and aims to publish its findings and guidance in April 2019.

My personal views on the FFT, is that the original concept of whether you would recommend a service to your family or friends, is very personal and therefore laudable in my eyes. However, there are some important elements about using a tool to gain feedback that have been lost or ‘not been discovered’ during its use, hence the review of the tool as indicated above. My own experience of working alongside clinical teams (who generally are expected to collect the information) using tools such as the FFT, is that there is a culture of gathering data/information or measuring care and services and is this is viewed as another task to be achieved in an already very busy day. I also have a sense that generally this data/information is collected at a local level and then sent to a central organisational location for this to be analysed and then used to assure the Trust board that services are running smoothly. In other words, the information provided is used to prove rather than improve the current situation. My experience is there is little widespread understanding, amongst clinical teams as to how to analyse or make sense of the information provided and how to use this to improve the care they provide. In fact, I have experienced real fear from clinical teams, that this data will be used against them in some way by the organisation, which leads to very defensive behaviour as you can imagine!

When using a tool such as the FFT I feel that there are also other issues to consider:

• Are the questions used within the current FFT helping to elicit what is good and bad about people’s experience? Without this information it is difficult to understand the person’s experience and what can be improved. (The review is focusing on this at length)
• Do patients/ service users feel genuinely able to give honest feedback via a written tool? Do they believe this information will make a difference? I personally am very suspicious of completing surveys for this reason. Are patients/service users concerned how the feedback will be received by the clinical teams who maybe giving ongoing care? When is a good time to ask for feedback of a person’s experience?
• Is the purpose of the tool to prove that a service is functioning or is the tool and information gathered from it being used to identify areas for improvement as part of an overall patient experience/ quality improvement strategy? And if so, how do clinical teams access this information?
• How are organisations upskilling their staff and clinical teams to collect, make sense of and the use the information generated at a local level rather than at a corporate level to drive improvement?

I applaud the work of the project team reviewing the FFT to enable it to be a more usable tool. However, in addition there is still much work to be done to enable Patient Experience Leads at a corporate level to provide support to Quality Improvement Leads and clinical teams to use the information to improve local services. Providing support and empowering clinical teams and leaders at a local level requires time and resources. Are organisations able to commit to this for the long term? For those that do or plan to, there is a real opportunity to use the FFT as a tool to really listen and hear the patient/service user voice and use this to start to challenge the culture of measurement to prove to one of gathering information to improve care.