Skip to main content

30 January 2018

'Friends and family test' should no longer be compulsory, argue experts

The friends and family test should no longer be mandatory, argue experts in The BMJ.

Drawing of people speaking

Professor Glenn Robert in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King's College London and colleagues, say the test ‘remains a questionable measure of performance’ and that by making it non-mandatory, ‘NHS England could free up the time and resources that providers currently spend on metrics that provide little insight for practitioners.’

The inpatient 'friends and family test' was introduced in all English acute hospitals in April 2013. The aim was to provide a simple metric that, when combined with follow-up questions, could be used to drive cultural change and improve the quality of the care.

Well over 30 million pieces of feedback have now been collected - and the total rises by over a million a month, which NHS England says makes it the 'biggest source of patient opinion in the world.'

Yet collecting and managing such large amounts of data is complex, requiring substantial investments of time and other limited resources, explain the authors.

For example, over the past four years about £12 million has been allocated centrally to support the test across England, and although expenditure has decreased it was still around £1.5 million in 2016-17. However, this does not include costs for local implementation, which are borne by providers and can be considerable, they add.

Several years after its introduction, the case for a compulsory friends and family test 'lacks a strong rationale and scientific evidence,' they argue.

In acute hospitals, for instance, teams responsible for improving patient experience speak of devoting much of their time to collecting, collating and reporting the data, while in primary care, a recent evaluation found 'widespread unease about the friends and family test,' with many staff perceiving it to be purely a tool for national bodies to monitor them. Recently, NHS England has shifted its interest in the test away from individual providers to assessing patients' experiences of systems such as emerging accountable care systems, but it has made clear that stopping central data collection is not an option. But continuing with a compulsory friends and family test ‘risks displacing more fruitful approaches to patient feedback that are more likely to engage clinicians,’ write Robert and colleagues. ‘It is time to stop compelling all NHS organisations to collect large amounts of data of unknown representativeness with poor response rates that provide little insight,’ they conclude.

Notes to Editors:
Editorial: Friends and family test should no longer be mandatory
Journal: The BMJ

Read full article

Author contact: 
Glenn Robert, Professor of Healthcare Quality and Innovation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK
Tel: 07908 561541