Using the Friends and Family Test to improve patient experience

This guidance sets out the requirements of the NHS Friends and Family Test (FFT). These revisions to the FFT guidance are effective from 1 April 2020 | NHS England

The NHS FFT is designed to be a quick and simple mechanism for patients and other people who use NHS services to give feedback, which can then be used to identify what is working well and to improve the quality of any aspect of patient experience. feedback-3239454_1920

This guidance is intended to support all provider organisations that are required through their NHS Standard Contracts (including independent sector providers, primary medical and primary dentistry contracts) to deliver the FFT.  It is hoped commissioners will find it useful too.

The guidance replaces all previous implementation guidance for the patient focused FFT, including the guidance specifically relating to GPs and dentists, and the supplementary guidance and advice published in relation to information governance, sensitive situations and contracting with a commercial supplier of FFT services.

Full resource: NHS England and NHS Improvement guidance: Using the Friends and Family Test to improve patient experience

Patient experience of NHS and social care services

Nuffield Trust | August 2019| Patient experience of NHS and social care services

The Nuffield Trust has published its latest indicator which considers how patient experience of NHS and social care services has changed over time.

Overall experience

  • Parents with a child who had been admitted to hospital tended to rate their child’s overall experience highly, with over 80% of respondents rating their child’s experience as ‘8’, ‘9’ or ‘10’ (very good).
  • Only 52% of Community Mental Health Survey respondents rated their overall experience of NHS mental health services in the last 12 months as ‘8’, ‘9’ or ‘10’ (very good), and 10% rated their experience as ‘2’, ‘1’ or ‘0’ (very poor).
  • Adult inpatients’ overall experience has improved over time, with the proportion of survey respondents rating their experience as ‘8’, ‘9’ or ‘10’ (very good) increasing from 67% in 2012 to 73% in 2017. However, overall experience declined slightly to 71% in 2018.
  • The proportion of GP Patient Survey respondents who had a good overall experience (‘very good’ or ‘fairly good’) decreased from 88% in 2012 to 85% in 2017. In 2018, 84% of patients had a good overall experience and this declined slightly to 83% in 2019.*
  • Service users’ satisfaction with adult social care services has remained stable over time, with 65% of respondents ‘extremely or very satisfied’ in 2017-18.
  • Between 2012 and 2019, the proportion of patients who had a good overall experience (‘very good’ or ‘fairly good’) of NHS dental services increased from 83% to 85%.

The patient experience indicators include:

  • Confidence and trust in clinicians
  • Respect and dignity
  • Patients’ involvement in decisions
  • Medication side effects
  • Access to GP services
  • Carers’ views of social quality
  • Mixed-sex accommodation breaches (Source: Nuffield Trust)

Full details are available from the Nuffield Trust 

NHS inpatient satisfaction falls for first time in six years

Adult inpatient survey 2018 | Care Quality Commission (CQC)

The results of the latest inpatient survey show what over 75,000 adults who stayed in hospital for at least one night in July last year said about the care they received. The survey covered the quality of information and communication with staff, whether they were given enough privacy, the amount of support given to help them eat and drink, and their discharge arrangements. The results are provided for England as a whole and by NHS trust.

feedback-3676922_1920Across the majority of questions asked in the survey there has been no improvement since it was last carried out, and this year’s results show an increase in those reporting lengthy delays, greater dissatisfaction with the amount of information provided when leaving hospital, and those who felt a lack of involvement in their care.

Most results for the 2018 Adult Inpatient Survey have slightly declined since last year or remained static.

Positive findings:

  • Relationships with the medical and nursing staff are usually positive although there is a small decline compared to last year. For example, patients reported that overall, doctors and nurses answered their questions in a way they understood.
  • Trust in doctor and nurse is high, although declining slightly compared to last year.
  • Fundamental needs of most patients are being met in terms of food, hydration and rest.
  • The proportion of patients reporting being given enough privacy when being examined or treated continues to be very high.

However, this year’s results indicate that there are many areas in need of improvement:

  • Patients are reporting poorer experience when it comes to the integration of their care.
  • Patients are reporting that they are waiting too long at admission and longer than previous years at discharge.
  • At the time of being discharged, significant numbers of patients were unsure about their situation. This includes not being given appropriate information about their care after leaving the hospital, and not receiving enough notice.
  • Significant numbers of patients reported not being sufficiently involved in decisions regarding their care and treatment.

Certain groups of patients consistently reported poorer experiences of their time in hospital, including

  • Patients with a mental health condition
  • Younger patients (aged 16 to 35)
  • Patients who were admitted in an emergency

Full report: Adult inpatient survey 2018

CQC press release: Confidence and trust in hospital staff high but overall improvements in people’s inpatient experience have stalled

See also:


Smartphones improve adherence for TB treatment, instead of direct supervision

NIHR | June 2019 | Smartphones instead of direct supervision can improve adherence rates for TB treatment

New research indicates that for people who require direct supervision, also known as directly-observed therapy in community and outpatient settings,  using smartphones and clinical attendance can improve levels of adherence. 


Observation is reserved for those at risk of not completing treatment because they have socially complex lives or mental illness. The study aimed to identify whether video surveillance can improve levels of adherence.

The randomised controlled trial (RCT) included over 200 patients, randomised into receiving standard observation or video observation; direct observations were carried out between three and five times per week, those assigned to video observation by smartphone were trained to record video footage of them taking each dose (Source: NIHR).

Read the NIHR Signal here 

Full reference: Story, A. 2019| Smartphone-enabled video-observed versus directly observed treatment for tuberculosis: a multicentre, analyst-blinded, randomised, controlled superiority trial | The Lancet | DOI:


Background Directly observed treatment (DOT) has been the standard of care for tuberculosis since the early 1990s, but it is inconvenient for patients and service providers. Video-observed therapy (VOT) has been conditionally recommended by WHO as an alternative to DOT. We tested whether levels of treatment observation were improved with VOT.

Methods We did a multicentre, analyst-blinded, randomised controlled superiority trial in 22 clinics in England (UK). Eligible participants were patients aged at least 16 years with active pulmonary or non-pulmonary tuberculosis who were eligible for DOT according to local guidance. Exclusion criteria included patients who did not have access to charging a smartphone. We randomly assigned participants to either VOT (daily remote observation using a smartphone app) or DOT (observations done three to five times per week in the home, community, or clinic settings). Randomisation was done by the SealedEnvelope service using minimisation. DOT involved treatment observation by a health-care or lay worker, with any remaining daily doses self-administered. VOT was provided by a centralised service in London. Patients were trained to record and send videos of every dose ingested 7 days per week using a smartphone app. Trained treatment observers viewed these videos through a password-protected website. Patients were also encouraged to report adverse drug events on the videos. Smartphones and data plans were provided free of charge by study investigators. DOT or VOT observation records were completed by observers until treatment or study end. The primary outcome was completion of 80% or more scheduled treatment observations over the first 2 months following enrolment. Intention-to-treat (ITT) and restricted (including only patients completing at least 1 week of observation on allocated arm) analyses were done. Superiority was determined by a 15% difference in the proportion of patients with the primary outcome (60% vs 75%). This trial is registered with the International Standard Randomised Controlled Trials Number registry, number ISRCTN26184967.

Findings Between Sept 1, 2014, and Oct 1, 2016, we randomly assigned 226 patients; 112 to VOT and 114 to DOT. Overall, 131 (58%) patients had a history of homelessness, imprisonment, drug use, alcohol problems or mental health problems. In the ITT analysis, 78 (70%) of 112 patients on VOT achieved more than or equal to 80% scheduled observations successfully completed during the first 2 months compared with 35 (31%) of 114 on DOT. In the restricted analysis, 78 (77%) of 101 patients on VOT achieved the primary outcome compared with 35 (63%) of 56 on DOT. Stomach pain, nausea, and vomiting were the most common adverse events reported (in 16 [14%] of 112 on VOT and nine [8%] of 114 on DOT). Interpretation VOT was a more effective approach to observation of tuberculosis treatment than DOT.

The full article is available from The Lancet

Furhter details of the NIHR Signal can be found here

NIHR Signal: Communication problems are top of patients’ concerns about hospital care

National Institute for Health Research | April 2019 | Communication problems are top of patients’ concerns about hospital care

A study that provides insight into patient concerns, trained volunteers to ask inpatients about their care aimed to find out what proportion of patients had concerns about their care. The researchers used this data to categorise and understand their concerns, and to assess whether these concerns were in line with the types of patient safety incidents identified by clinicians. 


The surveys identified:

  • The biggest category of concern (21.7%) was communication, either from staff to patient, staff to staff, or patient to staff. Examples included confusion about when patients were due for surgery, with resulting uncertainty about when they could eat, and unnecessary missed meals. One in ten patients raised a safety concern of some kind.
  • Almost a quarter (23%) of patients surveyed raised an incident of concern, with a total of 1,155 incidents provided by 579 patients.
  • Staff shortage issues accounted for 13.2% of concerns. The ward environment was a concern for 12.2% of people, with noise and accessibility cited as examples. Other concerns included a perceived lack of compassion, dignity and respect for patients; medication issues including late, missed or wrong medication; delays in treatment, results or discharge; staff training, food and drink and ward management.
  • The assessing doctors said 406 of the 1,155 incidents reported (35%) qualified as patient safety incidents. They were most likely to identify medication issues as a safety issue, and least likely to flag up concerns about the ward environment. Although communication was the single biggest concern for patients, cited in 251 reports, only 54 of these (21.5%) were seen as patient safety issues by doctors.
  • Of identified patient safety reports, the doctors said 90% were probably or definitely avoidable. They also said 99% were of ‘negligible, minor or moderate’ severity. Only one incident identified by patients was categorised as of major severity.

The NIHR signal is available in full from NIHR 

Home to the unknown: getting hospital discharge right

This research explored patients’ unplanned stays in hospital and what it was like for them after they had returned home | British Red Cross

The research sought to reveal: patients’ experiences of being discharged from hospital; hospital systems and healthcare professionals’ experiences and perceptions of the discharge process; and what it was like for people returning home from hospital feeling more or less prepared.

As a result, it aimed to explore the impact of discharge on recovery and wellbeing and to identify opportunities to improve systems, communication and support.

Based on the experience of the British Red Cross and the research, the report argues:

  1. There is a substantial opportunity for commissioners and providers to harness the power of non-clinical support, including the voluntary and community sector (VCS), to relieve the pressure on the NHS and to create better outcomes for people and improved patient flow within and between health and social care providers.
  2. Every point of hand-off between clinical teams in hospital and from the hospital to the community is a potential point of success or failure for patient recovery. The report recommends that there is a clinical responsibility to ensure the effective management of these transitions, so that there is continuity of care and patients don’t fall through the gaps between teams.
  3. The report recommends that a five part ‘independence check’ should be completed as part of an improved approach to patient discharge – prior to discharge or within 72 hours of going home. This would help to inform the setting of a realistic discharge date and would include assessing:
  • Practical independence (for example, suitable home environment and adaptations)
  • Social independence (for example, risk of loneliness and social isolation, if they have meaningful connections and support networks)
  • Psychological independence (for example, how they are feeling about going home, dealing with stress associated with injury)
  • Physical independence (for example, washing, getting dressed, making tea) and mobility (for example, need for a short-term wheelchair loan)
  • Financial independence (for example, ability to cope with financial burdens).