Friends and family test should no longer be compulsory

Stethoscope. Credit: Pixabay

The friends and family 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, argue a group of experts in a new BMJ Editorial.

Introduced in all English acute hospitals in April 2013, the inpatient friends and family test’s 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.

However Professor Nick Black from the London School of Hygiene & Tropical Medicine, Professor Glenn Robert at King's College London and Jocelyn Cornwell from the Point of Care Foundation, say the case for it continuing to exist “lacks a strong rationale and scientific evidence.”

Since the test’s introduction, well over 30 million pieces of feedback have now been collected - and the total rises by more than 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, say the authors.

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.

However the authors of the BMJ article say that a compulsory friends and family test “risks displacing more fruitful approaches to patient feedback that are more likely to engage clinicians,” and that “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.”


Glenn Robert, Jocelyn Cornwell, Nick Black. Friends and family test should no longer be mandatory. The BMJ. DOI:10.1136/bmj.k367