Kailash Chand on the value of the “friends and family test”

Kailash ChandLast week prime minister David Cameron announced a series of measures to improve nursing standards and care, including a “friends and family test” (FFT). To me, it appears more of a political gimmick rather than a clinically meaningful mandate for the NHS. The FFT proposes that every patient will be able to give feedback on the quality of their care after undergoing treatment:


  • in acute hospital wards and accident and emergency departments, from April 2013,
  • in maternity services, from October 2013,
  • in other parts of the NHS, as soon as possible after October 2013.

The premise is that the FFT will determine whether patients would recommend a particular NHS service, and data collection will commence within 48 hours of discharge.

Laudable or daft? Probably a bit of both. It would be hard to argue against some consumer feedback about any service and in that sense the NHS should not be an exception. In recent years the NHS has enjoyed record growth, and the public has, overall, expressed high levels of satisfaction with the NHS. That is, the NHS as a whole. There is less clarity regarding how patients feel about individual services. The prime minister believes that adoption of some really simple tests will empower patients and lead to data which can be used constructively to improve the NHS.

However, critics point out that the new test is vulnerable to manipulation and “game playing,” and will distract trusts and clinical commissioning groups (CCGs) from their real purpose of providing quality healthcare.

I am not opposed to feedback from patients and their families. However, the FFT is based on a model developed to test satisfaction with consumer products. Clare Gerada, Chair of the Council of the Royal College of GPs, rightly questioned whether friends and family are proper judges of the NHS in all its complexity: “The NHS isn’t Facebook, and healthcare isn’t a commodity like eating in a restaurant. And we must make sure that we don’t confuse issues around the NHS such as shortages, with the care that patients get from the staff that look after them.” Who can disagree with that?

The national GP patient survey already includes a question on whether you would recommend a GP practice to someone who has just moved into the area. About a million people a year respond to this question—a sample size big enough to flag up major concerns at practice level and to provide reasonably solid results at CCG level. It’s difficult to see what value this new proposal adds.

Consider the question: “How likely are you to recommend our GP surgery/ward/A&E department to friends and family if they needed similar care or treatment?”

Does anyone really think this will improve patient care? There is no published clinical trial demonstrating its validity, nor is there evidence of its efficacy in raising the quality of services. The lack of any improvement in NHS patients’ experiences is not down to a lack of data. NHS trusts and GPs already have more data than they can handle and they don’t need more meaningless or misleading figures. Indeed, collecting the data would be quite a challenge (visualise a busy A&E department on a Friday evening, with mainly intoxicated, behaviourally disturbed patients) let alone the interpretation of it. It will create a whole new layer of managers, taking much needed resource away from front line staff.

The NHS can deliver, but in my view this burdensome data collection will only serve to generate league tables based on customer satisfaction, rather than waiting times, clinical outcomes, and mortality rates.

I am as committed as anyone else to providing quality care to our patients, but the FFT is simplistic, lacks authenticity, and will lead to distortions of families’ and friends’ perception of hospitality, rather than clinical services, rendered to patients. What is required is to empower patients by changing the culture throughout NHS organisations and developing a more collaborative working relationship with service users. If David Cameron really wants to give patients the best care, he should introduce better quality measures, and ensure that the NHS is adequately resourced so that we can match up to the high levels of expectations that friends and family have.

Kailash Chand has been a GP for last 30 years. He is on the BMA council and he was on the general practitioner’s committee. He was awarded an OBE in 2010 for services to the NHS. The views he expresses in his blog posts are entirely his own.

See also:

  • News: Critics question whether “friends and family” test in NHS is fit for prime minister’s purpose