The National Health Service (NHS) Friends and Family Test (FFT)

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The Friends and Family Test (FFT) is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. Listening to the views of patients and staff helps identify what is working well, what can be improved and how.

The guidance for FFT focuses on supporting the best possible use of data and has an emphasis on use of the FFT free text feedback to drive improvement.


Background of The Friends and Family Test (FFT)

NHS England and NHS Improvement commissions the Friends and Family Test (FFT), a continuous improvement tool allowing patients and people who use NHS services to feed back on their experience. The NHS constitution sets out a requirement to collect and act on patient feedback – the FFT supports that requirement and provides a framework to do it. Since 2013, NHS provider organisations have been mandated to collect feedback via the FFT.

The FFT is a simple feedback tool which offers patients of NHS-funded services the opportunity to provide feedback about the care and treatment they have received. The FFT tool combines a question, asking patients about their overall experience of the service they used, with at least one complementary follow-up free text question to enable patients to provide further detail about their experience. This free text question can be tailored by the service to elicit feedback which reflects their local priorities and strategy.

The Government’s Mandate to NHS England for 2018/19 required revision of the FFT guidance to strengthen the FFT as an improvement tool. A substantial engagement exercise was conducted, involving providers, commissioners, suppliers, and regional patient experience leads: This work drove policy changes, set out in the revised FFT guidance published in September 2019. One area of focus was encouraging providers and commissioners to actively generate insight from their feedback and use it to make improvements. As such, in the updated FFT guidance there is a greater emphasis on the use of the qualitative or free text portion of FFT feedback to drive quality improvement locally.


The Friends and Family Test (FFT) Free Text

The FFT free text follow up question has long been considered the most valuable aspect of FFT. It enables organisations to identify the “why” behind responses, providing a richer, more nuanced picture of patient experience. Free text data can help to identify issues by shedding light on the drivers behind poor scores, and therefore areas for service improvement. There is appetite to do more across staff, stakeholders, and commissioners, to get the most out of this invaluable data.

Although engagement with feedback at ward or departmental level is sometimes possible, the quantity of collected feedback means that oversight of qualitative feedback at organisational level is often cursory. In some cases, trusts can make sense of their free text comments either by paying a commercial supplier to undertake the analysis or by using the expertise in house to build an analytical system. However, in most cases the potential insight in this feedback is underutilised due to a lack of time, skill, and resource. As such, support is needed to set up formal, systematic and rigorous approaches to free text analysis that will ensure staff can get the most out of free text data.

The FFT development process highlighted the requirement to make it easier for providers and commissioners to actively use the insight to improve services. To help enable that, the FFT guidance focuses on supporting the best possible use of data and has an emphasis on use of the free text feedback to drive improvement. NHS England and NHS Improvement is exploring ways it can support the system through providing access to easily reproducible and sustainable free text analysis solutions. These solutions should be accessible, easy to implement, sustainable and offer a systematic approach that can improve the way that trusts use and process comments.


The Friends and Family Test (FFT) Free Text Development Programmes

NHS England and NHS Improvement has collaborated with two trusts to help develop and test bespoke free text analysis solutions. Two separate programmes of work have been conducted by Imperial College Health NHS Trust and Nottinghamshire Healthcare NHS FT, each developing their own solution. Each programme involves development, implementation, and piloting of the free text analysis solution. The solutions involve semi-automated approaches which use machine learning algorithms to help analyse and process FFT comments. The solutions have been developed and tested in a range of secondary care settings and services, including but not limited to: community and mental health, paediatrics, and acute inpatient and outpatient services. The pilot trusts also cover a range of geographies in urban and rural settings, including a total of 10 trusts across London, the Midlands, the North West and North East. Early pilot work is scheduled to finish in Autumn 2021.


The Aims and Objectives of the Two Programmes are as Follows:


  • These programmes aim to improve the use of FFT and its free text component in selected NHS Trusts. This involves working with the trusts to support improvement of their analytical capabilities, through providing text analytics methods for processing patient experience feedback, with a view to supporting quality improvement processes and service improvement. The programmes involve working closely with patient experience, IT and quality improvement teams at trusts to develop, implement and pilot the text analytics solutions.
  • Using learning from these programmes of work, NHS England and NHS Improvement will work towards a strategy to support the use of FFT free text and other qualitative patient experience feedback.


  • Improve the processing and analysis of FFT free text data using text analytics (e.g., machine learning), through developing methods for routine, semi-automated and systematic analysis of qualitative data.
  • Establish data visualisation and/or reporting approaches that support the use of patient experience feedback for quality improvement.
  • Gain a better understanding of the variation in NHS trust needs across different service settings and geographies. For example, user requirements and support required for implementation.
  • Develop a process that is reproducible, sustainable and can be implemented in different service areas and NHS provider organisations.


Your NHS Friends and Family Test (FFT) Research Completed – On Time; Within Budget; Exactly to Your Specifications

UX/UI NHS Friends and Family Test (FFT) Qualitative Analysis Services by Smart Consult & Research provides you with the assurance that the views and interests of NHS Service Users and key stakeholders have been considered in a way which fits in with the context of the Government’s FFT guidance and mandate to NHS England for 2018/19: and the revised guidance published in 2019


Commission our Services Using any of the Following Frameworks:

  • NHS Health and Care Evaluation Services (HaCE) – NHS Leeds CCG
  • Lived Experience Service – NHS England and NHS Improvement (NHSE&I)
  • Health Systems Support Framework – NHS England and NHS Improvement (NHSE&I)
  • GP services and GP Caretaking services – NHS England and NHS Improvement (NHSE&I)
  • Research Marketplace DPS – Crown Commercial Service RM6018
  • G-Cloud – Crown Commercial Service RM1557.12
  • Data SaSiE – Office for National Statistics

Available under the Open Government Licence v3.0.

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