Reforming the NHS Friends and Family Test (FFT) 

A new report by Picker sets out a roadmap for reforming the NHS Friends and Family Test (FFT), with recommendations for the Department of Health and Social Care (DHSC), NHS England (NHSE) and local NHS providers.   

Building on feedback from stakeholders, a published literature review, and Picker’s expertise in measuring and understanding patient experience, the report explores the historical context of the FFT and its current structure, strengths and weaknesses, before exploring options to reform the feedback mechanism first introduced in 2013. 

The report finds that while the FFT has raised the profile of patient experience and provides valuable qualitative insights, it also shows limited variation in results and lacks comparability due to the use of inconsistent methodologies.  

Currently, the FFT presents a significant annual cost to providers. The report outlines how the FFT can be reformed to deliver better value for money, enhancing the usefulness of patient feedback for service transformation and design. It also highlights opportunities to align with national policy ambitions – including those outlined in the Ten Year Plan for Health – for a more person centred NHS that empowers patients.  

Central to our proposed programme of reform is the assembly of an advisory group of patients and stakeholders to co-produce a reformed, rebranded, and renamed FFT. We also recommend that:  

• Demographic data is collected as part of a reformed FFT to understand who providers are hearing from in their local communities – and, crucially, which groups’ voices are missing. 

• Analysis of qualitative data is supported by an AI tool endorsed by DHSC and NHSE, to ensure this valuable data can be better used at scale to drive improvements.  

• The role and effectiveness of ‘patient experience champions’ outlined in NHS England’s ‘Reforming Elective Care for Patients’ should be clarified and reviewed, before consideration is given to requiring a dedicated board level ‘Director of Patient Experience’ at all NHS provider organisations. Both roles would be expected to work with the proposed National Director of Patient Experience at DHSC to align national and local initiatives around improving people’s experiences of care.  

• Providers should report directly to their boards on how FFT data is used locally to drive improvement, using a similar model to complaints reporting. They should also share examples of best practice with other providers to promote wider learning and innovation.  

Commenting on the report, Chris Graham, Chief Executive at Picker, said:

“Since its introduction in 2013, the NHS Friends and Family Test (FFT) has helped to raise the profile of people’s experiences of care. Today the FFT is collected across a range of settings and in incredible volumes, but it has important limitations: single question numeric ratings are too simplified to drive improvement, and patients’ written comments, whilst powerful and rich with insight, are difficult to process and interpret at scale. These limitations mean that the vast amounts of data collected daily are not used as effectively as they could be to improve and transform patient care in the NHS.  

“Reforming the FFT provides an opportunity to align with the ambitions of the Ten Year Plan for Health, placing patients at the centre of efforts to improve the NHS while delivering better value for money. To truly ‘make the patient king’, we need to ensure that the feedback that is already being collected can effectively empower patient choice and amplify patient voice.” 

Picker’s team of researchers and data scientists are available to support organisations in understanding, measuring, and using workforce and user experience. For queries about our services or to request a call, please contact info@pickereurope.ac.uk.

Notes to editor

• For media enquiries, please contact Picker’s Marketing and Communications team at pressoffice@pickereurope.ac.uk, or phone: 01865 632 235.
• Picker’s peer-reviewed literature review was published in the Patient Experience Journal (PXJ) in November 2025 and is available at: https://pxjournal.org/journal/vol12/iss3/19/.