Making the NHS Friends and Family Test ‘fit for the future (Picker, 4 December 2025)

Summary

The NHS Friends and Family Test (FFT), introduced nationally in 2013, was designed to provide a simple mechanism for gathering patient feedback across health services in near real-time. Today its use is mandated across the NHS, and provider organisations are encouraged to focus on the unstructured comments that it gathers from patients.

This report, explores the historical context of the FFT, its current structure, strengths, and weaknesses, and sets out a case for reform. It draws on stakeholder engagement, a published literature review, and wider analysis to assess the FFT’s effectiveness and future potential against the wider current political and economic context.

Content

Key findings from this report include:

• The FFT has raised the profile of patient experience and provides valuable qualitative insights. It can empower staff when used effectively, and patient comments can highlight areas for improvement.
• The FFT shows limited variation in results, lacks comparability due to inconsistent methodologies, and is only moderately associated with other quality measures. It is vulnerable to misuse and does not always provide actionable insights.
• Collection of the FFT involves considerable expense. For the 205 trusts in England, estimated combined provider costs range from £10-16 million annually. These figures exclude staff time and broader system costs.
• Recent government publications, including the Ten Year Plan for Health and the Dash Review of the patient safety landscape, emphasise the importance of patient voice and feedback, but highlight shortcomings in current approaches.

Recommendations

Picker recommends reforming the FFT to improve its impact and value for money. Nationally, the Department of Health and Social Care and NHS England (the centre) should:

• Maintain the FFT mandate while improving flexibility and comparability through a programme of reform. This programme of reform should be supported by a diverse advisory group of patients and stakeholders and should deliver national guidance for providers, drawing on examples of local best practice. This guidance should also clarify the purpose of the reformed FFT, rebrand and rename it, and commit to trialling the collection of demographic data to support wider objectives to tackle health inequalities. It should also consider offering a national solution for FFT administration and data capture, such as by providing a facility for patients to be sent and complete FFT surveys through the NHS App.
• Continue to mandate the collection of both qualitative and quantitative data, with Artificial Intelligence (AI)-supported analysis explored for qualitative feedback. Rollout of an AI tool should be coordinated at a national level and appropriate training should be provided to relevant staff.
• Continue to ensure public availability of national and local FFT data, supporting the transparency agenda.
• Clarify the role of ‘patient experience champions’ outlined in ‘Reforming Elective Care for Patients’, including how they should support the local use of the FFT.

Locally, providers should:

• Continue to submit mandated quantitative data for national benchmarking.
• Support a trial of demographic data collection to identify feedback gaps and variation in patient experience. Best practice should be shared to inform next steps for adoption after reflection on this initial pilot.
• Share best practice examples with national bodies to support wider sector improvement – providers should report not only what patients told them of their experience, but what they did with this information too.
• Organisations that are leaders in patient experience measurement should share best practice examples that showcase approaches that go beyond baseline FFT requirements.
• Report to their board how the FFT is used locally to drive improvement.
• Clearly identify board-level ‘patient experience champions’ on their existing ‘Our Board’ webpage, outlining the remit of the role. The champion’s contact details should not be shared on this page to avoid confusing an already complex complaints landscape.