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Friends and Family Test should ‘no longer be mandatory’



Over £12 million has been spent by NHS England on collecting feedback from patients for a test with a “questionable measure of performance”, experts say.

The Friends and Family Test was introduced in all acute hospitals in England in April 2013 to highlight both good and poor patient experiences. The main question is “How likely are you to recommend our service to friends and family if they needed similar care or treatment?” and respondents can rank their answer from “extremely likely” to “extremely unlikely.”

Glenn Robert, Professor of health care quality and innovation at King’s College London, said there was “widespread unease” about it among staff.


He argues in the BMJ that the Friends and Family Test should no longer be mandatory as it is used “purely a tool for national bodies to monitor them [hospitals]”.

According to NHS England, the FFT has seen more than 30 million pieces of feedback collected, with a further million added each month, which makes it the biggest source of patient opinion in the world.

Prof Robert and his colleagues’ claims that collecting and managing such large amount of data is complex and requiring substantial investments of time and other limited resources – over the past four years about £12million has been allocated centrally to support the test across England costing and around £1.5 million a year to maintain.

He goes on explain that “NHS England could free up the time and resources that providers currently spend on metrics that provide little insight for practitioners” and states the case for a compulsory friends and family test “lacks a strong rationale and scientific evidence”.

Dr Neil Churchill, NHS England’s Director for Patient Experience, said:

“More than half of NHS staff say they use this patient feedback to improve services to patients and in a recent survey 88 per cent of trusts said FFT was working well and 78 per cent said it had increased their emphasis on patient experience.”

There are presently no national CQUIN targets or financial incentives attached to the Friends and Family Feedback Test.



One in six nursing associates drop out before qualifying, finds report

Despite this trainees showed “high levels of enthusiasm and commitment to the programme”.



Group of nurses in meeting

Only 65% of trainee nursing associates said they planned to work as a nursing associate once qualified.

An independent evaluation of the nursing associate role commissioned by Health Education England (HEE) has found that while there are “high levels of enthusiasm and commitment to the programme”, one in six nursing associates are dropping out before completing the course.

Attrition rates for trainee nursing associates fell slightly below that of student nurses, with 18% leaving before completing the course.


While ill health and personal issues were some of the most common reasons for leaving the programme, nearly a quarter (23%) withdrew because they failed to meet the academic requirements of the programme – with numeracy skills cited as a key issue.

One trainee said they found the “attitudes towards the role and the negative feedback about Nursing Associates” challenging.

Only 65% of trainees said they intend to continue working as a nursing associate once qualified as the programme is often seen as a stepping stone to becoming a registered nursing.

Highlighting challenges.

Mark Radford, Chief Nursing Officer, Health Education England said the report “highlights some challenges that we must address to ensure that students such as ensuring the quality and oversight of placements, attrition and numeracy support.”

“We also recognise that further work and research is required to ensure that the profession is supported and utilised in the workforce of health and social care as part of the MDT. I am pleased to be able to report that we are in the process of identifying candidates to be considered as NA ambassadors across England.

Commenting on the report, Andrea Sutcliffe, Chief Executive and Registrar for the Nursing and Midwifery Council (NMC), said; “Having had the pleasure of meeting many nursing associates across the country, I am continually inspired by their enthusiasm and dedication for providing care and they should be very proud of the difference they make for the people they support.”

“I look forward to seeing how nursing associates continue to develop and be supported in their work, long into the future.”

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UCAS accused of having an ‘outdated’ view on nurses

They describe the nursing role to prospective students as looking after people when they are sick or injured.



Student Nurse Lecture Theatre

UCAS describes nurses as providing “support to doctors and other medical staff”.

The Universities and Colleges Admissions Service (UCAS) has been accused of having an “outdated” view on nurses after it described the profession as providing “support to doctors and other medical staff”.

UCAS describes the nursing role to prospective students as looking after people when they are sick or injured. Adding; “You’ll provide support to doctors and other medical staff, take blood and urine samples, and in some cases, you may carry out minor surgical procedures.”


Nurses, alongside a multitude of other healthcare professionals, have taken to social media calling for the description to be amended so it “adequately reflects nursing in the 21st century”. They also criticised the article for failing to highlight a large number of health promotion and research roles frequently undertaken by the profession.

BJ Walto, a senior member of the Royal College of Nursing (RCN) commented that the description is “inaccurate, demeaning and totally misleading portrayal of nursing.”

Tom Wavlin, a Lecturer in Adult Nursing & Admissions Tutor at the University of Plymouth, suggested the description could instead read; “an autonomous practitioner of nursing who works closely with other healthcare professionals”.

In comparison, the Nursing and Midwifery Council (NMC) website reads; “Registered nurses play a vital role in providing, leading and coordinating care that is compassionate, evidence-based, and person-centred. They are accountable for their own actions and must be able to work autonomously, or as an equal partner with a range of other professionals, and in interdisciplinary teams.”

A spokesperson for UCAS said; “It’s clear that our current role profile for nurses doesn’t reflect the amazing work that nurses across the country do each day, and we welcome the feedback we’ve recently received.

“We want to make sure that students considering their future options have up-to date information about all different careers available to them.

“We’re currently updating all of our job profiles and are in touch with nursing experts to help us make sure that we better reflect the roles and responsibilities of nurses today.”

UPDATE (17/10/19 09:55): This article was updated to include a comment from UCAS.

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