As NHS A&E 4 hour waits grow, so FFT response rates fall

As NHS England shines a spotlight on the Friends & Family Test, John Morley of Formic Solutions looks at the relationship between falling response rates and increasing A&E 4 hour waits.

Much is written over the increasing number of times that patients have waited longer than four hours, but less so about the falling response rates for patients completing the NHS Friends & Family Test.

Since July 2015, the NHS has seen the proportion of those waiting four hours or more in A&E steadily increase. At the same time, the proportion of those filling out the Friends & Family Test (FFT) in A&E has fallen below the 15% target of eligible A&E patients, as required by NHS England.

Overall satisfaction, measured by the percentage of those who would recommend the service to others, has experienced a slight dip – hovering around the 88% mark. It would seem that, however long we wait, we still are happy with the service the NHS provides in its A&E departments.

But it would appear that, as 4 hour waits increase, so the proportion of patients filling out the FFT in A&E has fallen – as our graph shows.

AE wait performance vs FFT response

Graph 1: A&E wait performance vs % recommending A&E vs FFT response rate – click for larger image

Source: NHS England Friends & Family Test data for A&E and NHS England A&E Attendances and Emergency Admissions

There could be numerous reasons why this is happening.

One reason may be more attendances, which would mean that the same number of responses are being collected, but from a larger eligible population. For example, if an A&E department collects 150 responses, out of an eligible population of 1,000, then it will achieve the 15% target. But if that population grows to 2,000, it would have to collect 300 responses to meet the 15% response rate target.

But NHS England data shows that attendances fell from 1,952,895 in July 2015 to 1,867,657 in December 2015. So growing numbers of attendances do not seem to be the cause.

Another reason could be fewer people interested in filling out the forms. Perhaps; although you would have thought that more people spending longer in A&E would mean that you would see more FFT responses.

Or there could be fewer staff to administer the FFT, or A&E staff have less time to administer the test. If this was the case, there are ways to address this.

Formic is dedicated to helping the NHS to provide the Friends & Family Test (FFT), working with customers such as the University Hospitals of Leicester NHS Trust to help run this important patient feedback initiative.

North Tees and Hartlepool NHS Foundation Trust, for example, wanted to process approximately 1500-2000 returns per month across multiple care settings. We have been working with them to achieve this, as well as provide a solution that can support clinical audit and wider patient experience initiatives.

Using paper, online and mobile channels, we provide solutions that enable trusts to rapidly increase the number of FFT surveys that can be carried out and – most importantly – generate useful data and insight that can help transform the quality of care.

As NHS England’s director of patient and public voice Anu Singh said, “any service needs to understand the people it serves,” and the FFT is an important part of that process.

So, as NHS England shines a spotlight on the FFT this week, we would like to better understand why FFT targets in A&E are being missed.

Frontline staff are key to identifying why FFT response rates are falling. We are keen to hear from those staff to understand why the target is being missed. Contact us at to share your views and experiences so that we can better support you.

Find out more about our Friends and Family Test solutions

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