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The Friends and Family Test is unfit for purpose

The Friends and Family Test has now been live for over a month. How long will it be before we are presented with a league table, complete with some unfortunate NHS Trust languishing at the bottom, ready to be held up for a flogging in order to ‘drive up standards’? Six months? Maybe 12? Allowing for the inevitable teething problems and gremlins that affect most public sector programmes, we might be spared for a little longer before we find out who is top and who is bottom – but as sure as the Health Secretary gets all his new ideas from the Education Secretary, we can be certain that the tables are on their way.

If we have to have a league table that pits one Trust against another, then I have no problem with the idea of asking patients. What I do object to, however, is deceiving patients in order to use their voice to beat the NHS about the head.

The Friends and Family Test appears straight forward at first glance. The actual question, ‘How likely are you to recommend our ward to friends and family if they needed similar care or treatment?’, couldn’t be simpler. The possible answers, though, start to make things a little more complex with a five-point range from ‘Extremely likely’ to ‘Extremely unlikely’, and a sixth option of ‘Don’t know.’ What the Department of Health has not shouted from the rooftops, however, is how the scores are then calculated.

Whenever I explain the scoring system to someone, I always get the same reaction – their jaw drops open slightly, their brow furrows as they try to work out if I’m serious, then they shake their head and declare, ‘That’s ridiculous! That’s so biased!’

Because that is what it is. The only responses that score in the Trust’s favour are those that are graded as ‘Extremely likely’. Those patients who respond ‘likely’ are all thrown out with the ‘Don’t know’ cohort, while all the others – ‘Neither likely nor unlikely’, ‘Unlikely’ and ‘Extremely unlikely’ – are lumped together as a black mark.

The explanations I have heard for why the scores should be skewed in this way are that patients are inclined to be too generous, and so Trusts would all scored too highly.

In other words, the Department of Health wants to know what patients think, but doesn’t trust them to say the right thing. The scoring is a distortion of the English language. When someone says they are likely to recommend a hospital ward or department, do they expect their answer to be ignored? If they say they are unsure, would they anticipate their response being tied up with the reply of another patient who says they are extremely unlikely to make a recommendation?

Will the scoring system be explained to patients at the time of the test? If it is explained then it will soon be apparent that the five-point scoring system has been reduced to three points, and patients will answer accordingly. What if some Trusts explain the scoring to their patients, while others do not? The league tables could reflect how savvy Trusts are when they administer the test rather than what patients actually think about the care they have received.

The test has been sold as a tool to give patients more choice – it is nothing of the sort. Tellingly, the word ‘choice’ only appears twice in the text of the Government’s implementation guide, while the word ‘drive’ crops up no fewer than 12 times. The Government is spending public money on private companies to implement this test, in order to obtain distorted data with which to continue its assault on the NHS.

Our only defence is to highlight the inadequacies of this test, expose its hidden deception, and join with Peter Lynn of The Guardian in declaring it unfit for purpose.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.