NHS England is to change how the friends and family test is implemented and presented after a major review concluded it cannot be used as a “single measure” for the quality of care across the health service as originally intended.

The review – published a year on from when the test was rolled out nationally – found the new metric was “widely misunderstood” by staff and the public, and raised concerns about the data being “gamed”.

New guidance issued alongside the review said from April 2015 trusts will be mandated to collect free text comments from patients and should collect demographic variables alongside the test data.

Under the current friends and family test, patients are asked a standard question (see box, below) which they can answer as “extremely likely”; “likely”; “neither likely nor unlikely”; “unlikely”; “extremely unlikely”; or “don’t know”.

The new guidance also said that token systems – where patients are able to give a score by dropping a token into a box – will not be permitted after April 2015 because they have to be collected separately from follow up comments. This means scores and comments cannot be linked.

The guidance also confirmed trusts must collect data from all inpatient services including day cases from April.

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