Summary of our recent Friends and Family Test webinar


22 / 8 / 2013 10.27am

On 13 August NHS Employers organised a webinar on the issue of staff advocacy and the Friends and Family Test. This webinar was hosted with Joe Dromey of the Involvement and Participation Association, who has looked into the evidence on staff advocacy in the NHS andwhat lessons the NHS can learn from other organisations. The webinar was chaired by Steven Weeks of NHS Employers who updated participants on developments in the staff Friends and Family Test in the NHS.

The key topics covered in the webinar were;

  • The main differences between staff advocacy in the NHS and elsewhere
  • Trends in staff advocacy within the staff survey
  • The main factors affecting the willingness of staff to recommend the service they work in
  • Lessons learnt from other organisations
  • The most effective things local organisations can do to improve advocacy.

What is staff advocacy?

Staff advocacy refers to the willingness of staff to be an "advocate" of their organisation. It is one of the aspects of staff engagement alongside job satisfaction, motivation and involvement. Advocacy has been included in the measure of staff engagement in the NHS since 2009. In recent years, much greater emphasis has been placed on the issue of advocacy with data being made more readily available and the publication of the Francis report. The report highlighted that high levels of unwillingness to be an advocate can be an indicator of issues with quality.

The annual NHS Staff Survey includes questions on the willingness of staff to recommend their workplace as a place to be treated. NHS England has indicated that it plans to create a more frequent measure of this issue and adopt a staff version of the Friends and Family Test that already exists for patients.

Why is staff advocacy important?

The concept of staff advocacy was originally developed in retail and other private sector customer service organisations. These organisations recognised the impact that staff attitudes can have on customers. They wanted their staff to support their products and services and recommend them to friends and family.

In the NHS, advocacy has been seen as an indicator of quality as data from the staff survey showed that low levels of staff advocacy appeared to correlate closely with poor patient experience. 

What are the current levels of advocacy in the NHS?

Evidence from the staff survey showed that the NHS had improved its levels of staff advocacy in 2011/12 with levels comparing well with average UK employers. However, the levels of staff support varied considerably with a sizable minority of organisations having low levels of staff support. There was also a high level of non response. Specialist Trusts scored most highly and ambulances least. Doctors and managers were most likely to be advocates and back office functions least likely.

Evidence also showed that levels of staff advocacy are closely linked to the overall levels of engagement and views on quality. Staff are only prepared to be advocates when they are engaged and have confidence in the services. More surprisingly, there is also a link to some aspects of how staff perceive that they are being treated. In general organisations where staff are prepared to recommend it as a place to work, they would also recommend its services.

Advocacy is influenced both by intellectual and emotional factors. It appears provision of information can help improve advocacy levels. Staff can be made more aware of improvements with the help of communications colleagues. It is worth noting though that only genuine improvements are likely to persuade staff.

The most effective HR related interventions are those that create sustainable improvements in levels of engagement, although this is hard to achieve. In the short term improvements in appraisal and in staff health and wellbeing can also have an impact.

During the webinar discussion participants raised issues with the wording of the current question around staff advocacy, as this referred to willingness to recommend the service in the organisation as whole and argued that a question focussed on individual ward/area would be better. The issue of how to make advocacy relevant for "back office" staff was also raised. NHS Employers is already raising the issue of the most appropriate wording for any such measure because of concerns that have been raised over the current wording the NHS staff survey question. The report drawn up by Joe Dromey of the IPA will be made available shortly on the NHS Employers website with new pages on Friends and Family issues.

Friends and Family Test

Steven Weeks updated participants on current plans by NHS England. NHS England intends to give greater publicity to scores on the advocacy question and performance on this question would affect  Commissioning for Quality and Innovation (CQUIN) payments in 2014. It is also intended that from April 2014 a new question will be developed asking staff how far they would recommend services and this will be asked more frequently. NHS Employers is involved in discussions on these ideas and welcomes feedback from NHS organisations on these issues. For more information and to give your views please contact  

Latest Tweets

Why Register?

Great reasons to register with NHS Employers

  • A personalised website
    Manage your profile and select topics of interest to you
  • Access your dashboard
    Bookmark useful content to help you quickly find what you're looking for
  • Get involved
    Contribute to our Talking Points discussions, comment on and rate our webpages
  • Keep up to date
    Receive the latest newsletters and media summaries

Sounds great, what next?

Register Now

Not now, I will register later

Log In