Outside looking in: An external perspective of the NHS

By Roy Lilley

The NHS occupies a special place in the public’s heart and politicians are keenly aware it can win or lose them votes. Life in the NHS is more challenging than ever but the NHS has one huge benefit on its side – amazing staff and strong communicators who recognise that transparency is the only way forward.

You’ll learn:

• Good comms centres all around transparency
• Why staff are your greatest asset
• That organisations must avoid becoming corporate and distant if they are to maintain goodwill

An NHS is crisis

As I write, making my contribution to this book, the NHS is under siege.

It’s early January and the NHS is dealing with what has to be the worst winter crisis since the ‘90s.

Patients in A&E are on trolleys, ambulances are lined up outside and wards are fuller than full with sick people. For the first time in my 30 plus years, in and around the NHS, the Secretary of State for Health has appeared, voluntarily, in front of the cameras and said... “Sorry”.

A day later the Prime Minister did the same. She was sorry for the cancelled operations and praised the hard work of the staff.

We are so used to the Department of Health press office dissembling and camouflage, it came as something of a surprise. For senior politicians to apologise for failings (you can’t call it anything else), is unheard of.

You can bet the policy wonks, ministers, the lawyers and probably the Cabinet and the communications experts would have had a say in the decision to fess-up.

It truth, there wasn’t much else they could do. The usual bluster and conflation, the barrage of statistics, wasn’t going to wash. Take it on the chin. Admit it on your terms and dilute it, best you can, with lavish praise for the ‘hard working staff’ at the front line of health care.

A public communications case study if ever I saw one. A hollow confession, a plastic apology and a dollop of sickly praise. 

‘Oops, sorry and luv ya!’ What’s not to like!

Nowhere to hide

This winter thing isn’t over yet and already NHS communications teams are struggling to know what to do. Generally their job is to put on a brave face, be sunny-side-up and polish the cow pat.

It’s difficult to do that when the evidence of the system melt-down is all around you. Staff are taking to social media to say how ‘third world’ it all is and the public are only too willing to go on the telly to share bad experiences.

How do you handle all that? What are the lessons learned?

The first; there is no hiding place. The good old days of issuing a press release and going home at five o’clock are over. The press are more intrusive and the public more demanding. Second, the media has a 24-7 avarice.

Communicate openly and honestly

There is only one word that comes to mind. It’s a painful word, rapier-like and hurts. The word is transparency. The only defence is transparency. The only comfort transparency. This is the only answer.

In times of crisis and heightened public interest, there are three things to do, communicate, communicate and communicate. 

Tell ‘em what you’re going to tell ‘em... tell ‘em... and tell ‘em again.

It’s not rocket science and it certainly isn’t new. To answer the question, how often should I communicate, the answer is before somebody else does and in a global, 24-7 media world that’s tricky.

A clear idea of what you want to communicate is no bad idea. 

In the current crisis the only approach can be:

‘Our hospital has 600 beds, when they are full, they are full. We are moving people through the system as fast and as safely as we can but we depend on colleagues in primary care to keep people at home and our colleagues in social care to get them back home. They are struggling too. We all are. There is unprecedented demand and people are having to wait, sometimes for hours. Please don’t come unless you are very ill...’

In dealing with frustrated staff, taking to social media and creating hell with their smart phone, communicators have to be smart. It’s part of the new repertoire of communications management that was certainly not on the agenda back in 1948, when the NHS was born.

Finding the line between freedom to speak, getting the facts straight and not alarming the public is the job of a diplomat and a colleague who is trusted to make sure the truth is told.

A brand like no other

The enduring love affair the public has with the NHS, the undying affection, poses a question of its own. Is the NHS such a strong brand it doesn’t need communications strategists fussing over it?

The NHS runs out of money. The public gives it more. Piles people up in waiting rooms, stacks them up in corridors. The public comes back for more. Makes terrible mistakes. The public are forgiving. Why?

Because the NHS is the only show in town? There’s no choice? The same is true of the trains and look at the stick they get.

The NHS survives because of the amazing talents and vocational skills of the front line of health care. They are the communications department’s greatest asset. The evangelists, disciples and best advert. What other ‘business’ is there with such an enduring brand, public affection and committed workforce.

Of all the public services and the impatience users have with them the NHS is the one that politicians are the most nervous of. History tells us the health service can make or break careers and win or lose elections.

Time to close the corporate gap

If we think the NHS is a special case and a one off there is a risk to that. 

At the birth of the NHS hospitals were part of the community, funded by charities and public generosity. Local, up-the-road and ‘part of us’. 

Increasingly, they are bigger, more remote, management more distant. Social media gives health communications professionals the opportunity to connect with service users, talk to them directly, listen to their thanks and pay attention to their concerns.

It’s a lesson the NHS was slow to learn and is a warning for corporations everywhere.

The disgruntled no longer write in and complain. They take pictures and plaster them over social media for a global audience to gawp at.

Lessons for the wider communications community? The people who deliver the product are your case studies and ambassadors. Equally there is no substitute for a good product.


Roy Lilley has a background in business and as a Trust chairman. He now writes and broadcasts on the NHS and social care. He is the author of 27 books on healthcare management.

Twitter: @RoyLilley
Online: http://fabnhsstuff.net/