A journalist’s perspective: The good and bad of NHS comms

by Denis Campbell

Public relations practitioners and journalists need each other but without trust, honesty and an open line of communication, relationships can soon get strained. This chapter looks at the good, bad and ugly of NHS comms, focusing on engagement with the media.

You’ll learn:

• How the NHS, by being more honest about its situation, could potentially make greater in-roads into securing greater investment into its services
• How positive, compelling journalism results from journalists and NHS PRs working closely together
• Why stonewalling reflects badly on an organisation because the story will find its way into the public domain anyway

A poisoned chalice

To be asked to write about how NHS PRs engage with health journalists like me is the professional equivalent of being offered a cyanide pill. 

As the health policy editor (main NHS reporter) of the Guardian and the Observer I seek these people’s help daily; I couldn’t do my job without them. So why would I say anything at all, lest even a smidgeon of criticism alienates those whose goodwill, determination and professionalism I routinely rely upon? 

Because from my experience of covering health for almost 11 years, while some NHS comms officers are superb (creative, resourceful, at least as keen as me to make the story work), others display behaviours which are unhelpful, unbecoming of their profession and, most importantly, ultimately damaging to the NHS. 

I need the former to win out over the latter, for both my sake and also to help the service itself. 

Be honest and hold the line

The health service’s well-rehearsed weaknesses – too little money, too few staff, a fragmented system, rising demand involving epic amounts of avoidable illness – mean it is increasingly, visibly unable to do the job it wants and citizens expect.

Any health system that seriously considers rationing chemotherapy to newly-diagnosed and existing cancer patients, as Oxford University Hospitals Trust did in January, is clearly in very serious trouble and breaching its social contract with the nation, albeit involuntarily. 

So dissembling or downplaying the NHS’s many problems, or going along with the government’s fantasy version of events – part Big Lie, part cruel blame game, part Yes, Minister amateurishness – is unforgiveable. 

Yet in my view, worryingly many NHS bodies, local but especially national and their leaders are making that mistake, for example by pretending that understaffing isn’t the disaster that it clearly is. 

NHS public relations professionals are inevitable handmaidens in that disgraceful and dishonourable mission, which is itself partly the product of pressure from government. 

I exempt NHS England chief executive Simon Stevens from that criticism. His speaking of truth unto power about the NHS’s budget, even at the cost of antagonising Theresa May, has been bold, necessary and very impressive – not to mention effective. 

A mixed bag of talent

The baffling, atomised nature of the NHS in England – 240-odd Trusts, 200-odd Clinical Commissioning Groups and array of NHS arm’s length bodies – makes it impossible to talk in any meaningful way about how good or bad ‘NHS PRs’ are. 

There are so many of them: thousands of them, compared to a few dozen health journalists in national media outlets. And working as a PR for an NHS Hospital Trust, with its primarily local focus, is clearly very different to working for national bodies such as NHS England, Health Education England or NHS Improvement. 

Overall, I find them a mixed bag: some brilliant, some appalling and many perfectly average. 

In early 2016 the Guardian ran a month-long series called This Is The NHS. 

It was the most in-depth look ever attempted by any media outlet at the work and superb staff of what is, rightly, the country’s most-loved institution. We couldn’t have done that without the help and trust of NHS England, who helped open doors for us and NHS Trusts, who gave us access to people, places and sometimes mind-bogglingly amazing work, like heart surgery on babies performed in utero. 

The result was compelling journalism about fascinating things, facilitated by a virtuous circle of journalists and NHS PRs working closely together to mutual advantage. 

Guiding principles

So why don’t things work like that more often? Well, the NHS Constitution sets out seven ‘principles that guide the NHS in all it does’. 

According to this fine, thoughtful document, these seven are ‘underpinned by core NHS values which have been derived from extensive discussions with staff, patients and the public,’ like care being free at the point of use. 

These principles sound great: honourable, uplifting, in spirit with what most of its bosses would say were the service’s values. For me as a journalist the most important is the seventh principle. 

This specifies that ‘the NHS is accountable to the public, communities and patients that it serves…The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff.’ 

In my view that principle should guide and bind the behaviour of NHS PR practitioners too. 

Moving from good to bad

The accountability described above involves board meetings, annual reports, appearances at the local health scrutiny committee and – crucially – engagement with the media. Some NHS bodies I deal with take such responsibilities seriously. 

Yet almost daily, sometimes hourly, I encounter examples of how NHS organisations don’t so much as drive a coach and horses through their constitutional duty – to explain and answer honestly for what they do – as ignore it altogether, such is the level of opaqueness, evasion and outright denial of information which I encounter. 

I cannot tell how much NHS PRs themselves are to blame and how much of it is them simply implementing media-unfriendly policies dictated by their bosses. 

But I do tear my hair out at how bland, opaque and evasive replies to simple queries I submit to NHS organisations often are. 

I marvel at the effort senior managers and clever PRs put into coming up with entirely irrelevant answers. Do they think that will stop the story appearing? 

I am appalled at receiving so many Whitehall-style non-response answers – a refusal to respond to the evidence or opinions that are the basis of the story – that deliberately refuse to engage with concerns raised by doctors, researchers, health charities and grieving relatives. 

Because they have no good answer, presumably. In a health service of all things, why are those doing this not ashamed of themselves? 

And I know that, obviously, if the issue is something that will embarrass an NHS body, even a little bit, too often the seventh principle means nothing and damage limitation all that matters. 

When I was looking into understaffing and compromised patient safety at North Middlesex hospital in London, the hospital deserved an Olympic medal for stonewalling and denial of basic facts. 

Happily, previously-unpublished documents circulating within the wider NHS, which outlined the troubled Trust’s many problems in graphic detail, rendered their unhelpfulness irrelevant. Given that 99% of the time the story is still going to get out there, why not just be honest instead? 

Transparency is key

I despair, too, at the NHS’s addiction to secrecy: over the rationing of care, Strategic Transformation Plans, the creation of ‘Accountable Care Organisations’, plans to reshape local hospital services and much more. 

These things are always controversial, I appreciate. But when the truth gets out, as it nearly always does – via local campaigners, 38 Degrees, the BMA, people submitting FOI requests and so on – that secrecy makes things worse, because people (MPs, councillors, local people, the media) have been taken for fools and don’t like it. 

NHS PRs’ background and talents lie in communicating. So why not spend more time and put more creative energy into communicating what their bit of the NHS does and who the staff are that make that possible? 

And why not be routinely honest with the media – and thus the public – about the pressures the service is under and not be afraid to acknowledge that that can cause problems? Why not trust journalists much more to do a decent job and not be so suspicious all the time? 

I know these are all in NHS terms risky behaviours. But they might just help – people like me and people like you - and so the NHS itself. 

As the NHS turns 70, these are my NHS birthday wishes. 


Denis Campbell is the health policy editor of the Guardian and the Observer.

Twitter: @denis_campbell
Online: https://www.theguardian.com/profile/deniscampbell