Public trust and the NHS

By Alan Maine

At a time when trust in business, government, NGOs and the media is at an all-time low, hospitals and clinics continue to perform well, helped by direct and ongoing relationships with patients. 

You’ll learn:

• That the fact hospitals and clinics present a human face helps to build trust with the public
• Employees are more trusted than CEOs or senior business executives to communicate information
• The top five trust-building behaviours for organisations

The NHS: A much-loved institution

The NHS is woven into Britain’s DNA. A recent King’s Fund study showed that almost four out of five Britons believe ‘the NHS is crucial to British society and we must do everything to maintain it.’ [1]

Clearly, it is one of Britain’s proudest and most loved institutions. But do the public trust it? And how is trust critical to the future of the NHS?

We think there are three reasons:

1. The pace of change is moving faster than ever before. Britons are now living much longer; advances in technology and genomics are changing how health professionals advise; and big data is revolutionising the future of healthcare. Do Britons trust that these advancements can help us lead healthier – and happier - lives?

2. Patients are doing their own independent research – thanks to ‘Dr Google’. What happens when a patient finds information online that conflicts with their doctor’s recommendation?

3. Service reconfiguration. With potential closures of local hospital services and clinics, do Britons trust that the goal is to improve patient care and outcomes?

Edelman has studied trust for 18 years and we are now in our seventh year of surveying an extended sample of the general online population. This year, we spoke to more than 33,000 respondents in 28 countries. We ask them a series of questions to gauge their trust in the institutions of business, government, NGOs and the media. 

The 2018 findings revealed that Britons mistrust all four institutions. In an era where trust is distinctly lacking, one would hope to be able to say that the public ‘trusts’ the NHS.

The good news is that our findings are encouraging. As one might expect, comparatively, ‘Hospitals/Clinics’ have consistently remained the most trusted healthcare sub-sector since this category was added to our global study in 2015.

FIGURE 1 Globally, Hospitals / Clinics Remain Most Trusted

Trust in the Healthcare sub-sectors, 2015-2017, (27-country global total), General Population


We believe their continued and growing levels of trust are due to:

• Patient Relationships: Hospitals/Clinics have always had a trust advantage given their direct and ongoing relationship with patients. In the US, we believe this is because more of the population are receiving access to Hospitals/Clinics thanks to public reform.

• Benefit of Real People: As opposed to other segments of the healthcare industry where employees are many steps removed from the patient or consumer, hospitals and clinics have a human face and real people on the frontlines of treatment and care.

Who can build trust?

The data helps us form some thinking around who in the NHS can help build trust. Who should represent the NHS to communicate its strategic policies; talk about change; and outline its future?

Our survey found that employees are the most credible voices - more than leaders and more than experts. 

Across the board, employees are more trusted than CEOs or senior business executives to communicate information. This includes information about financial earnings and operating performance, how to handle a crisis and - of course - how to treat employees and customers.

FIGURE 2 Employees Most Credible
Most trusted spokesperson to communicate each topic


Healthcare communicators should also be interested to find out that along with academic and technical experts, ‘a person like yourself’ is seen as credible by most people. This reinforces that people want to be spoken with, not talked at.

Engaging the public with the public health agenda – critical to the sustainability of the NHS – is another area where trust is key. 

Interestingly, The King’s Fund found that two-thirds of the public (65 per cent) agree that keeping healthy is primarily the responsibility of the individual, while just 7 per cent put this responsibility on the NHS.

This links to another finding of the Trust Barometer. Globally, 7 in 10 people agreed with the statement ‘I am confident in my ability to find answers about healthcare related questions and make informed decisions for myself and my family.’ This points to the increased availability of health information across non-traditional platforms, including online sources, social media and companies’ owned media channels.

Building trust in institutions 

In our dialogue with businesses globally on trust, Edelman identifies five top trust-building behaviours: 

1. Ensure quality control and protect consumer data
2. Be transparent and authentic in how you operate
3. Contribute to the greater good
4. Develop innovations that have a positive impact on people’s life and the world
5. Show leadership that effectively represents the interest of all stakeholders.

It goes without saying that the NHS should own points three and four. Also, transparency remains high on the agenda of the NHS, particularly with initiatives such as ‘My NHS’ on performance data.

Protection of consumer data - or in the case of the NHS, patient data - remains an area of public debate and often concern. As technology advances, along with our modern lifestyles, it is critical that the NHS builds the public’s trust in NHS safeguarding and use of personal data. 

Who should lead that debate? Certainly not the politicians. Our findings show the public trust in ‘people like me’ and ‘employees’, however. This could point the way to organically building the public trust and understanding in the NHS’s future use of their health information. 

Some steps are already being taken. Setting out her vision of the use of genomics in the NHS, Sally Davies, Chief Medical Officer, notes ‘as members of clinical teams we must engage patients and the public and develop real partnerships. […] To achieve this we need to maintain patients’ and the public’s trust and make genomics everyone’s business.’

More leaders must adopt this approach.




Alan Maine is Senior Director for UK Health Public Affairs at Edelman. Alan has worked in healthcare and science policy public affairs for 15 years. Before joining Edelman he was Head of Policy and Public Affairs at Pfizer and he also worked for Wyeth and Merck Sharp and Dohme. Prior to his time in the life sciences industry he was head of the foreign affairs section of the Conservative Research Department.

Twitter: @edelmanuk