Hospital treatment is a highly charged, ultra-emotive issue. The NHS is
a cherished institution. And the British public has come to expect high-
quality hospital treatment as its tax-given right.
Having paid for the privilege of ‘free’ treatment, it is little wonder
that the public usually responds negatively to stories of rationing or
hospital closures. Change to the way treatment is delivered, even if it
is for the better, raises the ire of the man in the street.
Consequently, providers of hospital services have to take great pains to
communicate change and provide reassurances that the standard of care
available is not being diminished. That applies to both NHS Trusts and
With the latter, there is also the need to overcome antagonism from some
sections of the community who view private healthcare as divisive,
offering first rate treatment to those who can afford it while the less
affluent have to make do with public sectors services that are being run
Harvard Public Relations associate director Barbara Rayner, who
represents both NHS Trusts and private clients such as the Evelyn
Hospital in Cambridge, argues that the core task in undertaking PR for a
private hospital is to establish it as ‘part of the fabric of a local
community’. This is seldom easy as most communities have over the years
built up a strong loyalty to their NHS general hospital. ‘The key
message is that private healthcare gives the consumer choice. It is not
about private versus NHS,’ says Rayner.
Those working in private hospital PR need to prove that their facility
is not a threat to the NHS and that it is not limited to a tiny elite of
users. This may be done by explaining the benefits of services such as
fixed price surgery to show that it is not out of reach to the vast
majority of the general public.
David Freeland, managing director of Southampton marketing
communications agency The Partnership, has also worked for both private
and public sector health clients.
‘In the private sector the scope of PR work is rather more limited
because it is driven by business generation rather than social
responsibility,’ he says.
In the NHS much of the recent communications work has been to explain
the reforms of its management structure. These have seen the creation of
single area purchasing authorities through the merger of the Family
Health Services Authorities (FHSAs) and the District Health Authorities
to become simply local health authorities. At the same time, the 14
semi-autonomous Regional Health Authorities (RHAs) have been replaced by
eight regional offices of the NHS Executive under the direction of its
Most of these changes have been effected ahead of the deadline of 1
April this year. But among the public there is still a great deal of
confusion about the divide between purchaser and provider. And while the
role of the providers, eg Trust hospitals, is clear many people are less
sure about what the purchasers and regional offices do.
‘There has been some central Government funding for purchasing agencies
to improve their communications with the public but I suspect a lot of
that has been spent inappropriately because of a shortage of PR
professionals and consultancies with a real understanding of how you
effect programmes that aren’t just about health education, closure
battles, fund raising or marketing support,’ says Kinross and Render
chief executive Sara Render.
‘The challenge can be summarised as creating the means for on-going
dialogue with the public in a period where your own future is uncertain
- and at next to no cost.’
The point about communications expenditure is valid. The NHS still has
tremendous problems justifying PR costs when the expectation is that the
maximum amount of money available will go into the provision of
This situation has persuaded many healthcare consultancies to keep their
NHS work to a minimum and pursue more lucrative pharmaceutical business
instead. Yet clearly it is vital for the NHS to communicate with public.
If it doesn’t, setbacks beckon.
A case in point is offered by Manchester health commission which last
November saw its plan to shut down Booth Hall Children’s Hospital and
centralise services at the Royal Manchester Children’s Hospital
ignominiously defeated. Although the proposal had the overwhelming
support of clinicians it was defeated by an alliance of local MPs and a
Neil Goodwin, the commission’s chief executive, went on record as saying
it is ‘increasingly difficult’ to bring about change within the NHS and
wondered whether it would ever again be possible to completely close a
district general hospital - such was the strength of public enmity
directed against the closure.
HSMU, a healthcare management and academic health policy unit based at
Manchester University and chaired by ex-NHS chief executive Sir Duncan
Nichol, has teamed up with Hill and Knowlton to form a joint venture
offering communications consultancy in the medical sector.
Jill Pooley is the head of health policy for the joint venture, which
will provide advice for pharmaceutical companies on how to deal with the
new NHS structure; giving the drug companies access to key personnel in
the NHS and assisting in establishing joint ventures such as disease
Nick Samuels, policy co-ordinator at the Institute of Health Service
Management advises health service managers to ‘tune themselves into is
the political and media environment in which their decisions will be
But it is NHS Executive head of communications Helen McCallum who has
had the unenviable task of trying to improve communications through the
regions. She concedes: ‘There’s still a long way to go until the NHS
takes its full share of communicating.’
But she also argues that the NHS has made a lot headway in understanding
how to communicate effectively. A good thing too - there are a lot of
people out there who get very upset about any threat, perceived or
actual, to their local treatment centres.
Smear scare: Countering the panic
When the Daily Express contacted Kent & Canterbury Hospitals NHS Trust
on 2 February this year about rumours of problems with its cervical
smear test procedures, its management team went into crisis handling
mode. The Trust’s own internal quality controls had highlighted a need
for improvement and the hospital was considering what course of action
to take when its hand was forced.
On that same afternoon the Trust hired specialist healthcare agency
Elliott and Cater to help it formulate a course of action, enabling it
to air its point of view before speculation began appearing in the
media. E&C advised bringing forward the announcement that a review was
to take place concerning the screening given to 70,000 women at the
hospital between 1990 and 1995.
It was decided to make an official announcement about the situation on
Monday 5 February and an 11-strong team of senior Trust managers worked
throughout the weekend to prepare.
A leaflet was drawn up advising patients on the state of affairs and
50,000 were sent to doctors’ surgeries. E&C put together a press pack,
copies of which were also sent to GPs so that they had all the material
to hand to answer patients’ questions.
At the same time a telephone helpline, manned by trained nurses was set
up and made operational from the moment the story was released to the
All through Monday, the Trust’s chief executive Edward Pearson made
himself available for interview by the media. As did other key Kent and
Canterbury staff members including clinical director of obstetrics and
gynaecology Michael Milligan.
‘The whole team worked together from Saturday morning to Monday evening
without really leaving the hospital,’ says E&C managing director Claire
Although the smear scare was quite a big story on the Monday and
Tuesday, the press began to lose interest by the middle of the week.
There was, of course, the odd sensationalist headline such as the Daily
Telegraph’s ‘Helpline Staff Struggle to Prevent Smear Test Panic’. But a
lot of the coverage was balanced, pointing out that the problem had been
picked up by the hospital’s own quality control system.
The helpline received about 1,300 calls on the first day - nowhere near
the deluge anticipated. An indication, perhaps, that the hospital had
got its message across succinctly through well-briefed doctors.
There’s no such thing as a good crisis. But this one was assuredly well
Case study: One stop healthcare in Soho
Parkside Health is one of the largest NHS trusts in the country, serving
an area that runs from Fleet Street on the edge of the Square Mile out
as far as Harrow, taking in much of central London on the way. In 1990
it acquired the building formerly occupied by the Soho Hospital for
Women which has been largely empty for the past nine years.
Instead of selling off this prime Soho Square site to property
developers, the Trust decided it would refurbish the listed building,
turning it into the first one-stop community care centre of its kind in
central London. The scheme is known as Soho Centre for Health and Care
and has an estimated cost of pounds 5.2 million.
Harvard Public Relations was brought on board two years ago to assist
Parkside in launching what is essentially its flagship project. The
centre will offer integrated health and social care services under one
roof including dentistry, paediatrics, gynaecology, care of the elderly
and disabled and - potentially more controversially - care for those
with mental health problems.
‘We’ve taken on board the lesson that although what we’re offering may
be very good, it’s still necessary to communicate it better than we have
in the past,’ says Parkside director of corporate development Bashir
‘People might question why we have a PR agency. But it’s very important
that public services communicate better with the community and PR helps
us do that.’
The first stage of the communications process was to find out what the
local residents and business community wanted from a health centre in
Soho. To this end, Parkside carried out focus group interviews,
including qualitative research with representatives of the large
Chinese community in the area to find out their specific wants and
Harvard organised a community relations campaign that included one-to-
one meetings with key interest groups such as the Soho Society to listen
to any concerns and provide updates on developments. The consultancy
also co-ordinated a series of public meetings where local people were
encouraged to air their views. Parkside speakers were given presentation
training to ensure they delivered their messages effectively.
The Trust also took a stand at the annual Soho Festival in July, from
which leaflets and other material were handed out to local residents.
On the whole, the response of local residents and businesses has been
‘The challenge has been to ensure that local people feel they have
ownership of the project,’ says Harvard associate director Barbara
The communications campaign has also had a media relations element, with
coverage gained in professional publications like NHS Magazine,
Healthcare Today and dental magazine The Probe as well as in the local
press. The media relations programme will continue during the
The project received the planning go-ahead on 3 November 1995 and
development work is expected to start shortly.