Jo Bullen, APCO - Selling change in the NHS

PR professionals must look beyond policymakers and politicians if they are to drive innovation.

Health services across Europe are struggling to accommodate the rising needs and expectations of patients in an uncertain economic environment. Politicians and policymakers are working to reform their health service models to achieve the excellence and cost effectiveness necessary to deliver patient care while balancing access and quality.

But where do the services offered by the communication and public affairs industry fit into this reform process? What role do we play in ensuring that in a reform environment, innovation reaches those who deserve it most - the patient? Does the work that we do drive reform and are our efforts even directed at the right people?

Governments have often, quite rightly, looked to lobbying groups - be they patient representatives, campaigning charities or professional societies - when seeking direction on healthcare reform. In the UK, patient organisations have a well-recognised role in setting the tone for Department of Health policy, particularly in the areas of cancer, mental health and long-term conditions. Campaigns about specific diseases may have secured specific policy success, but have these efforts been instrumental in driving through reform in healthcare, particularly when it comes to areas of significant change?

In the UK, there has been a concerted drive by private organisations to bring innovation to the NHS, led, in part, by a Government keen to drive a reform process that overcame negative perceptions about private sector involvement. Yet, despite perceptible change about the debate in the media and the support of politicians across political parties, many organisations ultimately failed to gain traction, although they deployed the best of their communications resources. Entrenched priorities in the NHS trusts make it difficult for them to justify taking significant risks while the provision of care and the more recent debate on preferred providers creates further uncertainty.

Beyond the UK, similar trends hold. In Germany, campaigners point to the power of insurers in driving healthcare reform. Regardless of political intentions, the health service is institutionally and financially dependent on their involvement in the market and therefore their view holds sway. In France, barriers to innovation do not just lie with the people who hold the pursestrings; cultural attitudes at the coal face often make or break its adoption. Government initiatives for health IT reform have been limited by objections from clinicians that it threatens their clinical freedom.

Similarly, experience of the adoption of IT systems in the UK shows that pressure from central government rarely results in successful clinical adoption without intelligent engagement of clinicians and managers.

It is important to engage with people who work in individual healthcare organisations, so a communications focus on a few individuals at the heart of government may be misdirected. Campaigning efforts to drive innovation may be more successful if a multi-pronged approach is taken. It should be directed, organisation by organisation, at financial and clinical decision-makers in the health service - and at media that represent their interests - rather than at policymakers and politicians.

As the reform process bears fruit and healthcare organisations become more financially independent and accountable to their local communities, stakeholders will have to be convinced that innovation is necessary for their organisation and is not a risk or a threat to services. Innovation and reform will still need political endorsement, but success will depend on its adoption and implementation. It is here that our profession can play a vital role.


- Which pharma company has improved its profile most in the past year?

GSK was accused of profiteering through sales of its H1N1 vaccine and flu drug but made a strong case for the R&D behind vaccine and medicines production.

- Who is the most effective third-party advocate you have worked with?

Sir Steve Redgrave, on behalf of Diabetes UK and Lloydspharmacy. A respected public figure (and diabetes sufferer) who can speak to anyone in any situation.

- What did you learn from the swine flu episode?

The medicines supply chain worked collaboratively, but local PCT autonomy was sometimes at odds with the need for a uniform national response.

- Jo Bullen is a director at APCO.

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