In PRWeek's 2011's healthcare supplement I argued that comms specialists would need to be nimble to help clients negotiate the misty terrain ahead, and that waiting for the fog to lift wasn't an option.
A year later and the outlook is, if anything, murkier, the fog denser and the need for insight, guidance and dexterity greater than ever. Never before has health reform been the subject of such visceral debate. Scrutinised under the microscope of professional and public opinion, poked and prodded from all sides, one has to question its chance of survival.
But survive it probably will. Significant change has already taken place on the front line; clinical commissioning groups are in place and in charge of hard budgets, and to back down now would be unpalatable.
That the Health Bill finds itself in such a bloodied state is largely down to a catastrophic lack of effective communication. A pre-election promise of 'no change to the NHS' swiftly mutated into 'extreme change to the NHS' once the coalition deal was done. The media, hungry for conflict and debate, have gorged at the table of health reform ever since.
In truth, the Bill, which essentially wanted leadership within the NHS to come from doctors rather than managers and to hand control of the health budget to commissioning groups led by GPs, simply built on the previous administration's policies of practice-based commissioning and clinical leadership. And the 'any willing (now qualified) provider' clause, which has caused such ructions, was hardly ground breaking.
But the already hostile media sharpened their knives further. 'Any willing provider' could only mean one thing - full-on privatisation of the NHS.
Logically, this can't be true. A health service that is free at the point of need is by definition a public service. If, though, by privatisation we mean the provision of health services by people or organisations not directly employed by the NHS, then the NHS was privatised long ago - at its inception in 1948 - when GPs negotiated to provide their services as private contractors.
Since then, the NHS, like the BBC, has moved inexorably from a role of provider to one of commissioner, partnering with independent organisations, social enterprises and charities like Nuffield to provide both general and specialist services.
The NHS is a service paid for, and therefore owned, by us all - and it is up to all of us to treat it with the same level of care we expect in return. Reform may be needed from within but it is just as urgently needed from without. Nuffield is absolutely right to focus on prevention and self-care.
If we are to reverse the tsunami of long-term conditions that threatens to swallow the NHS whole, we have to change perceptions and behaviours. Innovations in telehealth, self-care initiatives, social enterprises and partnership agreements are beginning to show demonstrable results; but real change takes time.
And in that time, expect to see an increase in integrated care; between primary and secondary care, doctor and patient or carer, between the NHS and local authorities, the pharma industry, and independent providers.
Media and public relations remain key to raising awareness or positioning an organisation; by combining these with insight from a reference group like Salix 100, enabling third party endorsement and personal introductions, we are providing guiding lights that are helping our clients negotiate their way towards the new commissioners and new contracts.
Views in brief
On which healthcare comms project are you most proud of working?
Self Care: An Ethical Imperative was a three-year programme with the Self Care Forum - a collective of health and industry professionals - to raise awareness of the benefits of self-care for the patient and its role in reducing the £2bn cost of GP appointments for minor ailments; it has generated £2.5m of media coverage and measurable behavioural change has been achieved.
Which patient group has deployed the most effective comms strategy?
The World's Biggest Coffee Morning by Macmillan is a brilliant strategy that raises awareness, is a huge fundraiser, and brings communities together.