NHS SPECIAL: NHS transformation raises PROs' stakes - In April, 95 health authorities will become 28 as part of the health service's reorganisation. In this special report, PRWeek looks at how the reforms will affect PROs

In addition, the Forum has been thrashing out how to deal with the region's mixed bag of shared and exclusive clinical services, while meeting the needs of the local media.

'Basically, journalists won't want to approach all three PCTs, to find out how the city is dealing with cross-city services such as family planning or the free emergency contraception programme that we're piloting,' adds Altwarg.

However, while the changes in April represent a huge communications challenge, it would be a mistake to believe that St Bop is unwelcome.

While some in the media have criticised the initiative as privatisation dressed up as progress, those within the service view greater local accountability as a positive development.

Lamont reflects the views of many when he says: 'It's an extremely laudable objective, whereby local decision makers will have the autonomy to meet local needs'.

The next six months are likely to be difficult as people change and adapt to new jobs, but if patients and staff are to become truly empowered, then communications will have a crucial role.

Nobody is pretending that the 1 April represents the silver bullet for the NHS's woes, but as Lamont says: 'The new PCTs will eventually realise that to be successful, they will have to invest heavily in communications. That means lots of opportunities for PR professionals to come in and work for what is a vibrant and exciting organisation.'

Health secretary Alan Milburn's announcements on the forthcoming NHS reforms have been met with mixed press coverage.

The main messages from Milburn on his vision for the NHS have been its liberation from government control, a greater responsiveness to patients, and the fairness and efficiency of the tax-funded system.

Positive coverage has been recorded over issues such as openness. The publication of surgeon's death rates was described as 'a milestone in the development of a more open, responsive and patient-centred NHS' (The Guardian, 18/1).

By contrast, the policy itself has received mixed coverage.

A leader (The Financial Times, 16/1) said Milburn's reforms: 'mark a return to the original ideal of the Conservatives' internal market in health'.

The Sun (25/1), however, showed support for the plan: 'There are problems with the NHS but there's progress coming through!'.

The NHS has never been renowned for its skills and depth in communications.

Of course, public service-bashing is something of a bloodsport for the media and politicians, particularly at the moment, but perceptions of the NHS have become locked into a never-ending downward spiral.

From one-off crises, such as the Bristol Royal Infirmary babies heart scandal and the current MMR vaccine debate, to the ongoing wrangles over investment and staffing levels, hospital bed numbers and waiting times, the health service is continually the subject of communications discord.

The frustration for those within the health service, however, is that much of the day-to-day antagonism towards the organisation is driven by mismanaged PR, rather than failing services.

Hugh Lamont, head of communications for the NHS Executive North West says: 'Around 75 per cent of all NHS complaints could probably be resolved through better communications.'

This situation is not helped by the huge disparity in skills, experience and qualifications of those holding the PR reins. While there are pockets of true excellence, an alarming number of NHS employees - the likes of chief executives' secretaries - have had a PR remit thrust upon them.

However, as Prime Minister Tony Blair stakes his reputation upon the successful turnaround of the NHS, the burning question is whether this will all change come 1 April, when the first phase of 'Shifting The Balance of Power' comes into force.

Such is the pressure on Blair that the radical reform plan has been followed by strong hints from him that the Budget, on 17 April, will involve tax rises to fund extra spending on the NHS.

On the BBC's Your NHS: Your Future last month, Blair said: 'In the forthcoming Budget there will be a very tough choice, not just for politicians but for the country: if we want a sustained investment in the NHS, we are going to have to pay for it and I believe we should fund that out of general taxation.'

He added: 'If people are going to pay more tax for sustained investment in the NHS, then they want to know the money they are paying is going to the health service.'

The pressure to make the whole process successful and for the various communications departments to demonstrate improvements and results during the period is therefore immense, as most of the UK's public services are exposed to intense public and media scrutiny.

Between now and 1 April, media and government focus will be placed firmly on the restructuring process, with the Government most likely showing support for health and public service workers while the media makes up its own mind on whether it supports the introduction of new taxation, the reforms themselves, and - ultimately - the Government.

Driven by the NHS Plan, the Government's ten-year reform programme for the health service, 'St Bop' as it is affectionately known, is health secretary Alan Milburn's vision for placing patients and staff at the heart of the NHS, by devolving greater power from Whitehall to local communities.

As he declared last April: 'All parts of the NHS must be reformed to redesign it around the needs of patients. Patients should have more information, more influence and more power over the services they receive. The balance of power in the NHS will shift decisively in favour of the patient.'

The reality behind this rhetoric is a massive reorganisation of primary care - GPs, midwives, health visitors and other community health services - across England, and involving a £100m transitional fund in each of the next two financial years.

Naturally such upheaval will necessitate a changeover period, but on 31 March, the eight regional NHS Executive offices will be abolished, as will the 95 health authorities.

In their place, will be four directors of health and social care (civil servants appointed to cover London, South, Midlands and East, and North); 28 merged Health Authorities (which, subject to legislation, will become Strategic Health Authorities, SHAs, this October); and more than 300 Primary Care Trusts (PCTs).

The Department of Health, the Modernisation Agency and the Commission for Health Improvement, is to use PR to ensure this local focus and emphasis on customer service is delivered. But the greatest sticking point - as ever - is the maths, and the fact that there are going to be more PR jobs than there are at present.

As Brenda Irons, communications manager for the NHS Executive London (soon to be the Directorate of Health and Social Care London), highlights: 'With PCTs taking over many of the responsibilities of Health Authorities, such as purchasing services and care for the local population, each PCT needs a strong communications function.'

Indeed, within the national framework, PCTs will be responsible for planning and delivering local services, negotiating with providers, working with social services, emergency planning, health promotion and liaising with other internal and external stakeholders, including staff and the voluntary sector.

To address this vast remit and the widely-predicted communications shortfall, the DoH is talking to ministers, and conducting an assessment programme of what is needed in each region.

Shifting The Balance of Power communications project manager Nick Court says: 'We need to get a clear view on how to get communications to work better and how we're going to train people up to meet the current shortage of skilled communications people within the NHS.'

With most of the SHAs yet to appoint communications heads, and some PCTs still to be established, this is a tall order.

But Court and his colleagues are working on a set of guidelines for all chief executives, highlighting the need for strong communications.

'We have a powerful message that communications will have a huge role in how the NHS works with the local public, patients and other partners,' says Court.

The NHS is also hoping to attract talent and experience from the private sector, by positioning itself as a thriving place to work.

But while the DoH has guaranteed employment for all those currently working for health authorities and trusts until 31 March 2003, for some on the frontline, these changes present a massive upheaval.

Parkside Health is a Community NHS Trust with more than 2,600 staff providing services to a population of more than 500,000 in the London Borough of Brent and parts of Westminster and Kensington & Chelsea. On 1 April, Parkside is breaking up into three PCTs based on borough boundaries.

'For most clinical staff it's quite straightforward and they will transfer automatically,' says Parkside press and communications manager Ann Cohen.

'However, for about 300 staff providing central support services, such as finance, human resources, IT and press and communications, it's more complicated,' she adds.

In fact, some services, such as the recruitment bureau, are being hosted by one PCT and shared across four trusts, while other services will be exclusive to one PCT or shared by two or three.

Cohen and her colleagues are transferring to Westminster PCT on a one-borough remit, but as yet it is unclear what form provision will take at the other two PCTs. 'They're both very committed to communications,' she says.

'But it's not as if the current work load will simply be divided by three, so they will have to have something in place by 1 April,' she adds.

Likewise, some health authority staff are experiencing an uneasy transition.

'The great news is that the NHS is now dedicated to communications and the issue is how we will be positioned within the management structure,' says Anne Akers, Wakefield Health Authority head of communications and a committee member of the Association of Healthcare Communicators.

However, she highlights that staff morale has been a problem. 'The greater emphasis placed on PCTs by the DoH guidelines last July was handled as well as it could be, considering a lot of the information was out of our control. But it would have been better if staff here had not ended up going somewhere different to where they were originally told,' she says.

In addition, many question how in the short term, the NHS will meet the full compliment of core PR competences and how it will prevent PROs working alone or in two-man teams from becoming professionally isolated.

'I think the NHS will be short on opportunities for staff to develop and maintain a full-range of PR skills,' says Bob Schofield, managing director of Wigan-based Atlas PR, which specialises in providing services to the NHS.

He cites crisis management, saying: 'For staff in PCTs, these crises will come around fairly infrequently and most trusts will not be able to justify employing the right number of individuals to cover every eventuality.'

It seems that, for most, the solution will be some sort of common service arrangement. This is something that the three PCTs covering Manchester are striving to develop.

At the end of February, Manchester held its first cross-city Communications Health Forum. 'All three PCTs have a communications manager and, with the hospital trusts, we've being trying to join up health and social services across the city.' says Hadas Altwarg, Central Manchester PCT communications manager.

Aside from tackling the PR remit inherited from the local health authority, an important issue for Manchester is its cultural diversity. 'For example, there are language and accessibility issues and factors such as Muslim women having sensitivities around people visiting the home,' says Altwarg.

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