NHS SPECIAL: Talking change - Karen Stafford talks to Department of Health head of comms Sian Jarvis about how PR will play a part in NHS transformation

Sian Jarvis, director of communications at the Department of Health - the most senior communications post in the largest employer in the UK - says the NHS is preparing for change with a new approach to communications.

She draws the unlikely comparison between the NHS and actress and model Liz Hurley when explaining how things should change.

'Liz Hurley knows exactly how to sell herself and the NHS should do the same,' says Jarvis. 'It is no longer enough to be doing a good job, they have to be seen to be doing a good job. If trusts or health authorities feel they have had unfair criticism, they should stand up for themselves.'

This determination to back up staff and provide support from the highest level for those at the frontline is a key element of Jarvis's strategy as the NHS begins its programme of change. It was witnessed most recently when Jarvis advised health secretary Alan Milburn and Prime Minister Tony Blair to offer strong support for the staff at the Whittington Hospital in north London, which had come under heavy media criticism for its alleged poor treatment of an elderly patient. The incident led to Parliamentary wrangles over the disclosure of private medical records, in which Jarvis had no involvement.

'I have met many doctors and nurses and the feedback I have had is that they were delighted to be supported in that way,' she says. 'Yes, of course, there will be mistakes and when things go wrong we should be open, honest, deal with the criticisms quickly and do whatever it takes to put them right. But it is time for the NHS to stand up for itself if it feels it has had unfair criticism.'

Jarvis was appointed head of communications at the DoH in September last year and had been deputy director of comms for the previous two years.

Prior to that she was political lobby correspondent with GMTV for seven years. Her appointment coincides with a period of radical reform in the NHS, as the balance of power is shifted towards frontline staff who, it is hoped, can better understand patients' needs and concerns. A key to making the reforms work, believes Jarvis, will be engagement with staff.

As she says: 'The staff are the only people who can deliver the changes; you cannot do it if you do not have them on board.'

Under the slimmed-down system at regional level with 28 strategic health authorities, probably the most significant change will be in the elevation of importance of primary care trusts (PCTs), or groups of family doctors, and this alone will pose new communications challenges.

Jarvis explains: 'They (PCT's) will now hold 75 per cent of the budget and will be responsible for spending it, whereas before they were, so to speak, at the very bottom rung of the ladder. GPs are now in the driving seat but traditionally many PCTs have been quite weak at management and I think it will be a big challenge for us to get good communications systems in place. GPs will need to know what their patients want, what the public wants and how to connect communities to their local health services.'

It is not just PCTs that will need to be aware of communications issues.

Not all health executives have embraced the benefits of PR and while many trusts have excellent teams of PR professionals, some do not yet have a dedicated communications professional on the staff.

Jarvis estimates that 50 per cent of organisations in the NHS fall into that category. 'I am telling chief executives that they will need to manage their reputations,' says Jarvis. 'We can't do it all from here and that wouldn't reflect the spirit of shifting the balance either. It is a challenge but I need to put communications in the mainstream of all the leaders' minds.

'We have a big job of work to make sure we grow the talent we have, and also to grow the numbers - and that is difficult at a time when resources are short,' she adds.

Jarvis's task is obviously complicated by the fact that each organisation in the NHS makes its own decision about who to employ. There is no stick she can wave to force them to put PR high on the agenda and believes this is not the way forward in any case.

'You can't on the one hand say we're shifting the balance to this more grown-up relationship between the centre and service and then say "but we don't like the way you're doing things". It is my job to persuade those who are still doubtful and you don't win the argument by beating people up,' she says.

Instead Jarvis would like NHS managers to learn from the private sector and see how the emphasis on internal communications and reputation management can reap rewards.

'When Tesco describes its success during the past 30 years, it will put it down to the fact that it listens to customers and values its staff and communicates with them properly,' Jarvis says.

Structural change often means job losses but Jarvis seems genuinely horrified at the thought of losing PR staff: 'There is some great talent out there but we need more of it,' she says. 'I see it as my job to say, "Please don't worry, you will have a bigger and better role". In a period of transition it is easy for people to walk and get a job elsewhere. I need to keep the enthusiasm going.'

Unfortunately, as Jarvis recognises, one of the major problems is that she has no control over staff employment outside her own department, which she is currently restructuring, and so can only persuade.

She is getting her message across via a rolling programme of seminars, conferences and meetings. On 13 February, for example, Jarvis made a presentation to a conference of all the trust chief executives in the country. In the previous week there were seminars for doctors and nurses. Speakers are going out from the DoH two or three times a week to talk to frontline staff about the changes and to drum home the mantra - putting the patient first.

Jarvis is also keen to take current best practice and extend it across the organisation. In the near future she will be working on pilots that will then be spread through the service.

Jarvis also recognises the challenge of maintaining uniformity. 'We will have a performance management role,' she explains. 'We will look at the good communicators we have out in the field, bring them on and make sure we have a core framework of standards they will be working to. But they don't have a career structure in the way a lot of professions have and I need to look at how we can develop that.'

The challenges may be great but Jarvis feels her communications strategy is crucial to the success of the NHS programme of change. 'It has to be a priority,' she states. 'One in four people take their view of the NHS from those who work in it, so I have to tell those workers that they have a very powerful voice.

'My greatest fear is that the NHS could hit every single target in the plan but the reforms could still fail because we wouldn't have made the service look or feel better for the patients.'

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