Despite Government figures showing that key targets such as hospital waiting times have almost been cracked, the public still tends to view the National Health Service as an over-stretched monolith. Indeed, the NHS still faces a perception problem, where opinions of the health service are out of kilter with reality.
'Perceptions always run behind any improvements, but we are making progress,' says Department of Health director of comms Sian Jarvis. 'The gap has closed, but patients still believe that they've been lucky if they've had a good experience at the hands of their local health service, and people still tend to talk down the NHS and its staff.'
Repositioning the service
This attitude presents a major headache for the service's PROs. As the NHS undertakes huge reforms, which, according to Jarvis, will reposition the brand as a service for health, rather than a service for sickness, and personalise its offering, it has become even more important that individual trusts and authorities secure public buy-in.
A case in point is the current modernisation agenda, which is driving major cultural change through the NHS. This aims to place the patient at the heart of the organisation and provide care in the right place at the right time.
Broadly speaking, this means that in future, the emphasis on patient care will switch from a reliance on hospitals to locally provided clinics by GPs, nurses and pharmacists. All of which is great news if your practice nurse performs an on-the-spot X-ray. However, for NHS trusts, this represents a potential media relations nightmare, should any journalist discover that, as a result, local hospital services have shrunk.
'The public are not expecting this major cultural change and it needs explaining; there's not a lot of that going on at the moment,' says Nexus Healthcare director Jonathan Street.
This is a view challenged, in part, by South London and Maudsley NHS Trust head of communications Dan Charlton: 'It is fair to say that, in the past, the NHS has not always been good at explaining what it does, but we're getting better at creating dialogue that promotes a better understanding and confidence in what we do.'
As the provider of mental health and substance misuse services for the London boroughs of Croydon, Lambeth, Lewisham and Southwark, the trust has been engaging the community through initiatives with private business, the police and local councils.
However, as the body increasingly looks to intervene in illness in a community setting, this has not prevented some of the old stigmas against mental health services materialising. For example, the trust has been working with Croydon PCT and private firm Care UK to open a residential home to rehabilitate patients that may have committed serious crimes.
Inevitably, this has created public opposition in the area. Nevertheless, Charlton and his team have spent time with the Croydon Advertiser to ensure that both sides of the argument are presented fairly.
There are also serious issues to be communicated across the NHS itself, around the £6.2bn National Programme for IT (NPfIT). This is currently rolling out an electronic booking system, which, by the end of 2005, will allow all patients to select the date and time of their hospital appointments from the comfort of a GP's surgery.
Coupled with the wider initiative of patient choice between four or five hospitals for long-awaited operations, this development will be a major improvement on the old system, where consultants ruled the roost.
But the success of the scheme depends on a full understanding by the public that the balance of power has shifted in their favour. In addition, as Street highlights: 'GPs will have to get up to speed and some of them do not have the technology to do so straight away.'
And, as the new arrangement sees patients rather than GPs or hospitals effectively control the budget, there is uncertainty about how far hospital trust PROs will be responsible for influencing patient choice in their favour.
With this in mind, the comms team at Guy's and St Thomas's Hospital NHS Trust recently secured three years funding to take over the soon-to-be foundation trust's written patient information service.
This followed an internal review of literature, revealing a disparity in the quality of written leaflets and brochures produced by internal departments.
It was coupled with a long-standing involvement in BBC1's City Hospital programme and a new community magazine. Head of comms Anita Knowles feels that this is indicative of the overall shift in emphasis within the NHS towards greater access to information and services for patients: 'Communications is no longer just about media relations, it's about ensuring that communications is seen as being part of good quality care.'
The other key agenda for the NHS is public health, where the service needs to convey the boundaries between personal responsibility and state provision (a Government white paper is expected later this autumn).
Likewise, the DoH has finally rolled out new local and personalised services for tackling diseases such as diabetes.
Winning over staff
While there is a strong emphasis within the health service on public and patient-facing communications, as the largest employer in Europe, its key task is to win over the staff.
For example, the comms team at Brighton and Hove City Teaching PCT has been ensuring that all clinical and admin employees understand the implications of the NPfIT, Patient Choice and whole system reform. This is on the premise that most patients' primary contact with the service is frontline staff.
Head of comms Richard Forshaw adds: 'As a PCT and a relatively new organisation, staff have been through a lot of upheaval and are facing a very new world.'
While Forshaw is one of the lucky NHS PROs who has board-level influence, elsewhere health service communications can be patchy.
But the organisation is taking the discipline to heart. Charlton regularly shares best practice with his PR colleagues within South East London Strategic Health Authority's remit, while Jarvis meets the communications heads from England's 28 Strategic Health Authorities once a month.
More significantly, a very clear message was sent out last month when, for the first time, Strategic Health Authority CEOs found communications built in to their performance measures.
With so many comms issues to deal with, changing public perception will not happen overnight for the NHS. Significantly, however, there is commitment to working towards this goal.
THE NHS CONFEDERATION - COMMUNICATING ISSUES
Set up in 1997, the NHS Confederation is a charitable body that brings together NHS organisations across the UK.
Last month (23 to 25 June), it held its annual national conference and exhibition entitled 'Real leadership: tough choices, difficult decisions'.
As the body typically engages its members at board level, the conference dealt mainly with leadership issues. However, there were a number of comms sessions, most notably, a presentation on 'Having difficult conversations', which looked at the importance of staff behaviour, feedback and trust.
In addition, IPR president Anne Gregory, DoH director of comms Sian Jarvis and King's Fund CEO Niall Dickson led a session on 'Reputation: make or break', addressing how NHS bodies can communicate an accurate and balanced view of the state of the health service.
'We wanted to use the event as an opportunity to kick off a new, more honest debate around the NHS and get political commentators to stop ducking many of the tough choices and difficult decisions ahead,' says NHS Confederation director of strategy and comms Helen Bradburn.
As election season approaches, the body is also determined that political parties resist the temptation to try and win over electors by proposing radical change. 'The NHS needs a period of stability for existing reforms to take place,' says Bradburn.
Other priorities for the body include developing a more segmented approach to its members' needs, to meet the increasing diversity of the NHS. However, the major shake-up will be in October, when it becomes the employers' organisation for the health service. This will see the charity representing NHS bodies in negotiations with unions, while the comms directorate is set to increase. from 27 to 50 members.
Working with its members, the Confederation aims to be an independent driving force to transform health services, by influencing policy and public debate, while connecting health leaders through networking and information sharing.
, it provided around 2,000 delegates the opportunity to map out some of the challenges facing the future of the NHS.
However, the Confederation also spent the three days launching the consultation process for its new manifesto, which it intends to publish this autumn.
'As it was our last major conference before the next general election, we'