FOCUS: HEALTHCARE PR - Looking good, feeling good?/As local health authorities and NHS Trusts face a new onslaught of reforms, the challenge is to communicate the changes effectively

The health secretary, Frank Dobson, seems to have delivered health service communicators a double whammy. Not only has he just announced a whole series of reforms for trusts and health authorities to implement, causing them a major PR headache, but he also wants them to cut their management budgets.

The health secretary, Frank Dobson, seems to have delivered health

service communicators a double whammy. Not only has he just announced a

whole series of reforms for trusts and health authorities to implement,

causing them a major PR headache, but he also wants them to cut their

management budgets.

Fourteen trusts around the country have just been given the green light

for their private finance initiatives and will face a massive

communications exercise to persuade detractors of the benefits of these

privately-owned and privately-run new NHS hospitals. Elsewhere, trusts

and health authorities will seek to reassure a wary population that

hospital mergers will lead to greater efficiency and cost savings.

All trusts will now have to hold board meetings in public and clinical

indicators are to be added to NHS league tables revealing the number of

deaths of patients within 30 days of surgery and the number of emergency

readmissions to hospital.

Although this looks like a big surge of activity, in fact most of the

new reforms are simply the final implementation of initiatives started

by the previous Conservative administration, and trusts have already

been working steadily towards them.

However, Gareth Zundel, group PR director at Harvard PR, says: ’One

thing I think has changed is that, since the election campaigns, there

is a general attitude that people realise there is only a finite amount

of money available for the NHS. The public is ripe for a

locally-expressed statement of compromise and, provided trusts are open

and honest about the reasons for, say, longer waiting lists, the public

will accept it.’

Zundel, who has provided PR for NHS health agencies and trained NHS

managers to fulfil their own communications activities, believes that

the best place for hospital and health authority PR is in-house.

’The predominant influence occurs at the patient interface,’ he


’And that means you have to have all staff believing in your reforms or

changes and communicating them in a positive way to patients while they

are in the waiting room or having an x-ray. Staff have to accept that

waving the current corporate flag is part of their job.’

He adds: ’The role of agencies will therefore be a training one and that

is probably the best thing for the NHS.’

Claire Cater, managing director of Milton Cater Communications, agrees

that consultancies will win fewer all-encompassing PR contracts from the

NHS. She says that the new administration’s determination to cut

management costs in the NHS will have a knock-on effect on PR.

’More of the communications function will be provided in-house in the

future as the NHS continues to have to examine whether money spent in

the private sector achieves value for money,’ she says. But, unlike

Zundel, Cater believes this could be disadvantageous for the health


’The question is whether NHS managers will be able to dedicate

sufficient time and internal resources to pursuing consistent,

strategic, communication initiatives,’ she adds. ’We anticipate

providing more consultancy to trusts, with the actual implementation of

the communications strategy provided by them in-house. This may

particularly be needed where trusts face mergers or service transfers

and need to buy in the extra advice necessary for such a major

communications exercise.’

One NHS trust which is facing just such a communications challenge is

the Bromley Hospitals NHS Trust. For the past few years it has been

fielding plans to centralise its in-patient and accident and emergency

services on a new purpose-built site and has just been given the

go-ahead by the Government. Funding for the new site will be provided

under the Private Finance Initiative.

Head of corporate services Mandy Scott has the job of presenting a

positive communications message to staff and the local population, a

task which is made harder because of the complexities of the private

finance scheme.

’It is a priority to explain the changes first to staff because many of

them will be affected by the PFI. Some services have already been

contracted out and, as the rest follow, I want staff to hear the latest

news as soon as possible.’

As well as keeping staff informed, Scott also has to keep the local

’customers’ happy. In the Bromley area that means a largely middle-class

population which has taken to writing long letters to the local

freesheet ever since the Trust proposed to build its new hospital on

green belt land. A Department of Environment enquiry vetoed that option,

but the new initiative, to build on the Trust’s own Farnborough Hospital

site, is bound to upset some residents.

’Bromley Health Authority has supported our plans for the Farnborough

site and we have held consultations to get our message across,’ says


’We have held public meetings and produced a document which we invited

the public to respond to and we go to residents’ associations to hear

what they have to say.’

Scott combines this communications role with her job as Trust board


It is common in the NHS to find PR has been slotted into another

manager’s job description. But whereas Scott clearly understands the

role of PR, many NHS managers are simply too busy or unskilled to


Hazel Brand is the internal and external communications manager at the

Doncaster Royal Infirmary and Montagu Hospital NHS Trust, and also

secretary of the Association of Healthcare Communicators - a body which

would like to see a more professional approach to communications in the

health sector.

’There is a concern that managers are being asked to do PR, but without

proper training,’ she says. ’And the government’s resolution to cut

layers of management has meant that PR people will be victims of

cutbacks. A trust might feel it is saving pounds 25,000 on a public

relations officer’s salary, but it could well have to spend that on

bringing a consultancy in to deal with a crisis.’

On a more positive note, Brand welcomes the government’s directive that

trusts must hold their board meetings in public.’The task of organising

this fits in nicely with a communications manager’s role,’ she says. ’We

have a positive attitude towards openness and can use this as another

way of getting our messages across.’

But the drive towards more openness and accountability will not be

without its problems. Matt Tee, of Guy’s and St Thomas’ in London, heads

one of the largest in-house PR departments of an NHS Trust and gives the

reforms a cautious welcome.

’There will be problems of confidentiality when holding open board

meetings,’ he says. ’And we will have to ensure that the public is

excluded from certain discussions, for example where personal complaints

are being considered and when the board discusses private personnel


A potentially greater communications problem may be caused by Frank

Dobson’s decision to add clinical indicators to NHS league tables,

already a source of controversy. Now hospitals will have to provide

figures on deaths occurring within 30 days of surgery and emergency


’This will put us under the spotlight,’ admits Tee. ’Because we are a

large teaching (and specialist) hospital more of our patients will die

within the 30 days because they are more ill when they come into


We don’t want to sound defensive about our figures, but when it comes to

someone dying there may be a host of individual reasons behind it.’

There are indeed many initiatives under way in the NHS, all of which

require effective communications so that the public can understand the

resulting changes - but at the same time there seems to be a reluctance

within the NHS to spend money on PR.

It may be that the biggest challenge facing NHS communications managers

is that of persuading the health service of their own value, as the

health service is warned to spend more on direct patient care. But, as

Tee says, much of what PR departments do does relate directly to patient


’We write and publish a travel leaflet for patients, for example,’ he

says. ’There’s a good argument for saying that has nothing to do with

management and all to do with patient care.’


Last month the Government introduced tough new regulations on the levels

of hospitality that doctors are allowed to enjoy from pharmaceutical

companies. It is now a criminal offence for a doctor to solicit or to

accept excessive hospitality, money or ’freebies’. Drug companies which

offer lavish hospitality and gifts will also face charges.

The Association of the British Pharmaceutical Industry (ABPI) fought the

introduction of criminal sanctions, saying its own voluntary code of

practice was enough. A spokesman said: ’We would say that the existing

code of practice is regarded around the world as a standard which other

countries try to achieve.’

This is a view echoed by the PR consultancies working on pharmaceutical


Charlene Bargeron, managing director of Greenlines Healthcare

Communications, says: ’In my experience, pharmaceutical companies work

within the letter and spirit of the ABPI Code of Practice. Most

pharmaceutical companies now send their marketing and sales staff on

ABPI Code of Practice courses and all of our account staff also attend

the course.’

Bargeron adds that the ABPI rules have always been constricting for

marketing and PR professionals. ’The desire to balance promotional

objectives with the demands of the Code is perhaps under-appreciated of

an industry which historically has a poor reputation, which has been

further tarnished by a few bad apples,’ she says.

Peter Field, managing director of Shire Hall Communications, agrees that

the pharmaceutical industry’s image is not the best in the world, but

says individual PR consultancies are not to blame. ’The pharmaceutical

industry’s image is very much handled by the ABPI,’ he says. ’It could

do much more to promote the benefits.’ However, Field says that

consultancies can help their clients stay within the Code by recruiting

more people from the NHS. ’It is useful to us to be able to call on

their background and find out what they do and don’t want from

pharmaceutical companies.’ Scott Clark, managing director of health

consultancy Complete Pharma, is used to US marketers pushing hospitality

as far as it will go.

’Marketers are much more conservative in the UK,’ he says.

’Pharmaceutical companies stand to lose billions if they have a drug

withdrawn and so they are very strict at adhering to the


’The media seems to have picked up on a few companies that did something

wrong, but, in my experience, that doesn’t typify the business in the

UK. Pharmaceutical companies need to do a better job communicating that

they do stay within the guidelines.’


Newcastle’s largest hospital, the Royal Victoria Infirmary and

Associated Hospitals NHS Trust, employs over 6,000 staff, has an annual

income of pounds 175 million and provides emergency and planned health

care to 285,000 of the city’s residents. It might be expected that a

private enterprise of that magnitude would have a well-established PR

department, but the Royal Victoria Infirmary appointed its first PR

manager in May this year.

It seems that the NHS is finally starting to recognise the need for good

in-house specialists.

As newly-appointed press and communications manager, Edmund Lovell, who

was in City PR and, latterly, at Guy’s and St Thomas’ NHS Trust, is head

of a large communications undertaking.

As the new Government finally starts to put in place its health

proposals, Lovell sees the changes offering a golden PR opportunity. ’It

gives trusts a second chance to explain what their role is,’ he says.

’Trusts have soaked up most of the pressure in the past, for example, on

waiting times, and the NHS should seize this new opportunity to explain

exactly how the system works.’

It has been proposed that the Royal Victoria Infirmary will merge with

Newcastle’s second hospital, the Freeman, which will result in a massive

communications exercise for Lovell. ’Initially, there will be a lot of

work to do organising board meetings and then there is the educational

element, informing staff and explaining the jargon to local

journalists,’ says Lovell.

Keeping journalists informed and fully briefed is crucial. Whereas most

trusts are just starting to think about how to fulfil the Government’s

new directives on openness, the Royal Victoria Infirmary has for the

past three years been holding not just one, but four, open trust board

meetings. This means they are old hands at avoiding the traps those less

experienced may fall prey to.

’You have to be much more careful what you say in open meetings and also

when writing board papers,’ says Lovell. ’For example, the Royal

Victoria Infirmary revealed at a board meeting earlier this year that a

cash flow problem meant the trust would have difficulty conforming to

the public sector payments policy. A local journalist rang up believing

we were having problems paying our staff. What it actually meant was a

delay in paying large creditors, such as pharmaceutical companies.

’You cannot take it for granted that journalists understand the workings

of the NHS and that doesn’t just apply to the local press. A few weeks

ago I heard someone on the Today programme refer to NHS trusts as

purchasers rather than providers.’

Lovell believes the other key to good relations is explaining changes to

staff. ’We are producing a new staff newspaper in the autumn,’ he says.

’We consider it a priority to keep staff informed.’


Kenyon Associates, a Liverpool and Cumbria-based consultancy, has been

dealing with NHS clients for seven years, since the first wave of trusts

were created, working for the West Lancashire NHS Trust and Liverpool

Health Authority among others.

’In-house PR capabilities are dramatically stronger than they were in

1990,’ says managing director Roger Kenyon. ’When we first started

working with hospitals and health authorities, we were called in because

we were the only way they could handle PR issues across the board.

Hardly anyone in the NHS had any experience of media relations or staff

and community information programmes so they had to bring in outside

help. Now, most NHS organisations have seen the importance of a

sophisticated approach to PR and many have set up strong internal

structures to handle this.’ As a result, Kenyon thinks there will be

less scope for external consultancies to carry out full service

programmes, with hospitals and health authorities using consultancies

more on a project basis.

’We are doing more media training, mainly for middle and senior

management, which would have been unheard of ten years ago,’ he says.

This is handled by Kenyon’s own media training team headed by Caroline

Kenyon and Mike Henfield.

In addition, understanding of the strategic role of PR has developed

considerably, so the types of projects consultancies get involved in

tend to revolve around core issues.

’Where there used to be an emphasis on ’feelgood’ media relations, there

are now more difficult issues to be handled,’ says Kenyon. ’The

Government is applying its new priorities, pressures for mergers grow

and the financial background is uncertain. The community is still very

protective about its local hospital and trusts know they have to handle

these issues professionally.

They probably do not have the relevant in-house experience for this and

understand the key role PR consultants can play.’ But Kenyon admits

there is a move towards hospitals and health authorities, at least on

straightforward issues, grasping the PR nettle themselves.

’Four years ago, 50 per cent of our income came from the NHS,’ he


’But we felt the mood was changing and that the health sector wouldn’t

be spending as much on external PR services. Now about 35 per cent of

our income comes from the NHS.’

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