Over the last decade, there has been an incredible erosion of transparency in the NHS. As hospitals became foundation trusts, they (for a while), had the right to hold their board meetings in private.
Ambulance trusts have become regional, rather than county, wide and therefore the level of information presented at board meetings is more sparse. Strategic Health Authorities, which the Government finally scrapped in April, seemed to exist solely to take the credit for things which worked and to fog over the things which didn’t. For most of the last year, one SHA covered the whole of the North – decisions about Manchester being taken in Tyneside and vice versa. For journalists, it’s great to see the back of SHAs, although a shame that they aren’t around to take their share of the blame for the horrific incidents uncovered by the Keogh Review.
There there are the Clinical Commissioning Groups, which have replaced Primary Care Trusts. Founded on the best of intentions – to give GPs control over spending – the level of transparency remains to be seen.
So all in all, if Jeremy Hunt is serious about transparency improving the NHS, it’s a good thing. He can start by getting the Government to knock its plan to restrict access to FOI on the head. With the constant political meddling and restructuring the NHS is subject to, the one constant is FOI from an access to information point of view.
When he’s done that, he should suggest that PR firms have no place in the NHS.
The 2000s saw a steady increase in the number of PR firms involved in the public sector, and indeed the rise of a PR culture in general. That’s not necessarily a bad thing – I know many good, in fact excellent, PR professionals who work in the public sector. The good ones are the ones who know that representing a public sector organisation is different from representing a private company – because the public is also effectively the owner of organisation they are speaking on behalf of.
Whether their bosses get that is another matter entirely, and where the heart of the problem is. At some point in the 2000s, many public sector leaders began comparing themselves to the private sector bosses who ran organisations with a similar turnover. It’s a flawed comparison, but one which sets them off down a dangerous path away from what they’re supposed to be doing: serving the public.
For a while I reported on a hospital trust which was in debt. There were problems in its senior management team and the internal communications officer was expected to deal with our press inquiries too. They used to take a while to come through, but they used to come through in the end.
Then a bright spark at this hospital decided to hire a PR firm. All of a sudden, comments took even longer and it was no longer assumed the hospital would comment. A comment was only issued after long conversations with those at this firm, which usually started with: “I was a health reporter for X years and I know this isn’t news” and end with a huff, moments before the newsdesk phone rang and a news editor was taken out of action for 20 minutes.
The upshot was an increase in ‘no comments’ on stories and within a couple of weeks, the PR firm and hospital trust had parted company. The hospital trust has crossed the line which separates making itself accountable by defending its actions and seeking to manipulate the media to protect its reputation.
Hospitals shouldn’t be in the business of reputation management. Reputations of hospitals are made and lost based on the service they give to the public. Everyone loves the NHS – so if you need private PR firms presenting a positive image, something has gone wrong. Badly wrong.
Tameside Hospital in Greater Manchester didn’t become known as Shameside Hospital overnight (Even Google’s advanced search results posted an image of the grim reaper alongside it in search). As the Keogh Review – which included Tameside – noted about that hospital:
“The frequent external reviews of the Trust and what was seen as constant criticism from the media is affecting the morale of staff.”
A justification for the use of a reputation-managing PR firm? Actually, Tameside has had such a firm contracted to it for several years. Act PR, based in Yorkshire, claims: “Our team of former journalists and public sector PR specialists focus on delivering results which will enhance and protect your reputation.” In what is perhaps the best example of proof that you can’t make a silk purse out of a sow’s ear, the Keogh Review in Tameside also concludes:
“There is a need to develop the organisational culture to remove tolerance of sub-optimal care and engage more effectively with staff at all levels to improve quality and patient experience.”
In other words, the previous management at Tameside allowed a culture of ‘sub optimal’ care to fester and failed to communicate properly with staff while at the same time hiring a PR firm to manage its external reputation. Of just 15 companies the hospital trust documented as having on-going financial commitments with, Act PR was among them – costing £135,000 over two years, and dating back a year before that. Based on that document, the Hospital spends more on PR than it does on a contract for medical gases, and the PR spend is equivlant to 10% of its spend on a laundry services contract.
None of this is in anyway intended to be a criticism of Act PR. They saw a contract, went for it and have, I guess (but don’t have personal experience) have done the job required of them. But is it a job which should be done within the NHS at all? Act PR aren’t the only PR firm involved in the NHS, nor is Tameside the only hospital to use private PR firms. And I’d add in ex-editors and the like who do ‘media consultancy’ for hospitals too. Paying for ‘crisis media management’ isn’t actually solve the problem,
At Tameside, this was the same hospital trust which accused by Keogh of not having enough staff on its books, and not doing enough to tackle infection control. Yet the management felt it important to have a PR firm on the books.
If prevention is better than cure, then this is a classic example of management seeking a cure to entirely preventable problems. That, by the way, is the former management – a new team have now arrived.
The long-term prevention of the problems highlighted by Keogh is to ensure that hospitals remember their role: To serve the public, not present an image of what they want the public to believe. Ending the culture of reputation management in the NHS would be a good start.