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In the public eye

As those in business know, bad news spreads faster than good. The NHS, like any industry, has seen the public's perception of it damaged by the media.

OpinionIf you are fed up with the constant battering the pharmaceutical industry has received recently, it may be worth remembering that it is not the only recipient of less than flattering media attention. The NHS finds itself in a similar, perilous position, receiving a daily mauling.

Media neutral?
As those in business know, bad news spreads faster than good, hence the plethora of Vioxx and Seroxat headlines. We have become a nation that feeds on scandal and this applies to the NHS as much as any other sector. In the week before writing this feature I counted 17 'negative' NHS stories (eg hospital mistakes, patient dissatisfaction) across all the national papers compared to only nine `positive' stories (eg new services and treatments).

So why does the NHS find it difficult to get positive coverage? The media would obviously argue that their stories represent what readers want to read because this is what sells their papers. They may also argue that the public has a right to know about the failings of the NHS.

Off the record however, several journalists have confessed they feel the Department of Health is guilty of sugar-coating stories and many have become very cynical about what is issued to them. Some also believe that the NHS is one of the government's biggest footballs and its image has subsequently suffered.

In contrast, the regional papers are known to be much more receptive to 'good' news and feature many optimistic and motivating NHS stories. This is likely to be powered by the strong and open working relationships between the press departments of local hospitals and the local media. Local people also want reassurance that they are living in a positive and happy area.

Cause and effect
The media is a strong influencer of public perceptions and opinions. In 1991, press coverage of successful businessman Gerald Ratner's speech at the Albert Hall wiped £500m pounds off his jewellery company's value. Describing the firm's earrings as cheaper than a prawn sandwich at M&S, he turned a £121m profit into a £122m loss. The triple vaccine scare saw MMR uptake drop by 10 per cent from 1996 to 2004. However, the debate is a lot more complicated than these well-known examples would suggest.

Some positive stories can actually harm reputation. For example, articles covering falling waiting times create negative public opinion as they simply remind us that some patients are still waiting. Media influence is not all-powerful nor is it irrelevant. It is quite simply a balance of the two. Interpretation and acceptance of media text is dependent on many factors including ethnicity, social background, education, gender, religion, relationships with others, personal experience and sceptical disposition towards the media.

General opinion suggests that in recent years the power of the media has increased for several reasons. Most importantly, the public's access to alternative views and information has shrunk. The family circle has generally reduced, and less and less of the public attend church or are influenced by religious opinion. Those the public do turn to are themselves influenced by, and exposed to, the media which is now run by only a handful of powerful and mainly western publishers and broadcasters distributing increasingly homogenised media content.

As a consequence the media has become the public's highly trusted source of information, a position the media itself promotes. The situation is not helped by issues such as BSE, where public perception now is that the government and its scientists were attempting to hide the truth from the press and public. Is it any wonder then, that the public opted to believe the press rather than the government during the MMR scare?

Being responsible
Does the media have a greater responsibility to report health stories accurately and fairly? Risk is a difficult concept for most of us to grasp and so the media must ensure that health stories are reported not only precisely but in a way that is easily understood. Sensationalising health stories is dangerous and can often worsen the original problem.

Last year, there were 442 confirmed cases of measles, this is eight times the number of cases recorded in 1998 and is a consequence of parents choosing to leave their children unvaccinated. Despite the recent Channel 4 Dispatches investigation, which claimed that Dr Wakefield's research showed statistically insignificant results, it may be too late to reverse the public's negative views on the MMR vaccination. When the arguments are this scientific and complicated, it becomes difficult for the press to understand let alone the public; and it has been found that, unsurprisingly, the public are not influenced by arguments they do not understand.

A King's Fund study accused the media of enhancing the misconception of risk by focusing on 'interesting' or 'sensational' diseases compared to `boring' but much more widespread illnesses. SARS was well reported in the press and caused widespread panic all over the world. However, only 800 people worldwide have actually died of it.

The media's constant attack on the reputation of the NHS, whether it be the competence of doctors, or the ability of hospitals to deal with ever-increasing demands for certain treatment or surgery, is obviously hazardous as it greatly undermines the authority of healthcare workers and adds to the growing culture of blame.

A 2003 MORI poll - Public Perceptions of the NHS - found that nearly a third of the public believe the NHS is not providing a good service nationally. With recent stories such as the retention of infants' organs without parental permission and the Shipman murder cases, we can hardly blame them. These are extremely emotive stories and remain in the memory for much longer than articles of new drugs or greater funding.

However, the media should feel able to criticise the NHS when there is cause to do so. It often takes such criticism for action to be taken and change to occur.

The focus on the cleanliness, or lack thereof, of NHS hospitals and links to rising MRSA cases has caused the Department of Health to introduce new cleaning guidelines. Perhaps such reactions could be dismissed as knee-jerk, but ultimately patients will benefit.

Turnaround
Hope should not be abandoned. There are things both the NHS and the industry can do to redress the balance. Positive coverage does yield dividends. During the 50th anniversary of the NHS, MORI tracked its reputation. When media coverage, along with public awareness, peaked over the anniversary weekend, the public's satisfaction with the NHS rose by 16 per cent. This is a fine example of what a thorough understanding of how the media works can achieve.

The Department of Health was well prepared for the anniversary, providing the media with background press materials, interviews and statistics. Local departments and hospitals were also briefed and given media toolkits, including template press releases.

Developing relationships with the media will reward in the long term. An open and honest approach will mean that journalists are more trusting of what you have to say. This is especially important when things go awry. Faults or mistakes must be acknowledged and a proactive response to the problem demonstrated.

Explanations, or arguments, must be clear and understandable, remembering the average level of knowledge of your audience. A sense of empathy must also be shown. Providing statements, facts or even stories when a journalist asks will create a contact for when you hope to gain coverage in the future. It will also encourage the journalist to turn to you to clarify a lead, or provide a statement, rather than another outside source.

Working together
The NHS may feel nervous about working with the pharma industry and both parties could benefit from cooperation. Joining forces to implement non-media PR campaigns can be an effective way of reaching patients and improving reputation. Direct contact or communication is important. MORI polls have consistently found that those members of the public with recent experience of NHS services have a more positive perception of the organisation than those who have only secondhand information.

A fine example of what can be achieved from a joint-campaign is the Chronic Disease Management Partnership between Haringey Teaching Primary Care Trust and Pfizer. The 12-month pilot programme is redesigning services for patients with chronic conditions, aiming to include greater patient interaction and discussion.

Media relations may seem expensive for an organisation as strapped as the NHS, but it must protect its reputation in order that patients trust the health advice and information it provides. The difficulty faced by the NHS is that it is a political tool and at the mercy of ministerial whims. It is unlikely in the near future that it will be possible to separate the two, providing the NHS with a significant challenge.

The Author
Liz Shanahan is managing director of Sante Communications and chair of GLOBALHealth PR

2nd September 2008

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