Health Service Focus

An emotional connection with the NHS

Among the speakers at this year’s QIPP awards in Manchester on June 28 was Colin Douglas, director of NHS communications at the Department of Health, who spoke about the emotional connection the British public has with the NHS, its status as a ‘super-brand’, and the way to make the case for changes to local health services.

Around 98% of the UK public recognise the NHS visual brand, while the establishment of the health service was named the greatest ever achievement by any British government in one survey, beating the next three contenders combined (and that included winning the Second World War and establishing the welfare state).

So politicians and health managers tinker with the health service at their peril.

Colin Douglas, director of NHS communications, spoke at the recent QIPP awards conference in Manchester, hosted by LinkGov, where he said: “The NHS resonates with the public and has always done, in a way that goes beyond it simply being a ‘collection of services’. It’s a concept and a set of values that resonates with the values of the public, and it’s in that respect that it is such a massive and powerful brand.

“When you change the way in which you are delivering services to local communities, when they have very fixed ideas about what that brand stands for and means and delivers to them – then it’s hard.”

He said there is “unavoidable” change ahead – more because of the £20bn productivity challenge than the Health & Social Care Act. “That change has to take place against the backdrop of this emotional connection the public have with the NHS,” he said.

Use of language

Too often, he suggested, people communicating with the public about changes in the NHS forget people’s emotional connection with it, plumping for overly-rational, bureaucratic and technocratic language that makes voters suspicious.

He said: “We have often provoked really strong negative reactions to that rational case for change, because we’ve failed to connect with the fears, the anxieties and the emotional connections people have with the NHS.”

He said the tough economic environment has changed attitudes, and that research shows that people recognise the need for NHS belttightening: but never as the primary reason for altering services.

He said: “The public know the NHS has a constrained budget and believe there’s waste and inefficiency to be addressed, and also believe that you can make the system more efficient whilst improving quality at the same time. But they are very suspicious about the motivation of leaders within the NHS in sticking to those principles of driving both quality and productivity.

“We need to reassure them that quality remains at the forefront, and that financial considerations are secondary to that, not the driving force.”

Engagement

It is important, he said, that NHS organisations don’t suddenly try to engage with communities and stakeholders at the point change is required. By then it’s too late: such relationships need lots of energy invested in them and must be built over time if they are to withstand the disruptive consequences of making the case for change.

Douglas added: “The clinical voice is critical to any effective service change: the public will believe clinicians far more than they will believe managers, far far more than they will politicians. Clinical leadership is absolutely key.”

Ultimately, he said, there has to be a compelling vision. “If that vision’s wrong, if that vision is not crafted in a way that resonates with and can be communicated to your key stakeholders and audiences, you’re on a hiding to nothing.

“Having got the vision right, and worked out how you communicate that vision, crystallising it down to very concrete and specific ways of illustrating the change and vision of change are stories that matter to people. It’s not just about pounds or pence or the broad clinical outcome, but that describe in ways that resonate with individuals how a service they use is going to be made easier or better.”

‘What they will gain, not what they will lose’

Failure to get across the strategic vision leaves the public focusing not on the changes the NHS wants to make, but the “paraphernalia of what they will lose” – on “what is happening in terms of the reduction in beds, closure of A&E, rather than the creation of new facilities that are genuinely better for them”.

He said: “We lose our public when we fail to connect with those emotional concerns and get them along with us to see the benefit of the new world we’re trying to create. It’s massively hard, because the context is the NHS. We benefit from being custodians of a brand that means so much to our public, but we suffer the consequences of that. Personally I think that’s a great privilege to have and I think sometimes the NHS has been a bit too arrogant and insular in our approach to change and too quick to grow frustrated with the attitudes our public adopt in resistance to that change.

“We need to be more embracing of those anxieties and more confident that we have a really strong case that we can make – and many systems have made – in connecting with our patients and communities and taking them with us on journeys of essential change.”

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