The NHS's biggest challenge is convincing the public it has a plan
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Version 0 of 1. The British public has begun to talk of an NHS in crisis. This is a perception based on headlines decrying the state of the service; reports from healthcare staff (the NHS is the UK’s biggest employer; most people have at least one person in their social circle who works in it); and occasionally participants’ own bad experiences (although most still receive a great service – a tension that can give rise to “I was lucky” syndrome). Meanwhile, according to Ipsos Mori’s January issues index, 49% of respondents said that the NHS is one of the biggest issues (pdf) facing Britain today, a nine-point jump since December 2016 and its highest level since April 2003. Public opinion abhors a vacuum. In the absence of a clear, concerted and disciplined message, people fill the gaps with their own assumptions, experiences and prejudices. Months of dire headlines have told them the NHS is in trouble, but the public are seeing and hearing little to tell them why, how, or what can be done about it. So they draw their own conclusions. In many respects, when it comes to diagnosing the problem, the public get the causes right. They almost always blame a shortage of funding and a lack of staff. They also know that our ageing population is leading to increased demand. However, their analysis can also diverge from that of those working in health policy in key ways. For example, there is a widespread, deeply held fear about the impact of immigration on the NHS; in a recent Opinium poll, 68% of respondents agreed that immigration places too much pressure on public services like housing and the NHS. Concerns about immigration are often linked in people’s minds to the issue of health tourism, which is frequently seen as a major pressure on services. It’s pretty unusual to hear someone working in policy describe either of these issues as key causes of the NHS’s current woes. In one focus group that we ran at BritainThinks, a participant said: “My wife works at the NHS, and she’s saying there’s too much work, under pressure and things like that. And that’s where immigration comes in, because they use up the NHS.” Our focus groups reveal little sense that anything is being done to tackle these issues. Awareness of the sustainability and transformation plans (STPs) is, to all to intents and purposes, non-existent. Introducing the name is met, at best, with blank faces, often followed by eye rolls. At the less positive end of responses, the acronym makes some think about STDs (sexually transmitted diseases). Once the public start becoming aware of the changes that are being planned in local areas, STPs are going to face an uphill struggle to win them over, given a strong focus on service reconfiguration, which the public interpret as politician speak for cuts and closures. This poses a major communications challenge. The vacuum is already filling up, and in the current climate, the public are more likely to place trust in their own beliefs, or whispers picked up from friends of friends working in local hospitals, than they are to give credence to information provided through central government. To have any chance of cutting through the inevitable storm, STPs will need to have a really clear account of what they are doing; how those changes address the challenges the NHS faces; and why the plan has patient benefit at its heart. They will also need a thick skin. Anastasia Knox will be speaking at the Nuffield Trust health policy summit this week. The Guardian Healthcare Professionals Network is media partner for the summit. Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |