by John Underwood, Bill Nichols, Adam Brimelow and Daniel Reynolds
If there needs to be a centralised command and control approach to communication – and, in a national emergency, there does need to be such an approach – in future this should be applied with the wider support of the communicators in frontline NHS organisations helping to deliver it.
You’ll learn:
• How COVID-19 has created a greater appreciation of professional communications as a strategic
function within NHS organisations
• That the pandemic crisis has created less resistance to change and enabled greater organisational
flexibility and innovation
• How a more digital future for the NHS has been realised
The Coronavirus pandemic is triggering dramatic change across the NHS.
Hundreds of thousands of GP and hospital outpatient appointments are taking place by telephone or through video conferencing, health and care services are being transformed overnight and decisions that would normally have taken many months are being actioned in hours. This spectacular transformation involves everyone who works in the NHS, not least professional communications and engagement specialists.
Recent research conducted by the Centre for Health Communication Research at Bucks New University, with NHS Providers and the NHS Confederation, explored the major communication lessons emerging from the pandemic.
The research was based on a large-scale quantitative survey that was circulated to NHS communicators in May 2020. Fieldwork took place between 20 May and 3 June 2020. In total 165 NHS communicators responded from across the country and from a range of NHS organisations.
We found that during the early stages of the pandemic there was a greater appreciation of professional communications within NHS organisations and an enhanced recognition of communications as a strategic and vital function. 84% of NHS professional communicators felt they had been more influential during the pandemic – with just 6% feeling they had been less influential - and they wrote of being “more involved in helping to inform and shape organisational decision making” and of getting “a seat at the top table and a more strategic role”.
And the recognition of the communications team went beyond NHS leaders. Respondents talked of staff being more engaged with NHS organisational communications and actively seeking out corporate communications advice. One survey respondent said, “One of the biggest changes I’ve experienced is an acknowledgement and appreciation of the communications team and our work from both senior leaders and frontline staff.”
We also found that communicators celebrated the “tearing down of barriers”, a reduction in bureaucracy and the development of streamlined local approval processes during the pandemic with 82% feeling that management decision-making was generally faster.
Respondents found less resistance to change, greater organisational flexibility and an ability for people to adapt quickly. They reported that “barriers which have been in place for years, preventing things like online communications, rapidly fell away when the lockdown kicked in.”
Perhaps most positively, professional communicators felt the pandemic had triggered a strong wave of transformative innovation across the NHS.
We were told that engagement events had been live streamed on Facebook Live, Microsoft Teams or YouTube. Apps such as Slido or Glisser have been used to encourage and gauge audience interaction. Team collaboration software like Trello is being used more and more. Video shot on smart phones has become commonplace with more user generated content than ever. Secure, clinical messaging platforms such as Pando have a growing network of users. And patient communication software like AccuRX and Attend Anywhere is now much more commonplace.
This race towards a more digital future has inevitably raised some concern over those who do not have access to the necessary hardware or software and what one respondent described as “pearl clutching about leaving people behind” but there appears to be a strong belief that the NHS must seize the opportunity of the moment and encourage greater digital interaction between staff and between patients and clinicians, while being mindful of the need to address the challenge of the digital divide.
In common with the rest of the population NHS communicators spent more time working from home during lockdown. Of course, as key workers, many continued to work from their offices but on average, they spent almost two thirds of their time working from home. While for some this was a welcome boon, for others it has raised issues of personal isolation, a loss of work-life balance, a negative impact on family life and a tendency towards an unhealthy, sedentary, desk-based lifestyle.
The pandemic also appears to have driven a notable improvement in relationships between NHS communicators and the various professional colleagues they interact with. Respondents reported that the pandemic had “galvanised” their professional relationships as the NHS and its partners had come together with a single focus of activity that created a “sense of one team working together”.
The proliferation of new, closed staff Facebook groups was mentioned by many NHS communicators and was widely deemed to be very effective. One respondent said, “We have been trying to get a staff Facebook page off the ground for ages and it has now become a really effective comms tool, particularly for clinical staff.”
The issue that generated most discussion, however, was the question of centralised “command and control” NHS communication. NHS England announced in early March 2020 that Coronavirus had been declared a level four national emergency. The NHS England Emergency Preparedness, Resilience and Response Framework describes level four as being “an incident that requires NHS England National Command and Control to support the NHS response”.
The Framework describes command and control in the following terms, “For responses at Alert Level 4… NHS England (national) may take command of all NHS resources across England. In this situation direction from the national team will be actioned through the regional teams”.
In practical terms the understandable purpose of the central command and control of communications is to ensure consistency of message, that the NHS speaks with one voice and that it fulfils its duty under the Civil Contingencies Act to warn and inform the public.
41% of respondents to our survey felt the application of the national command and control of communications strategy and activities had not been appropriate, with the most senior professional communicators even more inclined (57%) to that view.
The weight of detailed comment was clearly troubled by the way command and control of communication had been applied with respondents saying things like, “Micro-management by regulators has been very frustrating and at times completely disproportionate and muddled.” And “Of course, there needs to be national command and control but the national team can’t run comms from a bunker in London to parts of the UK all with very different needs and audiences.”
These local concerns were an urgent and persistent theme of our dialogue with senior NHS communicators in private conversations and social media exchanges, particularly at the height of the pandemic. We pointed out this disquiet to colleagues at NHS England and NHS Improvement, so they were fully sighted on the potential difficulties that could arise.
The lesson here seems clear enough. If there needs to be a centralised command and control approach to communication – and, in a national emergency, there does need to be such an approach – its recent application should be evaluated to determine how in future it might be applied with the wider support of senior NHS communicators in frontline NHS organisations. This is particularly important given the possibility of further waves of Coronavirus infection.
Overall, however, the findings from this study make very positive reading for NHS professional communicators who wish to see their role fully recognised as a valuable, strategic function. In any crisis an expert, specialist communications team comes into its own and so it proved across the NHS during the early stages of the 2020 Coronavirus pandemic.
The full research white paper can be found at https://www.chcr.org.uk/research/
John Underwood is director of the Centre for Health Communication Research and an executive director at Freshwater where he advises NHS organisations on communication and engagement issues. He was previously a reporter and presenter for the BBC, ITV News and Channel Four.
Twitter: @JUHealthComms
LinkedIn: linkedin.com/in/johnunderwood1/
Dr Bill Nichols is deputy director of the Centre for Health Communications Research and a 40-year PR industry veteran. He has spent the last ten years primarily in health education. Once Sir Clive Sinclair’s publicity director, his consultancy and commercial career includes spells in France, India and the USA.
Twitter: @billnicholsPR
LinkedIn: linkedin.com/in/drbillnichols/
Adam Brimelow is director of communications at NHS Providers. Previously Adam was BBC health correspondent for 14 years, working across all the main national TV and radio bulletins, the Today Programme and BBC online. Adam also worked at Westminster as a BBC political reporter.
Twitter: @adambrimelow
LinkedIn: linkedin.com/in/adambrimelow/
Daniel Reynolds is director of communications at NHS Confederation. He also oversees the communications activities of NHS Employers, the voice of employers in the NHS. He has been director of communications at both NHS Providers and the Nuffield Trust. Before moving into the health sector, he was a reporter with Sky TV.
Twitter: @DanielReynolds4
LinkedIn: linkedin.com/in/daniel-reynolds-462ba8131/