Fear And Reassurance: Communications And The NHS

Two recent issues of public concern over healthcare, though very different in their details, demonstrate some common threads in the way public opinion on such issues arises and the importance of good communications in averting such potential crises.

At the end of January, when we conducted our political poll for The Times, the issue was NHS treatment of patients and especially the political furore over the Rose Addis case and other cases, reported in the London Evening Standard and then raised in the Commons by Iain Duncan Smith. The extent of the concern can be gauged from that poll three weeks ago: health, hospitals or the NHS were named by 66% of adults as one of the most important issues, twice as many as the 32% who named education, next in the ranking, and the highest figure for two years. Indeed, two in five of the public named the NHS as the single most important issue, five times as many as did so for any other issue. Other polls have confirmed that the public is - and has been for a long time - seriously concerned about the management of the NHS and fears for its future.

As I mentioned in this column back in November [More Cash For The NHS], public satisfaction with the NHS always lags behind the personal satisfaction of patients with their experiences, or satisfaction with their own GP or local hospital. A Gallup survey for the Daily Telegraph last month illustrated this once more. Two-thirds of the public believe the NHS is in poor shape, and barely one in eight (13%) believe it is getting better, compared with two-fifths (40%) who think it's getting worse. Yet use of the NHS remains high - 88% of people said they had visited a GP or hospital since last summer - and they were overwhelmingly satisfied with their experience, with 86% happy with their GP and 77% happy with the hospital treatment they received. Despite this, two in five say they would use private healthcare, rather than the NHS, if they could afford to.

Now the debate has moved on, and it is the safety of the MMR vaccine, and the NHS policy of refusing children separate injections for mumps, measles and rubella, that has been dominating the headlines. According to an NOP poll for the ITV1 programme Tonight with Trevor MacDonald, more than half the public, 55%, believe Tony Blair should say whether his son Leo has had the MMR jab, and 85% think the NHS should offer the option of three separate injections. Even so, only 38% said they were dissatisfied with the government's handling of the crisis of confidence in the vaccine's safety.

Both are issues that have arisen from media coverage which has concentrated on isolated cases. In both cases, the concern or demand for action goes much wider than the comparatively small group with personal fears or personal experience of NHS failure. And in both cases part of the solution is better communications with the public, building up a relationship of trust.

The way in which dissatisfaction with the NHS far exceeds the number of dissatisfied patients is part of a much wider pattern which applies across many fields. The local, personal or familiar always scores better than the general, national or remote. In politics, for example, far more of the public are always satisfied with the job that their own MP is doing than are satisfied with MPs in general.

All this is yet another instance of the general principle we persistently find in research into corporate or institutional reputations, that familiarity breeds favourability, not contempt. Communications are important; and this applies perhaps even more than usual to medical matters, where trust is so central.

The public trust doctors. Not only do our regular surveys testing which professions are most trusted to tell the truth invariably find doctors at the top of the poll. [Doctors Win Overwhelming Vote Of Confidence From Public - BMA poll, March 2001], which of course is important, but they are generally trusted to know what they are talking about as well. Of course it is vital that they should be trusted: it is much better that we should leave ourselves in the hands of the experts on medical matters than try to do without them. Nevertheless, it is not blind trust: the public still wants to be informed on medical issues. Time and again, on many different issues, the public tell us that what they want most is to be given information.

And once the public feel that they are being properly informed, it starts to calm their fears - both specific medical fears, such as MMR, and wider concerns about the health service. As far as MMR is concerned, three years ago (in research on the People's Panel for the Better Regulation Unit of the Cabinet Office), we asked the public about several "issues that have been described as health risks". At that point 36% of the public said they felt well informed about the MMR issue, but only 14% felt it posed "a serious risk to you and your family" (and only a quarter of those with children under 5). At the same time, only 16% felt well informed about any health risks posed by genetically-modified food, yet 31% thought GM food posed a serious risk.

On the wider front, MORI research has found a clear link between how well local people feel they are informed about their NHS trust and how satisfied they are with its standard of service and the value for money it offers. But the majority of the public feel they have too little information abut preventing serious illness, about the different services provided by local GPs, about length of waiting lists and - especially - about how local health budgets are spent.

Of course, none of this will entirely put an end to health scares like MMR, which are based not on conviction but on doubt - and they certainly can't reverse the juggernaut of public panic once it is started. Media coverage will always be able to find an element of risk, because there are very few things that are 100% certain, and the public tends to be a very poor judge of relative risk. A doubt raised, however remote, shakes public confidence. When the public are told that scientific opinion is split on an issue - as they always will be once it is raised, since broadcasters invariably try to present "balanced" coverage of such issues by including a spokesman for the minority viewpoint, however tiny the minority - little wonder they are not sure who to believe. (And, of course, sometimes the minority turns out to be right, as in the case of BSE.)

The trouble is that media coverage tends to raise such panics only in one direction, at least until it is too late. The possible risks of MMR immunisation are debated, the possible risks of not taking it receive scant consideration. But here GPs may be in the best position to explain the issues to their patients, in a balanced way. In 1999 MORI conducted a survey for the Office of Science and Technology regarding trust on "biological developments and their regulation". Although this is a fairly specific topic, it would be surprising if trust on medical issues such as the safety of MMR did not follow a broadly similar hierarchy.

GPs topped the list of those who were trusted to provide "honest and balanced information about biological developments and their regulation" (60% trusted, 6% not trusted), as well as "to make decisions on your behalf in the regulation of the biological sciences" (71% trusted, 13% not trusted).

In both cases the GPs came ahead of "hospital doctors" - again, the local and familiar wins out - and well ahead of scientists (only 34% trusted and 55% trusted on the two questions). It is clear that this is partly because some of the public doubt the objectivity or perhaps even the integrity of scientists (scientists working for environmental groups are more trusted than those working for industry or the government), but also because many doubt whether the scientists know the truth themselves. But even so, all the groups of what might be described as the professional experts, including scientists, are trusted by more than distrust them.

Q Which, if any, of the following types of people or institutions would you trust to provide you with honest and balanced information about biological developments and their regulation?

Q And which, if any, would you not trust to provide you with honest and balanced information about biological developments and their regulation?

Source: MORI/OST 13 March-14 April 1999 Base: 1,109 British adults

The media is inevitably the main channel of information about such issues (and most other issues) for the vast majority of the public. Yet note how little public trust there is for the media on these issues (as on many others). If a journalist were to say one thing and their doctor another, there is little question which of the two most of the public would believe. If the doctor were to present both sides of the argument fairly, their patients would be far less likely afterwards to be panicked by one-sided coverage in the newspapers or on the television. But the doctor has to say it first.

Information and communication - always essential.

Roger Mortimore 15 February 2002