There is a vast gulf between the real health service as experienced by people and the 'virtual NHS' of official statistics.
The New Labour government has announced plans to improve the NHS with a massive injection of public funding. But the public’s response has been sceptical.
People suspect that increased resources will just be wasted on administration and flashy but irrelevant initiatives like NHS Direct. As the prime minister’s press secretary Alastair Campbell admitted on May 2002, trust in official policy pronouncements has been so eroded by hype that the public has difficulty telling the difference between propaganda and fact.
The unpredictable value of political information is a bit like ‘hyper-inflation’. Just as money loses its value when there are massive rises, so information loses its value when there is widespread exaggeration and bias. Communication hyper-inflation arises when the gap between the ‘face value’ of official announcements and their ‘real world’ value becomes so uncertain that the messages can no longer be relied upon.
This happens in the NHS as a result of the increasing emphasis on ‘transparency’, and the need to translate NHS administrative information into publicly comprehensible terms – providing many opportunities for a bit of self-serving distortion.
Communication among NHS professionals is more straightforward, as most of them have a common background and expectations. But communicating that same information to the public can be a more long-winded affair. Conveying an understanding of health service policy would mean going into economics, organisation theory, statistics and other areas that most people find dull.
All of this would take time and a long attention span – both anathema to the media. So rather than attempting to explain fully difficult facts and issues, the information is dispensed in ‘soundbites’ – with a highly selective process of simplification in which technical terms are translated into roughly equivalent common language terms.
It is at this point that communication inflation occurs – where there is the irresistible temptation to distort necessary simplifications in a self-serving direction. This tendency towards bias during the translation of information steps up a gear when the audience is seen as potentially hostile – investigative journalists, say, or government auditors.
Of course, some official information is accurate, even by external ‘real world’ criteria – such as announcements that the MMR (measles, mumps, rubella) vaccine is safe. Yet other official reports are wildly distorted, like those that claim there have been big improvements in NHS waiting times. These kind of announcements may be ‘legalistically’ true – but they are sometimes derived from such selective and biased sources that they have little real meaning.
The fear of being caught usually prevents actual falsification of data, but still allows tremendous leeway in using language to mislead. The most important skill is to be able to communicate one thing while apparently saying another – to make statements that are accurate by strictly legalistic criteria, while exaggerating the public significance of such statements.
When a ‘public relations’ bureaucracy is interposed between NHS officials and the public, communication inflation becomes almost a certainty. PR groups are charged with disseminating information in ways that benefit the institution – in short, their job is to hype and spin.
The end result is that public communications from the NHS are now little more than mass advertising – generating signals with little reliable informational content.
This culture of hype and spin is more than just irritating – it effectively insulates the health service from scrutiny and effective regulation. The consequence is a widening ‘democratic deficit’. The vast gulf between the real health service as experienced by individuals and the ‘virtual NHS’ of official statistics leads to increasing and unsatisfied public demands for ‘real world’ transparency and control of the NHS.
The NHS increasingly uses PR to evade the need for public understanding and control of major services. So restoring some honesty to health service communications is now a major priority for all those concerned about national health.
The present level of hype and spin in public institutions like the NHS is incompatible with the ideals of an open, democratic society.
Dr Peter Andras and Dr Bruce Charlton are at the Department of Psychology, Medical School, University of Newcastle upon Tyne (Email firstname.lastname@example.org or email@example.com. See their paper Hype and Spin in the NHS.
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