Rebuilding public trust in the NHS through honest communication

For the people running NHS trusts and health boards, trust is an operational problem as much as a reputational one. A patient who doesn’t believe the advice on the website goes to A&E anyway. A community that suspects the real motive behind a service change will fight it at every public meeting, however strong the clinical case.

Staff matter just as much. If people on the wards hear one thing from leadership and see something different on shift, they stop passing the message on, and that’s the channel the public trusts most.

So the first question for a communications team is which of these problems needs solving, and what people would need to believe for it to shift. Sentiment scores can wait.

Reassurance has stopped working

Under pressure, the default is to lead with reassurance and hold back until there’s good news to share. People notice. Most have recent experience of the service or know someone who does. A statement that everything is under control gets compared with a relative’s long wait in A&E or a cancelled operation. When the two don’t match, people believe what they saw, and every later statement is read with more suspicion.

Saying nothing does similar damage. A trust that goes quiet during a difficult week usually looks like it has something to hide.

Say the hard thing first

If waiting lists are long, say so. Then explain what’s being done and when people should expect to see a difference. If a service is under strain, don’t present it as a success story. Admitting a problem costs less credibility than being caught understating it later. Proportion matters too, since overclaiming progress and catastrophising both make people stop listening.

Tell one story everywhere

Sooner or later, someone notices when the message changes between the local paper, the board papers and the staff intranet. Usually, it’s a journalist who has read all three. At that point the inconsistency becomes the story, even if each version was accurate.

A consultant explaining in their own words why a unit is moving will usually carry more weight than a centrally drafted statement saying the same thing. That only works if clinicians are properly briefed and the organisation backs them when the coverage turns difficult. Clinicians who are handed a script tend to sound like it.

Trust built now is spent in a crisis

BIG’s roots are in crisis work, and in healthcare the pattern is consistent. When something goes seriously wrong, such as a patient safety incident or a damning inspection report, the organisations that keep public confidence are the ones that were straight with people beforehand. A chief executive known for plain speaking can apologise and be believed. One known for reassurance has to rebuild credibility at the worst possible moment.

Measure the problem, not the coverage

Positive coverage is easy to report, but it says little about whether anything has changed. Better measures go back to the problem you started with. Did patients use the service you pointed them to? Did a reconfiguration get through consultation without a legal challenge? Do staff survey results show people believe what leadership tells them? Those numbers take longer to move – and they show whether trust is actually returning.

Trust is easier to build before you need it.

Talk to BIG’s healthcare team about where yours stands by emailing us at [email protected]