news focus How did the trusts that fared worst in September's performance ratings deal with the blizzard of media coverage when their 'failure'was made public? Alison Moore discovered that some coped surprisingly well

Published: 20/12/2001, Volume III, No.5786 Page 14 15

If ever there was a story that a trust press officer would like to see buried, it is their hospital being highlighted as one of the 12 worst in the country.

But burying bad news proved to be impossible for the 'dirty dozen' when the government's star ratings were unveiled on 25 September. How have they fared in their dealings with the local press and politicians?

Many press officers are only now drawing breath after the onslaught of media interest provoked by the government's performance-ratings table. The 12 'zero star' trusts bore the brunt of this, with both national and local media hammering at their door.

Some trusts knew they would come out of any performance ratings badly and were able to prepare for the media deluge. At Brighton Health Care trust, communications manager Ian Keeber knew the trust had done badly on certain targets and had a briefing ready, with quotes from chief executive Stuart Welling on key issues.

This helped to explain the context in which the trust was operating - recruitment and retention issues and the closure of care homes in particular.

Much of the coverage in the local media was well-balanced and included the trust's point of view, he says - though one headline did brand the trust as providing 'the worst care in the country'.

But several of the 12 had other problems which made it difficult to get their message across.Where there had been a recent change in chief executive, for example, it was difficult for the new incumbent to sound positive without appearing to criticise their predecessor.

Ashford and St Peter's Hospital trust had to cope with both the secondment of chief executive Stephen Fash out of the trust - announced the day before the ratings tables were released - and the zero-star rating.

Despite this, press officer Jane O'Kill feels the trust got a reasonable showing in the local media - partly because she was able to hint that the trust's Commission for Health Improvement report would be more favourable.

Coverage included positive leader columns, while one newspaper listed every performance target they had met.

Some local papers went on a strongly pro-hospital line - that the trust's deficit was due to a refusal to close wards and therefore affect patients.One even gave out its own 'stars' - zilch to health secretary Alan Milburn, three each to Mr Fash and the rest of the trust's staff.

But new chief executive Andrew Morris - on secondment for six months - has had a rougher ride.

He was publicly criticised by an MP for taking a family half-term break - though the trust swiftly pointed out he had made himself available for meetings with MPs beforehand. It is only in the last few weeks that he has started to give interviews.

But having good relations with the media has been difficult for some trusts. At Dartford and Gravesham trust, a new private finance initiative-funded hospital had been the target of much local criticism long before the performance ratings were released. One paper, The News Shopper, had been running a readers' poll since January on whether the chief executive should go.

Bad press coverage continued when the trust got its zero-star rating, and may have been a factor in the departure of chief executive Anne-Marie Dean. And though The News Shopper is now proclaiming a 'new dawn' for the hospital, staff may be excused for feeling they can't do anything right.

Even when the hospital won an award for its standards of catering and cleaning, the news was branded 'incredible' by the paper.

But could the trust have done anything to improve matters?

Melody Ryall, editor of the Kentish Times - one of several local papers which regularly feature the hospital - says the trust could have been more proactive.

'I think we got a fairly low-key comment that it [the star rating] was under investigation and the chief executive was going to apply her mind to it, ' she says.

'We would have liked to have heard more from them about the good things that the staff were doing - it was rare to get the human interest behind the health service stories.'

At Medway trust, chief executive Jan Filochowski had spent time building bridges with the media after a long period in which relations had been patchy. This paid off when the trust was unexpectedly given zero stars: the press coverage soon became fairly supportive, helped by the staff and patients who were prepared to speak out in defence of the trust. This was followed by a series in one local paper looking at the roles of various departments and staff within the hospital - including porters and radiographers.

This has not meant the local media has become a soft touch - critical stories do still appear - but the overall impression of the trust has certainly mellowed.

Good relations with the main local paper also seem to have helped Oxford Radcliffe Hospitals trust. Oxford Mail health reporter Victoria Owen says she was able to cover the background to the nostar rating, effectively putting it into a wider context. She praises the trust for its willingness to admit when there are problems:

'Other trusts in our area clam up - it makes me want to write a negative story about them, ' she adds.

But while good relations with the media seems to have carried some trusts through a difficult periods, others are reluctant even now to talk about how they handled the media.

The three no-star trusts whose press relations are handled by PR company Nexus - Barnet and Chase Farm Hospitals trust, Stoke Mandeville Hospital trust and East and North Hertfordshire trust - did not want to comment.Nor did Nexus want to talk about its role and strategy.

The fallout from 25 September has made some trusts reconsider how they handle the media, especially when big stories break. As many trusts employ a single press officer - and some none at all - there are capacity issues in dealing with a flood of media inquiries.

With local papers, radio and television demanding information and interviews - as well as some national media interest in individual hospitals - press officers were under extreme pressure.

At least one trust is now considering whether it needs to call on extra help at such times.

Other trusts are now actively looking for positive news stories which can be fed to the media and help to build up a more balanced picture.

Ian Keeber, from Brighton Health Care trust, believes trying to 'spin' the message - or hide from media interest over the rating system - is counterproductive.

But there are plenty of 'good news' stories lurking in the trust, which the local media would be interested in. 'You need a longterm balancing strategy, ' he says.

'I am trying to spend less time reacting and responding to media inquiries and more time looking for balancing stories.'

At University Hospitals Coventry and Warwickshire trust, a head of communications has been appointed since the trust's damning CHI report was followed by a no-star rating.

John Richardson sees his role as relieving the chief executive and other senior managers of some of the burden of dealing with media enquiries, and promoting good communications within the trust.

Mr Richardson is well aware the media is likely to be critical of everything the trust does - he dubs it the 'circlingshark syndrome'.

'It is like an exothermic reaction - the heat causes further reactions, ' he says. 'I do think that when things are like this, they do not go away by themselves. You need to do something.When you think you are being shelled it is tempting to dig deeper - I do not think it is the right option.'

There are glimmers of light.

When a report on cardiac services across the country highlighted University Hospitals Coventry and Warwickshire trust's relatively poor performance, he was able to work with the cardiac team to put out a consistent picture of the trust, and to explain to staff what the position actually was.

But being in the spotlight is time-consuming - because both national and local media chose to focus on the trust, he had to deal with numerous inquiries. One day he dealt with 27 interviews, back-to-back.

But the media are only part of the audience chief executives have to keep in mind: the views of local politicians and the wider health economy are also important - and their opposition can lead to more critical media coverage. Portsmouth Hospitals trust sent its chief executive and chair to the local council meeting to explain the position, and also invited local MPs in to talk about it.

In the South East, local MPs seemed decidedly lukewarm about Anne-Marie Dean at Dartford and Gravesham trust, pointing out that the penalties of not improving within the threemonth timescale were obvious.

Across in Medway, however, local MPs and the community health council lined up to express support for Mr Filochowski. His position seems quite secure.

However, David Loughton is still in post in Coventry, despite calls for his resignation from a number of MPs, and criticism from the community health council.

An easy ride from the press and politicians may make life more pleasant for the beleaguered chief executive, but perhaps it is not the only factor which decides who goes and who stays.