Comment / Brand value

The recent coverage about the difficulties in accident and emergency came as no surprise to members of the association. There are differences in analysis depending on which statistics you look at and whether you look at attendances or admissions. But, however you cut the numbers, anyone working in a provider organisation – or commissioning services from one – will have direct experience to back up the impression of rising pressure.

What we need is balance. As the HFMA president says on page 10, the pressure has not been caused by one factor. Convenient though it may be to identify a simple cause – lack of confidence in out-of-hours services or teething problems with new 111 emergency number – real life is more complex. Organisations like ours must be careful how we deliver these messages.

My professional background is marketing and training. I’ve watched the NHS ‘brand’ go from national treasure to every facility being regarded as unsafe. A few years ago, when the coalition reforms were announced, the public rose up at the idea that ‘any qualified provider’ could mean the ‘nasty’ private sector being involved. This feel-good factor was reinforced by the NHS’s appearance in the Olympic opening ceremony.

High-profile difficulties and the publication of the Francis report changed all that. It seemed to me the public’s perception of the NHS – fuelled by a media machine in outraged mode – nose-dived. The day after publication of Francis, BBC Breakfast announced that inspectors were being drafted into five other hospitals – at once! While the responses was rightly designed to give the appearance of rapid action, the undesired side-effect was to further dent confidence in a system already reeling from the events and the coverage of the Mid Staffordshire problems.

The NHS may be a national system, but we know there is variation in trusts, between different services and perhaps even different consultants, and variation between areas and providers. Some of these will be driven by differences in casemix and quirks of allocation and historic funding, others will reflect real differences in performance and efficiency.

Don’t get me wrong, eliminating unnecessary variation and fixing organisations that fall short is absolutely right. And I’d be grossly unfair to members if I didn’t acknowledge the extreme pressure many of you are under. But organisations like ours need to be careful how we deliver these messages. The HFMA has a responsibility to use its influence to ensure comments are balanced and be mindful of the context. There is always room for improvement, but the NHS broadly delivers excellent services and leads the world in terms of access to services for all.

The HFMA way is to go on the front foot. Our board has invested wisely in a research function – one of its first projects is a study on transformation. This will aim to showcase where real transformation is taking place and highlight obstacles to delivery and how they can be overcome. It will be practical and constructive. And we will continue to provide direct feedback of finance experience to key stakeholders as part of our regular programme of engagement.

The NHS is special, an organisation we know and respect. We need to go about the job of improvement and transformation, but also ensure we retain the trust of the public. We damage the NHS brand at our peril.