There was laughter in the room when John Lister ironically described the new NHS structure as “streamlined” and shared a Guardian graphic of the new bureaucracy. It set the tone for the NUJ’s Reporting on our health services masterclass, aimed at helping health reporters get to grips with confusing changes.
Lister, senior lecturer in health journalism at Coventry University, identified some of the main issues for journalists:
- access to information
- getting that information in a timely manner
- getting a range of information – not just press releases, but also Board papers, statistics, other info that isn’t specifically targeted at the press
- access to expert analysis. (You have the info, but can you make sense of it? Is there a specialist who can put it in context or add insight?)
He spoke about the slippery nature of transparency. For example, NHS England (the new name for the NHS Commissioning Board) is relatively open to reporting, but the real nitty-gritty decisions are made by Local Area Teams (LATs).
Many of the bodies that you might want to report on are not obliged to let you do so. CCGs (Clinical Commissioning Groups) have no requirement to meet in public; Commissioning Support Services are not public bodies and Foundation Trusts have no requirement to publish papers or agendas from each board meeting.
Shaun Lintern, of the Health Service Journal and Nursing Times, raised another barrier to quality health reporting: the lack of paid health reporting posts.
It’s a deep irony that health service cuts are being underreported because of staffing cuts in our own newsrooms. Shaun was the man who broke the Mid Staffs story, but he wasn’t even a specialist health reporter at the time. He was just a regular reporter on the West Midlands Express & Star who picked up the story from a colleague who was too busy to follow it up.
On that day, six years ago, he had no idea that he was about to break a huge story and become one of the country’s best-known health reporters.
He said that we “need to get back to old-fashioned journalism” – not just accepting press releases but digging around, talking to people and so on. He described staying up until the early hours reading the board papers of health service bodies.
“[The papers] won’t have a story – but they might have a clue to the story. Then you can talk to someone.”
But he believes that for this approach to be successful, editors need to take the lead, giving reporters time and permission to attend conferences, read through health service paperwork and so on.
He moved to the Health Service Journal over a year ago and the Express & Star has not replaced him yet.
Other comments from Shaun: the new structure is without a doubt not permanent and will almost certainly change in the next couple of years.
He believes that the trend for CCGs to merge with each other will continue, because individually they’re too small to be sustainable.
The next speaker was Branwen Jeffreys, a BBC journalist speaking in a personal capacity.
She commented that GPs have “taken a step inside the establishment tent” from their traditional position as relative outsiders. 90% of public contact with the NHS is through GPs, but in the past they have seemed less part of the system.
She regretted the loss of Community Health Councils, the “awkward squad” who questioned decisions, and wondered what will replace them.
She highlighted the issue of underspending as important: why are some departments not spending their full budget when there are patients waiting for treatment? It’s an important issue because only a small proportion of a department’s budget can be carried over to the next financial year. The rest is lost.
Her final tip for journalists was that hospital doctors are more willing to speak out than they used to be, as long as they’re guaranteed anonymity.
Paul Bradshaw (of this very blog) spoke about the public information crisis. In the West Midlands, one and a half health journalists are covering an area with a population of two million. How can you provide in-depth coverage when you’re stretched so thin?
He pointed out that many activists are becoming de facto journalists and commented that “it’s the non-journalists who do the digging, but they often don’t know how to tell stories.” For a story to work, you can’t just dump facts on a page; you need a narrative and a human interest angle.
He mentioned the Department of Health website’s recent move to the gov.uk website, and there was a groan in the room. The new version of the site makes it harder to find information that used to be easily accessible. He added that some of it has proved impossible to find at all.
He gave some more useful tips for sourcing information:
- Many CCGs have a news feed that you can subscribe to.
- It’s worth looking at other bodies involved in delivering health and social care, such as local authorities. They might be a good source of stories or comments that don’t fit the official NHS spin.
- The NHS Information Centre is a good resource but there are cost restrictions on accessing the information and these may get tighter soon.
The discussion from the floor was lively and raised some interesting points. One patient advocate pointed out that patients have more power now and may often have insider information. It’s a mistake to use them just for anecdotes and human interest stories.
During the discussion Branwen Jefferies made the point that it’s hard to work out which problems are caused by structural change and which are caused by a lack of money.
We discussed the pricing of services and she reminded us to challenge the assumption that everything is cheaper “in the community”.
John Lister added that the unit costs of A&E departments are surprisingly low. They don’t get shut down to save money, they get shut down to soften up communities for other closures.
One trainee reporter from Brighton shared a recent scoop about the new 111 service and how it has doubled the workload for paramedics because poorly trained phone staff send them out on unnecessary calls, including one to a cat with diarrhoea.
Her story was picked up by that day’s Metro – sadly without any payment or acknowledgement!
We also discussed mortality rates and how hospitals with high rates will state they don’t prove anything while hospitals with low rates will mention the fact on their websites.
Shaun Lintern said that they “may not prove anything – but they’re a smoke-signal, a sign something may be wrong.”
Paul Bradshaw said that he believes health data will be among the last public data to “go real time” for use by the public, journalists and statisticians.
We also very quickly discussed bullying, including intimidation of whistleblowers. John Lister described bullying in the NHS as “rife” and “tolerated as a management style”. He added that there is still no support for whistleblowers, so how do we expect them to speak out?
We were running out of time, but touched on the issue of health markets and competition. Anna Wagstaff of the NUJ’s Oxford & District branch said that health services across Europe are being reorganised on the assumption that opening up services to competition makes them better, but she doesn’t know of any evidence that it does – or that it doesn’t. There just hasn’t been enough research into this.
John Lister wrapped up the session by sharing a useful link for health reporters: www.europeanhealthjournalism.com.
A final thought: it’s clear that health reporters aren’t going to get the real stories handed to them in a press release. If a story is really explosive like the Mid Staffs scandal, there will be forces working to keep it covered up. That makes life tougher for working journalists. But it’s also a golden opportunity to combine old-fashioned digging with 21st-century data-wrangling and produce absolutely top-class journalism in the process.