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Perception and reality

Alistair Burnett Alistair Burnett | 11:39 UK time, Thursday, 2 November 2006

What a difference we often come across with many stories we cover - especially in areas such as crime, the justice system and the NHS. The World Tonight asked why it is that given all the extra investment the government has put into the health service - with new GP surgeries and new hospitals being built, and new technology being introduced into those surgeries and hospitals - why the latest opinion polls suggest a majority of the population think the NHS has got worse over the last ten years.

The World TonightAre people just badly informed or is there a more nuanced explanation? The pollster, Joe Twyman from YouGov, discussed his findings with Robin Lustig on Wednesday's programme (listen here) and it seems a large part of the explanation is that people don't trust politicians, so the more our politicians say the NHS has improved, the less people believe it.

There are also the protests of staff and unions which get publicity, and people tend to believe the professionals more than the politicians. There's also a lot of negative coverage of health issues in the press which add to this. Finally there are the anecdotes that get passed from person to person and end up inevitably getting distorted. Only today a colleague told me a particular hospital had killed his father - if I passed this on to you, maybe you'd tell a friend and another anecdote could take off.

Set against this on the other hand, Anna Walker of the independent watchdog the Healthcare Commission, told Robin Lustig their surveys of patients shows most think they get good care from the NHS.

This is a potent mix with pretty disturbing implications - it appears people are more prepared to believe things they hear about a crucial public service than to believe politicians or their own direct experience. We also need to look to the role of media in this - is our coverage of the health service giving an accurate picture overall? After all, news is what is unusual and so the 'bad stories' about the NHS such as job cuts, hospital closures, or outbreaks of MRSA tend to get more coverage than the building of a new hospital on time and to budget.

I think as journalists we tend to assume our listeners, viewers and readers make allowances for the fact that what makes news is not the norm but the exception. Are we right to do so?



How can we make such allowances, when we only see a tiny, tiny bit of the norm?

I know of no source of readily-digestible, up-to-date, reliable (and reliably impartial) background information for current affairs. Wikipedia comes closest but has significant disadvantages.

  • 2.
  • At 12:36 PM on 02 Nov 2006,
  • Mark wrote:

Then there is the possibility that health service really has gotten worse.

"Only today a collegue told me a particular hospital had killed his father."

Without THOROUGHLY investigating there is no way to know whether or not this is true but it would hardly be surprising if it were. Medical incompetence in hospitals all over the world including some of the most prestigious results in needless death every day.

If the majority of people don't believe what they are told by politicians, bureaucrats, and others with a vested interest in sugar coating the truth or hiding it altogether, perhaps it ultimately boils down to the reality that what they are told often flies in the face of experiences in their own lives. Among those they believe the least if you give any credence to the postings last week about reporting bias is the media which spoon feeds them the news incessently. And which media voice do they hear most and which voice speaks loudest? Why BBC's of course. Once lost, how do you restore trust?

  • 3.
  • At 01:05 PM on 02 Nov 2006,
  • Adam wrote:

I don't know whether the health service has got better or worse in the last 10 years, as I am fortunate enough to have very little to do with it.

However, it is an inescapable fact that people get less healthy as they get older, and are therefore likely to make more demands on the health service. One thing that will be true of 100% of the respondents in the opinion polls is that they are 10 years older than they were 10 years ago. Just a thought, but could that be why people tend to think the health service is worse now than it was 10 years ago?

On the other hand, if Tony Bliar says that it's better now than it was 10 years ago, that's probably good enough for me to assume that it really has got worse.

  • 4.
  • At 01:09 PM on 02 Nov 2006,
  • Richard wrote:

While my direct experience of the NHS is limited it is the employer of a significant chunk of my family. From them I hear not so much that things are getting worse from the 'customer' end but that the staff are working in a frenzy to meet targets, survive budget cuts, reorganise to lower staffing levels (oh, but apparently only 900 are getting fired nationally - rot) and their stress is going through the roof.

Having said that I would love to see a BBC report on the state of the NHS. The Economist magazine regularly reviews the state of nations, industries, services to give an idea of trends and outcomes: how about more of your in-depth reports in this vein? It would let you present a fuller and more balanced picture, and would let us have a better idea what is going on.

  • 5.
  • At 01:42 PM on 02 Nov 2006,
  • Charlie wrote:

OK so people think the NHS has got worse. A person's opinion isn't the truth, and one explanation might be that with such a political issue as the NHS, people may not be stating their opinion of the NHS but rather the government.

Has anyone actually considered that given the NHS is one of the - if not the - largest employing organisations in the country, that it is impossible to measure its "goodness" by one, single, independent variable? Any statistician would tell you this impossible.

Anyone's personal experience is only a drop in the ocean compared to the wealth of data out there. Given that you're only likely to hear about below average experiences and very, very good ones, most people would say that the NHS is bad.

  • 6.
  • At 01:50 PM on 02 Nov 2006,
  • E R King wrote:

My husband has been unfortunate enough to have had a series of operations (Five major, requiring stays in hospital, and 22 day surgery), plus outpatient attendance, radiotherapy and concomitant support over the past six years, and has therefore had the dubious opportunity to sample a range of Midlands hospitals over the period in which money has been invested.

Our experience is almost without fail positive. There have been visible and tangible improvements in quality, cleanliness and facilities.

I suspect those with personal experience assume that their's is exceptional, whilst in fact it is probably the norm.

  • 7.
  • At 02:21 PM on 02 Nov 2006,
  • Jessica wrote:

I think your last paragraph is a very dangerous assumption.

I know intellectually that news covers exceptions, and that bad news sells better than good.

But in the face of the constant cascade of exception news, it's still hard to maintain a perspective. And one human case story of a disaster sticks more in our minds than the most rigorous survey demonstrating successes.

I think journalists need to do more to set the context for their stories. And try to find ways of telling good stories as well as bad. And be very careful about distorting the truth slightly to make a more sellable headline, or looking for the bad news in a report that overall is good news.

Sorry to post twice but I had another thought, a memory.

Several years ago I watched a Newsnight discussion about the state of the NHS. There was the usual sort of panel: an NHS defender, an NHS basher, and an academic health economist of no obvious affiliation.

The economist managed to start one sentence, to the effect that the NHS was neither performing poorly nor meeting the public's expectation, but suffering from a crisis of rising expectations. That sounded like the start of a more 'nuanced explanation' - but it was more than enough nuance for the other two, who went on to dominate the rest of the discussion without saying anything new or of interest.

I was annoyed at the time with the Newsnight presenter for not shutting up the time-servers and letting the person who knew something speak.

I think things have got a bit better since then, but, while the adversarial approach to getting at the story has its uses, it still tends to become the story too much of the time.

  • 9.
  • At 03:48 PM on 02 Nov 2006,
  • Jackie wrote:

As someone who has worked for the NHS since 1979 I've seen all the reorganisations since then, and I've lost count of how many we've had! As an employee and a potential user of the service the current situation is worrying. We can't deny the large sums of money that the government have handed to the NHS since 1997 however all this money has done is fill the void from underfunding in the previous decade or more.

Even those of us employed by the NHS find it difficult to understand the current deficits across NHS Trusts and how we've got to this state.

  • 10.
  • At 07:29 PM on 02 Nov 2006,
  • Tarannum wrote:

Misuse of media

I think the media shows only a fraction of truth and sometimes not even thats, it baseless stories made up according to one convience.Media should go and investigate throughly the real should be a fair play not one sided.People depend upon it.mostly it is full of lies.Be honest to your profesional and show the correct news.DO not be ashammed to print it.

  • 11.
  • At 07:30 PM on 02 Nov 2006,
  • Tarannum wrote:

Misuse of media

I think the media shows only a fraction of truth and sometimes not even thats, it baseless stories made up according to one convience.Media should go and investigate throughly the real should be a fair play not one sided.People depend upon it.mostly it is full of lies.Be honest to your profesional and show the correct news.DO not be ashammed to print it.

  • 12.
  • At 11:05 PM on 02 Nov 2006,
  • Jenny wrote:

The BBC and other mainstream media give the NHS far too little serious journalistic coverage, and too much fictional representation, that's the root of the problem. Outdated dramas and sitcoms repeated endlessly on ITV, pure rubbish, as far as the NHS is portrayed, like Holby City and No Angels colour many opinions. News is restricted to the most sensational stories. And yet the service is our largest employer, a huge investment, the healthcare provider for most of us, and the medical safety net for us all.

The decisions within it are mostly made by bodies that hold public meetings which it is rare for anyone of the public, or even press to attend. The decisions whereby the government's huge recent cash injection got mostly diverted to raised salaries, new buildings, horrendous computer fiascos and the drug companies instead of to health were there to be reported and questioned at the time. Instead just the eventual outcome rates coverage, when it is too late, as if it were something that happened within some big private concern.

I would suggest the lack of airtime devoted to the NHS is something dating from the 1950s, after the initial enthusiasm under the Attlee government, when most senior figures in the media still saw doctors privately, most journalist smoked and drank themselves stupid, "real men" never got ill, and the Conservative government were hoping the NHS, and everything else "socialist", like the nationalised industries, the Common Market, the Council of Europe and the United Nations would wither away as people became more prosperous and forgot the war.

Huge and vital public bodies require big coverage. We rightly chose, in a well-informed way, to have public, universal healthcare, but the national media sees much else as more important. It's not dissimilar to what they say about democracy, that the price is eternal vigilance. And look what has happened to our democracy too.

I often wonder how many senior journalists have private medical insurance.

Talking of private treatment. I don't see how any survey could say that most people are happy with NHS care when the dental side of it is disappearing in the way it is. Dentistry is supposed to be part of the NHS you know, and yet it operates by totally different rules. Not enough surgeries, people unable to get care for years, only the cheapest care provided and no new procedures added, dental hospitals unmodermised for decades, practitioners allowed to use any trick to get patients to pay for treatment, to turn people away and barred from helping them find an alternative provider. And government ministers care so little they don't even turn up for Commons debates on NHS dentisty. That would colour the views of many about the NHS as a whole. Nothing would convince me that all politicians and senior journalists don't use private dentists.

  • 13.
  • At 07:39 AM on 03 Nov 2006,
  • dave B wrote:

In 2004 I needed an operation on my knee. Although the operation was canceled once, it was performed just a little after 6 months from my GP referring me to the hospital. Sadly it wasn’t successful and the problem recurred within two months, so having already been discharged from the hospital, I returned to my GP. I was referred back to the hospital again in 2005 and a second operation was carried out a staggering thirteen months later. Im not entirely sure if I was lucky the first time, or unlucky the second time, but either way my experience tells me an entirely different story to that of the many government ministers, who during this time were boasting about the huge investment and improvements they had made to NHS waiting times. My conclusion then and now is that what I was hearing was in fact nothing short of a monstrous lie.

  • 14.
  • At 10:44 AM on 03 Nov 2006,
  • Mark E wrote:

My experience of the NHS is that 10 years ago things did appear to be better.

A big difference I have noticed is in trips to the GP, previously you actually had the chance to take off your coat and sit down to chat with the Doctor, now GPs seem to be pushing you out the door the very second you have walked into them.

I have also experiences differences in A&E departments, the wait to see even a triage nurse is longer now then the wait to be treated used to be (and I only had to go the A&E the last time because I was discharged early to clear a bed)

Labour have thrown money at the NHS, the problem is that very little of it landed where it was needed.

  • 15.
  • At 10:51 AM on 03 Nov 2006,
  • Peter Copping wrote:

An illnessand injury service, which is what the NHS mostly offers, is what the maketing people call a distress purchase. Most of us only use it when it is we think we must. Most people between the ages of 16-65 use it rarely. I am typical. I have been twice in hospital between those ages and visited the GP (apart from the incidents which required hospital treatment) less that ten times between those ages. The service is disprortionately used by those over 65 like me (luckly not very much at the moment). So its reputation mostly depends on hearsay and media reports available to the majority who are very light users. Those surveying opinion on the NHS and journalists using such surveys need therefore to distinguish between users and non users opinion, and to back the survey with checking a selection of people to discover what information they used to form their opinion. Of course surveys done for interest groups, and political purposes are useless. One other interesting point I discovered when doing some evaluation work with a NHS professional staff member who was a user of a service they were professionally knowledgable about. When we asked such users we found them much more critical of the service they received than normal users were. Perhaps just as shops employ mystery shoppers, the NHS should use mystery professional patients to help improve the standards.

  • 16.
  • At 11:55 AM on 03 Nov 2006,
  • Mark wrote:

It is the job of the media to align perception with reality by presenting all of the relevant facts clearly and plainly, connecting them into a coherent picture, and putting it in context of other facts which help explain it. If there is a gap insofar as an issue which is of concern to so many people such as the NHS, the Middle East, or global warming, then the media hasn't done its job properly. Instead of wringing its hands bemoaning the fact that the public doesn't understand, BBC better serve its audience by shedding some light on the topic rather than just adding to the heat.

  • 17.
  • At 03:32 PM on 04 Nov 2006,
  • J Westerman wrote:

My experience is that the NHS is a great deal better from the patient's point of view, although the statistics clearly show that the financial management, in some regions, needs urgent attention.
Unfortunately one major political party voted against the NHS right from the beginning because it effects a transfer of income down to those who could not afford all the necessary, or even any, health care.
That party owns, or is otherwise supported, by much of the media so we can expect a continuous barrage of articles designed to undermine the NHS.

  • 18.
  • At 07:28 PM on 06 Nov 2006,
  • Carole Shenton-Tan wrote:

Just what allowances do you want your viewer, listener and reader to make in relation to the information that is put out as news by the BBC? You state “… what makes the news is the exception rather than the norm”. What does this actually mean? Does some ‘additional incentive’ have to be evident before it can become a “News Story” or is taken seriously?

So what is real news today? Should I ask myself just how much truth and fact has been sacrificed on the altar of financial gain or some other advantage somewhere down the line? Which self appointed individual or organisation has or is trying to pull strings this time?

Fact, press and news releases from conferences, Government spin doctors, propaganda machines and public relations organisations pour onto the media stage 24/7 world wide. Multinational news and media empires have editorial policy and controls imposed on them by their wealthy owner’s, determine to influence their output and so public opinion. Numerous people and organisations clamour to persuade and impose their ideas, dogma and beliefs on their fellow human beings every minute of the day.

It has already been reported on many occasions that the public distrust politicians, journalists and the media generally. Is it any wonder, they are all suppose to tell us the truth, but fiction and the embellishment of the facts not to mention the truth are more often the norm. Can’t they see for themselves that they have lost the plot? In all honestly (should I use that word loosely?) how can we then believe a single words they say!

No wonder Blogs have become a favoured means of trying to find the truth and the facts of what is really going on around the world. At least one can expect and assume that this information is based on an individual’s personal reaction to a particular event or set of events, their reality. Allowing for different perspectives and opinions, wouldn’t a picture built up from these stories contain a good deal more facts and present a more normal local reality than those that qualify as ‘exceptions’ and make the news?

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