Intended for healthcare professionals

Views And Reviews Acute Perspective

David Oliver: How not to do covid-19 comms—copy our government

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3986 (Published 21 October 2020) Cite this as: BMJ 2020;371:m3986

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  1. David Oliver, consultant in geriatrics and acute general medicine
  1. Berkshire
  1. davidoliver372{at}googlemail.com
    Follow David on Twitter @mancunianmedic

I’ve been thinking for months that many failings in our pandemic response are really public communication failings. Compared with consistent communications and strategy in other countries, the UK government has fallen far short.

Messaging should be clear, consistent, and easily understood. The evidence base and rationale for decisions should be shared openly and readily understandable. We should also know who’s involved in advising, deciding, and consulting; who has final accountability for decisions, nationally and locally; and where the balance lies. For example, where did the recent decision on the 10 pm curfew arise?

We all understand, as the facts and situation evolve and the impact of decisions emerges, that our leaders may need to change tack. People can accept this, as long as the rationale is explained. But if new decisions and directions are taken, tell people why. And don’t, for goodness’ sake, appear to change advice or decisions to justify not having enough kit or capacity—such as access to personal protective equipment or the use and importance of testing.

When we present data—for example, about deaths and excess deaths from covid-19 or other causes or about the availability of tests—we need to do so honestly and transparently, with all workings and raw numbers shown. Preferably, this should be done by a completely independent agency such as the Office for National Statistics or the National Audit Office, not by a government executive agency such as Public Health England or the Department of Health and Social Care, or in No 10 press briefings, which often pick data reference points to suit reputation.

When clinicians and scientists are employed in government advisory roles, inside and outside the civil service, a duty should be written into their contract to speak openly, independently, and honestly—and sometimes challengingly. Far too often advisers have been put up in pandemic press conferences as a human shield for ministers, having to stand in silence while misleading statements are made—such as the claim of a “protective ring thrown around care homes”1—and unable to contradict them.

In fact, don’t make public statements that are laughably at odds with reality in plain sight, for instance claiming that our pandemic preparedness has been “world class,”2 or that NHS staff are having no problem getting tested for covid-19,3 or that there was no mass discharge of hospital patients to care homes.4

If you’re going to announce a new policy, don’t do it by leaking it to selected media outlets in advance of announcements. This has happened repeatedly throughout the pandemic. And don’t give long advance notice of possible behaviour change relaxations. Many people will see that as an invitation on day one.

Don’t suppress or scare frontline NHS workers, or senior managers, to prevent them speaking out on issues of concern in social or mainstream media, in turn damaging morale and trust.5

Be open with appointments to key public agencies, such as NHS Track and Trace or the new National Institute for Health Protection, and when big public contracts are awarded. We’ve seen no transparency in processes of appointment and tendering in this pandemic, and clearly unqualified people or contractors have been given key roles.6

Finally, lead by example. Adhering to the Nolan principles for conduct in public office,7 which include integrity and transparency, is important. Several ministers and MPs have been caught behaving hypocritically or against their own government’s advice. The most egregious example was not a minister but Dominic Cummings, the unelected adviser to the prime minister, whose road trip to Barnard Castle has been much criticised. Even worse was the cabinet’s concerted defence of his actions. A recent Lancet paper reported just how much this had undermined trust and made people more reluctant to accept strictures on their own behaviour.8

Looking through the public communications from this government and its agencies throughout the pandemic could serve as a training exercise for years to come on how not to communicate.

Footnotes

  • Competing interests: See bmj.com/about-bmj/freelance-contributors.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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References

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