Community Health Reporters – a new role for local journalism?
What can the worlds of community-led journalism and healthcare learn from each other? In March, we ran a workshop with NHS England's Public Participation Team to answer that question. The workshop brought together health and journalism professionals with an interest in community wellbeing around the idea of designing a ‘community health reporter’. Their views do not necessarily represent the views of PINF.
At last year's 'Stronger Things' conference (aside: PINF will be at this year’s conference on Tues 23 May) Jonathan Heawood, director of PINF, met two members of NHS England’s Public Participation Team. He subsequently joined their next #StartWithPeople conference, and an idea was sparked...
PINF works with people reinventing news journalism to be driven by and in the service of communities. Increasingly, healthcare professionals are looking to do a similar thing: shifting from a top-down, Whitehall-knows-best approach to a system of healthcare where local people are involved in setting priorities and governing services. In fact, this has been a statutory duty of the NHS for a number of years.
And as the health system goes through another reorganisation - into Integrated Care Systems (see this useful video from the Kings Fund) - a lightbulb went off:
Might the worlds of community journalists and community healthcare professionals be able to learn from each other?
Bringing worlds together
We began with a small-group videocall with members from each of the health and community journalism 'worlds'. We asked everyone to introduce themselves and to talk about the work they do with communities – and how these worlds might collide for good or ill.
There was some mutual wariness: the journalists worry that the NHS hides things from them, or simply that it was just too vast to understand. The NHS worries that journalists are looking for scoops or scalps - or simplified stories that earn clicks, but do not tell the full, accurate story.
Where there was common ground, however, was in the stories of working with communities - such as in deep discussions with a community around mental health, or around the gender health gap.
At some point, someone who worked in communications in the NHS asked: ‘whatever happened to health correspondents?’ She said these would have existed at a regional news level in the not-too-distant past. Well, what did happen to them? We've looked for data - and contacted various folks to see if they might have lists of health correspondents outside the national newsrooms – but we've not found, er, any. It's possible there are no local or regional health correspondents left. Please let us know if we’re wrong.
Towards a ‘community health reporter’?
The question got us thinking about how the BBC now funds a Local Democracy Reporting Service, with around 150 'local democracy reporters' in newsrooms across the UK. The BBC pays for them, but they’re hosted by news titles. Rhiannon Davies at Greater Govanhill suggested that we could borrow that concept: what would a local health reporter look like? Or better still, a community health reporter?
We took this community health reporter idea as a jumping-off point for an in-person discussion. With the help of NHS England, we put together a workshop in Bristol in late March, with a range of local and national journalists and news publishers, NHS staffers, comms people and charity representatives.
We asked the group several questions:
• What information does a community need for better health outcomes?
• What conversations does a community need for better health outcomes?
• Who is accountable for community health - and how are they held accountable?
• What would a community health reporter do?
• What skills/attributes would they need?
• What resources/support would they need?
• What are the risks and opportunities here?
In mixed groups, people came up with plenty of ideas, as well as concerns and questions. These are written up below.
On the community’s needs for information, conversations and accountability, they said:
The community needs information on how to access services and support, which to access and when, how to share their views and voices, connections with relevant groups or networks, knowledge of the system and stats to highlight abnormalities, breaking health news (e.g., outbreaks), different voices and perspectives, human interest stories.
That information should be straightforward, accessible, accurate, timely, relevant, trustworthy, clear, avoid jargon, use analogies and be in multiple formats and languages. It should be provided by appropriate messengers - people who sound like the community.
There needs to be a conversation about what a community understands by ‘health and wellbeing’, about who makes up the local community or communities, and about what matters to them. There may need to be many conversations along the ‘healthcare journey’.
Those conversations need to be representative, sometimes face-to-face, truthful and authentic, honest, ‘culturally competent’, two-way, ongoing and generating feedback loops to move forward together. They need to include decision-makers in healthcare and leaders in communities, and to acknowledge inequalities. There need to be safe spaces for difficult discussions. There needs to be listening. Local and community media can play a role in gathering public views or hosting conversations.
Accountability in healthcare runs from individuals to communities to practitioners, executives, officers, management and elected representatives, and parallel organisations involved throughout the process, such as charities and the media. It can be achieved through community feedback and listening, by asking the right questions, via public meetings, open board meetings, scrutiny meetings.
On the idea of a community health reporter, they said:
The ideal reporter would be expected: to produce explainers, investigative and news content; work across a range of media, from joining radio shows to producing social media content; to co-produce content with the community; to attend NHS meetings and maintain a two-way conversation between community and NHS; to breakdown data to tell stories; to interview decision-makers, budget-holders and to hold them to account; to tell powerful patient stories; to conduct research with the community; to produce content that is accessible and interesting; to provide voice to the community; to manage Q&A from the community.
They would ideally have skills and attributes such as: expertise in public health and in community needs, perhaps through buddying with those with lived experience of the issue at hand; fantastic personal skills, empathy, communication, listening skills and a moral compass; journalism skills in multimedia, data journalism and solutions journalism; curiosity, creativity, integrity, honesty, independence and openness; being of the community, trustworthy, appropriate and capable of being upskilled and of constantly learning.
They would need support, such as: regular training to understand the health system as well as media platforms; long term funding to follow up stories and build trust by regularly showing up; access to data, health professionals and leadership (not just the press office); links to – and support from - local charities, voluntary and community groups; autonomy to follow their noses; buy-in from other stakeholders like elected officials; peer support, reflection space and digital support.
The group noted that the opportunities on offer are nothing less than better health and wellbeing outcomes for people and communities, a more effective and efficient NHS, cultural change within health providers, stronger communities and better trust between people and institutions.
And they noted risks too: of expectation management given the potentially vast role; of difficulties maintaining impartiality and independence combined with enhanced access to institutions; of political interference; of a lack of sufficient funding; of running an inadequate pilot that does not give us a real indication of the role’s effect; of maintaining a duty of care to the community; of handling sensitive data and stories.
In terms of funding, the group seemed strongly in agreement that the role should not be wholly funded by the NHS, but there was a sense that a range of institutional public actors (local authorities, NHS actors) could join with others (charities, communities, media owners) to collectively chip in to make it happen. Perhaps the funding and the management of the role could come from different places, a la the Local Democracy Reporting Service (funded by the BBC, managed by local news publishers).
Phew. That hopefully captures most of what the group discussed. We at PINF and NHS England are very grateful for everyone’s time and contribution of ideas at the workshop.
PINF’s next step is to bring this altogether into a proposal or vision document that we can use to approach potential funders of such a role. We'll aim to keep everyone updated. If you weren’t at the workshop, but have ideas or would want to know what happens next, please get in touch.
Joe Mitchell is Deputy Director at PINF.