by Health Policy Insight editor Andy Cowper

There are survivors and there are thrivers. Cabinet Office Permanent Secretary of Government Communications Matt Tee is the latter.

His career in communications, culminating in the role of Director General of Communications for the DH, took an interesting tangent when he was appointed chief executive of NHS Direct. He also worked as Business Development Manager for Dr Foster.

Tee’s reputation as a quick thinker and safe pair of hands goes along with a recognisable shrewdness. We met shortly before electoral purdah, to discuss his views of government communications overall, and to review some of his experiences in health.

HPI: What is the purpose of government communications?

MT: Its purpose has changed in an interesting way over time. If you go back to the 70s, its purpose was to be the way government transferred information either by talking to newspapers or by buying advertising.

I think you can trace through time how government communications became part of the policymaking process, so one question when developing policy nowadays is not just ‘what will be the effect’ but ‘how will it be perceived’?

HPI: When would you date that change to?

MT: Some point during the Thatcher government. Another thing that happened toward the tail end of the Thatcher government was an understanding, which grew slowly under John Major and grew a lot under the current administration is the role of government communications in changing citizens behaviours.

HPI: So it starts around the ‘AIDS: don’t die of ignorance’ campaign?

MT: Exactly. A campaign you could critique now, but one that was nothing other than a conscious effort to change behaviours. We might do it differently today, but it was a good attempt.

The change in the last 5-6 years is that digital media have made government communications much more 2-way engagement than 1-way broadcast.

Alastair Campbell is very interesting on that – he was the supreme operator of controlled communications in which government kept tight discipline on message, messengers (and indeed recipients!) - but he acknowledges openly that you couldn’t run government communications today as they did back then.

You have to open up to government communications landing in environments where they are a basis of discussion, not a received message.

And we as government communicators must open up to a world in which people talk about our stuff in their space. Every day, thousands of parents have conversations about recognisable government policy on Mumsnet – it’s no good sending them a press release.

HPI: How do you define effective communications?

MT: One of the things that always frustrate me on some elements of government communications is that unless you work very hard at it, it’s easy to be short-term and tactical, and seeing your outcomes as what is printed or broadcast.

I always say to Whitehall press officers – ‘what does the article achieve? What is its effect on the audience and what was our objective in the first place’? I think we’re getting better, more strategic, and more objective-focused. But we still concentrate too much on outputs, not outcomes; and too easily take refuge in the long-term nature of outcomes or difficulty in measuring our outcomes.

HPI: You sound like a health economist talking about medics!

MT: I argue with press offices that you can’t measure stories that don’t appear. I say ‘work out a metric that I’m happy with, or I’ll come up with something you don’t like’!

I think we’re much better on paid ad campaigns, where the concept of return on investment (ROI) is pretty wide currency. The DH, for example, can show with good numbers that for every £1 spent on smoking cessation, we save the NHS £5.

HPI: How do you measure effective communications? Do you have an annual report on their effectiveness?

MT: Increasingly, perhaps not a report, but we’re becoming very public and transparent about our use of public money to communicate, and the ROI.

Public expenditure is about to fall significantly, and comms spend will too. The question of how much it falls will depend to a very great extent on how well we can justify comms budgets as good use of public money.

It’s no use as communicators nowadays to say ‘you know it’s good for you’; too often there’s been a tendency to shy away from hard numbers, and that has to stop. We will be more public: at some point in the next year, we will publish a comms benchmark across Whitehall.

HPI: How will that work?

MT: Initially, it’ll focus on inputs (cost, staff), but over time we’ll move to outputs and outcomes. That is new world, and we cannot be scared of it. If what we do is worthwhile, we should be able to demonstrate that.

HPI: How much of a customer is government of market research in the guise of opinion polling?

MT: The government is a huge consumer of market research, insight work, focus group work – we do a lot.

One of my worries, not just about research, is that we’re not as intelligent as we should be about how we buy some of that. Most government departments have a contract with a pollster, often IPSOS MORI, for opinion research. If we were to procure intelligently, we could get better rates rather than buy 20 times over. We may even be asking some of the same questions!

I want us to be more intelligent in buying and sharing of research, sometimes we’re still a bit departmental and not sharing.

HPI: When doing market research, do you value quantitative or qualitative more?

MT: We’ve got a lot better: 10 years ago, when I started, we only did quantitative research. The Labour government, having done a lot of focus group work, had ministers who understood qualitative research and were much more interested in that.

Over time, this has fed into our large-scale deliberative work. What we do quite well for that is choose research methodologies in an intelligent way, and it’s rarely just qualitative or quantitative; it’s actually pretty sophisticated.

HPI: How much capacity and capability to produce comms exists in-house and how much is bought in?

MT: As a government, we have usually tended to the in-house model. Over time, we’ve recognised that having our own printing and graphic design is unwise, and outsourced those.

Looking to the future and reductions in cost, we’ll look at outsourcing a lot more than we currently do, maybe by outsourcing to another department. We could have a web team across 2-3 departments, or even across the whole of government. We will have to look at the in-house model quite carefully

HPI: In your evidence to the Commons’ Public Affairs Select Committee (PASC), they quoted figures that communication staff and press officers had increased by around 72% between 1998 and September 2008. You suggested that was an under-estimate. Has that been clarified?

MT: My feeling is that in the last 15 years, the numbers have basically doubled. As I said at PASC, we’re doing rather more things than we used to. So it’s not simply the number of press officers; it’s the number of people working in government as communicators. We had no web teams 15 years ago.

Now we use the web for internal comms. We also now have different ways of using marketing, customer insight research, which have all developed significantly.

There are more media, and we’re better at being proactive – one example from the Department of Work and Pensions, when the winter snows were coming down, our team proactively got on to the regional media and reminded them of the existence of the cold weather payment scheme, so they could feature it in their ‘snowbound Britain’ stories. And the media did.

HPI: What does your remit over cross-governmental work around customer insight mean in practice?

MT: I think we have come to realise that we can be a lot more specific about understanding the citizen for whom we’re trying to develop policy services and with whom we’re trying to communicate.

Some of this is building on techniques familiar to us as communicators. If we’re doing Change4Life obesity work, then obviously, not everyone is obese. So it’s how we analyse the population to know who we should targets in work around obesity – and it can then include comms work or other forms of activity to address the diabetes issue; customer segmentation and insight to choose which part of the population to target.

We can equally adapt this for policymakers to target which bit of the population to target in developing their policies.

I’m trying to build a community of people across Whitehall who get this stuff, building out of three departments - health, work and pensions and revenue and customs. We’re using an exercise with those three to help other departments with big policy challenges, like the department for energy and climate change – whose behaviours should they be targeting to make for more sustainable lower cabon future

HPI: You told PASC “propriety is important” to you pre-election. What does that mean in practice?

MT: Three things: firstly, as head of the Whitehall comms profession, I'm ultimately responsible to the cabinet secretary for communications coming out of government being proper, non-political and good value for public money.

So we need the right systems in place so if concerns arise, they get escalated to me in the end.

The other two bits involve being clear about rules, which are developing where we face new challenges - digital communication, use of personal blogs touching on work stuff, propriety issues for civil servants. The third bit is for people working in comms at all levels to understand what is proper and not. It’s easier to deal with propriety at the point something arises, and for it not having to be escalated to me. I want the most junior press officer to say ‘sorry minister, we can not do it that way, but we can do it in a different way which is proper’.

HPI: What is the most demonstrably successful government communications campaign you’ve seen?

MT: There have been so many!

One of them is the HMRC campaign to get people to fill in tax returns online. Firstly, a really good example using customer insight: HMRC used to believe that the biggest problem was bad people who didn’t want to pay tax. Customer insight taught us that people wanted to pay their tax, but found the whole thing difficult and complicated. That really changed HMRC's focus, and they went on to make online filing simpler, and think about how to encourage people to do. They came up with incentives: stop letting file on paper unless they file six months early. And they ran good ad campaigns to get people to file online.

The real reason to pick this was that it proved one of most effective. HMRC can prove for every pound spent getting people to file online, because of administrative savings for HMRC and because more people were paying their tax, they earned £2.73 for every £1 spent. That’s the way stuff should be done!

HPI: And the least successful?

MT: I hope we’re in a position where we wouldn’t spend public money on something we could see was markedly ineffective, through doing the right research and piloting, before we did it. And that we’re big enough to be able to do it.

We spend the best part of £300m a year on advertising. You could point to campaigns that are less effective than we would like. Testing means we really shouldn’t be doing something ineffective.

HPI: Is there a relationship between a department’s communications competency and its status in the cabinet office capacity and capability review?

MT: I think that’s a really interesting question, on two levels. On one level, I think we could say there’s an absolute correlation between capable departments and engaged staff. So where we do the annual staff survey, where staff say they’re fully engaged, they understand clearly what their work is and how that fits in the organisation. From that, you get capable departments. It’s interesting, and we now know this beyond much reasonable doubt: internal comms really matter.

What capacity and capability reviews have not teased out sufficiently is whether departments who are highly capable at external communication (understand objectives, use good methods to reach targets) are clearly more capable. To some degree, one thing we need to think about is how to focus more on outcomes than on internal capability. Is there direct correlation between outcomes and effective capability?

HPI: The Government is promising to make big cuts in comms budgets, as part of the overall £3bn of new efficiency savings, including £650m from marketing and management consultancy spend. What are the consequences of this losing capacity in a recession?

MT: There’s quite a lot we can do before we start seriously affecting capacity and effectiveness. I think if start working together across government in a more smart way - buying research as an example I’ve given - then we can take quote a lot of money out of budgets without reducing capability.

Another ‘holy grail’ example would be if we could aim comms campaigns at an overall audience or behaviour rather than via a department - that might be more effective for less money. At health, whether it’s smoking, drinking, safe sex, you’re probably talking to a similar bunch of 16-24 year-olds about all these issues, but we tend to do it with separate campaigns. In a cross-government context, we could do this a lot better.

But this will mean real cuts. That means some quite tough choices for government. Having discovered that comms can give them a way of implementing policy, not just selling it, a long think will be needed about cutting the budget for smoking cessation – think of the knock-on effect on the end quitter.

We need to decide what we’re not going to do any more. In plenty of areas, we’ve probably over-specified a lot of things we do around comms. I’m not sure we need so many specialist teams of press officers. We’re not quite providing super-Rolls Royce service, but at a time of falling expenditure, there will be deals we have to do with ministers

HPI: The COI spent £41m on PR and news management in 2008/09, more than 50 per cent up on the previous year. Education and Health were mostly responsible for the growth in PR spend. Is this delivering value for money?

MT: I don’t think you can judge value for money just by looking at a big number.

The value-for-money questions are:
- was it clear what the campaigns tried to achieve;
- who it was trying to reach, and
- were there good measures of whether reached objectives?

In policymaking sense, our return on investment figure is about justifying these. I think we’re a lot better in the last 5-6 years at basing our spend on things we know will be effective and achieve effective outcomes. Just because spend doubles, that does not mean we're not giving the public value for money

HPI: When you were seconded as head of comms into the DH from Dr Foster, what was the attitude to comms that you found?

MT: I think it was a great time to be seconded. We had a secretary of state in Patricia Hewitt who was determined to make some difficult decisions.

I remember a conversation with her saying to me, 'we're going to do some stuff that's going to be difficult, and it won’t always be popular. Your job is to make sure we get across message of why need to do, not just to stop being any bad headlines ever’.

Which was very refreshing. She accepted comms as an important part of achieving change, with realism about the impact some actions were likely to have on public and stakeholder opinion, and recognition that my measurement of effectiveness was not down to positive headlines every day.

HPI: What impact did you have in making these massive changes to the DH’s pre-existing comms culture?

MT: I think it’s wrong to say people in the DH were resistant to that - though there were some. There were also some very good people who were up to challenge, and I think that was true of communicators down through the NHS.

They were worried about doing the right thing and then having ministers come down on them like a ton of bricks. When we said and demonstrated that if you do the right thing, even if it’s unpopular, there will be no ton of bricks, people felt quite liberated.

We did have to explain to people that doing the right thing was not just doing the unpopular thing. That was not the objective! They had to be a bit smart and consider timing and when announcements appeared, but having some bad headlines or getting some negative campaigns in area because they were doing the right thing did not bring ministers down on them in the way they feared. So I felt people were very up for it.

HPI: What was your experience of working with Dr Foster as business development manager?

MT: When I joined Dr Foster, it was a real eye-opener for me. My career had been in large public service organisations. All of a sudden, here I was in a small, very dynamic, driven business with some visionary leadership and an ability to get in doors that defied understanding. Everywhere you went, people knew who Tim Kelsey was.

It was tough at first. I remember at the end of my first quarter, doing my appraisal and being asked how I thought it had gone. I said, ‘quite well, we’ve got some new product development and I’ve made some good contacts’, and they said ‘exactly how much money have you brought in?’ I knew I was in a different word.

Dr Foster was a great place to work, very buzzy and dynamic, with a real sense being able to make things happen.

HPI: And as CE of NHS Direct?

MT: I’d had a feeling for quite a bit that I’d like to do a CE job, and felt I had amassed right tools, and understood what the job was.

When NHS Direct job came up, I thought, this is a really good fit – health, digital, reputational issue, all my sort of stuff, and I really enjoyed it.

I think when I look back in time, a couple of things about the establishment of NHS Direct didn’t help. The principal one was that nobody was entirely clear what the value equation was. What value did NHS Direct give to the citizen and to NHS as a system, to prove it was good VFM?

Because that hadn’t been done, GPs could always say 'NHS Direct adds no value to me, and actually makes my life worse'. So part of the job was being able to create a real sense that NHS Direct was part of the system.

HPI: Which was more than taking a stand at conferences …

MT: Absolutely. A GP has no way of knowing if their patient contacted NHS Direct in the night before a surgery visit or not. If a patient was told to go to A&E by NHS Direct, they had no way of carrying that conversation with them. Patients used to ask, 'will they know I’m coming?', and we had to say 'No'.

But that was wrong. If the NHS Direct conversation was a clinical interaction, ending in a clinical decision that they need urgent clinical care, we should have been able to transfer that in some form. For me, that a more real sense of the electronic patient record (EPR) than the national record.

We started working towards that with people like EMIS, on how to convey the fact that NHS Direct was part of the patient journey to other parts of NHS.

Your line about stands at conferences is interesting – it’s clear to me that part of the problem with NHS Direct was not lack of communication with the rest of the NHS, but the wrong sort of communication.

HPI: Is NHS Direct going to be vulnerable to cuts?

MT: I'd start from the point that most public services will vulnerable to cuts (except for the NHS front line, obviously …). NHS Direct may be vulnerable if it's not able to demonstrate its value. I think it’s a very valuable service, but unless it can demonstrate that with numbers, it wiil be vulnerable

HPI: Is the reason why implementing innovation and best practice in the NHS remains optional down to comms being more of an add-on than a core function?

MT: I’m struggling with the word ‘optional’. I don’t think David Nicholson would feel adoption of innovation and best practice was optional, and he might say things like QIPP programme and some of work around tariff are designed to make and encourage some of those things to happen.

The plain fact is that in a system where we’re encouraging local accountability and local autonomy, there will be people who for good or bad reasons, don’t do things the same way as very successful organisations elsewhere.

One thing we’ve been doing a lot of work on in the Cabinet Office is behaviour change for organisation, and everything we know from that is that we have a toolbox here with a umber of elements; not just one way of doing things. As government, we have power for legislate, but that’s not the right answer to change behaviour in all circumstances.

In health: you use different tools. Sometimes, you legislate, sometimes, you build incentives or disincentives; sometimes, you just raise awareness. You don’t always know what is going to get people to do the right thing. Communications has its role to play, but a role in the sense of helping senior managers and clinicians understand what we want them to do.

HPI: How is working in the Cabinet Office now feeling, overall?

MT: What’s driving an awful lot of what I’m doing is the knowledge that after 16 years of increased reliance on communications, and so growing resources, things are about to move pretty fast the other way.

And after 15 years of communicating about public expenditure rising, that story is also about to go other way.

So we’re going to have fewer communicators, communicating about falling levels of public expenditure. That’s a pretty fundamental change, and we’re going to have to more very quickly and dynamically if we’re going to meet that.