NHS marketing: Winter is coming…

The NHS is about to launch its annual winter marketing campaign, but will today’s economic climate leave patients out in the cold?

The summer in Britain just doesn’t seem to want to end, but it will. As the clocks go back and the temperature drops to single digits, the NHS begins to prepare for the worst. A&E figures locally are already showing a system that is struggling, and nationally doctors are already warning the service will experience ‘pockets of meltdown’ as essential services are unable to cope with demand.

Into this potentially toxic environment, NHS England is launching its winter health campaign to help reduce the burden on A&E. They claim they’ve ‘pulled out all the stops’ this year, but will it work?

Setting the scene

It’s not hyperbolic to state that the NHS is stretched. As our population grows in size, and its demographics shifts our health services, and in particular those that deal with emergencies, are finding things tough.

The subject is complex, multifaceted and – when it comes to immigration – emotive, but distilled down it’s clear that demand is increasing in all areas, and it’s not likely to stop soon.

It’s also clear that this demand increases disproportionately through the winter.

In recent years the NHS has increasingly used commercial marketing techniques to help communicate with the public the range of services available, and the alternatives to expensive emergency care.

These techniques and approaches have been proven to work at persuading a willing public to invest in new products, but there is still concern, both inside and outside the NHS, about the efficacy of such programmes in changing behaviours.

A short, but well researched, BMJ investigation by journalist Chris Mahony was equivocal on the issue. While there are clear illustrations of successes in healthcare marketing – the reduction in childhood pregnancy rates for instance – there is less evidence that healthcare marketing campaigns work and are successful at influencing patients to choose alternatives to A&E. In fact, the statistics suggest the opposite may be true as the numbers of patients attending A&E continue to rise each year.

It’s hard to untangle just how much the NHS spends on marketing and communications to cope with winter pressures, but it’s likely that the figure runs into tens of millions of pounds.

Much of this will be spent centrally on large agencies, with smaller local business (and that includes bespoke agencies like us at 42group) working with NHS organisations to support the roll out of campaigns.

Communications around healthcare, often called social marketing, is now a core part of what the NHS does. But the jury is still out on whether it actually works. As we head into this winter money is already being spent, whether it will be spent wisely is a question we need to ask.

Focus on the frontline

At about this point, unless you have direct experience of the NHS, the first question most people ask is why the NHS needs to spend money on marketing at all.

Surely this money could be better spent ‘on the frontline’?

In our experience, the NHS focuses on staffing during winter more than at any time. If there is a staffing need identified, the money will be spent to fill it. There will be difficulties – the shortage of trained nurses and doctors being one – but these are mitigated as far as possible.

The spend on marketing is based on the clear evidence that up to 20% of all A&E visits are unnecessary.

The problem is, once those people have entered the hospital doors, that money has been spent. The key is to try and influence them before they make the journey.

And the best way to do that is through marketing.

Assessing impact

So, hopefully by this point, we can agree that marketing, if done properly, is a good idea.

If we accept that a large number of A&E visits are unnecessary, success is about changing behaviour and getting these potential patients to either seek help elsewhere (Minor Injuries Unit, Urgent Care Centre, GP, Pharmacist or 111 – since you ask).

If they do this and avoid a trip to A&E, the problem is, how do you know?

The biggest issue for a social marketing approach like NHS England’s winter campaign is to quantify how many people haven’t done something as a result of coming into contact with your material.

If things remained as a constant it would be relatively simple. When you factor in some of the other variables – trend, population size and so on, the situation becomes much more complicated.

Let’s use an example. The target of a campaign may be to reduce A&E attendance. That’s simple enough, isn’t it?

But of course, it isn’t. If the percentage of patients attending A&E increases locally by 1% during the year, but the national trend is for an increase in attendance of 3% is this considered a success or a failure?

If your local population has increased by 5% over the course of a year, will the researcher recalculate the baseline in consideration of the fact that the population has increased? If they do, a failure of a campaign could quickly be considered a success.

As a result of this complexity, the NHS traditionally focuses its assessment of campaigns on more readily available metrics. These include simple statistics on the ‘opportunities to see’, website visits, tweet reach and so on.

While these can provide some quite impressive numbers, they’re limited in terms of the lessons that can be learned from them. In fact, in many cases they’re not worth a great deal. It’s also true that these superficial measures can be manipulated. And just looking at numbers doesn’t mean that you’re not getting through to the right people.

It all makes it very difficult to assess whether what you’re doing has much impact or value at all.

What’s the alternative?

An interesting experiment would involve the NHS doing nothing during the winter. No leaflets, no communications, no marketing, no websites, no press releases, nothing.

Would the NHS be in a better or worse position? Would we see an increase or reduction in the numbers of people attending? Genuinely, it’s not clear.

This experiment would however,help us to establish a baseline – something lacking in the current approach. Against this we could measure all activity, and provide a comparative figure. Was it more, or less effective at reducing A&E attendance than doing nothing?

The reality is though, that no Government would run the risk of not having a campaign. The reputational damage would be huge.

It is an interesting theoretical experiment. There is an argument that, paradoxically, public campaigns that aim to push patients to seek treatment in alternative areas than A&E actually raise awareness of A&E. As a result more, not less, people turn up.

It’s just a theory of course, but one that has at least some support anecdotally.

Making an impact

We’ve established that social marketing is the right approach, and that we need to have a campaign because doing nothing isn’t a palatable option.

One question that remains is whether the NHS is doing the right things.

Stay well this winter” sounds more like a barked instruction from a school nurse than the warm and supportive arm of the NHS wrapped around your shoulder.

It’s also pretty bland and uninspiring.

That’s not to say it won’t work – if you spend enough money, even the most banal of messages can permeate the collective conscience, but it’s hardly likely to grab the public’s attention, particularly while it jostles for position with commercial adverts at the busiest time of the year.

If the NHS wants to embrace commercial marketing techniques and approaches to help it achieve its aims, then it should. But it needs to embrace all aspects of the commercial approach, not just cherry-pick those aspects which it feels comfortable with.

It needs to be bold, strong and create an identity that resonates with people. It needs to have confidence in it and maintain this investment and effort. These can all be achieved within the current creative of course – and there will be some examples of wonderful work across the country, but they’re not making it easy.

The irony of course is that the NHS itself is the best marketed brand in the UK, with incredible recognition, recall and emotional relationships.

And why is the NHS so recognised and revered?

It’s had a single, strong message; a simple but compelling creative identity; and continual reinforcement and support – not over a season but over decades. It’s what makes the NHS so special, not just for the winter but forever.

42group is a leading agency that works with healthcare clients including the NHS to help them develop, design and deliver marketing campaigns that make a difference. If you’d like to chat about how we can help you tell your story this winter, contact us today.