Savings will only be achievable if the NHS uses marketing and advertising to effect behavioural change, says Chris Powell
Despite the savings identified by NHS England chief executive Simon Stevens and the competition among the political parties to offer a billion here and a billion there, much money will still have to be found if the NHS is to remain in good health.
Savings will require change. But entrenched habits and attitudes among the public – exhibited in unnecessary visits to accident and emergency departments and GP surgeries, for example – represent a substantial barrier.
Great financial benefit could come from redirecting demand.
Well targeted marketing and advertising can effect considerable change. But so far these tools are really only used to influence personal habits in health – for example, the campaigns for Change4Life, flu vaccinations and bowel cancer checks.
‘Although advertising is expensive – costing millions – it could help effect change worth billions’
The brief should be widened to include system change.
Atul Gawande, the current BBC Reith lecturer, who is a surgeon at Brigham and Women’s Hospital and Harvard professor, points out that many of the great strides in health have come not from new drugs or better surgical techniques, but from replanning the system.
Health secretary Jeremy Hunt in his recent speech at the King’s Fund called for process innovation, much of that too will need public “buy in” if it is to happen.
Although advertising is expensive – costing millions – it could help effect change worth billions.
Here are two examples of the messages we could send out.
It would be economically efficient to market pharmacies as the first port of call. GP surgeries are crammed with people who have the sniffles.
A chemist is well able to diagnose and offer suitable medicines to sufferers from minor conditions. The system would be more economical, the GP surgeries emptier and the patient would have a quicker, “no appointment necessary” service.
‘A chemist is well able to diagnose and offer suitable medicines to sufferers from minor conditions’
No doubt with incentives, chemists’ outlets could be designed to make it clear that they offer this service. Advertising could point out the patient advantage and build a brand of “first visit”.
It wouldn’t be easy.
It is not a magic bullet: advertising rarely produces dramatic and immediate results. But with consistent effort and spend we could see a big diversion of patients to the quicker, better service of a chemist for minor complaints. In Europe this is already the custom, so it should not impossible.
When it’s not an emergency
Another possibility could be the use of advertising to allay public fears about A&E departments and the proximity of hospitals. The medical advice is clear: with the proliferation of medical specialities, only the largest hospitals can offer round the clock cover for emergency conditions.
We have far too many, too small hospitals. If the ambulance takes you to one of those on a Sunday afternoon, you’re more likely to be met by a medical student than an appropriate specialist.
But any politician who supports the closure of a hospital does so at their peril. Seats have been lost on this issue alone, so it just doesn’t happen. The medics are blocked by the terrified politicians.
‘A sustained campaign to demonstrate the skills of the paramedics would reassure the public’
It is likely that the root of the problem is the public belief that, in an emergency, proximity to a hospital is all. But it isn’t.
The critical factor is how quickly the ambulance can get to you. Once the paramedic has arrived, it is very rare that the patient will not survive for at least the next hour – and any large hospital can be reached in an hour.
I suspect that most people still think of the ambulance driver as a stretcher bearer, not someone skilled in stabilising patients until they reach the hospital.
Not only is there direct public benefit in lives saved from having appropriately staffed hospitals, but the economic efficiencies of scale also produce considerable savings and better value for the taxpayer.
I can imagine that a sustained campaign to demonstrate the skills of the paramedics would reassure the public and reduce the pressure to have an A&E at the bottom of every road – not to mention giving a much needed boost to the recruitment and morale of paramedics.
Maybe these two examples are flawed. There have certainly been previous attempts to divert patients to chemists, but not of any impressive scale or persistence.
Nevertheless, the principle of using advertising and marketing as part of the armoury for change in the public services, in the same way they form part of the weaponry of the private sector, should stand.
‘Behavioural economists have been able to improve some aspects of public service’
In understanding how human beings react, behavioural economists – aka the “nudgers” – have been able to bring some of the skills of marketing to improve some aspects of public service. A small unit was even based in Downing Street for a while.
Advertising and marketing within the Department of Health could usefully be asked to broaden their remit in order to spot opportunities where savings could be made or services improved economically.
Chris Powell is chair of the Advertising Standards Board of Finance