The NHS and its multiple organisations are constantly evolving and the scene is set for further change under the government. The one constant in the last two decades has been the NHS brand and the way it has been applied by communications and marketing professionals.

The coming together of community and mental health, acute and community and the future possibility of all manner of permutations is a real challenge to branding. We fastidiously apply the NHS Identity rulebook to pantone colours, NHS logo, name and all manner of logos.

 It is becoming increasingly difficult to develop meaningful brand architecture for these NHS organisations. We need to adopt a new approach to NHS branding that reflects the changes that have been developing and I believe that it is time to consider the adoption of a silent parent brand approach for NHS trust names where appropriate.

 What is a silent parent brand?

Except to certain stakeholder groups to whom it is of relevance or for those who wish to know, the company or owning organisation name is almost invisible to key stakeholders such as patients and the public in general. A commercial example of this is Procter & Gamble who own the brands Head & Shoulders, Pampers, Oil of Olay and Pringles.

I am not suggesting that our service providers drop the NHS logo, which clearly identifies them as adhering to the values of the NHS. I am however proposing that we enable the service providers to hide the trust name when this is appropriate in the brand hierarchy, or architecture of the organisation.

 What is the current NHS brand?

The NHS brand is made up of two key components that mutually make up the brand architecture of the NHS. Of course there is the NHS logo. This logo is used alongside the organisations name to identify it, such as the trust name. In the brand architecture of the NHS Identity this is written in tablets of stone, i.e. this part of the brand is required in the format stated in the style guide.

The second component of the NHS brand occurs when the national NHS identity is applied to an NHS service provider or other organisation. The NHS brand taps into the values that have been built up over time and by the experience of stakeholders that have and are interacting with that organisation.

In the case of a hospital trust this can be derived from the personal experience of family, friends and the historical interaction of a community or patients group. Often this is the historical name of the service provider or hospital.

What’s wrong with the current system?

Community and mental health trusts are already taking over services provided by other providers in adjacent areas, an increasingly common and entirely sensible way forward. Currently mental health trust brands are obliged to choose a geographical location to be part of its NHS brand. This means that a mental health trust in Sussex that wishes to provide services to patients in Essex is likely to be branded as a Sussex service provider, which is contrary to common sense branding and confusing for patients, carers and families.

Equally some acute providers are part of a larger trust “family” sometimes consisting of up to six separate providers. This can sometimes lead to problems when developing brand architecture that is meaningful to patients and the public. The trust has to retain its trust branding while reassuring stakeholders that their service provider and hospital of choice has not been affected. There are many examples where, despite a trust changing its name, its key stakeholders continue to call the service or hospital the same name, or brand they have become familiar with over time.

Increasingly the NHS is using private sector providers and community health providers are engaging with charitable bodies and social enterprise. These are not trusts and most likely never will be but they and their NHS services do need to be clearly identified as being provided by the NHS where this is relevant to patients and public.

Developing brand architecture that is meaningful to stakeholders can be challenging and complex. There may be many visual elements to consider such as service providers within the trust group, logo’s, phrases or straplines, colours etc. Most of the complexity derives from the need to apply the trust name to all communications and visual elements of all of its sub-brands.

The NHS identity guidelines (2011) clearly state how the trust or foundation trust part of the brand should be developed. All NHS trusts are obliged to: “contain a geographical reference where possible” in their brand name. It goes on to say: “This is to enable patients and the public to identify our organisations and understand their roles”.

Clearly this part of the guide does work for some NHS organisations whose trust name identifies them as being part of a geographic location, but for others where it doesn’t, I’m not so sure. Even for those whose geographic location is identified, what happens when they take over the running of another hospital or service in an neighboring geographic location.

Christine Watts, chief marketing officer at University Hospitals Coventry and Warwickshire Trust notes how existing guidelines do not always serve to make access to NHS services easy and obvious for our patients. 

She states: “During last winters swine flu, patients were being asked to collect medication from Coventry and Warwick Hospital … a site in the city centre of Coventry but many patients were confusing the name with our trust and arriving on our hospital site, having spent time and money to get to the out of town hospital  . . the place all the communications campaigns were encouraging suspected swine flu patients not to come to  unless needing urgent care!  The confusion is then compounded locally with PCT names, NHS Coventry and NHS Warwickshire and the local Coventry and Warwickshire Partnership Trust. It’s all our NHS but how can anyone decipher who is doing what and for whom!”

Some trusts have very strong brands such as GOS, Royal Marsden and Stoke Mandeville. These brands have been developed over significant time, and because they mostly offer unique specialty services they are some of the exceptions to the rule. If one of these big brands were part of another group hospital trust it would be commercial suicide to apply any other brand to its service provision.

The NHS Identity guide also states: “When choosing a trust name an organisation should: ‘also consider what will make most sense to service users’”.

Not so long ago we also had primary care trusts across the country, which firstly split into provider and commissioner organisations. Then it was decided it would be more relevant for their stakeholders if they simply call themselves ‘location’ NHS. Now many have become few and we now have clinical commissioning groups. Will these organisations be forced to brand themselves trusts, or will some other equally meaningless phraseology be enforced on them? 

What do patients and the public think about trust and foundation trusts?

It is common knowledge that most of our stakeholders, especially patients and the public don’t really care about the name of the trust or whether it is a FT or not. Neither are they likely to know what a PCT or a CCG actually does, let alone what it is called.

All patients really care about is whether the service is being provided by the NHS, and the brand values they associate with this institution. The name of the trust is far less important than the fact that the service is being provided by the same people or service in their local area. They know what to call their local hospitals (the brand they recognise) and will continue to do so whatever the organisations call themselves or whoever ‘owns’ each provider and its services.

Helen Stevens, associate director of communications and marketing at Barnsley Hospital, agrees: “When Barnsley became an FT, we changed our logo and started to refer to ourselves as an FT. But the reality is that Barnsley people call us either ‘the hospital’, ‘the district general’ or ‘Barnsley hospital’. They simply don’t recognise ‘foundation trust’, no matter how we market ourselves.”

How will silent parent branding work?

When an NHS organisation plans its marketing communications mix for key stakeholder groups it will be able to decide whether the inclusion of the trust name is meaningful and appropriate. For instance when communications are targeted at patients and public the name of the provider, such as the hospital or local facility can be included along with the NHS logo to identify it as an NHS provided service. When the same organisation is communicating with PCTs, CCGs and SHAs they can incorporate their trust brand name in the same way as the NHS Identity guide currently states.

Christine Watts believes this approach would give communications and marketing professionals the flexibility they need in their segmented marketing approaches. “How we market ourselves with our patients, staff and commissioners in Coventry and in Rugby should be different. Both towns have separate identities and we should be reflecting this with bespoke marketing efforts.”

By adopting this form of brand architecture, service providers will be free to identify themselves using a brand that is already familiar to the public and patients as a whole, such as the hospital name. Even if the service provider is relatively new, patients and key stakeholder groups can be involved in deciding an appropriate name for the organisation or service provider.

What would be the benefit of such a structure to patients?

It could be argued that patients will find it easier to relate to their service providers who will be able to adopt and use names for their “sub-brands” that have meaning, whether historical or simply most commonly used by patients and the public. An acute trust such as Cambridge University Hospitals NHS FT can target the commonly used brand name “Addenbrookes Hospital” where appropriate and its other hospital brand “the Rosie Hospital” to its target population and patients.

A PCT or mental health trust will be able to provide services to areas outside its geographically identified trust name without confusing patients and the public using a parent silent brand approach where it deems the architecture appropriate to patients and the public.

By using the hospital or service provider brand, internal staff communications may seem less “corporate”. When staff communicate with patients and their families, the hospital or service they work in will seem to be the focus rather than the “trust”.

The interaction between an organisation and its customers/users and the experience thereof make a brand, not a name applied to it.

Would this lead to a proliferation of new and unregulated brands that bare no relation to the NHS Identity and values?

On the contrary, there should be less confusion as all NHS services will still be identifiable as such. The NHS Identity guide will still apply to all NHS organisations. Stakeholders such as patients and the public will most likely be able to identify their service provider more easily and be less exposed to which trust organisation is running the service, unless of course they wish to find out or be more involved.

Will the NHS identity guide have to be re-written?

There is no reason that the NHS Identity guide will have to change radically. There will have to be a small section on how to chose where the silent parent brand approach should be used, but other than that there is no reason for the identity guide to change. Patients and the public will not really notice any change.

Remember, the NHS Identity 2011 says: “When choosing a trust name an organisation should: “consider what will make most sense to service users”.

Perhaps then it is time to consider a silent parent brand revolution for the NHS trust and foundation trust elements of our NHS brand names if we are genuinely to consider what makes most sense to our service users.