Published: 24/02/2005, Volume II5, No. 5944 Page 3

It is not hard to imagine. A London bus carrying an advertisement featuring a smiling woman: 'I got a new hip at the Hammersmith.' In the opposite direction, another bus, another advert: 'No MRSA at St Mary's.' Not difficult either to envisage the tussle for celebrity endorsement, the elevation of high-performing consultants to marketable stars or the exploitation of one of the UK's most powerful brands:

'Stay loyal to the NHS at the Norfolk and Norwich.' The introduction of choice could persuade NHS trusts to become aggressive advertisers of services. Under payment by results, patients mean prosperity. But in marketing terms choice should have a much more significant impact.

What underpins the best marketing is a deep understanding of what consumers want and how they behave. The NHS has a patchy record on exploring how patients wish to access healthcare, what information they need and how they interact with organisations and staff. But as we report this week, the attitude of staff and the paucity of helpful information are among the biggest causes of patient complaint (see news, page 7).

Now the Department of Health is to launch a 'marketing intelligence unit' which it claims will help trusts to 'understand patients better' by exploiting electronically gathered information in a way beloved of modern supermarkets (see news, page 5).

Marketing is seen as a black art because it sometimes involves understanding subliminal motivation and persuading people to do things for reasons they are not aware of. Without outside intervention, patients make similar decisions all the time, often with damaging consequences for health outcomes and patient experience.

Understanding why patients act they way they do - both consciously and unconsciously - will make the NHS better able to deliver the information patients need, as well as making healthcare more responsive and effective.

Trusts should also seek to get inside the heads of GPs. They are going to be the greatest influence on choices made by patients.

There remains the question of how the use of marketing intelligence by the NHS will be policed. Experience elsewhere in the world shows healthcare information is ripe for manipulation. NHS staff will resist that, but choice and payment by results are a powerful combination and could encourage some unwelcome behaviour. No surprise then, that the DoH is seeking advice from the Advertising Standards Authority?