Few in the public sector are more keenly aware of the burden of cost savings than the NHS.
It is a burden that will increase in years to come, and we are all expected to do more with less, eliminating waste and ensuring that services maximise value.
But to do this effectively, we must have a proper understanding of the very different types of people who access health services. Let’s face it, with over 65 million people using the NHS at some point in their lives, a “one-size-fits-all” approach seems a ludicrous way to plan and deliver services.
People have very different needs and wants. This is something the private sector knows well, and it develops a set of services and products that are tailored to the needs of various segments of the population. You only have to walk into any major supermarket and see the huge array of products and lately, services, to know how important really understanding your customer is.
In the health sector, we have tended to treat patients as homogeneous groups, defining people by their condition or illness and not by their needs and the services they require. If everyone was the same, and conditions could be treated with uniform methods and one-size-fits-all services, our jobs would be much easier. But anyone who has worked in public health or service design knows that this is far from the case.
Far too often, I have been involved in developing health services, where a group of us “experts” decided the best proposition, consulting a token group of perhaps four of five patients. If we were lucky, we would end up with a broadly appropriate service. Often, we were not; in most cases, our offering fell wide of the mark. Failing to properly involve the people we were trying to help resulted in ill-fitting services that were out of touch with the intended beneficiaries.
In this case, the balance is wrong: services should be weighted towards people, not the provider. They must be delivered at patients’ convenience, not ours. We must understand their needs and wants, and the expert-led approach simply does not allow this.
We are told, for example, that liver disease is rising across the population. But when we look at the information more closely, we find that it is rising in distinct segments of the population. It rises according to age, gender, socio-economic status and location, but more importantly, by attitudes and behaviours.
Accordingly, the one-size-fits-all approach to reducing liver disease is totally inappropriate, because it can never meet the needs of the diverse, distinct groups who are suffering, or will suffer, from the condition.
Again, it is worth drawing an analogy with the commercial sector. In order to be competitive and make the most profit, companies pump vast resources into understanding their customers, ensuring they produce a range of products that meet the needs of society’s many personalities, lifestyles, ambitions and circumstances.
Car companies do not simply produce one model and then attempt to foist it on us all. Instead, the young are offered fun, cheap hatchbacks; families provided spacious, safe estates; there are low-emission cars for the environmentally-conscious and powerful sports models for wealthy boy racers.
Any company that attempted to sell us a product without knowledge of whether it meets our needs would not last long.
If services are tailored according to segments or groups in local populations, based on an understanding of their lives arrived at through participatory research, those services will be more effective. This means that scant financial resources can be allocated where they will have the greatest return in terms of uptake and behaviour change. This in turn pays long-term dividends, if costly treatments for chronic conditions are avoided as a result of better prevention. If services and interventions match needs rather than expectations, costly and ineffective campaigning and commissioning will be a thing of the past.
Social marketing gives commissioners and practitioners a framework by which to go about this. As well as enabling commissioners to pinpoint resources where they are most needed, it allows us to track whether or not our efforts are meeting those needs. This is important, if previously apt services are not to drift. It can allow a level of responsiveness rarely seen in the NHS.
Throwing money at problems has never made them go away. We now live in a world in which this is simply not an option; we must be able to show the benefits of our efforts. To this end, the National Social Marketing Centre is developing an online tool to measure the cost-effectiveness of social marketing and behaviour change programmes. Bringing together existing analysis methods into an agreed standard, it will be launched in March 2011.
John Bromley is director of the National Social Marketing Centre