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Thursday 20th October 2016

Trust Advertising Regulations

31st March 2007

The 12 week consultation on the Department of Health’s proposed Code of Practice for Promoting NHS services has just closed.  What is it proposing, and what has been the initial reaction to the Code?


Why the need for a Code of Practice now?

Patient Choice, Payment by Results and more independent sector providers being encouraged into the healthcare market have all meant one thing for NHS Trusts – greater competition for referrals.  A natural consequence of competition is the need to market and promote your organisation above the others in order to protect or enlarge market share, income streams and services.  The Department of Health has acted sooner rather than later to put some boundaries around such activities before some embarrassing examples become public, or awkward precedents are set.

What guidelines does the Code propose?

What the Department of Health wants to guard against are the expensive and aggressive styles of advertising campaigns seen in the US.  The Code that it has produced is concerned first and foremost with:

  • Protecting the NHS brand and reputation.
  • Limiting expenditure on marketing to within a reasonable limit – it suggests that advertising on TV and in the cinema is unlikely to be justifiable.
  • Ensuring information used in marketing material is accurate, fair and inoffensive.

The Code would sit under standards already set out by the Advertising Standards Authority and UK law, but in addition would rule out:

  • Anything that encourages patients to have unnecessary treatments.
  • Marketing activities targeted at under 16s.
  • Gifts, benefits in kind or other inducements.  Reasonable hospitality is still allowed within the context of professional or scientific events which are put on in a way that is suitable to their purpose.

The Code does allow:

  • Trusts to compare their performance to others, as long as the information used is accurate and fair.
  • Celebrities to be used in advertising campaigns, as long as they have been patients of the trust, have not been paid for the campaign, and are not perceived by the public as medical experts.
  • Testimonies from other patients as long as they are real, up to date, and the patients have given their express consent.

The Code will apply to Foundation Trusts and independent sector providers as well as to NHS Trusts.  One question the consultation document asks is whether it should in fact extend further to cover, for example, GPs and dentists.

How would the Code be enforced?

The consultation document proposes that the Code should be self-enforcing by the NHS bodies engaged in promotional activities.  Every Trust should appoint a member of staff who is responsible for checking compliance with the Code.  Every Trust would sign up to the Code via its contracts with its commissioners.  A national secretariat would handle enquiries about the way trusts have marketed themselves, and give initial rulings on complaints received about promotional material.  The consultation document suggests that the role of the secretariat could be expanded to take on active scrutiny of promotional activities, as well as responding to specific complaints.  An expert panel would also be set up to take referrals from the secretariat regarding complaints which have been investigated.

The whole system should be self-financing from membership charges to participate under the Code, and from charges levied against Trusts where a complaint has been upheld.

What marketing activities do Trusts indicate they will be pursuing now?

Most trusts who were interviewed by the media when the Code was released for consultation said that they did not expect to be spending significantly greater sums of money on marketing in the coming years as a result of increased competition.  Trusts have three key audiences in trying to attract new referrals – patients, GPs and commissioners.  What most recognise is that GPs are the most influential customer in generating referrals, so marketing activities are likely to be targeted at them.  But this is not all about smart adverts or glossy brochures.  So far only one provider – Capio, the independent treatment centre operator – has advertised directly to GPs and commissioners by placing adverts in publications such as the Health Service Journal.  For many years Trusts have provided information of varying quality to GPs about their services and access times.  What Trusts intend to do first and foremost is to get much sharper about the quality and impact of such information, as well as fostering generally more positive relationships with GPs.
When it comes to marketing directly to patients, providing good quality information about services on the web will be key.  It remains unclear what impact direct advertising campaigns are likely to have (eg mail shots and newspaper adverts).  If such campaigns have any impact, it is likely that it would be greatest in cities where there is true competition between a number of local providers, rather than in rural areas where there is really only choice of one local provider.

What Choice and PbR does mean is that Trusts are going to have to think more commercially about which of their services to actively promote because they are profitable under PbR, or to bolster existing market share to sustain services in jeopardy.  Trusts are increasingly turning to referral and demand mapping software to understand their local market and customer base.

What have been the initial reactions to the Code?

Predictably, much concern has been expressed by patients’ and doctors’ organisations over NHS resources being spent on marketing at all, when that money could be spent directly on patient care, particularly in light of current financial deficits.  They argue that the whole idea of NHS organisations competing for business, and claiming they are better than each other, undermines the whole concept of the National Health Service.  And they are concerned that NHS providers will never be able to compete with the marketing might of independent sector providers.

But if the government is serious about increasing choice and competition as a lever to improving quality and efficiency, then the health service is going to have to become comfortable with a level of commercial overhead, such as marketing costs, as part and parcel of behaving more like a business.  We will have to wait and see what the outcome of the consultation will is.

For more information on the proposed Code of Practice for Promoting NHS services, go to:



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