NHS Services Information Campaign

NHS Services Information Campaign

Summary of evidence

July 2015

Introduction

A new integrated campaign is being developed for 2015, which aims to make patients and the public who are at risk of preventable winter admission aware of, and motivated to take, those actions that could prevent that admission.

If successful, the campaign will reduce pressures on NHS services, particularly urgent and emergency care, in the winter months, prevent illness and improve patient experience.

This document briefly summarises the evidence in support of the campaign approach, and signposts readers to published sources for more detail.

This evidence is focused around four themes:

·  The focus on acuity.

·  The choice of target audiences.

·  The key messages.

·  Investment level and channel strategy.

Focus on acuity

While the media often focus on the rise in attendances at A&E, all available evidence suggests that this is not the driver of hospital congestive failure or of hospitals missing the 4 hour standard.

This was highlighted by a report from Quality Watch (in partnership with the Nuffield Trust and the Health Foundation) published in July 2014[i], which concluded that:

·  “Despite large increases in the number of people using A&E services overall, attendances at major A&E units (where waits are a significant issue) have only increased in line with what would be expected from population growth – there has not been a great surge in attendances.

·  “High occupancy levels (in excess of what a department would expect for a given time of week) are associated with longer average waiting times, and an increased likelihood of breaching the four-hour target. However, high occupancy (often termed ‘crowding’) does not always explain breaches – around one quarter of breaches occurs when the department is less crowded than would be expected.

·  “We also found evidence that a lack of availability of inpatient beds increased waiting times for all patients in the A&E department.”

The report recommended that the NHS “renew efforts to reduce demand for urgent care and/or divert it away from A&E.”

The Quality Watch findings were echoed by recent econometric modelling by Monitor, which concluded that increases in admissions (particularly people arriving at the hospital by ambulance), combined with high occupancy in the rest of the hospital, not an increase in attendances, was driving poor performance against the 4 hour standard.

This does not mean that in some areas there may be a local issue with attendances (or attendances by discrete patient groups), only that it is not an appropriate focus for national activity. Moreover inappropriate attendance, while it does not appear to be driving breaches of the 4 hour standard, can lead to poor patient experience, if an individual might have been treated more quickly and conveniently closer to home. Marketing resources to “nudge” inappropriate attenders away from A&E will be included in the toolkit for local areas.

Choice of target audiences

While younger adults attend A&E, it is the very young and very old who are most likely to be admitted.

Analysis of data from Hospital Episode Statistics, published by HSCIC[ii], highlighted that:

·  The growth in A&E usage is being driven by older people.

·  Nearly half (46.9%) of all over 64s who arrive at A&E are admitted. This compares with 13.6% of under 10s and 14.9% of people aged between 10 and 64.

·  There is a social gradient in A&E usage – the most deprived 10% of the population are twice as likely to use A&E as the least deprived.

·  Users of mental health services are more than twice as likely to use A&E, and to attend more frequently.

In addition, the Quality Watch report[iii] highlighted that people with long-term conditions are more frequent users of A&E, with the prevalence of long-term conditions increasing with age.

This was confirmed by the Cold Weather Plan for England 2014[iv] which highlighted that frail older people, the under- fives and people with existing chronic conditions are most vulnerable in winter.

Data compiled by the Urgent and Emergency Care Review team highlighted that respiratory illnesses cause a particular spike during the winter months:

Respiratory illnesses include colds, upper respiratory tract infections, lung disease (bronchitis and emphysema) and pneumonia.

Analysis by British Lung Foundation[v] highlighted that lung disease is highly concentrated in particular “COPD hotspots”, and individuals at risk of admission can be identified at postcode level:

Key messages

The messages recommended in the campaign focus on those actions that are most likely to prevent an emergency admission, for example:

·  Taking up the offer of flu vaccination.

·  Self-care (for example using over-the-counter medicines) and pharmacy as a first point of call.

·  For people who have long-term conditions, seeking prompt medical attention, so that minor illnesses do not escalate to the point where hospitalisation is necessary.

·  Keeping homes warm in cold weather.

·  Avoiding falls (for example by stocking up on food and medicines so that it is not necessary to go outside in icy conditions).

·  Avoiding A&E except for emergencies (calling NHS 111 if in doubt).

The evidence in support of these actions includes:

·  Every year tens of thousands of people are hospitalised with flu and hundreds of thousands see their GP[vi].

·  The Urgent and Emergency Care Review[vii] recommended providing better support for people to self-care, including improving the quality and accessibility of information so that people can avoid the need to see a healthcare professional. Further it recommended helping people with urgent care needs to get the right advice in the right place, first time, via the NHS 111 service.

·  The Cold Weather Plan for England[viii] highlighted the importance of keeping homes at a minimum of 18˚C to prevent winter admissions (and deaths) and of preventing injury through slips and falls.

·  Research published by the Keep Warm In Later Life initiative[ix] highlighted that there are many incorrect beliefs among older people in particular about how to keep healthy in cold weather (for example that it is better to keep central heating off and windows open or that colds and flu should not be treated).

Moreover, independent evaluation of the last two winter campaigns by Ipsos MORI (see Appendix One), highlighted that it is possible to change behaviour – last year the campaign generated an estimated 1.8 million additional pharmacy visits from people at the early stages of common winter illnesses.

Channel Selection

In developing the marketing campaign, we commissioned MEC, a specialist media planning agency, to make recommendations on the optimum media budget and most efficient and effective channels for reaching the target audiences.

MEC recommended a media budget of £8.5 million (£10.6 million total spend, when production, agency fees, evaluation etc. are included).

This budget will achieve the following reach and frequency:

·  NHS111: 97% of the defined target audience will be reached at least once, with 80% reached at least three times.

·  Flu: 84% of the target audience will be reached on average six times.

·  Winter pressures: 99% of the target audience will be reached at least once, with 93% reached five times or more.

MEC took into account the performance of different channels in previous evaluations, as well as the demographic profiles of those channels, to recommend the following media selections:

·  NHS 111: TV, radio, press, digital, biddable.

·  Flu: Digital (including VOD), radio, press, biddable.

·  Winter Pressures: TV, door drops, out of home (pharmacy bags and six sheets), radio, press, digital, biddable.

We will also be producing a core piece of collateral (an 8 page leaflet) which, in addition to being door-dropped to 11.5 million targeted home, will be made available to partners (commercial and third sector) for distribution.

Data provided by local areas, notably Arden and GEM (See Appendix 2), indicate that local activity, particularly face-to-face and healthcare professional-led engagement, aligned with and using the national activity as air cover, has the potential to engage local people in their own care.

Conclusions

In short, the available data indicate that the most efficient and effective use of national resources is:

·  A campaign to reduce admissions.

·  Via behaviour change among older people, parents of under-fives and people with long-term conditions.

·  The desired behaviour changes are: flu vaccination, self-care, prompt seeking of medical help at the first sign of illness via pharmacies, warm homes and falls prevention (with NHS 111 as a go-to point in the event people are unsure whether or not to use urgent and emergency care).

·  National resources should focus on television, radio, press, out of home, door drops and digital channels.

·  Local areas should focus their resources on face-to-face and HCP-led patient interactions.

Appendix One

Appendix Two

Footnote references

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[i] www.nuffieldtrust.org.uk/sites/files/nuffield/publication/140724_focus_on_ae_attendances.pdf

[ii] www.hscic.gov.uk/catalogue/PUB13040/acci-emer-focu-on-2013-rep-V2.pdf

[iii] ibid

[iv]www.gov.uk/government/uploads/system/uploads/attachment_data/file/365269/CWP_Making_the_Case_2014_FINAL.pdf

[v] www.blf.org.uk/Page/Special-Reports

[vi] www.gov.uk/government/news/public-health-england-and-the-nhs-prepare-for-unpredictable-flu-season

[vii] www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1Report.FV.pdf

[viii] ibid

[ix] Keeping Warm in Later Life http://kwillt.org/index.php/pen-portraits