More than “make the right choice”: planning winter pressures campaigns that work

If pressures on NHS services could truly be alleviated by posters in waiting rooms urging people to “choose the right care” or “think first before you go to A&E”, winter would be a walk in the park for NHS communications professionals. 

But the reality is that winter communications campaigns are a really tricky thing to get right. 

And to be clear, when we say “right”, we aren’t talking about the graphics looking slick and sign-off coming through from the Executive team on time. 

We’re talking about having a tangible impact on operational pressures. Reducing the 20% or so of A&E visits which are clinically unnecessary. Trying to reverse last year’s trend of falling flu vaccine uptake rates in older adults and frontline healthcare workers.  

Despite all the work that goes into them, sadly there isn’t a lot of evidence that many winter communications campaigns have the impact intended. Where thorough evaluations have taken place, most of the results are disappointing. Take NHS Wales’ multi-year Choose Well campaign; an evaluation by Audit Wales suggested the true impact of the activity on reducing urgent care demand was “minimal”.  

At Blue Lozenge, our perspective is that while the objectives of winter campaigns tend to be easily understood, the underlying behaviours they seek to change are often fiendishly complex. Understanding of these behaviours is fundamental to influencing them, yet the briefs communicators are asked to work from are almost always light on detailed insight – putting communications professionals on the back foot right from the outset. 

For example, an often-targeted group for urgent care “demand management” campaigns is parents of younger children; up to 90% of A&E attendances related to this population result in no further treatment. 

But helping this group to make more appropriate care choices is likely to take much more than simple signposting. An excellent “realist synthesis” of evidence about the root causes of over-usage of urgent care by younger parents identifies at least six distinct (but interrelated) mental mechanisms at play. These range from system-induced frustrations about the lack of appointments in primary care, through to cognitive biases related to risk perception which are heightened in parents. 

Every NHS communicator will have their own hard-learned experiences of what works and what doesn’t work with regards to winter campaigning. At Blue Lozenge, we’ve found three key ingredients for planning effective behaviour change activities which might be worth considering as we head into winter: 

1. Co-design your campaign with patients, communities and staff 

One of the biggest success stories of the pandemic for NHS communicators was harnessing the power of people, communities and frontline staff to change behaviours. From engaging with religious leaders to drive vaccine uptake rates in local communities, through to the power of staff stories to encourage people to #StayAtHome, Covid-19 emphasised that communications really is a collective activity. 

We believe that bringing patients and carers together with communicators and frontline staff to develop creative campaigns is an approach that is perfectly suited to the multifaceted problems we face over winter. Meaningful engagement and involvement activities offer the chance to build an understanding of target audiences impossible through secondary research alone. Going further, co-design and co-production have the potential to deliver new types of public health intervention, blurring the lines between communications, engagement and community-led health and care. 

Some striking examples of this type of this type of work include recent piloting of blood pressure testing in barbershops and HEAL-D, a south London diabetes programme co-designed with the African and Caribbean communities. 

Understanding that often the barriers to effectively involving people and communities in planning and delivering campaigns are practical – especially during the frantic winter period – we have designed our own framework for bringing people together to power change. This framework, which we call BlueShift, is intended to easily flex and scale to different behaviour change briefs, as well as bearing in mind NHS England best practice on involvement. 

2. Find the opportunities to nudge rather than shove 

“Nudge theory” has rather fallen out of favour in public sector communications in recent years, but there is still plenty of inspiration that NHS communicators can take from its principles. 

We know that trying to get the public to do a 180 on deep-seated health behaviours is a big ask. So why not take a more nuanced approach and bring the levers of psychological science into play. 

For example, we’ve seen that the timing of interventions can be crucial in making them a success. 

Working with a large ICS, for the past two winters we’ve run campaigns encouraging people to use 111 Online instead of heading straight to urgent care. So far, so familiar? 

Our point of difference has been the timing of when people see our messaging. Using Google search marketing, we redirect users towards the 111 triage service at the very moment they are searching for urgent care services near them. 

The results have been remarkable; tens of thousands of users have chosen to click onto the 111 Online service from our ads. Using local system data, we estimate that each redirection away from A&E towards community or self-care has cost less than £1.  

3. Operationalise and optimise 

Communicators and data analysts have different superpowers; we’ve found that bringing them together to tackle winter is a bit like being able to assemble your own team of Avengers (or X-Men, if that’s the comic-book-verse you prefer). 

Being able to analyse and interpret the NHS’s vast datasets unlocks a new perspective on behavioural and tactical insights. Whether it’s cross-referencing Census information against your targeting to make sure you’re reaching underserved populations, or digging into Hospital Episode Statistics (HES) data to figure out which conditions local people are actually presenting at A&E inappropriately with, data helps you make better decisions. 

And during the campaign, a close working relationship between operations and communications teams gives you the best chance of reacting effectively to the curve balls which winter tends to throw at us all. 

Digital advertising gives us the option of responding in near real-time to emerging operational pressures; in recent years we’ve worked closely with NHS teams to pivot activity to focus on particular hospital catchment areas as they experience capacity challenges. And likewise, the data we get about how audiences are responding to campaign messaging can be fed back to hospital or ICS teams to inform planning and operational decisions on the fly. 

Whatever your brief this winter, we’re here to help. We’ll be running a “Chatham House rules” workshop with NHS communicators from across the country to discuss best practice on winter campaigns. If you’d like to attend, or if you want to find out more about any of the case studies mentioned in this article, please get in touch.