Consultation on promotion of NHS services

In her foreword to Code of Practice for Promotion of NHS Services, the Secretary of State for Health, the Right Honorable Patricia Hewitt states that: “Patients have a right to determine what type of treatment they receive and people of all ages and backgrounds have told us that they want choice. Choice and information are a normal part of their lives and health services are no different.

“A MORI survey on choice found that 76% of patients and the public think the main priority in healthcare is involving patients in decisions about their illness and treatment. The British Social Attitudes Survey in 2005 also found that 63% of people want to be able to choose the hospital for treatment.”

She goes on to describe some of the effects that patient choice will have on the NHS: “Coupled with access to clinical quality information, [patient choice] will help drive up standards across the NHS.

Providers will want to make more information about their services available to patients and referring clinicians in order to help them make choices and advise patients. Appropriate levels of promotional activity by providers are a way of making this information more easily available.

“Through promotional activity, providers will develop a better understanding of the needs and wants of patients and GPs. This will enable them to respond and reshape services accordingly and deliver services that better meet those needs.”

APPROPRIATE PROMOTIONAL ACTIVITY

To enable patients to make informed decisions about their treatment and where their own particular needs will be best served, hospitals and other service providers will need to make information about their services available in the public domain. However, the document states that safeguards should be in place to ensure that any promotional activity is “appropriate”. The Executive Summary lists three main points that providers should take into account:

• That the information patients receive is not misleading, inaccurate, unfair or offensive.

• That the brand of the NHS is protected.

• That expenditure of public money on promotional activity is not excessive.

Proposals within the document outline the structure and governance of a self-regulatory system that “will be administered through a secretariat and an expert panel which will rule on complaints and apply sanctions”.

They go on to state that “the selfregulatory system will be self-financing through a combination of membership charges and administration fees”.

WHAT ARE THE ADVANTAGES?

The Code of Practice that has been proposed is designed to underpin the self-regulatory system, and have “real benefits for both patients and providers”.

The benefits on offer for patients and referring clinicians are listed as:

• Protection from misleading and inaccurate promotion, giving patients and referring clinicians the confidence to use the information given to them by providers. • A simple, practical complaints procedure, which will put power in the hands of the patient by making it clear what is and what is not acceptable promotional behaviour by providers. For providers the document states that the Code will offer:

• A practical code, which [providers] will own and which will evolve in partnership with the sector.

• Clear, simple and efficient processes which will limit unnecessary bureaucracy and administrative burdens.

• Clarity around what the boundaries for acceptable promotional activity are and guidance to help providers maximise the efficiency of their promotional activity.

• A mechanism to drive innovation and competency, with providers having access to guidance to help them communicate effectively and abide by the Code.

• A collective system which will avoid damage to the reputations of individual providers, with the flexibility to anticipate potential problems before they arise.

• An opportunity to publicly adopt a framework that will allow providers to make patients and referring clinicians aware that their information and promotional activity complies with the high standards set out in the Code.

The release of this document sees the launch of a three-month consultation period in which individual members of staff and service users alike are invited to offer their opinions on the many questions that are posed within it.

STRUCTURE AND GOVERNANCE

The document states that: “Sign-up to the Code will be included in the contract between primary care trusts (PCTs) and providers of NHS services.” It then goes on to explain how the system is expected to operate, as follows: The secretariat and expert panel that are drawn together to administer the selfregulatory scheme “will comprise a small number of people who will handle routine enquiries and give an initial ruling on all complaints. To ensure value for money, the secretariat will be physically sited within another organisation to save on back-office functions. This organisation will not be the Department of Health.

The secretariat will be appointed by a subgroup of providers that have signed up to the Code. The rulings of the secretariat could be referred to an expert panel, by either the complainant or the respondent, or by the secretariat in more complex cases.

“The expert panel will rule on any disputed rulings made by the secretariat. The expert panel will be chaired by an independent chair with a legal background. It will include representatives of patients, providers, commissioners, clinicians and industry and will call on relevant expert witnesses and advisers. It will refer to good practice to determine the quorum, to balance stakeholder involvement and to ensure that panel members declare relevant interests.”

Recognition is also given to the fact that the healthcare system will continue to change and develop in the future. In order to deal with such developments it is stated that “the Code will be kept up to date through a proper stakeholder consultative process managed by the secretariat”.

MONITORING AND ENFORCEMENT

Initially it is anticipated that “the Code will be policed through rulings on complaints.

Complaints will be accepted from members and third parties, such as the public, patients, GPs and PCTs. Where no complaint has been made but concerns arise, for example through the media, these will be taken up, investigated and ruled on, where appropriate.

“Following a complaint, both the complainant and the respondent will have 10 working days to submit a written submission. Rulings will be based on these submissions. As already noted, these rulings could be referred to the expert panel, by the complainant, the respondent or the secretariat. The expert panel will meet as required to hear appeals and will consider the original written submissions. In addition, both the complainant and the respondent could be represented in person. Rules of representation will be decided by the expert panel.

“Each organisation that signs up to the Code of Practice will have to nominate a named individual to deal with complaints to ensure that the process can proceed quickly. It is not envisaged that these complaints will be dealt with through the patient complaints process.

“Where a complaint is made against a member by another member, there will be a requirement for the organisations to discuss the complaint and attempt to resolve it locally before referring it to the secretariat.”

QUESTIONS ASKED

The document states that the Code will be relevant to all promotion of NHS services. It also states that the Code is “not intended to restrict innovation, managing NHS Foundation Trust membership communications or engagement with local communities, but rather to encourage good promotional practice, and to ensure that the values and expected behaviours of the NHS are upheld”.

With this in mind, some of the questions that it poses are:

• Which organisation should the secretariat be sited within?

• Do you have any views on the make up of the Expert Panel?

• Should parties be allowed to be represented by lawyers?

• Do you have any views on suggested sanctions?

• In line with the approach to health reform, should the Code initially apply to secondary care providers, particularly in elective care?

• Should the Code be rolled out to other areas of healthcare provision?

• Should this include GPs, dentists, pharmacists, etc?

• Should the Code apply to all promotional activity by providers that undertake both NHS and non-NHS work?

• Is it possible to distinguish between promotion aimed at NHS and non-NHS patients?

• Should medical experts who are also public figures be permitted to be involved in promotional campaigns?

• Should there be specific exclusions relating to testimonials from children?

• Should there be specific exclusions relating to testimonials from celebrities or others likely through their position or fame to influence consumers?

The proposals set out in the Code of Practice for Promotion of NHS Services were developed by the Department of Health following “preliminary discussions with the NHS Confederation and a number of stakeholders”. It is currently still within its initial three-month consultation period and views from individual members of staff and service users are being encouraged. Anyone who wishes to submit a response to any of the questions posed within the document, or other related matters, should send their comments to: nhs.reform.promotion @dh.gsi.gov.uk by 28 February 2007.