Is it a name? Is it a brand? NO… It’s a SUPERBRAND!

A trial ad campaign linking the Primary Brand Assets of all the alternative immediate care services alongside A&E symbol achieved a 6.3% reduction in A&E visits.

A trial ad campaign linking the Primary Brand Assets of all the alternative immediate care services alongside A&E symbol achieved a 6.3% reduction in A&E visits.

Some say that A&E’s powers are failing. If that’s so, then its kryptonite is its own success.

When Fran and I were just starting this consultancy I was invited by Ian Mills of Hull University Business School to meet up with a CCG in east London. For those of you not familiar with NHS terminology a CCG is a Care Commissioning Group. They are the clinically led statutory NHS bodies responsible for the planning and commissioning of health care services for local areas. In other words, they handle the dosh. There are now 195 CCGs in England. In 2018/19 they will manage £75.6 billion of expenditure, roughly two thirds of England’s NHS budget. I’m not sure exactly what happens to the other £25 or so billion!

A&E is a part of the NHS, an organisation that employs 1.6 million people, dealing with 1 million patients a day and looking after 64 million people in the UK. In 2014, the Commonwealth Fund named the NHS as the world’s best healthcare system in terms of efficiency, effective care, safe care, co-ordinated care, and patient-centred care. Despite this excellent endorsement of our NHS, A&E departments in England have been heavily criticised, especially in the winter season, for not being able to cope with patient demand.

A&E has a bit of a problem. Research by A&E consultants estimates that up to 40% of A&E patients are classified as ‘inappropriate’. In other words, some patients do not need to be there at all. There are many reasons for this but it doesn’t mean they do not need treatment. It means they could have used a more appropriate, alternative service for the treatment of their symptoms.

So clearly, if we could understand what motivates ‘inappropriate patients’ to attend A&E we could save the NHS an awful lot of dosh and reduce the pressure on its A&E departments. They need to find ways of altering patient behaviour. To use a current fashionable marketing phrase they need to ‘give them a nudge’ towards more appropriate services.

Patients in the UK don’t think of A&E as a brand. Perhaps because, unlike a Cadburys chocolate bar, a bag of Walkers crisps or a tin of Heinz baked beans it is not seen as something you have to buy. If you don’t buy it, it’s not a brand!


But of course, in reality, it is a brand. A&E operates in the same way as Cadburys, Walkers or Heinz. Given the right circumstances, a brand will pop up in the brain to satisfy a need; when I am hungry McDonalds, Burger King or KFC may pop to mind, when I am thirsty I may think Coke, Pepsi or Fanta and when I have hurt myself (and a plaster won’t do) I think of A&E.

These brands, including the A&E brand, are embedded in our brains as solutions to our needs. Something that is often overlooked is the role brand design plays – what we at Walton Barker would call their Primary Brand Assets; these are the key to the embedding process. They are the visual hook that makes the brand a reality and, through exposure, creates the means by which they continue to reinforce the embedding process.

 A&E is an incredibly powerful Primary Brand Asset. It pops up automatically when we have a health problem that needs more than a plaster to remedy it. This is a subconscious system 1* behavioural script response. These are habitual behaviours that we use all the time because they help us to act without thinking. That’s why we can drive a car for ten miles and have no recall whatsoever of the journey. We can drive without conscious thought using subconscious system 1 behavioural scripts. They are acquired through habit, practice or innate knowledge. They are useful because they help us to save the time and mental effort required when deciding on an appropriate behaviour each time a problem or a need occurs.

Brands like Coca Cola, McDonalds and Cadbury have been very good at embedding themselves in our subconscious so that we think of them when we have a need relevant to their offering. But A&E, without trying, has been super efficient at doing this too. If a behavioural script is a definition of a successful brand, then A&E is certainly a superbrand.

 So here’s A&E’s problem, its kryptonite is its own success: There’s too much demand for it to work properly. P. J. O'Rourke’s satirical observation of the cost of American healthcare system rings true: 

 “If you think health care is expensive now, just wait 'til it's free”.

Working with Ian Mills and the University of Hull Business School, we realised there was a need to rewrite the System 1 script behaviour embedded in the brains of patients. Could it be done? 

‘Give them a nudge’

There are alternatives when seeking immediate medical treatment - for instance the 111 branded phone call service, as well as a range of out-of-hours services such as NHS walk-in centres and minor injuries units. 

A trial campaign in Bolton in 2014, researched conducted by Ian Mills, showed it was possible to nudge A&E patients into different behaviours by providing them with a credible, easy choices.

A simple ‘Let’s keep A&E for those who really need it’ campaign appeared in the locality on taxis, buses, telephone boxes, billboards, the local newspaper & council magazine and was supported by radio advertising for 60 days at launch and again before times of predicted high demand e.g. Christmas and Easter holidays.

The designed featured the Primary Brand Assets of all the alternative immediate care services alongside the A&E symbol. The implicit message was that there was now a credible choice to a 4 hour wait in A&E.

The design used the Primary Brand Assets of all the alternative immediate care services alongside the A&E symbol.

The design used the Primary Brand Assets of all the alternative immediate care services alongside the A&E symbol.

The results were impressive:

3,741 fewer minor A&E attendances compared to 2012, giving a 6.3% reduction in A&E admissions. This resulted in Bolton meeting the national A&E 4 hour performance target 95% of the time. It was the only CCG in the Greater Manchester area and one of only 6 CCGs in England to do so.

Rewriting the script

Like all campaigns you would need to repeat this periodically to refresh the message. But System 1 script behaviours are notoriously difficult to change. In the case of A&E, the public have had 70 years of exposure to the brand. Nudging is much easier if you have the right visual assets to work with. In our view, there was a large disconnect between A&E assets and those of the alternative services in the minds of most patients. As a group of assets they simply don’t hang together very well. This makes the embedding and the nudging process harder. Ian summed the solution very well when he recommended:

“Most users of A&E choose it because of the security coming from the brand name and its promise… one can provide alternative services BUT these MUST be part of the A&E brand service and NOT alternatives. If however you publicise them as ‘Alternatives’ to A&E they simply create confusion.” Ian Mills, University of Hull Business School

Nurofen uses its Primary Brand Asset – the target – to extend its franchise from tablets into different areas of pain relief to meet differing needs. The visual language of designs make the products hang together as a range with a simple, powerful, implicit message - ‘targets pain fast’. There’s no reason why A&E could not do the same. It would convey greater credibility for the other NHS services such as Minor Injuries Units and I guess the pharmacy trade would love the idea of extra custom.

Products for many types of pain linked together by the powerful & trusted Nurofen branding.

Products for many types of pain linked together by the powerful & trusted Nurofen branding.

In the NHS it is difficult to spread the word. CCGs aren’t marketers, they really don’t understand communication and they are committed to following NHS Identity Guidelines. The NHS needs more innovative marketing and needs to operate their brand with same expertise as Coca Cola, McDonalds or as any other superbrand does. This doesn’t necessarily mean spending more, it means using their assets more intelligently. 

Rob Barker, Partner

Rob Barker, Partner

Starting as a designer, Rob became curious about why certain designs worked better than others in the real world. It was from here, in conjunction with academia, that Rob started to develop early versions of our research methodology in 2004. Now Genesis Brand Language Decoder™ is a means to unlocking brand language opportunities for brands to exploit for commercial gain. Rob has used insight from our research approaches to drive strategic design for many successful global brands.