The new voice of social care pass their first test, but will they be able to maintain their poise?

The ongoing procrastination of social care reform must be testing the calm resolve of the interest groups who have demonstrated impressive political restraint and communications discipline to date.

A financial crisis in the care home sector, staff morale reportedly plummeting to an all time low, and no resolution in site, you could understand if social care campaigners took to the streets to show their anger at the pace of reforms.

In contrast however, campaigners have devoted their efforts towards developing a unified voice, and articulating their case clearly and effectively in public, and no doubt privately to Ministers and their advisors.  One thing that is clear, politically, is that social care campaigners seemed to have learnt key lessons from their healthcare cousins during the Health and Social Care Bill.

A combination of the ‘motherhood and apple pie’ nature of the Government’s Health White Paper, and the sheer size and complexity of the Bill that was then presented, meant that healthcare interest groups were on the back foot during the debates.  In fact, it wasn’t until the latter stages of the Bill’s progression through Parliament, fuelled by Liberal Democrat revolt and Baroness William’s entrance in to the debate, that the opposition began to find momentum. By this stage campaigners were forced into attritional dialogue, compounded by the evocative language of Lib Dem and Labour opposition to the Bill, and an uncompromising Richmond House. The result was an increasingly polarised debate, often populated with vitriol, hyperbole and multiple narratives which never really got traction.

Social care interest groups seem determined not to go down the same route. They have clearly worked out the areas they all agree on, the first rule of coalition, and therefore their messages are well developed and they are applying sustained and sensible pressure. 

The seeming de-prioritisation of social care to a ‘draft’ bill in Wednesday’s Queen’s Speech, was clearly a blow – kicking full legislation off the agenda for at least a year. However, campaigners appeared well prepared for the news with a well timed letter to David Cameron urging him to make reform his “personal mission”. Here they demonstrated another lesson learnt from the Health and Social Care scrap, that the Government looked at its most vulnerable when David Cameron had to intervene. Putting the focus on the PM from the beginning is a subtle and shrewd move.

The real tests will come when the details emerge, and there will surely be an unavoidable impasse as the question of funding comes into focus. There is simply not enough money to pay for the increasing social care burden this country faces, no matter how well you integrate care. This is surely the reason behind the procrastination, and a Treasury strategy that rests on simply hoping UK plc finances improves before they have to find a settlement looks increasingly optimistic.

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It’s a jungle out there: Keeping safe on social media

Richard Bacon’s documentary, The Anti-Social Network, was sobering watching on Monday night for anyone who is on Facebook, Twitter, or any other social networking site.  Nowadays, that means the huge majority of the UK population, particularly young people.

The idea that individuals exist who would deliberately stalk people online, including defacing memorial pages for dead children seems incredible. However, this documentary revealed that, for some, this is a popular past time.

What was troubling about the programme was the effective lack of controls over this kind of behaviour. The 2003 Communications Act can result in up to six months in jail for offenders. The problem is that gathering evidence is almost impossible – meaning only two people have ever been convicted.

Social media has been and can be a huge force for good, helping to bring people together, often across thousands of miles. It can provide innovative solutions to everyday issues. Apps, for example, are a source of information, entertainment, fun and a great way of not catching people’s eyes on the tube.  Personally, I have found the Ethical Shopping Guide app, a real source of help and advice when buying anything – from groceries to shoes. It has changed my shopping habits for the better.

Protection is key. Credit: Victor1558

However, the darker side of social media, is that revealed in this documentary, and it’s one we need to protect ourselves from, as well as be protected from.  It makes no sense that it is social media sites themselves who act as the arbiters of what is and is not offensive. Without a clearer legal framework it is simply a matter of their opinion. The government needs to wake up to what’s happening on their watch.

We also need to protect ourselves – by ensuring our privacy settings on sites like Facebook are tight and not entering into emotional exchanges with cyber bullies online.

Above all, we should not let the malicious actions of a few deter us from exploiting the massive potential the internet has to offer. We wouldn’t avoid roads for fear of being run down, so neither should we avoid digital and social media because we might be targeted.  And those who are responsible for these sites, and our own government, need to put much stricter controls in place to ensure that vicious online stalking is stamped out.

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Last Chance Saloon for the Health and Social Care Bill: three sobering reasons why Owen’s motion looks unlikely to succeed.

Opponents of the Health and Social Care Bill are currently drinking in the last-chance saloon, as the Bill staggers to its 3rd Reading in the House of Lords.

It appears that a consensus may be developing amongst the noble Lords that it is probably time to call it a night, having pushed the Bill to the edge of their revisionist powers. As the swashbuckling Peers dust themselves down and filter out of the bar of rebellion, they creep pass ex-Foreign Secretary Lord Owen. Eyes glazed, head lolling, he looks somewhat bewildered standing by himself desperately trying to convince Peers to stay with him and fight to save the NHS for one last hurrah.

This week Lord Owen has tabled a motion which, if accepted, would delay Third Reading until the risk register is finally published. The government are still fighting its release. The theory is that the risk register is so explosive the Bill will surely fail if it is released before Royal Assent.

Here are three reasons why Lord Owen’s motion is unlikely to succeed:

1) Whilst the Lords have becoming bolshier of late, they still don’t take unconventional acts lightly

Since the formation of the Coalition Government the Lords has become a much more tribal place and many of the agreed Conventions have begun to be overlooked. However, in the main, the Lords still take their role as the revising chamber very seriously. Whilst there is precedent for voting to approve motions like these, it will require significant support and strong feeling for their Lordships to take an unconventional stand like this. This could be present a problem for Lord Owen.

2) The Crossbench opposition may be softening

Crossbench Peers have played an important and fiery role in scrutinising and opposing this legislation, but there are signs amongst Peers that they feel that maybe their job is done. Respected former president of the BMA, neurologist, and Crossbench Peer, Lord Walton of Detchant, wrote this week to the Times(£) saying: ‘while I would have preferred it had never been tabled, I believe  that when the Bill completes its stages in the Lords…it will be much more acceptable and manageable.’ The question is whether his view that the ‘end of this marathon is in sight’ is shared amongst colleagues.

3) Relations are strained between Lord Owen and Liberal Democrat Peers

To be successful on unusual motions like these, a Peer will need to need to win friends and influence colleagues, often through demonstrating experience and expertise in the issue. Dr Owen, certainly has credentials for the latter, but can he win the support of Peers?

The House of Lords is a place steeped in political history and houses many rivalries that go back through decades and Governments. Some of the press coverage this week has focused on old battles of the Gang of Four. Many of the Lib Dem Peers in particular feel the scars of the break-up of the SDP and the troubled merger of the Liberal Democrats. Former SDP leader, Lord Owen, refused to recognise the merger and the battle scars run deep.

It is worth noting that on his Second Reading motion which also attempted to delay the Bill’s progression, he received just two Lib Dem rebels. There were some Lib Dem Peers who even voted against the Bill at 2nd Reading, but still weren’t able to vote for his motion. Whilst Lib Dem activists and MPs have shown their rebellious side recently, it is unlikely that his call for Lib Dems Peers to ‘stand by their principles’ will have helped already strained relations…

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‘Alcohol abuse’ – what’s in a name?

There was no need to read between the lines last week to see that the Prime Minister got tough on ‘alcohol abuse’.

Recently, a doctor I was talking to corrected me when I used the term ‘alcohol abuse’, saying that it was not the terminology that they now use – with ‘alcohol misuse’ tending to be preferred. A quick scan of the responses to Cameron’s speech from medical bodies, charities and the drinks industry showed various different terms used from ’alcohol related health harm’ by the Royal College of Physicians, to ‘problem drinking’ by Alcohol Concern and ‘alcohol misuse’ from Drinkaware. Interestingly, in the main, stakeholders have not adopted Cameron’s chosen term: ‘alcohol abuse’.

What is in a name? In truth, with so many possibilities, the terms are often, particularly in the press, used interchangeably.

Perhaps it comes down to context. There are often legitimate reasons, not least stigma, in ensuring that the terminology fits the actual issue. For doctors, terminology and stigma are acutely important as they look to work with individuals to tackle alcohol problems.

In this case, it was clear that Cameron was looking to move the focus on to ‘binge drinkers’ who he believes are ‘abusing’ their responsibility to drink sensibly.

The ‘responsibility’ message in his speech in the North East was clear: “it’s about responsibility and a sense of respect for others… Over the last decade we’ve seen a frightening growth in the number of people – many underage – who think it’s acceptable for people to get drunk in public in ways that wreck lives, spread fear and increase crime.”

What was striking about the speech was the extent to which it followed a Home Office agenda, focusing on policies around police, pubs and regulation. Given the tough message put out by Cameron, his ‘alcohol abuse’ terminology was possibly entirely deliberate.

There is one small problem though. The various statistics mentioned by Cameron and others (cost to the NHS of alcohol misuse of 2.7 billion per year etc.) and the problems described are caused not just by binge drinkers but by a wide range of different types of drinkers, many of whom may be alcohol dependent.

Some people may say that it doesn’t matter what you call it, the important thing is to tackle it. Yes, there is definitely some truth in this and indeed behind the terminology, Cameron outlined some radical measures yesterday, not least hinting at introducing a minimum price for alcohol.

However, alcohol stakeholders pointed out last week that tackling alcohol misuse is going to need an approach which looks at not only the criminal justice and regulatory issues but also focuses on healthcare. As the Public Health Minister, Anne Milton said, there is “no magic bullet” and what the Department of Health will need is a range of approaches, bringing on board the general public, the drinks industry, charities, and importantly the medical professionals, some of whom may take issue with the terminology used last week.

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Competition moves to front and centre of health debates as the Bill limps to its bloody conclusion

Through the mass of hyperbole and hysteria over the Health and Social Care Bill, political stances are finally starting to crystallize from the official opposition, sections of the Lib Dems who have represented the unofficial opposition, and the thoroughly disgruntled members of the Conservative Party (including three Cabinet members).

 Whilst there are significant differences in positions between the opposition parties on the Bill, there is clear unanimity that its political legacy has been startlingly effective at ‘retoxifiying’ the conservative party brand, and we can look forward to being continually reminded over the coming years how the ‘Conservative Party privatised the NHS’.

 Last week, Ed Miliband joined some medical professionals and trade union groups in calling for Cameron to “stop wasting millions and drop his bill” and his Shadow Health Secretary Andy Burnham said that he would his give Cameron the “fight of his life” over the issue.  But, it is hard to know how seriously Labour believe they can take the ‘drop the Bill’ message?

 It makes for good political posturing and does indeed carry some public support, as the list of names on the Government e-petition continues to grow. But, as John Rentoul has argued in the Independent, with Cameron’s support it seems likely that the Bill will limp to the finishing line.

 When Ed Miliband took the unprecedented step of writing to all Peers asking them to support Labour’s position on the Bill he stopped short of asking them to ‘kill’ the legislation. Instead his letter took a more nuanced and measured tone, talking about working together to ‘stop the Bill damaging the NHS’, appealing to their role as the ‘revising’ chamber. Anecdotal evidence suggest that the approach has not emboldened Peers – one told us this week that Miliband “has a nerve” for writing and told of another cross-bench Peer who retorted that it was “Labour who have done the real damage to the NHS”.

 If, as is likely, the Bill will survive the journey through parliament, the real question is what will be the battle lines ahead? Amongst a range of important issues that will be debated in the House of Lords there is one clear battle line being drawn: competition.

 This week, with his back firmly to the wall, Andrew Lansley drafted one of his most readable and brazen defences of ‘competition’ in the NHS and the Bill’s proposals. If some initial Tory Tweets are anything to go by, it is possible that Lansley’s article may go some way to placating the Cabinet Ministers and Tory faithful who don’t dislike the reforms but are exasperated by the way it has been handled. They may even be buoyed with the opportunity to have a debate on traditional Conservative themes in healthcare.

 On Andrew Marr over the weekend, Simon Hughes, voice of the Liberal Democrat backbenches, made clear that whilst the Bill was not what the Party would have wanted, it will be better after the changes made in the Lords.  Then, like clockwork, the day after Lansley’s defence of competition, Baroness Shirley Williams, the cheerleader of the Lib Dem opposition in the Lords, let it be known that she is reserving her energies for a fight on the issue.

Interestingly, chapter 3 of the NHS Bill on competition might also be the area where the Lords do feel empowered to go beyond their normal role of revision to something more radical, with the mandate they have been given by the Professional Membership Organisations representing those working in the NHS. The area of consensus materialising from the Membership Organisations, and notably in the Association of Royal Medical Colleges’ (an umbrella group) statement, has been in opposing the bill based on the uneasy concept of profit being taken out of the NHS. Even the Faculty of Public Health who has a lot to gain from the new public health arrangement has rejected the Bill on this premise.

Between now and Royal Assent the Lib Dems have the opportunity to create a Conference mark 2 situation where the grassroots delegates rally behind changes (supported by the professionals) which are accepted by the Coalition, being framed as a Lib Dem versus Coalition debate.

Away from the emerging policy battles, it is worth considering the bigger political picture. After years of work from Cameron to detoxify the Tories on healthcare (even resulting in the painful ‘NHYes’ poster from the 2010 election), the Health and Social Care Bill is single-handedly tarnishing his work. 

The bigger picture battle is now between Labour and the Lib Dems (backbench Lib Dems at least) who are in a fight over who can toxify the Tory brand the most whilst painting themselves as the real opposition. This has been summarised clearly by Liberal Democrat Peer, Lord Oakeshott, who after a brief spell in Government now remains a critical voice in the Lords.  Setting out what the Liberal Democrat role should be this week he tweeted: “back Coalition Ag’t (agreement) AND retoxify Tory brand”.

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A pot of gold for the new public health service

The launch of the Public Health Outcomes Framework is unlikely to even provide a brief respite for the beleaguered Ministerial team in Richmond House from the prevailing winds of negativity that scaled new peaks last week, and are set to continue to build this week with Stephen Dorrell’s Health Select Committee attempting to blow the House down.

A lot of the criticisms of the NHS reforms are fair. For example, was it necessary to abolish PCTs and replace them with Clinical Commissioning Groups, wouldn’t the same outcomes have been achieved by simply giving GPs greater commissioning and managerial responsibility within the current structure of PCTs. However, the transfer of commissioning responsibility for public health to local authorities is a hugely significant part of the reforms which do not receive enough credit. According to news reports this morning, the ring fenced budget for public health will be a healthy £5.2bn, surpassing expectations of those of us following these things. The sizeable budget settlement sends a positive signal, and should provide reassurance to critics claiming that it was simply a clever way of taking money out of the NHS and putting it into other areas suffering from greater cuts.

Successive Governments have sought to recalibrate the NHS from an organisation which operates as a crisis organisation – treating patients who are chronically and acutely ill – to one that also provides a prevention function. Given the huge and ever escalating demand pressures on the NHS, this was always going to remain impossible when the same commissioners were responsible for both functions. Indeed, PCTs were frequently accused of ‘raiding’ their public health budgets, most notoriously during the financial meltdown experienced by the NHS in 2005-06.

Creating a public health system and separating the commissioning arm for treatment from prevention is the right move. Furthermore, having that commissioning function within local authorities will enable more joined up work on tackling the wider social determinants of ill-health such as housing, environment and exercise.

The public health function will be overseen by a Health and Wellbeing Board in every local authority partly constituted by elected councillors. This arrangement has provoked concerns that the funding for public health will again be ‘raided’, but this time for more populist issues such as bin collection and fixing pot holes, under a loose interpretation of ‘public health’. The other main concern of elected officials overseeing public health is that those public health areas that polarise opinion such as abortion services and sexual health more generally could find themselves subject to attacks based on strong personal political views. The Department of Health have tacitly accepted these arguments by removing abortion services from the purview of local authority commissioning, and feeling obliged to make “access to comprehensive sexual health services” mandatory. Whilst these were both welcome moves, it begs the question what other important public health services could be subject to local political attacks. The ‘health premium’ – a bonus paid to local authorities for making progress against the public health outcomes framework – is designed to prevent ‘raiding’ of the budget for pot-holes by incentivising commissioning which achieves the outcomes prioritised by the Department. For this tool to be effective, the bonus has to be big enough to make it worth pursuing.

Hence the size of the budget is a welcome surprise and a good start for new public health services, especially as earlier predications had centred on a gloomy £3.7 to £4bn (or as Chris Skidmore MP neatly calculated, roughly £67 per person per year). According to the Marmot Review team £4bn roughly equalled the current value of the public health share of NHS budget, and they argued the public health budget should ideally be more like £7bn. The BMA have argued that £5bn would be a more appropriate figure.

The additional £1.5bn above most expectations, against a backdrop of budgets being slashed across the board, sends a welcome signal that the government is committed to public health and prevention, and crucially they are putting in enough gold to the bonus pot to get it off to a good start.

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Has the awareness week had its day?

About once a year a journalist writes one of those articles that all good PRs dread, on a topic it’s only right to admit is relatively fair game: the awareness week.  My favourite was when a journalist at the Independent a couple of years ago tried to do every awareness day and week for the whole of July – with predictably entertaining results.  More seriously last April, in what cynics could argue was their own PR bid, several union leaders came out against the growing number of special days, weeks and months that fill the calendar.  Awareness weeks have long been PR’s Achilles heel – with the media quick to mock the speed with which we profligate them and turning up their cynicism radar to full alert in response to ‘I’m just calling because it’s [insert name of random awareness week]’ pitches. 

So is the awareness week dead? 

Like government campaigns using celebrities in the early noughties, have we taken it too far and shot ourselves in the foot with the creation of one too many weeks? 

As an agency which has won multiple awards for awareness weeks, my answer would clearly have to be no.  But what PRs do need to remember is that an awareness week in itself is not the story. 

If PRs really ‘own’ awareness weeks, let’s make them something we can be proud of as a profession.  That means developing content that provides genuine news – a story that stands or falls without the week to prop it up – with the diary date serving as a convenient marker for a media launch and providing an extra incentive for ‘coverage now’. 

It means agencies and in-house teams asking robust questions about the purpose and value of the week: does the week promise a genuine change or provide a focused point in time for action? In Transplant Week, for example, an additional 11,500 signed up to the Organ Donor Register, a 172% increase on the weekly average.  For World Spirometry Day, where the public could take advantage of free lung tests, 25,000 people were referred to their GP, potentially catching dangerous conditions before it was too late.

Face-to-face events drive sign-ups during Transplant Week

It also means taking advantage of the fact that you have one thing in your corporate calendar that’s fixed and can be planned for – meetings with production teams six months before last year’s Climate Week secured climate change-themed programmes on the One Show and Blue Peter.

Done right, awareness weeks can be an opportunity for communications experts to work with colleagues in policy, campaigns and on the front-line to deliver genuine change.  Done for the sake of it, awareness weeks give our whole industry a bad name.  We need to put awareness weeks back on the calendar as bona fide reasons for media to stop and take note – before the general secretary of the Rail Maritime and Transport Union’s prediction comes true and someone starts an Ignore PR Puff Day.

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A new year and a new tone from Cameron on NHS reforms

Last Wednesday, David Cameron ‘ordered’ the integration of health and social services (an important, if tricky task). The following Friday, whilst outlining the Government’s vision for ‘compassion and dignity’ in the NHS, he continued his New Year’s tough stance. Referencing the long and slow progress of the reforms, Cameron smarted, ‘we’ve talked a lot in the last 18 months… we can’t just sit around waiting until the structural changes take effect’.  Is Cameron at the end of his tether with NHS reform, or is he just suffering from post-holiday blues?

Two excellent articles in the Health Service Journal last week outlined the types of problems that Department of Health are grappling with, that might underlie Cameron’s impatience. A leaked Government document showed that there remains uncertainty about the transfer of commissioning staff from PCTs to the new NHS bodies, with the future of over 11,228 full time equivalent PCT commissioning staff yet to be decided.  The document was also littered with ominous red markings showing areas where no organisation is currently taking commissioning responsibility. HSJ research also revealed that one in three PCTs have still not delegated funding for clinical commissioning groups, despite being asked to do so last April.

Public Health, in particular, is an area where the contagion of uncertainty is particularly acute. In December, the Department of Health published a series of fact sheets on the public health changes. However, as the Royal College of Nursing noted at the time, the Government still hasn’t published the actual operational details for the public health outcomes framework, nor the key documents on funding and a public health workforce strategy.

This lack of clarity about responsibilities for commissioning and delivery was further highlighted in the leaked HSJ document, which stated that “detailed functions mapping [has not yet been] conducted – so [it is] unclear what the Public Health England or local authority split will be.”  Core public health interventions, such as screening, were subject to the red marking in the DH document and remain areas where no organisation has been confirmed to take them over. 

For some areas, like alcohol and sexual health, it is not just the split between Public Health England and local authorities, but also the role of clinical commissioning groups and secondary care that will be important.  When competition was sidelined during the Lib Dem revolt over the NHS reforms, ‘integration’ became the new panacea for the NHS. Little wonder Cameron is giving ‘orders’.

Whilst the Prime Minister will be looking to win the political war on health as this year progresses, in particular in the Lords on the Health and Social Care Bill, it is clear that this is only a small part of the battle. There remains a lot of hard work ahead on the ground in 2012. It will be interesting to see whether the PM’s change of tone marks a new determination on his part to drive the NHS reforms forward in Whitehall.

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To eat or not to eat. That’s the Christmas question

As families and loved-ones come together for the festive season to celebrate their faith, delight in some time off work, reflect on the past year or argue over the TV’s remote control, the nation’s calorie intake invariably goes through the roof. Christmas means over-indulgence and why not? Tins of chocolates are eagerly unwrapped, big dinners are served to baying families and buffet tables are laid out to resemble Henry VIII’s court banquets. But is this two week nosh-up all bad?

Some argue that healthy eating should be a constant state of being and not something that slips at the first sight of a Christmas pudding. Others believe that in order to stick with a healthy diet people require occasional reward so their eating doesn’t slip into fanatical denial.

As anyone who has tried to eat healthily or stick to a diet (I hate that word) will know, Christmas provides little escape from temptation. There are ways to ensure calorie, fat and sugar intake doesn’t go off the scale. Replacing some of your meat, stuffing and gravy with more veg when you have your Christmas meal is one idea I recently read – and it makes sense.

We are all bombarded with healthy eating messages from the brands we buy, the packaging that shrouds them, the retailers we shop with, our favourite newspapers and magazines, the TV we will glare at throughout Christmas and the omnipresent internet. The danger is that some of this advice and ‘facts’ are often conflicting. One day we are told that eating plenty of fruit and vegetables is good for the heart and protects us from certain types of cancers; the next day we read that there is, in fact, little clinical evidence to support that claim. Just what are we meant to believe?

Consumers are more confused than ever about healthy eating and at Christmas this is overlaid by a niggling feeling of guilt. “I’ll start my diet in the New Year” is spoken with as much regularity as “can you pass me another roast potato” across the festive period.

I doubt that a few days’ over-consumption is going to cause too much damage to someone’s healthy eating regime. What we all need to watch is how easy it is for those ‘few days’ to spill into a few weeks. With work parties, family gatherings and a ‘fun’ New Year – we could all be looking at a month of consuming as much as 1,000 extra calories or more each day. That’s when we, as well as the famous goose, will get fat.

So the conclusion appears to be to take what you are told about healthy eating with a pinch of salt, just don’t add too much of it to your Christmas meal. Indulge but don’t allow a few days of pigging-out to turn into a few weeks. But most of all have fun – it is Christmas after all!

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New routes to health

The healthcare sector has been slower to get to grips with the new communication channels (targeting both patients and healthcare professionals) offered by digital and social media. However, it is clear that consumers are becoming more engaged in the management of their condition than ever before – connecting online with fellow consumers both locally and nationally and researching their own treatments (as patients expect to be partners in their own care). The patient opinion leader is rapidly becoming as important as the key opinion leader. Blogs, twitter feeds, patient group fora and Facebook pages all exist to share the experience of living with certain conditions.

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This presents an opportunity for communicators. More informed consumers can be offered targeted information such as lifestyle advice on a particular condition. Additionally, the use of apps, for example, means brands can help their customers get the most out of their product, for example by creating medication reminders or usage instructions.

Healthcare professionals are also waking up to the possibilities of digital media. Research presented in early March at the EyeForPharma conference suggests that, of the third of HCPs online during patient consultations, half are actively recommending patient sites. Research from the US suggests that two thirds of doctors believe wireless devices to be essential to their job taking connectivity further. While an iPhone app that takes an ECG reading (a simple and useful test which records the rhythm and electrical activity of your heart) is still in ‘gimmick’ phase, as technology improves we’ll continue to see more diagnostic and information tools being made available to doctors, and their patients, via tablets and smart-phones.

There will, no doubt, always be a place for traditional media – we know patients love taking pages from the Daily Mail into the GP surgery! But when developing our communications strategy, it is now essential to consider what these new channels can deliver.

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