‘Alcohol abuse’ – what’s in a name?

Posted on February 20, 2012 by Neil Balmer

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

Posted on February 15, 2012 by James Hollaway and Neil Balmer

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

Posted on January 23, 2012 by James Hollaway

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?

Posted on January 16, 2012 by Vicky McGuire

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

Posted on January 11, 2012 by Neil Balmer

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

Posted on December 21, 2011 by Ben Hickey

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

Posted on October 14, 2011 by Rachael Parkman

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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How do you reach families online?

Posted on October 14, 2011 by Nicole Sordell

I recently attended Figaro Digital’s Social Media Conference where there was a panel discussion on families and brands online. One question that really piqued our interest was, ‘How do we reach families online?’ the assumption being that mums are the gatekeepers to families in both the off and online worlds

Mummy bloggers are, undoubtedly, a force to be reckoned with and brands haven’t missed a trick in working with them. A quick look at the most recent Mummy Blogger Brand Index shows that alongside the ‘traditionally mummy brands’ like Lego and Disney, Mummy Bloggers are writing about things that matter to them wider than just being a mum like John Lewis, Zumba and WeightWatchers.

family

But are mums really the only route to get messages across to families online? Brands like Xbox are increasingly working to reach broader family members, they’ve moved from just being a gaming console to a ‘family entertainment hub’ and are using social media as a way to reach out beyond teenage boys and their dads into the wider family network.

Now more than ever, it’s not just mums who are engaged with social media and the online world. There’s now less fear about letting children go online and onto social media, instead parents work with their children to navigate the internet safely.

So families are online, not just mums. For a family focused campaign we should be looking at ways to engage the whole family, and often that means giving them something they can do as a family on or offline.

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