The NHS brand – predictive or promissory?

NHS What is the value of the NHS brand? Is it predictive? and is it promissory? I picked up this discussion in the 8 May edition of Philosophy at Cambridge in Winston Fletcher’s article on the Meaning of Harpic. Fletcher had read philosophy at Cambridge but found his living in the world of advertising.

The NHS – its achievements, its people, the money (sorry investment) – is unceasingly referenced in the election. What are politicians really talking about when they speak about the NHS and can we associate that discourse with particular sets of brand values? Is it useful to discuss the NHS in the same way as a brand of soap?

Andrew Craig has already picked up on the confusion of ends (health) with means (health and social care services) that occurs in the contested political arena that is the NHS. Many of the electoral claims and counter-claims are  not really about  health at all. The NHS is a promise to the people who live in the UK and is seen as one of the rewards of being British. It is this emotion around the fear of denial of service that is the political debate in part plays to. The NHS Constitution seeks to address those fears by making access to service a right balanced by rights-based promises to staff. When we talk of rights are we making a prediction or a promise?

Does  adman philosopher Fletcher’s description of how brand names are a curious form of noun give any sort of answer to this question. There is no mention of rights when he writes:

“a common noun say ‘soap’ identifies a multiplicity of roughly similar things.  A proper noun or a name, say ‘Ludwig Wittgenstein’ identifies a specific singular entity. Yet ‘Palmolive’  is absolutely specific – no other soaps are Palmolive, but it identifies a multiplicity of soap bars. A proper noun refers to something unique; a common noun to innumerable similar things; a brand name refers to innumerable things which are uniquely similar.”

Rumsfeld revisited was my first thought about things knowable or not. Can this be true of the NHS brand in our day to day experience? Innumerable actions and interventions every day but which are uniquely similar just because they are labelled NHS? Does the NHS brand function as a guarantor of predictable quality at all times and in all places? What does the brand promise and is that promise the same across the nation – even in the shrunken nations of the modern UK? Rights indicate what you should be getting – they state what is desirable, indeed demanded but also warn of a world where demands are not always met.

Or can an overarching  NHS promise only exist in the definition offered by this philosopher turned adman when it is caught up in an election? Now the brand becomes a symbol of a national promise and the resulting political competition is to see who can be entrusted with that promise.We abandon the predictive aspect of the brand – when I hear Palmolive I think I know what I am getting in terms of an outcome of a certain quality – and are left only with the promissory and the appeal to trust. It is the old ‘whose are the safer hands?’ argument.

Perhaps health and social care professionals are reconciled to their world being discussed in public in this way. Are they used to political competition in a the particular election context giving no clue as to what the elected government will actually do about the NHS when they come down to earth and have to contemplate the NHS at the level that patients and providers experience the service.

A recent posting on the King’s Fund blog underlines how the different parties have no coherent plan or ideas on how the NHS will really save money. Mark Jennings goes on to highlight the fact that there are practical measures that would save lots of money by tackling the wastage that comes from variations in local clinical and operational practice. The snag is that to collect the best practice and facilitate its implementation, needs – guess who? – managers to help the frontline apply consistent levels of better and more cost-effective service. The debate is neither about Health nor National best practice Service.


  1. Andrew Craig says

    Of course it might be an insurance policy – as Gordon Brown termed it recently – but that is even more confusing because it certainly isn’t an insurance based system supporting it. Maybe he thinks it should be, like the parallel proposed – and in MAC’s view wholly unnecessary – National Care Service. The arguments for the NCS are in fact arguments against the current tax funded NHS – surprising that the media hasn’t sussed that one yet.

    But on to more pressing electoral matters. The Kings Fund last week did us all an excellent service by organising a “health hustings” and you can see the video here as it happened. Don’t expect any blinding revelations about how Messrs. Burnham, Lansley or Lamb would address the budget deficit. But you will see Jeremy Hughes, Chairman of National Voices, raise the essential question of closing hospitals. That got them squirming and we need more of that. This is the kind of big thinking that must happen from Friday 7th May and it must be done on the basis of full and informed engagement – a tall order but one the NHS must not fudge.

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