A direct mailing for Bluecrest Health Screening, received in September 2018, was addressed directly to the recipient. The front of the envelope featured Bluecrest's name and logo. The reverse of the envelope featured the return address in small text. Directly beneath this, in the same font, was text stating "This contains marketing". Larger text stated "HELP AVOID A STROKE...".
The letter was headed "IMPORTANT INFORMATION ABOUT YOUR HEALTH SCREENING INVITATION". Further text stated "Dear [name], Although you are probably very well looked after by your NHS GP when you feel ill, you may not realise just how many serious health conditions don't give you any warning signs. For example, did you know that Strokes [sic] are the second most common cause of death worldwide and your Stroke risk increases 500% if you have atrial fibrillation ... As Mrs Smith from Oxfordshire put it after her screening ‘I'm so grateful for the Bluecrest check - it picked up the fact that I'd had a heart attack without knowing it. I'm now being treated to help me avoid another one’”. A further testimonial stated "I decided to have a health screening because I wasn't feeling very well. I was feeling exhausted after just a few hours' work and I was finding things really hard-going. I'd been to see my doctor previously but they didn't seem to know what was wrong with me. My results report showed that there was something wrong with my blood and follow up testing showed I had leukaemia. I'm now undergoing treatment but I feel very grateful to Bluecrest: if it wasn't for your results I wouldn't have detected the illness".
An insert featured further testimonials stating "You can't go to your GP and ask for this kind of testing [bold]" and "Despite having no symptoms [bold] your tests detected a serious condition [bold] which I'm told would have had a serious impact on my quality of life". The "Frequently Asked Questions" page stated "Q: Why can't I get this on the NHS? A: The NHS doesn't normally offer comprehensive screening with a detailed written report, unless your GP requests tests if you display symptoms. But many of the problems we screen for do not show symptoms until it's too late to act".
Eight complainants challenged whether the ad:
1. was identifiable as a marketing communication; and
2. could cause unnecessary fear and distress.
1. Bluecrest Health Screening Ltd (Bluecrest) said that the reverse of the envelope featured the words “this contains marketing”. This was written in the same font and font size as the return address above it, so was no less legible. The words “HELP AVOID A STROKE” written in larger font and placed close to the rest of the text also drew visual attention to the area. They said the envelope did not carry any official government, NHS or similar public body logo, and the Bluecrest logo and branding did not bear any similarity to that of such organisations. They pointed out that they did not use the manila or brown windowed envelopes that many government organisations employed. In addition, the letter stated throughout that it was not from the NHS, and referred to a “health screening invitation” rather than an appointment. However, Bluecrest said that they were willing to make changes to their advertising, such as removing the words “HELP AVOID A STROKE” or moving the “This contains marketing” statement to the front of the envelope.
2. Bluecrest said that the information about the risk of stroke included in the ad was factual and could be substantiated. They provided links to several articles that they believed substantiated the claims. They said that ischaemic heart disease, culminating in conditions such as stroke and heart attack, was the second leading cause of deaths in the UK.
They said that the information about strokes was pertinent to the subject of the letter and they did not believe it had been excessively used in a way that would cause fear and distress. They said they were trying to help individuals take a more proactive role in managing the causes of disease by understanding their health risks and seeking the right course of action.
Bluecrest said that the NHS bowel testing programme consisted of a home testing kit, which looked for evidence of blood in stools but could not distinguish between blood you may have eaten (such as from consuming red meat) and human blood. The test was offered only to men and women aged 60–74, because this was the age group at highest risk. The bowel cancer screening programme offered by Bluecrest could distinguish between animal and human blood, and was available to those under 60, although they would not recommend it for individuals under 40. They provided consumers with balanced information about the benefits and limitations of their bowel screening test before they decided if they would like it. They said that although they understood why the NHS took the approach they did, Bluecrest provided an option for those outside of the screening window which they could pay for themselves.
Bluecrest provided a sample copy of one of their results reports, which they said demonstrated how their testing differed from that offered by the NHS.
They said that the testimonials demonstrated how many of their customers felt let down by their local GP service and didn’t feel they were getting the level of attention they needed. They reflected the genuine views of customers and were all included in the mailing with their consent.
The CAP Code required that marketing communications were obviously identifiable as such, meaning that consumers should be able to tell from the envelope itself that it was a marketing communication. The ASA noted that there was no information on the front of the envelope stating that it contained marketing materials. On the reverse of the envelope, text stating “This contains marketing” appeared directly below the return address. The text size was very small, and written in the same size and font as the address. We considered that the marketing statement was insufficiently prominent and could easily be overlooked by consumers. Furthermore, the envelope featured text stating “Bluecrest Health Screening. Take control of your health”, the Bluecrest logo, and additional text stating “HELP AVOID A STROKE”. Overall, we considered that many recipients would understand that the mailing related to an existing health appointment. We concluded that the mailing was not obviously identifiable as a marketing communication and therefore breached the Code.
On that point, the ad breached CAP Code (Edition 12) rule 2.1 2.1 Marketing communications must be obviously identifiable as such. (Recognition of marketing communications).
The CAP Code stated that marketing communications must not cause fear or distress without justifiable reason.
As explained at point one, we considered that the ad was not obviously identifiable as a marketing communication. The envelope featured text stating “HELP AVOID A STROKE”, and particularly in a context in which it was not clear that the mailing was a marketing communication, we considered that had the potential to cause distress. The letter was headed “IMPORTANT INFORMATION ABOUT YOUR HEALTH SCREENING”, and there was no explicit statement to indicate that it was marketing. Taking into account the overall impression of the envelope and the initial impression of the letter, we considered that many recipients would understand that it related to an existing appointment. We considered that could cause confusion in relation to a sensitive subject, and result in alarm.
The first page of the letter included text stating “Although you are probably very well looked after by your NHS GP when you feel ill, you may not realise just how many serious health conditions don't give you any warning signs” and "I'm so grateful for the Bluecrest check - it picked up the fact that I'd had a heart attack without knowing it. I'm now being treated to help me avoid another one”. The second page featured a testimonial that stated "I'd been to see my doctor previously but they didn't seem to know what was wrong with me … if it wasn't for your results I wouldn't have detected the illness”. The insert stated "You can't go to your GP and ask for this kind of testing [bold]","Despite having no symptoms [bold] your tests detected a serious condition [bold] which I'm told would have had a serious impact on my quality of life" and “The NHS doesn't normally offer comprehensive screening with a detailed written report, unless your GP requests tests if you display symptoms. But many of the problems we screen for do not show symptoms until it's too late to act”. While the rest of the letter mainly related descriptive information about the test process and how the results would be reported, the emphasis toward the beginning of the letter and in the insert was on the potential dangers of not having the tests.
We acknowledged that there were differences between the tests offered by Bluecrest and those that were available on the NHS, and that their purpose was to offer additional individual health insights which some consumers might find helpful. We considered that the mailing implied people would be unable to obtain testing or treatment for certain serious and life-threatening health conditions from the NHS unless they displayed symptoms, and that many such conditions did not show symptoms. We considered that the letter’s tone and emphasis on the potential negative outcomes of serious health conditions, and particularly on the idea that recipients might have such a condition without knowing it or displaying any symptoms, was likely to cause fear and distress, including among those who were unable to afford the screening. While we recognised that the service was intended to give consumers an insight into their health, we considered that its purpose and function could be clearly explained without taking an approach that played on people’s fears.
We concluded that the ad was likely to cause fear and distress without justifiable reason and therefore breached the Code.
On that point, the ad breached CAP Code (Edition 12) rule 4.2 4.2 Marketing communications must not cause fear or distress without justifiable reason; if it can be justified, the fear or distress should not be excessive. Marketers must not use a shocking claim or image merely to attract attention. (Harm and offence).
The ad must not appear again in the form complained about. We told Bluecrest Health Screening Ltd to ensure their advertising was clearly identifiable as such. We also told them to ensure that their advertising did not cause fear or distress without justifiable reason – for example, by placing emphasis on the idea that consumers could have a serious or life-threatening illness without knowing it or showing symptoms.