A poster and claims on the advertiser's website www.rightcare4u.org.uk, seen on 5 October 2015:
a. The poster stated "For emergency use only ... A&E is for life-threatening emergencies only ... Other NHS services are available that will help you more quickly. For more information visit: www.rightcare4u.org.uk".
B. The website stated "For emergency use only ... A&E is for life-threatening emergencies only ... If you use A&E when you could get help somewhere else, you are taking NHS staff time away from life-threatening cases. Other NHS services are available that will help you more quickly ...".
Brent Patient Voice challenged whether the claim "A&E is for life-threatening emergencies only" was misleading and potentially harmful, because patients with serious medical conditions/injuries that were not necessarily life-threatening may be wrongly discouraged from going immediately to their nearest hospital A&E.
Department of Health trading as Brent Clinical Commissioning Group (BCCG) explained that the ads focused specifically on diverting unnecessary cases away from local A&E departments to more appropriate settings, such as Urgent Care Centres and Minor Injuries Units. They said the primary aim of the ads was patient safety. They had based the core message on nationally available NHS information, in particular the NHS Choices website. They provided an extract from that website which listed some examples of life-threatening emergencies and included loss of consciousness, persistent severe chest pain, breathing difficulties and severe bleeding that could not be stopped. BCCG said that in contrast to A&E departments, Urgent Care Centres could treat sprains and strains, broken bones, wound infections, minor burns and scalds, minor head injuries, insect and animal bites, minor eye injuries and injuries to the back, shoulder and chest.
BCCG said they had received clinical approval for the campaign. They accepted that there may be a few exceptions, for example, the ones cited by Brent Patient Voice, regarding some specific situations which might require A&E treatment in non-life-threatening situations. They said that was why there were well-established protocols in place in order to safely refer all patients requiring A&E treatment who presented at Urgent Care Centres. They believed the question was one of risk and, in the case of the ad campaign, communicating clearly to a whole patient population about the appropriate use of A&E overall, given the potentially serious and significant impact on those patients who genuinely required A&E treatment by those patients who would be better off (both for themselves and others) reporting to non-A&E services. They said it was important to emphasise that it was not their intention to present misleading information. They were seeking to educate people who might consider going to A&E for situations which were non-life-threatening and who could be treated more appropriately elsewhere.
They offered to remove the word "only" from the claim, in order to provide for those few situations which might require A&E treatment for non-life-threatening emergencies in the context of the A&E service overall being for life-threatening situations, as set out on the NHS Choices website. They believed their amendment was a reasonable and proportionate response to the complaint.
The ASA understood from Brent Patient Voice and BCCG that there were certain medical conditions and injuries that were not life-threatening but nevertheless required treatment in A&E, for example, some broken bones (e.g. ankle), facial injury requiring maxilla-facial surgery, saddle paraesthesia and serious eye injuries. We understood that those conditions and injuries could not be treated in Urgent Care Centres or Minor Injuries Units. We acknowledged that the intention behind the ad campaign was to encourage the appropriate use of A&E services, so as to ensure the proper allocation of NHS resources and patient safety, and was not to deter individuals from accessing A&E services if they genuinely required them. However, we noted that the claim "A&E is for life-threatening emergencies only" was an absolute claim, even though there were exceptions, and we were concerned that individuals presenting with the conditions listed above might be deterred from seeking urgent treatment at A&E as a result of seeing the ads. We considered that the amended claim, which omitted the word "only", did not resolve the complaint because there were certain conditions and injuries that were not life-threatening but which nevertheless required treatment in A&E. For those reasons, we concluded that the claim "A&E is for life-threatening emergencies only" was misleading and potentially harmful.
The ads breached CAP Code (Edition 12) rules
Marketing communications must be prepared with a sense of responsibility to consumers and to society.
Marketing communications must not materially mislead or be likely to do so.
Marketing communications must not mislead the consumer by omitting material information. They must not mislead by hiding material information or presenting it in an unclear, unintelligible, ambiguous or untimely manner.
Material information is information that the consumer needs to make informed decisions in relation to a product. Whether the omission or presentation of material information is likely to mislead the consumer depends on the context, the medium and, if the medium of the marketing communication is constrained by time or space, the measures that the marketer takes to make that information available to the consumer by other means. (Misleading advertising).
The ads must not appear again in their current form. We told Brent Clinical Commissioning Group to take care not to inadvertently make misleading and potentially harmful claims about the scope of A&E services in future.