Summary of Council decision:

Two issues were investigated, both of which were Upheld.

Ad description

A private health insurance comparison website,, included a web page headed "Your 3-Step Guide to Avoid the NHS Crisis". Text stated "Our National Health Service has been making regular appearances in the news lately. The most recent report by NHS England medical director, Professor Sir Bruce Keogh, highlighted the staggering 13,000 deaths that occurred between just 14 NHS sites since 2005. This awful statistic, he believes, is likely to have been a tragic consequence of negligence which could have been easily avoided. It's been shown that 7.2 million people in the UK alone have turned to health insurance to provide the peace-of-mind they need for their health. With policies costing from as little as 70p per day, health insurance is no longer just a luxury - it's an affordable and practical way to protect your health". Further text stated "Here is your 3-Step Guide to affordable health insurance: STEP 1: How can Health Insurance Benefit You? Unlike other forms of insurance that not everyone will need, health insurance benefits everyone. Should you need it, it could quite literally save your life!"


The ASA received 54 complaints:

1. All the complainants challenged whether the claim "13,000 deaths" and references to the Keogh Review were misleading, because they believed they misrepresented the report.

2. Seventeen complainants challenged whether the ad breached the Code, because they believed it used an appeal to fear to sell private health insurance.


1. eSmart Media Ltd t/a Best Medical Cover (eSmart Media) said they took the figure of 13,000 from various articles in leading UK newspapers, and provided links to some of the articles. They said these were the figures in the public domain at the time the ad was written, but that they understood the figure was now disputed and they would therefore not refer to it in their future advertising.

2. eSmart Media said that they would not refer to the figure again in their advertising. They also commented that in general they believed that pointing out documented examples of poor NHS treatment was important for the public and that concerns about such risks was a valid and justifiable reason to consider alternative methods of financing medical care.


1. Upheld

The ASA understood that a number of press articles in national newspapers published prior to the release of the 'Review into the quality of care and treatment provided by 14 hospital trusts in England' by Professor Sir Bruce Keogh had referred to excess deaths of up to 13,000 patients. The ad did refer in a footnote to a press article in relation to the claim. However, we considered that the ad presented the references to the contents of the review and the 13,000 excess deaths as factual, and we therefore considered they needed to hold robust evidence to support the claims. Because they had based the claims on press reports only, rather than the actual review, and we understood that the excess death figures quoted in the press had since been disputed and did not accurately represent the contents of the report, we therefore concluded the claims were misleading.

On this point the ad breached CAP Code (Edition 12) rules  3.1 3.1 Marketing communications must not materially mislead or be likely to do so.  (Misleading advertising) and  3.7 3.7 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation.  (Substantiation).

2. Upheld

The ad contained various references to the NHS such as "Your 3-Step Guide to Avoid the NHS Crisis" and "staggering 13,000 deaths … likely to have been a tragic consequence of negligence" and went on to state that health insurance could "provide the peace-of-mind they need for their health" and "quite literally save your life!". We acknowledged that consumers who were considering purchasing private health insurance would do so for a number of reasons, which might include concerns about the standard of NHS care, and that marketers were entitled to refer to this as long as such references complied with the Code, which stated that marketing communications must not cause fear or distress without justifiable reason. However, we considered that the references to excess deaths, an "NHS Crisis" and that health insurance could "save your life!" and the overall impression of the ad used an appeal to fear to sell private health insurance and that it was not justified to do so. We therefore concluded the ad breached the Code.

On this 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 its current form. We told eSmart Media to ensure they held robust substantiation to support claims in their ads, and to ensure that any references to the NHS did not use an appeal to fear.

CAP Code (Edition 12)

3.1     3.7     4.2    

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