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Marketing Code of Practice Contents I. A message from Transform 01 II. How our Code of Practice has been conceived 02 III. Transform’s Marketing Code of Practice General principles Our marketing and advertising policies Our policy on creative aspects of advertising imagery The use of promotions and incentives Free consultations Privacy Summary 03 04 05 08 12 14 15 16 Appendix 1) The current regulatory framework for marketing and advertising 2) Consumer responses to cosmetic surgery advertising 3) Responsible marketing and advertising 17 18 19 20 I. A message from Transform Steven Taylor Marketing Director As part of our Clear Patient Charter first set out in July 2012, we made a promise to our patients to establish a Marketing Code of Practice. The resulting Code set out herein reaffirms our ongoing commitment to undertake activity responsibly and with sensitivity. In addition, while conforming to all current regulatory and voluntary guidelines, our Marketing Code of Practice aspires to set new standards which are above and beyond what is required of us from existing regulation. Our aim is to demonstrate that when administered respectfully and responsibly, good marketing and advertising is beneficial and educational to patients. Our Code itself is set out in the final section (Part III) of this document. However, we have also set out contextual information on the current marketing landscape which supports Transform’s stance on certain topics that are often viewed with controversy in the media. As always, we are open to hearing your thoughts. You can share them with us on www.transformclear.co.uk Yours faithfully Steven Taylor Marketing Director 01 II: How our Code of Practice has been conceived The Clear Panel (left to right): Marva Hammond (Lead Clinical Nurse), Ann Gilbert, Christian Knowles, Melinda Messenger, Dr Hilary Jones, Pat Dunion (Managing Director, Transform), Sheli McCoy Our Code of Practice was conceived in November 2012 following contributions from The Clear Panel (transformclear.co.uk). With panel members comprising past patients, Channel 5 consumer champion Melinda Messenger and Dr Hilary Jones, valid viewpoints have been sought from all quarters. The Clear Panel helped us shape our policy with particular regard to avoiding portrayal of negative body images amongst the young, impressionable or vulnerable, “airbrushing images” and using “real” patients in marketing images. 02 The panel’s contributions challenged us and have been invaluable and we are grateful for their input. In addition, the Code draws on the thoughts of senior staff at Transform who contributed to The Department of Health review on cosmetic surgery in October 2012. III: Transform’s Marketing Code of Practice 03 General principles 1 2 3 4 5 6 7 04 We take every precaution to ensure Transform, or the benefits of cosmetic surgery are never promoted to under 18s. We aspire to promote a positive body image and never leave a reader feeling negative or with a lower sense of self worth. We aim to never trivialise a procedure and always provide patients with the materials and information to help them make an informed decision. We will never advertise price in press or TV as an inducement to undertake surgery, or undertake activity which commoditises cosmetic surgery. We will be truthful, authentic and never undertake activity that glamorises or gives an unrealistic expectation of what can be achieved from surgery. We aim for our methods never to impose undue pressure on a patient or encourage them to undertake a procedure that they would otherwise not consider. We recognise our role in the cosmetic surgery industry and at all times endeavour to provide leadership and be a good role model in all we do. Our marketing and advertising policies Transform is extremely conscious of its social responsibility, which is why we do not encourage persons under the age of 18 to consider cosmetic surgery. We diligently ensure this principle is adhered to in all communications. – Transform does not treat or operate on anyone under the age of 18. – To obtain an information brochure, arrange a consultation, or request a call back, via our website, a patient must confirm that they are over 18. 18 Our TV scheduling policy Since January 2013 our TV advertising predominantly takes place post watershed (9pm). Occasionally advertisements are broadcast during daytime hours, but since July 2012 our policy has been; – No broadcasts between 3:30pm - 9pm. – No broadcasts during recognised school holiday periods. 9pm – No broadcasts during programmes which might be interpreted as being attractive predominantly to under 18s. 05 Our press scheduling policy Transform will only place advertising in titles with an audited circulation and an average readership age over 18. Examples of the titles we advertise in and the publishers stated readership profile are below; Title % Readers over 18 Average Reader Age Cosmopolitan 93.2% 33 Heat 89.1% 31 OK! 90.2% 36 Star 90.1% 32 Glamour 94.9% 31 Marie Claire 96.4% 40 Look 88.9% 31 Source: Mediaedge, February 2013 On the internet Our internet display advertising, conforms to the same principles. Our advertising will only be placed on sites where the site owner can reassure us on visitor age profile. In the case of sites being bought through an advertising network, a specific exclusion is sites where the visitor profile is under 18. 06 Social media Access to our Facebook page, content and discussion boards therein has been restricted to over 18s since launch in late 2011. Posts which are 'promoted' on Facebook, are also restricted to over 18s only. This means that such posts will only appear for users who have indicated their age as 18 or above. 07 Our policy on creative aspects of advertising imagery Advertising and marketing are creative by their nature. However, Transform is steadfast in three aims; – We will never alter an image to give an unrealistic impression of a surgical outcome. – We aim never to trivialise or diminish the nature of a surgical procedure. – Images of patients featured on our website and advertising will only be over 21. 08 Promotion of healthy body images The portrayal of unnatural or unhealthy body images, (for example “size-zero”), is widely condemned in the media. Transform advocates promotion of healthy body images at all times. Indeed, our most popular procedure (breast augmentation), is fundamentally about attaining a more voluptuous body shape. To this end, – We aim never to promote an unhealthy look, or promote unattainable body images. – A further requirement of individuals featured in marketing is that they have a healthy body image visually and with a BMI (Body Mass Index) in the recommended range of between 18-25. Celebrities and role models We work with Dr Hilary Jones and Melinda Messenger to raise standards and promote greater responsibility. Transform believe that focusing on celebrities in advertising and marketing is not an appropriate way to promote cosmetic surgery. As a result, while such personalities can and do have procedures at Transform, we will never use their celebrity status as a means to overtly promote or advertise the virtues of cosmetic surgery. We do however believe it is legitimate to use high profile role models and / or media personalities to assist in instilling a sense of greater personal responsibility and providing patient information. In addition, their use in stimulating debate on raising standards on the clinical aspects of cosmetic surgery is entirely legitimate. 09 Authenticity For a free consultation call 08000 214 137or visit transforminglives.co.uk BREAST / BODY / FACIAL / HAIR / NON-SURGICAL TREATMENTS / MALE COSMETIC SURGERY Registered by the Care Quality Commission. Throughout 2012 Transform press advertising has featured only Transform patients. From June 2013 this philosophy will be extended to our TV advertising. Currently, on our website and in our marketing brochures, the images used are a mix of real patients, real staff and “models” who are representative of our patient demographics. By May 2013 of the 38 individuals featured, 10 are not bona fide Transform patients or employees. By the end of 2013, we aim for no “models” to be featured. 10 Funda Onal, Transform patient, has featured in our press advertising throughout 2012. Any case study or testimonial in the past, present, or in future on our website, press, or literature will only ever be of a genuine patient. Airbrushing 2013 advertising campaign prephotographic treatment. Transform do not use “airbrushing” techniques to give an artificial or false indication of the outcome of a surgical procedure. Postphotographic treatment. With regards to “before and after” pictures on our website, or in clinic, these have never been altered in any way. In our next advertising campaign (May 2013) the sole post-photographic treatment will be modest colour correction. Patients featuring in the campaign will be natural in every other respect. 11 The use of promotions and incentives Surgical procedures Transform advertisements do not carry the price of a surgical procedure. In 2011, recognising the concerns over “timelimited” offers, Transform introduced a 90-day period for patients in which to participate in a promotion. Subsequently, we were instrumental in the adoption of the same policy for all Independent Healthcare Advisory Service (IHAS) members, thus bringing to an end the practice of time-limited offers (amongst IHAS members). “ However, times and social expectations change. Today there is a very different landscape. As such, from January 2013, Transform no longer advocates the en masse marketing of promotions or price offers for a surgical procedure. Transform no longer advocates en masse promotions or price offers for surgical procedures ” Our stance on other promotional practices – Refer a friend - From May 2013 we will be bringing to an end our patient referral scheme. – Prize competitions - Transform will never support a competition in any media channel that offers a surgical procedure as a prize. 12 – Group buying websites - Transform will never participate in group-buying website offers for the sale of cut-price surgery. – Loyalty schemes - Transform will never condone any idea that encourages unnecessary or repeat surgery. Non-surgical The generally accepted definition of “nonsurgical” treatments are those which are noninvasive (needle, not scalpel). As such our policy on promotions for the nonsurgical sector differs from that outlined for surgical. Typically, these comprise a regular course of treatment, or are repeated at regular intervals (in the case of injectables such as dermal fillers or Botox®). – Price promotions - are a legitimate means to attract non-surgical patients. In determining terms and conditions for such offers we are mindful not to pressurise and also allow sufficient time for a patient to complete their course of treatment. At Transform such treatments are provided in a regulated, clinical environment by suitably qualified practitioners, doctors and nurses. Clinical standards and clinical care come first. – Loyalty schemes - Transform considers our loyalty scheme “For Me” to be an acceptable part of a competitive commercial landscape. However, within the industry such treatments are also administered in less clinically regulated environments, by lower qualified staff, using lower specification products and machines. Additionally, “price” and “promotions” are highly influential in patients determining where to have their treatment. Should greater regulation in the non-surgical sector be introduced (with particular regard to who administers, where they can do it and the products they use), Transform will review its marketing policy. 13 Free consultations Free consultations with a surgeon have been condemned in the media and other quarters as part of the “unacceptable face” of cosmetic surgery marketing. The reason cited is that free consultations create an obligation on the part of patients. Transform could not disagree more. Our belief is that cosmetic surgery should be about choice. Freedom to choose to have a procedure and freedom to make an informed choice on provider and surgeon. Typically; – A patient will seek opinions from a variety of surgeons / providers before settling on the one that’s right for them. On average 4.1 consultations are sought.* – A private surgeon will typically charge £150 to £300 for an initial consultation. *Source: Keynote market research study 2012 14 Given this, free consultations are a means to allow patients to assure themselves they are making an informed decision without incurring significant cost. It would be extremely lucrative for Transform to charge a fee for consultation. However we are steadfast in our belief that patients having to pay for their consultation benefit no one - except surgeons who impose a charge. “ Paying for a consultation benefits no-one - except surgeons who impose a fee ” Privacy Transform is registered with the Data Protection Registrar and we comply with the expectations and rules set out in the Data Protection Act. Over and above that we are particularly conscious of the sensitive nature of cosmetic surgery. As a consequence we will never approach patients unsolicited seeking their custom by mail, email, phone, text, personal call or any other medium. Direct marketing communications are only ever directed at patients who have previously made an enquiry to us. Any patients who no longer wish to receive marketing messages will be suppressed from the relevant databases upon instruction / intimation. Over and above these principles we are also mindful of the requirements of The Caldicott Code which require us to be protective of all medical data held and to ensure patient confidentiality and privacy is maintained. 15 Summary Whilst conceived by The Clear Panel, the Code belongs to our patients and its content or ideas are not fixed. Should there be a groundswell of opinion about a particular aspect or omission from the code, we will listen. Patients are at the heart of all we do at Transform and as such their views and contributions are welcome – particularly if they have had an experience that contravenes the standards we have set out to achieve. If you consider any of our advertising or marketing to be irresponsible and / or in breach of our own code, tell us – and tell the Advertising Standards Association (ASA). 16 To feedback, comment or participate : – Post on Facebook (search : Transform Cosmetic Surgery) – Comment at : transformclear.co.uk – Email the marketing team : [email protected] – Write to the Advertising Standards Association : asa.org.uk Appendix 17 1) The current regulatory framework for marketing and advertising Transform takes seriously its position as a responsible and ethical provider of cosmetic surgery. This philosophy extends beyond our clinical standards to all spheres of activity – including marketing. Our marketing communications adhere to the principles set out in: – The Independent Healthcare Advisory Service (IHAS) marketing code – The Medicines & Healthcare Regulatory Authority (MHRA) Blue Guide – Committee Advertising Practice (CAP) Guidance Notes on Cosmetic Surgery Advertising – The Medicines Act 1968 – The British Code of Advertising Practice (BCAP) 18 Moreover, we have always been respectful of and abided by the decisions of: – CAP - whose guidance we will voluntarily seek prior to running a new advertising campaign. – Clearcast - the body which approves advertisements prior to TV broadcast. – The Advertising Standards Association (ASA) the body charged with enforcement of BCAP principles in press, printed materials and on websites, to ensure advertisements and marketing claims conform to the principles of being “legal, decent, honest and truthful”. 2) Consumer responses to cosmetic surgery advertising Complaints against advertisers in 2011. All Sectors Cosmetic Surgery Sector Transform 22,397 advertisements complained against 32 advertisements complained against (majority relating to online Botox advertising) 0 complaints 31,458 complainants 36 complainants 4,591 advertisements amended or withdrawn 14 advertisements removed or amended Source : Advertising Standards Association, October 2012. In practice, cosmetic surgery adverts rarely contravene advertising regulations. The table above shows the relatively low concerns of the public to cosmetic surgery advertising. Upheld complaints against cosmetic surgery advertising in 2011 represented just 0.3% of the caseload of the ASA. These sentiments were also borne out in a OnePoll survey commissioned by Transform in November 2012, where 70% of respondents stated they saw no need to ban cosmetic surgery advertising. “ The ASA figures for 2012 have yet to be fully released, but Transform understands they largely mirror those of 2011. However, in the interest of transparency, we can report there were two consumer complaints lodged about Transform’s television advert. The first (that our advertisement portrayed a negative body image to young people) was rejected by the ASA. However, a further complaint (that our advert was broadcast aired during a programme that was watched predominantly by an under 18 audience), was upheld. We have subsequently tightened our administrative procedures and revised our TV scheduling policy to ensure this will never happen again. of the public see no need to ban cosmetic surgery advertising 70% ” 19 3) Responsible marketing and advertising By its nature advertising is creative - and as such, subjective. However, there are objective criteria too and parameters advertising must conform to; most importantly it must be legal, decent, honest and truthful. That is not to say bad advertising does not exist. It does. When it does though, there is a proven and universally successful system in place which has been supported by successive governments. The remit of the ASA is to police adverts and take appropriate action when required. We believe there is a role for advertising to help potential patients make an initial decision regarding providers available to them. To ban or outlaw cosmetic surgery advertising would be counterproductive and ultimately a disservice for patients: “ 20 – Patients will have a narrower understanding of providers available to them. – An advertising ban is likely to result in a proliferation of unregulated internet activity. – International providers will advertise surgery as a commodity, price will be the focal point and clinical standards and care will be less clear to patients. – The standards, regulatory controls and effective policing by the ASA over the last 50 years will count for nothing. What ultimately is required is a sense of responsibility - and that is the essence of Transform's Marketing Code of Practice. What ultimately is required is a sense of responsibility - and that is the essence of Transform's Marketing Code of Practice ”