BI podcast transcription: Liverpool

Rhian Gladman [00:00:11] Welcome to the latest episode of the 'Nudges for social good' podcasts from the Local Government Association. My name is Ryan Gladman, I've managed the Behavioural Insights programme at the LGA for the last four years and really we're here to help demystify behavioural insights and help people working in councils to actually have a go, learn from other councils and undertake your own behavioural insights projects. So today I'm joined by Sue Cummings, who's head of Behavioural Insights and Change at Liverpool City Council. Sue, I'll ask you to introduce yourself, thank you for being with us today. Really appreciate you giving up your time to speak to us and over to you really, to really introduce your career and your background.


Sue Cummings [00:00:53] Thank you, Rhian. In terms of my background, I started in the commercial sector, so I have 25 years of experience of marketing and research, working for a footsie one hundred company, and the commercial world are masters at understanding the customers, the public sector still need to catch up in terms of budgets.


Sue Cummings [00:01:15] Public sector has a fraction of the money, that the commercial world have, but I strongly believe by using behavioural insights it creates the effective, efficient and sustainable way to change behaviour, using very little money which the commercial world have lots of. So I brought this knowledge into the public sector 10 years ago, started life in the NHS, understanding why customers, patients, consumers behaved the way they do, understanding what they wanted and needed from services before they knew it themselves, and it's by using this understanding that we can then revolutionise things like services, pathways, how people are serviced in the public sector, and then how we can change the behaviour for social good.


Rhian Gladman [00:02:06] So to kick us off, would you mind giving us an example of a behavioural insights project that you've undertaken in the city and, and talk to us really about what was the behaviour that you were you were trying to change and what did you do?


Sue Cummings [00:02:20] So the example I'm going to use is reducing obesity. So in Liverpool, we have huge issues with childhood obesity. Over 40 percent of children in Liverpool who are age eleven are either obese or overweight. So we looked at how we could change this behaviour on both a population level and also during a trial. So we looked at two different types of approaches. We started off by using a nudge technique called salience. So salience is where something is drawn to your attention if it's personal to you. So there's a lot of confusion around the amount of sugar in products that children, adults, eat and consume. So we actually took on the commercial world ourselves, which is a first for a local authority. So we named and shamed branded products. First set of products was drinks, then it was breakfast cereals, then it was yogurt. And we named the exact products that the consumers in Liverpool eat and drink and we showed the amount of sugar within those products. It was a huge success, people could see exactly what they have in their cupboards. Look, in terms of how much sugar then they're consuming at the same time, we had the opportunity to apply for grant funding from the LGA. Now, this was a project then that we trialled in terms of reducing the sales of sugary drinks at the point of retail. So we had to find stakeholders to work with in a retail setting to trial this out in a setting whereby people went to buy drinks. So we started off looking for partners i.e. supermarkets, and we got into very lengthy talks with the co-op. We got sort of further down the line, with the co-op and it became apparent quite late on in those talks that the co-op had targets to meet in terms of sales, and so it wasn't the right environment for us to continue in trialling this type of work with the co-op. So we had to sort of take a pause and look for different partners to work with on the project. We looked closer to home in terms of environments that we had more control over, and we'd spoken to our colleagues in the NHS. We have seven hospitals in Liverpool, so we started there and we had talks with two of the major hospitals in terms of the cafes that are in those hospitals and the retail settings within those cafes and the cafes within those hospitals were very keen to work with us on a trial to reduce the sale of sugary drinks. So the nudge techniques which we use, those two techniques, one called choice architecture, so how choice is presented to us can influence our behaviour. So supermarkets, for example, know that if they present items middle of the shelf, at eye level people are going to buy more of those products than if the higher or below eye level. So one of the techniques we used was putting sugary drinks on the bottom shelf and putting the healthier drinks in the middle shelf. And then the second technique's was having nudge signs on the bottom shelf with those sugary drinks, highlighting the amount of sugar in those drinks.


Rhian Gladman [00:05:44] So sorry Sue, what did those signs look like? Okay can you tell me a bit more  and for the listeners as well, what did those signs look like if others wanted to recreate them?


Sue Cummings [00:05:54] It was something very simple. It was shaped like a stop sign. So it was a red hexagon stop sign. And the sign was high sugar. High sugar diet can lead to weight gain and tooth decay and drinks on this shelf contain at least eight grams of sugar per hundred mils. So it was a very simple message. And in terms of the actual nudge, it was very cheap to produce and then very cheap to administer. So the trial happened over 14 weeks and every alternative week,


Sue Cummings [00:06:27] We put these nudges on the shelves, in the cafes. So it was one week on, one week off. And then over those 14 weeks, we measured the sales of drinks while those nudges were on and were off and what the data concluded over those 14 weeks was that we reduced the sale of sugary drinks by 7.2 percent, but the overall sale of drinks remained the same. So leading to the conclusion that then people chose a healthier alternative during when the shelf nudges were used during the trial. So something which is very cheap, easy to administer and something which then we're hoping to upscale across the city.


Rhian Gladman [00:07:11] Do you think it was vitally important to put that nudge in at the right point in that customer's journey through the hospital cafe? So at that point of decision making about what drink am I going to get, here's a really visual kind of bright, bright red sign rather than actually when they got to the cashpoint or as they walked into the cafe.


Sue Cummings [00:07:37] The sugar and the consumption of sugar is actually through mindless consumption dependent on the environment. So we're actually bombarded with these nudges in the commercial world. You walk into a supermarket and you have the multi-buys, you have the meal deals and you don't consciously think about these, but these types of messages then nudge you in a certain direction in terms of your behaviour. So we do this unconsciously. We make these decisions without even thinking we're making them. So by having these nudges on the shelves at that point where you're making that decision, whether to have that drink or have something else is very important to have it at that point where you're actually making that purchase and that decision. If you have it before and then you come to a drink shelf, you'd forgotten that you need it, then, because it unconsciously directs you in a direction which we want to direct that consumer.


Rhian Gladman [00:08:34] So what lessons have you learned through undertaking the B-I projects such as the one you've just set out there?


Sue Cummings [00:08:42] Overall in terms of lessons learned


Sue Cummings [00:08:46]  It's a very effective and sustainable way to change behaviour. As I've just mentioned, now we've got the learnings from this.


Sue Cummings [00:08:55] We can upscale this at very little cost the shelf, nudges cost little money to administer. You need to find the right partners, though, to then administer this. So a key lane to us is starting at the very beginning and consider the partners you're going to work with in terms of how much control are you going to have over that environment. I'd say give yourself a lot of time to set something up because sometimes it may take longer to set up a trial than first envisaged, just as I've said, in terms of having to change partners partway through. It's not always the partners priority as well in terms of their day job. So you have to work with them, be very flexible in terms of what you're trialling with people and work within their environment. At the same time, you need to consider what data you have available. Ideally, you need pre-data to the trials, have data before the trial, data after the trial, and also with these types of things it would be really good to have a control group as well. Now, I'm not talking about control in a academic way, within this, trial to have our control, it's when we had the shelf nudges taken off the shelf. So we had one week on and one week off, and the week then that the nudges weren't applied was our control because you need to see would this behaviour have changed without this intervention. And so it's very important to have that sort of control that you can work out would this have happened otherwise because of other influences that may be happening. It's a hot day, it's a cold day or whatever. And that helps you understand whether the actual nudge is the reason for the change in behaviour. Data Governance is something else I'd consider at the very beginning in terms of the GDPR are rules. Is there something around those that you need to consider upfront in terms of gathering any data, is it personal data? Is anything happening in the environment around that same time that you need to be mindful of that may impact or skew the results?


Sue Cummings [00:11:17] In terms of sign up of your partners, once you've signed up your initial partner, how easy will it be to sign up future partners going forward? I've got another nudge example, which would sort of bring some of these other issues to life if it's worth me talking about that.


Rhian Gladman [00:11:40] I can just jump back. I think it's really important what you were saying about actually people substituted for another drink. It wasn't that they saw the nudge, the stop sign, and went, oh, I'm gonna leave the hospital cafe. So actually, commercially, if you're looking to roll this out into library cafes, museum cafes, other settings, the council owns cafes. It doesn't hit the bottom line. You are still buying something else.


Sue Cummings [00:12:05] Yes. Well, in terms of the future intentions of using the nudge trial, we've just built a strategy called health systems approach to healthy weight. And this trial is going to be central to that strategy so we've then spoken to other public sector partners in terms of their willingness to undertake this trial or this intervention within then their commercial settings. And we've got a lot of other public sector organisations within the city who are now on board with this approach, and willing to take this forward. So in terms of sustainability, it's something which has got a lot of sustainable future intentions for us and partners to take this on board to help with an issue that we have, not just in Liverpool, but it is a national issue around obesity and the overconsumption of sugar.


Rhian Gladman [00:13:01] It's such a good, easy project to understand. It's an easy story to tell, isn't it? You've got the stop signs to show people. It's a good one to get people on board with, isn't it? Nudge can work because it's worked with this one and it builds momentum, I guess.


Sue Cummings [00:13:17] It does,


Sue Cummings [00:13:17] And it's such an easy sign to peep at, whenever anyone sees a stop sign, it's universal in terms of its understanding, and so you don't have to explain what that sign is. It's just got a universal understanding and people can see  'stop danger', don't do this without even consciously thinking about, that's what it's telling them.


Rhian Gladman [00:13:41] Good stuff, and it would be great to hear about any other projects you've got, any other B-I projects, and I guess pulling out those top tips for others, looking to take these projects forward as well would be great.


Sue Cummings [00:13:51] So another project which we trialled and now have resorts for is increasing school attendance. So using nudge techniques whereby we send text to parents and to students, in terms of creating motivation and a conversation outside school between the child and the parent with the mindset, then this extra conversation creates more of a motivation to attend school. So we trialled this over a number of secondary schools in Liverpool with the years nine, ten and eleven. The students were in a certain attendance category, so their attendance was between 80 percent and 93 percent. And then we started sending the text over a whole academic year. We've got to the end of the year and we've found that with years nine and 10, we've increased attendance between those that received the trial and those that didn't by 1.9 percentage points, which in terms of school attendance results is very good. So we're very pleased with the outcome of that. And something again, once you trial something and you know it works, it's something that becomes very sustainable. We can now produce a toolkit for secondary schools, put them to self-administer this. We don't have to be involved going forward. We have to just give them the information of how to do it, when to do it and the texts. And then the schools can self-administer this and be in charge and control then of their own attendance strategy that we've we've set up and shown it works, and we've given the evidence so something which can be done at no cost to the school. The schools normally collect children's mobile phone numbers and parents, so they've got everything there, they just need. Then there's extra information which we're planning to put together for the schools and then they can just go off and do it themselves.


Rhian Gladman [00:15:59] Sue could you give some examples of kind of the wording of those texts? What kind of things were being sent out and which ones work? So I guess you say that's fantastic results around that 1.9 percent increase in attendance, which is a fantastic outcome. So if you could give more specifics?


Sue Cummings [00:16:17] It was actually, the texts were actually based on behavioural insights. So it's things like saying that the brain is a muscle. The more you use it, the more it works. Building what if plans into if a child has an issue, then that child's sort of foreseeing that type of issue and build some plans to solve that issue. So if I'm being distracted by my phone going off while I do my homework, I will always turn my phone off while I'm doing my homework.


Sue Cummings [00:16:49] So it's simple sort of learning tips and motivation tips then got that child sort of more focussed on the work, on the school, and it gave things also like revision tips and gave them different resources to go and look at and sort of learn more about how it's best to learn what does work and what doesn't work and so on. So it's based on sort of the psychology of how the brain works. Then we've just shared that knowledge with children so that they that it's sort of sparked their interest in terms of what they're doing and how they're doing it and then how they can make it better.


Rhian Gladman [00:17:33] So it's almost pre-empting things that could affect attendance and actually having a plan in place for if that arises, I will do, x, and starting to build that resilience, I guess.


Sue Cummings [00:17:44] It does build resilience because the pupils that we chose for the trial are ones that do have sort of issues with attendance.


Sue Cummings [00:17:52] So we chose those pupils specifically to change their behaviour. So by using this this technique, we've sort of proven that it in terms of certain cohorts of students, then they are more willing to take ownership of their own, sort of future and learning environment. Now, something to bear in mind is nudge


Sue Cummings [00:18:16] Techniques. You need to consider the audience that you're targeting them at. So with this particular one, we chose children with attendance of 80 percent above those below would need a completely different approach, maybe more of a one to one type approach in terms of mentoring and sort of face to face engagement with that child. So to bear in mind, you do need to consider the audience that you're targeting these two and how effective that's going to be to the audience, because it's not always going to work with everybody. And so you do need to consider if there's something different in terms of more complex needs that's needed, in terms of more one-to-one hand-holding, understanding maybe more ingrained reasons why that child isn't going to school. So it's just sort of not always a caution, but just from experience, you do need to understand the behaviour you're looking to change and the target audience that you're looking to change it within and understand sort of how much how effective it is going to be with that target audience.


Rhian Gladman [00:19:26] Yeah, makes sense, definitely makes sense in terms of, obviously, you've got the 1.9 percent increase in attendance, has there been any change in terms of the academic results of that group or their plans to look into that?


Sue Cummings [00:19:39] Right. There are plans to look into it because I would be very interested to find out, because a lot of the tools and techniques were giving them more information of how to sort of revise better, or to do homework or to study in a different way. So it's something we are looking into with those schools in terms of academic and attainment. Just to see if there was a difference within that as well. So it's something I'm very keen to look into.


Rhian Gladman [00:20:07] And there are plans to roll that out to other schools across the city?


Sue Cummings [00:20:12]  Yeah, we're at a very early stage.


Sue Cummings [00:20:16] And my recommendation to the senior people within the council is to make the recommendation that we produce a toolkit for secondary schools to then implement this themselves, which given the information we've learned, will be very easy for them to do.


Rhian Gladman [00:20:33] So, a question we like to always ask about leading thinkers in behaviour insights cos government which say you definitely are one, you've been doing this for a long time now, so I'm keen to understand where do you see behavioural insights going in local government?


Rhian Gladman [00:20:47] Where do you see the kind of future trends and opportunities not just for Liverpool but I guess across our sector?


Sue Cummings [00:20:56] Okay. So over the past three or four years, while I've been working with behavioural insights, I've found that there's a lot more subject matters that people are applying behavioural insights to. So when I started this, it was mainly health health agenda that people are applying them to. But over the past three, four years, I've seen councils and ourselves applying it to a whole range of different services. And this could be littering, fly tipping, recycling, overpayments of housing benefit or even increasing resilience. So the subject matter that this can be applied to is limitless. It could be applied to any issue that you have or any service. So in terms of the future, I believe it's certainly got a future in terms of local government. But in terms of its awareness, I still believe that some awareness raising is needed, and its full understanding, appreciated. There's still confusion, I believe, across within Liverpool City Council and other councils, the difference between things like campaigns, communications, marketing, social marketing, nudge and behavioural insights. And I strongly believe that if we can sort of raise awareness of all those different disciplines, then we can start to embed this more into services on issues that we have within local authority. So in terms of the future, because of what we've already trialled and what we've found, we know it is something that's sustainable, something which is effective and efficient, use of resource and time and something which works and can change behaviour in a positive direction given the budget issues that a lot of councils have now, it's got to be something which is firmly embedded into councils to help them understand their consumers and how we then adapt to consumer needs and service those consumers.


Rhian Gladman [00:23:03] Definitely would agree with you there. But yeah, that point around awareness raising around these different type of disciplines and always communications around the communications, really. I think that's a vital point. And the subject matter is limitless I really think, you know, the sky's the limit with this stuff, isn't it? What it can be applied to, is exciting.


Rhian Gladman [00:23:25] And so just to finish off, we would like to get your take on what your top tips are really, you've alluded to a few as we've gone through. I just think it's really vital to make it really clear for the listeners that they can take away top tips like we want them to get started and have a go on their own behavioural insights projects. So if you were speaking to yourself at the beginning of this journey, what are those top tips you would give yourself really on this work?


Sue Cummings [00:23:53] From the very beginning


Sue Cummings [00:23:55] When you start to consider behavioural insights, you need to consider, maybe try and look into the future.


Sue Cummings [00:24:00] So if this nudge was successful, could it be upscaled? And if so, what would it solve?


Sue Cummings [00:24:08] So.


Sue Cummings [00:24:10] In terms of the issues that you're looking to solve, you need to fully scope out at the beginning, what are the issues you're trying to solve? And then if you solve those, what effect would they have and then could you upscale the nudge technique to make it sustainable in the future.


Sue Cummings [00:24:29] So that's something which I firmly believe we need to consider at the very beginning to make sure that what you are going to attempt in terms of a trial is something which is going to make a difference going forward. Consider is there going to be any future costs in terms of then if you do want to roll out the nudge technique and if you consider that at the very beginning, you can then pre-empt in terms of cost effectiveness and design something that could potentially cost you nothing in the future to upscale and roll out. Stakeholder engagement is something else, which is something which is very important from the beginning.


Sue Cummings [00:25:14] Consider all the stakeholders that you need to sort of build relationships along the journey and make sure then those stakeholders have the same vision as what you have, in terms of the intentions of the nudge and what it's going to solve. Going forward.


Sue Cummings [00:25:35] And above all, give it a go. It's a trial. Sometimes it will work. Sometimes it may not. We have to try these things to see if they're going to work. There's not always evidence out there. My philosophy is you don't always have to do something that is evidence based. Give it a go. We can create our own evidence. We're trialling these things which could have huge impact, which haven't been trial before. And if we get it right, we can be the trailblazers of sort of making the understanding of nudge demystified. And I strongly believe that it's got a lot of potential. A lot of potential. So give it a go. Have fun, there's a lot of people out there that are willing to help and provide guidance, expertise if needed, if it's needed, go find those people, I'm sure they're going to be more willing to help and give it a go.


Rhian Gladman [00:26:36] Excellent stuff. Thanks Sue, a clear message there from everyone to give it a go, start something, have a go at your behaviour insights projects.


Rhian Gladman [00:26:43] We have got all of the reports and also stop signs and all of that stuff is on our website from the Liverpool Fizzy Drinks trial. And if you basically go on to and search for behavioural insights, the Liverpool Project is on our website so you can pick up all of the learning and give it a go in your local area.


Rhian Gladman [00:27:08] If you enjoyed the podcast, please do pass it on to your friends or colleagues and help us spread the word. And again, thank you very much for listening.