When responsibility for public health transferred to local government in 2013, HIV rates in London were rising. In 2012 the capital accounted for 48 per cent of all new diagnoses in England, while 19 out of the 20 local authority areas with the very highest diagnoses rates were in London. Paul Steinberg, lead commissioner and programme manager at The London HIV Prevention Programme (known to the public as Do It London), explains how effective stakeholder engagement and clear communication brought all 33 London boroughs together to tackle the issue and deliver change.
HIV prevention is a core part of delivering public health services in London, but the best way to achieve it has been the subject of debate. Before it became the responsibility of local government, primary care trusts took the lead in this work, but previous programmes had been patchy with varying degrees of success or evidence from which we could build on. When local government took over responsibility there was an appetite to illustrate that councils could be a leading force in tackling the rise of HIV, but there was a nervousness about embarking on another collaborative approach, particularly giving the fact that public health funding was devolved to councils at a local level and the issue was more prevalent in some boroughs than others. The challenge was to demonstrate the need and benefits of working collaboratively across the entire city, with its thirty-three authorities, to build trust and confidence amongst stakeholders and communities and ultimately reduce the rates of HIV in the capital.
The solution
We began by taking a formal request to carry out a needs assessment to the leaders of all London councils. This not only ensured that our future proposals were firmly rooted in insight and evidence, it also immediately engaged politicians from the very beginning. As key stakeholders and decision makers their early involvement was crucial in helping to get political support for this work and enabled us to navigate past variations in who had local responsibility for managing public health budgets.
With the needs assessment setting out the scale of the problem, the leaders of all London councils signed off proposals for a pan-London, collaborative approach and we began more concentrated lobbying work to promote the benefits of tackling the crisis in this way. We conducted regular meetings with directors of public health, members and other key stakeholders to discuss and develop the issue – maximising opportunities to engage them individually and through forums where they already collaborated or met together. We used our networks and stakeholder knowledge to adapt our messages to focus on the issues of greatest resonance to each audience – whether that be the political, medical, financial, or social.
We also ensured that our lobbying work was underpinned by a practical plan. We outlined a financial proposal which showed that boroughs would pay an annual contribution to a pan-London HIV prevention programme which would be proportionate to data collected from the Survey of Prevalent HIV Infections Diagnosed (SOPHID). Importantly, our plan also highlighted that the individual cost to councils would be less than before due to one borough, Lambeth, taking over responsibility for the management, commissioning and delivery of a pan-London programme, alongside a more strategic and in-house approach to communications.
Previously, the impact of direct communications about HIV prevention had differed significantly due to local variants in budgets and resources. Moving towards a pan-London approach to communications, which would be led by Lambeth, meant that all boroughs would benefit from economies of scale and would provide greater opportunities for larger, more coordinated, and more strategic communications across the city.
As part of working in this more strategic way we commissioned more research which revealed that around half of HIV transmissions are due to people not knowing that they have the virus. We therefore focused on communications that emphasised the need to get tested in the first phase of the campaign, alternating with messaging around condom use and other prevention methods.
We developed a brand – Do it London – which used eye catching visuals and bold messaging to attract attention and tackle the need to get tested head on. We used a range of channels to share this message across the city, from outdoor advertising, social media activity, press and PR work and more targeted, local events to amplify the message. Crucially, we also invested resources into developing our web information to allow people to find out information privately.
Alongside our messages encouraging people to get tested we developed new messages around safer sex methods, including the new technology known as PrEP (Pre-Exposure Prophylaxis), and ran these across all channels as part of the further development of the Do It London brand in 2017. We increased our activity on this issue at several targeted points in the year where risk levels might be higher, for example, during the London party season over Christmas and New Year.
The impact
Focusing our activities on direct stakeholder engagement and strong strategic communications helped us to develop a huge suite of materials and messages that could be used across a range of channels and for a number of different audiences. This not only strengthened the Do It London brand we had created, it also enabled stakeholders to more easily show their support for the programme as it was extremely visible and tangible. This approach also widened our reach, as our communications materials were perfectly placed to cascade our messages across the entire city, enabling us to continue focusing our immediate resources on influencing senior officers, politicians, and directors of public health – a task that was made easier as public support for the campaign began to gather pace.
Most importantly, the statistics on HIV incidence began to reveal a direct correlation between the years we have been running the campaign, and the reduction in diagnoses of HIV. There is still a lot of work to be done, by the level of reducing which perfectly illustrates the value of investing in communications and stakeholder engagement.
Why it worked / how we’re sustaining it
While lots of elements contributed to the success of the pan-London programme, from a communications and stakeholder engagement perspective our approach worked because we recognised the need to adapt our messages to our audiences and communicate the issues of important to them in a language they recognised. While we had core key messages, we had flexibility to emphasise different key issues to different groups. We also maximised opportunities to engage key stakeholders as a group wherever we could. The spread of London makes it difficult to meet all the key people from all the borough individually and repeatedly.
There were however multiple opportunities to meet with stakeholders as a group, for example, through the London Councils Heads of Communications Network, which helped us bring our message to one place, rather than repeating ourselves multiple times over. This helped us to achieve a big impact in a short space of time, make best use of our resources, and free up capacity to keep developing an eye catching public-facing brand that would resonate with communities.
Lessons learned
The importance our engaging with networks cannot be underestimated as forging, developing and strengthening key relationships with stakeholders is absolutely critical for making a programme like this a success. For the many councils involved in this programme, it also illustrated the value of strategic communications – not just for getting messages out, but for changing behaviours, and in this case, lives. Over the years many organisations had reduced their communications capacity but a programme like this highlights that that is a false economy. Good communications can make all the difference to improving the lives of the people your serve, especially when it comes to public health.
Want to know more?
For more information please contact Paul Steinberg, lead commissioner and programme manager, Do It London.