King's Fund unlocks the workings of the NHS Article icon


When the first album has been such a runaway success, inspiration for a follow up can prove difficult but that is the challenge faced by the King’s Fund when it set out to update its highly popular animation explaining how the NHS works.

The King’s Fund, which is celebrating its 120th anniversary this year, is an independent charity working to improve health and care in England. The Fund achieves its mission through research and policy analysis, promoting greater understanding of health and care policy and also organising leadership development programmes.

The array of organisations that make up the health service and the manner in which they each work together coupled with the plethora of acronyms to denote different initiatives can be baffling, and at no time was it more confusing than in the wake of the 2012 Health and Care Act. The Act reformed the way the service worked, throwing out the national boilerplate and changing how local authorities and health service organisations interacted.

Such was the complexity, which baffled even hardened health professionals, that one of the Fund’s leadership development consultants, Liz Saunders, devised a session using a series of flip charts (and a dose of humour) that explained the inner workings of the NHS over the course of a couple of hours. ‘Even the experts did not necessarily understand how the Act changed the system, why it had happened and how things now worked,’ concedes Katie Mantell, deputy director of communications and information at the King’s Fund.

When Saunders announced plans to move to another role, it prompted Mantell to work with her to assimilate her session into a six and a half minute animation. ‘We sat down together for a couple of afternoons to write the script,’ says Mantell, who decided to ‘tell things as they are, providing an insight into the politics and power tensions at play’ but, like Saunders, retain a playful approach.

The animation approach took place on a white board. Starting with the basics – the electorate going to the polls to vote for a new government – a maze of pipe work built up slowly to show the connections, reconnections and links between each department, body and interested party. ‘It was an aide memoire to explain the system,’ says Mantell.

The Alternative guide to the new NHS in England proved hugely popular. It has been downloaded more than 330,000 times, making it the Fund’s most viewed ever digital content, and is used in staff inductions and training sessions. The final image, which brought all the workings into one page, was found to work on its own, providing a visual impression of the system’s complexity. People started to use it as a poster. ‘We were also contacted by people in Norway and the Netherlands asking for permission to produce foreign language versions. People like to learn from other organisations,' says Mantell. 'And Dr Phil Hammond [a practising GP who is also a stand up comedian] asked permission to use it in his shows.' 

Four years on, though, and the King’s Fund recognised that, while still a valuable resource, the animation needed updating to reflect changes that have since taken place, including the launch of the sustainable and transformation partnership model and the demise of the Coalition Government. Similarly, in 2014 NHS England had launched a new five year plan, which was a more collaborative approach than before. ‘We didn’t want to produce a second version too early, but we now felt that enough had changed and that the broad direction of change had settled, so it was time,’ says Mantell.

The King’s Fund also drew lessons from the previous animation, recognising that the script had to build up to another final image that represented the complete story. Simplification remains at the heart of the initiative though. The final image is available to download or to buy as a poster.

While the white board approach had worked well, this time the Fund used a pin board onto which it stuck images, diagrams, pictures and post it notes. ‘We used a pin board because it is like solving a mystery,’ says Mantell. ‘We are talking about the way the NHS structure works and it is a jumbled picture. On the pin board, we can move an image from one place to another, and that reflects the constant changes. Nothing is set in stone. It is a metaphor.’ There are even ‘in jokes’ for industry professionals. For example, a caricature of Simon Stevens, head of NHS England, fluctuates between having a beard and being clean shaven.

The animation was released on 18 October. ‘We did lots of outreach work to encourage other organisations to share it in their bulletins, our senior staff shared it with Parliamentarians and other senior stakeholders, and we did some internal communications to help leverage people’s personal networks,’ says Mantell. ‘We ran an internal competition asking staff to share the animation with at least three people who they wouldn’t normally share the Fund’s work with. There were [chocolate based] prizes for the person who had shared it with the most people and the person who shared it with the most amusing person.’ One staff member shared it with the creator of Bob the Builder while others shared it with Hillary Clinton and Donald Trump, who recently expressed surprise that health care was so complicated.

In the first month since launch, the animation has been viewed more than 50,000 times, including 10,000 times on Facebook. ‘We are really pleased. The interest has really been prompted by word of mouth and people sharing the video on social media. People have been saying You really must watch this.’ The second animation is well on its way to beating the first version’s record.