Innovation through technology

By Alex Drinkall

Innovation is a much-used word within the NHS and as a word I associate with being aspirational I encourage its sentiment. However, as a communications professional working in the NHS it is important to remember: innovation is relative.

You’ll learn:

• A lack of access and acceptance can create barriers to technology adoption and therefore innovation
• Teams need to consider ways to address digital illiteracy for innovation through technology to succeed
• Strong internal comms is the only way to raise awareness and secure engagement where there is a call to action, particularly with a disparate and busy workforce

Equipping the workforce

Our lives are increasingly digital and we use technology every day, both personally and professionally, whether we like it or not. 

There is often the assumption that technology and innovation go hand in hand, but the opposite can in fact be true. For example, innovation can be stifled due to barriers to technology when it comes to access and acceptance. 

We see barriers to technology and digital acceptance within the NHS, which often reduces opportunities for innovation within health and social care too.

Health Education England’s (HEE) Technology Enhanced Learning (TEL) Programme has the vision that healthcare should be underpinned by education and training which is enhanced through innovation and the use of existing and emergent technologies and techniques. 

The work of the programme includes breaking down some of the barriers experienced in the NHS in terms of accessing technology. 

There is also an understanding that to embrace emerging technologies, the workforce needs to be digitally literate, so the team has been working to understand what is required to equip the workforce with the digital capabilities for living, learning, working, participating and thriving in a digital society. 

Achieving the aims of the TEL programme relies on engaging with the workforce to understand the current situation, how it could be improved and working to develop the solutions.

Health Education England’s digital capabilities


As a communications professional working in the NHS you have to find workarounds for engaging with the disparate and busy workforce to share educational resources and gather insight to inform future work. 

The NHS employs more staff now than at any time in its history and while technology has opened up opportunities for communicating with the workforce, it is still a huge challenge.

Engagement techniques

e-Learning for Healthcare (e-LfH) is an HEE programme that works in partnership with the NHS and professional bodies to support patient care by providing e-learning to educate and train the health and social care workforce. 

HEE e-LfH is currently developing and delivering more than 100 e-learning programmes comprising over 10,000 e-learning sessions covering subjects from audiology to anaesthesia, dentistry to dermatology, safeguarding to statutory and mandatory training. 

e-LfH is well-loved and well-used by those who know about it…and this was our challenge.

In Autumn 2017 we launched a campaign to raise awareness of the e-learning programmes with the target audience being the NHS workforce, for whom the resources can be accessed for free. 

The campaign was social media-led and we directed specific professional groups (midwives, surgeons, occupational therapists, GPs, medical students etc) to e-learning programmes relevant to their roles. 

We felt the approach was quite innovative – for the NHS – as we used informal, often clichéd, puns as the narrative hooks, which were complemented with high quality images including real members of the workforce doing their job or accessing e-learning. 

We launched the campaign across Facebook and Twitter and within its first week we saw an increase in new registrations to the e-LfH Hub of 175% compared to the same week the previous year.

We followed the campaign’s launch with the development of a toolkit of assets (posters, flyers, web banners etc), which we shared with communications teams in NHS Trusts and organisations throughout the country. 

The ask was for communications colleagues to localise the materials and share the information throughout their organisation to encourage even more members of the workforce to access the free e-learning programmes.

The next phase of the e-LfH campaign is currently being planned and will be rolled out using a similar model.

Twitter chats as a data gathering exercise

One key challenge for the TEL Programme and other parts of the NHS, is getting feedback from members of the workforce on projects that are being shaped and ensuring any feedback gathered is multi-professional. 

Getting such feedback is crucial to allow the NHS workforce to increase the relevance of proposed solutions. An incredibly useful channel for us to fulfil these requirements has been Twitter and more specifically Twitter chats.

We have worked with WeCommunities to run a series of Twitter chats on subjects including: simulation, digital literacy, barriers to accessing technology, e-learning, mobile device interaction, artificial intelligence and sharing resources and innovation. 

With the help of these chats we have engaged with nurses, midwives, health visitors, AHPs, paramedics, doctors and others. 

The hour-long chats are hosted by the WeCommunities team. The TEL Programme recruits colleagues in advance to be part of the expert panel, adding context and their own experience on the subject to the discussion. 

The pre-agreed questions are asked at intervals during the 60 minutes and members of the Twitter community respond to these questions, giving their own thoughts on the discussion points and how the issues relate to their professional practice or organisation.

Not only do we gather rich insight from the workforce to inform our work during these chats, but we also connect with people who are interested in what we are doing, who often become involved in the projects long after the Twitter chat has finished. 

Building that network is so important to the future of healthcare communications and is still a key challenge – admittedly it’s easier now than it was seventy years ago when there wasn’t the technology to help.

Innovation is here to stay

Innovation will continue to be key to the digital transformation of the NHS and its workforce in the coming years.

How communications teams support that work is vital and is intrinsically linked to communications being seen as a strategic corporate function – but that’s another drum to bang. 

The role I have to play as a communications professional working in the NHS is to support the work happening to ensure staff have the skills they need to respond to and adopt the emerging technologies and innovations. 

However as much as digital is becoming and for some already has become, our lives – the heart of the NHS must continue to be built around compassion and care with digital and the technological advancements being part of the everyday and enhancing that care, rather than something extra.

Technology has without a doubt helped NHS communications professionals to engage more widely, but that doesn’t always mean we are using the most innovative of practices, techniques or channels. Innovation is relative. 

In an organisation that is such an institution we have to use what is available to us that is most effective in helping us to realise our aims and objectives. 

What is innovative to one communications professional may not be to another – but surely, the skill and success in our profession is understanding.


Alex Drinkall is a freelance communications professional with over 20 years’ experience of working predominantly across the health, social care and education sectors. She has worked both inhouse and agency side for clients including Health Education England, Yorkshire Ambulance Service, Macmillan Cancer Support, Public Health England, Higher Education England and several primary care and acute hospital Trusts.

Twitter: @AlexDrinkall127 and @HEE_TEL




Selling to the NHS to enable its digital transformation

By Ben Judah

DrDoctor is a digital health company transforming the way hospitals and patients communicate, by using technology to tackle the financial strain on the NHS - one hospital at a time. We bring patient correspondence into the 21st century, to automate processes, collect outcomes, measure value and drive down costs. Our platform improves appointment scheduling, increasing clinic efficiency by reducing no-shows and filling empty slots. 

You’ll learn:

• Why the NHS doesn’t (like) change and how to achieve ‘gentle disruption’
• That even with big organisations you’re selling to a person, not a company
• Why slow and steady will always win the race

Why the NHS doesn’t (like) change

Consider Atlas – the Titan holding the world. Any slight shift in bodyweight or adjustment to the weight of the globe resting on his shoulders could result in disaster. 

The NHS is an organisation with around a quarter of a billion patient contacts per year. The risk that ‘change’ brings is colossal and because of this, the idea of ‘disruption’ is justifiably terrifying. 

It is for this reason that we at DrDoctor practice and preach an iterative approach – what we affectionately call ‘gentle disruption’ – where change is introduced in an evolutionary, patient and well-planned way.

This type of change has to come from the inside out, with the proponents of change listening to stakeholders at every level, aligning motivations and incentivising all those involved. From the patient to the admin team, doctors to senior managers, everyone must have the same goal and be pulling for the same outcome. 

The NHS is an organisation that is wary of change, but it is the opposite of an organisation against change. On every level, digital transformation is viewed as an opportunity if done right.

Selling to people, not companies

No company has ever bought anything. B2B versus B2C is more of a change in process than actual change in buyer. 

It would be an error of judgement to view a company, business or indeed government as the final purchaser of any product. There is always a person (or people) involved at every stage of the decision-making process. 

Different products or services are interesting to specific groups of users within the NHS and helpfully, they are signposted by job title. For example, being a technology business, we are interested at speaking primarily with CIOs or CCIOs (Chief Clinical Information Officers) within an NHS Foundation Trust. 

Unfortunately, within an organisation the size of the NHS, roles of this nature rarely share the exact objectives or responsibilities. Different Trusts and hospitals naturally have different technological needs. This means it is imperative to understand:

• Who cares about the obstacle we are trying to solve enough to deploy sizable chunks of their energy to solving it?

• Who has the decision-making power to implement it? (This is not always the same person as above)

• Who controls the budget to make this happen?

• Are there stakeholders who may raise objections?

Once we have identified these individuals, we can move forwards with the process of selling our solution. In a simple case, this can be one person, but it’s always best to be prepared for multiple stakeholders.

Selling technology in the NHS presents a unique challenge – forward thinking individuals who understand the benefits of new technology and can deliver results are often moved and can occupy a range of positions at various hospital Trusts. 

These movers and shakers may not be able to complete the project you started with them, therefore getting the buy in from those surrounding the role is crucial.

Slow and steady

The tortoise and the hare is a great analogy when trying to sell to the NHS – slow and steady wins the race. Designing your sales funnel to fit the style of long term relationship building is key. 

The average sales cycle from initial contact to signed contract can be around 18 months (aeons in the tech world) and where people are moving job roles at an increased rate this presents a unique challenge. 

Our cofounder Tom Whicher is an alumnus of the NHS Innovation Accelerator and has had the fortune of developing close relationships with many of the best and brightest people in the NHS. It is these relationships that make a difference. 

Regardless of a person’s position at the outset, having close ties to smart, motivated and driven people within the NHS is a great position to be in. These individuals will rise to positions of influence and will be conscious of companies who are their ‘new found friends’ following promotion.

When selling into healthcare and especially into the NHS, patience is the answer – regardless of the question – but momentum relies on nuance. It is the responsibility of the innovator to drive the project, ensuring that it doesn’t stagnate, while remaining sensitive to the buyer’s cautious outlook and need for time. 

It would be an error in judgement to assume that because your company’s product or service is being discussed internally a sale will come to fruition. Instead, the first step of the process has begun and as the innovator you must be the engine of change, swapping gears where necessary. 

The proof is in the pudding

Three years ago, our co-founder Tom Whicher met with Jenny Thomas, the general manager for Women’s Services at Guy’s and St. Thomas’ at a networking event, where they discussed one of Jenny’s major aims for the year - the reduction of DNA rates across her department. 

The next few months had Tom meeting with Jenny and her team, drawing up various solutions, but each struggled when it was introduced to the IT and Information Governance departments at the Trust. 

Their concern with security and ‘new way of working’ pushed them to err on the side of caution when embracing new technology, especially from a newer company. Jenny and Tom then agreed to create a Proof of Concept trial across her department, manually processing the data in a secure environment. 

The results were astounding, but rather than going straight back to the previous blockers, Tom invited around 15 other general managers from Guy’s and St. Thomas’ to a pizza and beer learning session. 

They discussed openly the concerns, data driven insights and results from the Proof of Concept trial and through constructive dialogue throughout the evening, piqued the desire of the others in the room. 

This led to a full-scale procurement process of the DrDoctor platform throughout the Trust, with a successful rollout to all outpatients’ departments beginning in April 2016. This has led to a 30% reduction in DNA rates and savings of £2.6 million within the first year of full deployment. 

The NHS has achieved an impressive amount in the last 70 years, but in relation to the illustrious history of the United Kingdom, it is still a baby - these years are formative and the need to embrace change is profound. 

There so is much to develop, learn and improve and if done correctly – pragmatically, powered by internal stakeholders and fuelled by innovators – we will surely leave a legacy for decades and even centuries to come.


Ben Judah is the Head of Marketing and Communications at DrDoctor.

Twitter: @BenJudah and @WeAreDrDoctor

Doing digital: Evolving the public and patient interface in health through technology

By Rachel Royall

Modern medicine and healthcare relies on modern technology and communication. So in the evolving world of digital, how is the public and patient interface in healthcare changing and what are the implications for public relations practitioners for the future?

You’ll learn:

• About changing habits in how the public are seeking and accessing healthcare
• Why dedicated and professional communication is required to build public understanding and trust as the digital transformation of the NHS takes place
• How communicators have the access and the influence to champion the role of patient and public centred design and services

A digital transformation

In our everyday lives we embrace technology from shopping online and sending photos and messages to friends via various apps, to using voice recognition to tell us the weather. 

We’ve embraced and adopted technology throughout our lives with what seems like relative ease. 

Of course, we all know people who have been slower to buy the latest smartphone, or who still choose to pop into the local Sainsbury’s rather than order online, but overall technology has pervaded every aspect of our lives.

In healthcare though there is something of a dichotomy. Computers were first used in the NHS for administrative purposes in the 1960s. Since then we’ve come a long way with advancements in robotics, artificial intelligence and precision surgery. 

So why is the NHS still the biggest procurer of fax machines? Why are we still spending so much on post as opposed to embracing email for patient communication? 

On the one hand the patient interface with the NHS is nothing short of miraculous as new technologies are used to treat and cure illness and disease, transforming the dynamic between patient and care giver, yet on the other hand we are slow to adopt technology for patient communication, (apps, text, email), even though it has been widely used in other sectors for the last decade.

Digital transformation has the potential to completely change the way the public engages with healthcare. 

In the UK technology has changed the way individuals access health services. For example, the original concept of 111 was telephone advice by a remote health care professional and this is now evolving to an online channel that will enable an online consultation. People will be able to receive advice, guidance and potentially manage their journey to a GP, pharmacist or even a hospital via the internet or on a smartphone.

The patient and public interface with health professionals is becoming more informal. In some areas, people no longer have to wait for a fixed appointment to ask a doctor a question and can send a secure message via their health record to their GP, or skype our doctors so they are able to offer diagnoses or treatment via phone or computer. 

The digital revolution not only impacts on how we access services, it also impacts on how we obtain information about our health and manage our care. On Google one in five internet searches are healthcare related. 

More than 1.5 million people access NHS Choices every day to seek advice about healthcare. As patients and the public become more knowledgeable and more informed and they increase their access to digital services, it is inevitable that the ways that patients and the public access the NHS will continue to change.

The implications for public relations practitioners

There are challenges and opportunities for public relations practitioners in embracing the digital revolution in healthcare; digital transformation is mission critical, public trust is essential and the dynamic of power between professionals and patients is changing.

The population is growing and changing, putting additional demands on the NHS and social care. The Office of National Statistics has projected that the UK population is set to pass 70 million before the end of the next decade. 

It also highlighted the ageing nature of the UK population. In 2016 there were 1.6 million people aged 85 and over and by mid-2041 this is projected to double to 3.2 million. 

Technology can help deal with demands in healthcare, as societal change embraces the fact that many things, but not all, can be done without direct face-to-face interaction. 

Targeting the dissemination of health information to the right audiences at the right time to encourage self-care can help to reduce demand. 

Using digital technology well can free up more time for care givers to spend face-to-face with the patients who need that care. It’s all about giving people the right care, in the right way, at the right time. 

Embracing digital across the health and care sector isn’t optional, it’s business critical and the PR community is well placed to amplify this message, to encourage adoption and also to support leadership teams to understand the changing environment. 

To use the words of Robert Watcher: “The one thing that NHS cannot afford to do is to remain a largely non-digital system. It is time to get on with IT.” [1]

Public trust

The simple reality facing us is that without public understanding and professional engagement to build trust, we won’t deliver the potential of digital technology in healthcare. 

The NHS is one of the most trusted brands in the world with 98 percent recognition. However, the Edelman Trust Barometer shows us all that public trust in institutions is declining. Not only that but alongside immigration one of the issues that Britons are most fearful of is the pace of technological change. 

Against a constant backdrop of media crisis, the public relations profession has a key role to play in helping to build public trust in the use of digital technology for healthcare, both in terms of technology for patient care and moving information around the system and using it to improve things. 

Tactically we can help build trust by being proactive about communicating the benefits of using healthcare data for research, by encouraging the adoption of digital technology that is already in place and by explaining how we keep personal information and systems safe. We also need to be transparent when things go wrong and be open about progress and challenges. 

All of this is essential to building public trust. And whilst trust in politicians is at an all-time low, there is a huge opportunity for the NHS workforce to be advocates as trust in doctors and nurses is still high at over 90 percent. 

To truly benefit from the opportunities that digital can bring, we need the support of public relations professionals to bring doctors, nurses and all other healthcare workers with us. 

There is a piece of work here to truly engage those managing and designing healthcare systems and those delivering care, as well as to understand and respond to any concerns and to support them to see how embracing technology could transform their practice and free up more time at the patient bedside.

Patient power

Improved access to information and technology in healthcare shifts the dynamic of power between healthcare professionals and the patient – it increasingly puts patients in the driving seat, as they have more access to their own information. 

There is also a tension between care and technology, some systems feel clunky for nurses and doctors – they get in the way of the human relationship. The language and tone can sometimes feel inaccessible, using systems sometimes doesn’t feel human. 

Above any other profession, PRs have the access and the influence to champion the role of patient and public centred design and services, improving them for the patient and healthcare professional alike. 

PRs can help leaders listen to the public, access insight and develop technologies that meet public expectations. Also once patients understand the benefits to their care they can be a catalyst for change. 

The digital revolution in healthcare will continue apace over the next thirty years and will be unrecognisable to those of us who get to celebrate the 100th birthday of the NHS. However, it is a huge opportunity and communication is at the heart of it. 

The collision of information, technology and communications will continue to impact on the public and patient interface with the NHS. The technology in some ways is the easy bit, as the technology develops, the communications and PR profession needs to take its rightful role in the leadership of the digital agenda.

The digital transformation is not only business critical in medical innovation but also in communication innovation. 

Only through professional and ethical PR can we build public trust and only through helping our organisations listen and understand the needs of NHS staff, patients and the public will we develop services that meet their future needs. 


[1] P.6 Watcher Review:


Rachel Royall is an experienced Board level communications and engagement director and is currently the Director of Communication for NHS Digital, the government arms-length body responsible for implementing digital transformation across the NHS and health care in the UK. Rachel has held senior level communication roles across the public sector, including the NHS, HM Revenue and Customs, Cabinet Office and Department of Health. Graduating from Kings College London with a degree in Theology, Rachel has an MA in Public Communication, a Diploma in Strategic Communication and is a member of the Chartered Institute of Public Relations and the Institute of Internal Communications.

Twitter: @RachRoyall

Achieving public health behaviour change

By Alexia Clifford

Changing people’s behaviours, especially when they are ingrained, is no easy feat. It takes audience insight, coupled with a focussed drive to raise awareness, as well as long-term engagement. Results can take years to achieve but the investment required is more than worth it in terms of health outcomes and a reduction in care costs to the state.

You’ll learn:

• How good social marketing campaigns have audience insights at their heart
• How solid measurement and evaluation enables campaigns to be more agile, responsive and therefore successful
• How personalised marketing and digital innovation can significantly help change behaviour

Change for the better

Public Health England’s (PHE) Social Marketing programmes are designed to motivate and support millions of people to make and sustain changes that will improve their health.

All of our campaigns start with insight into people’s lives. We take an audience-centred approach, which means that we work to understand how people live, how they feel about health and what it means to make good health a part of daily lives. Audience insights help inform our campaign strategies as well as the creative ideas at the centre of our campaigns.

We take evidence-based public health guidance and repurpose it. We make it user-friendly, accessible, shareable, ownable, personalised, dynamic, actionable, rewarding and, when appropriate, fun.

We use a range of behaviour change models to guide our planning, recognising that different models are suitable for different issues and audiences. For example, what may work for youth resilience may not be appropriate for healthy eating.

Rather than telling people they will feel better if they change their behaviour, we create tools that nudge people into the desired behaviour and then help them notice how much better they feel as a result.

We build on and contribute to, the evidence base for key public health challenges. Our evaluation framework allows us to pinpoint which elements of a campaign are working most effectively and what needs adjusting or improving. 

As well as looking at activity and reach across paid, earned, shared and owned channels and awareness and engagement, we look at claimed and actual behaviour change. 

Every PHE marketing evaluation follows our framework, although the combination of evaluation tools, techniques and data points varies between campaigns to reflect differences in each campaign’s objectives and structure.

Saving lives and money

The Act FAST campaign for stroke is one of our longest-running and best-evidenced campaigns – raising awareness of the symptoms of stroke and encouraging people to dial 999 when any of the signs are noticed. It was launched in 2009 and has been creatively refreshed several times.

Since launch and as at 2016, at least 5,365 fewer people have become disabled as a result of a stroke, giving a return on investment of £28 for every £1 spent. And in terms of behaviour change there has been a 78% increase in calls to 999 for a stroke, contributing to saving around 12.2k additional quality adjusted life years, a saving of over £410m in benefits to the state and reduction in care costs as a result for the same period.

An example of personalised marketing: Stoptober

Many smokers struggle to quit and need motivation and support. Now smoking rates have fallen from 20% to just over 15% of the population, smokers are also becoming harder to reach. We wanted to find the most efficient and cost effective to reach them.

We decided to use personalised marketing and the power of data to reach our audience. Personalised marketing, also called one-to-one marketing, involves using data analysis to deliver individual messages, promotions and product offerings to existing or prospective customers.

Stoptober 2016 employed a new data strategy – combining Facebook data, search and PR – which enabled hyper-targeting of smokers on social media. This involved:

• Building an Interest audience using audience behavioural data on the Facebook platform, for example users that ‘liked’ smoking related pages

• Retargeting smokers based on their engagement to previous PHE campaigns, for example those who engaged with the Stoptober Facebook video.

• Using combined survey and panel-based data to identify people who had responded as being a smoker and sending them relevant Stoptober content.

To increase engagement, we also partnered with Spotify to create a series of Stoptober playlists to reflect the various emotions that quitters experience during their 28 days - from hope, excitement and nervousness to elation. This was promoted via Facebook and through consumer PR with celebrity DJs discussing their playlists and smoking stories.

The results were impressive - we drove 16% of smokers to make a reported quit attempt and we increased the efficiency of our spend through reducing media wastage significantly (90% of social impressions were delivered directly to smokers).

An example of digital innovation: Start4Life – Breastfeeding Friend Alexa Integration

In England, almost three-quarters of women start breastfeeding when their child is born, however by weeks 6-8 this drops to 44%, making our rates among the lowest in the world. 

Online search for breastfeeding support peaks between 2am and 6am, when technology can play a complementary role to the vital support offered by healthcare professionals. We worked with midwives, health visitors and mothers to create new tools that could provide helpful advice at any time of the day or night, quickly and easily.

We developed a new ‘Breastfeeding Friend’ Facebook Messenger bot [1], an AI powered product that provides a simple interface via text-based conversations, just like interacting with a friend on Messenger. The bot is designed to provide information any time the user needs it, such as how to establish breastfeeding and check your baby is feeding well.

Over 20% of new first time mothers interacted with the Breastfeeding Friend bot during its first

month; 46% of whom signed up to receive motivational push messages, which enjoyed an exceptionally high average opening rate of 90%.

Building on this success, we partnered with Amazon to recreate this experience on the Alexa platform, moving from text-based interaction to voice interaction with Alexa. Together we built an app (or ‘skill’) for Alexa allowing mums to talk to any device running the voice assistant in order to provide help, support and advice around breastfeeding entirely through natural-voice conversation, making the experience more personal and “human”.




Alexia Clifford is Deputy Director of Marketing at Public Health England, an Executive Agency of the Department of Health. Alexia has led a number of highly successful, flagship social marketing campaigns including Change4Life, which encourages millions of families in England to ‘eat well, move more, live longer’, Stoptober, which has helped more than a million people to quit smoking and Be Clear on Cancer, which has helped to save hundreds of lives through earlier diagnosis. Alexia is a communications and marketing professional with more than 15 years’ experience across the public and private sector. She has an MSc in Mathematics from Cambridge University and an MA in Film Studies from the University of Westminster.

Twitter: @PHE_uk

Managing consultation and the major change process in the NHS

By Stephanie Hood

Successfully managing large-scale service change in the NHS demonstrates perfectly that excellent communications practice is no longer all about shaping perceptions but working with audiences to shape realities together.

You’ll learn:

• Major change requires capacity, capability and dedicated resource
• Co-design is the only way to develop new models of care
• Expectation management is critical to successful outcomes

Managing change means difficult decisions

Why is it we regularly see impassioned crowds outside hospitals waving placards to protect services that we know don’t always consistently meet quality standards, or which are no longer being delivered from the most appropriate place? 

Why don’t we see those same committed campaigners outside the offices of commissioners demanding better outcomes? 

Despite leaps forward in NHS transparency, people often don’t believe there is anything wrong with the status quo or believe it can all be fixed with additional funding. 

There is concern about the unknown. Judgements requiring compromise: which is more important - access and travel times, or quality and safety? People feeling ‘done to’ rather than ‘with’. Cynicism from an inability to implement change quickly and offer confidence in the new. 

Political arguments playing out which would be better targeted at politicians than NHS leaders and clinicians.

Staff who think proposals are a criticism of individual performance, rather than an acknowledgement they are delivering the best care they can despite, rather than because of, the way services are designed around them. 

Within this context, what can communications professionals do to support and help deliver major service change in the NHS?

Pre-consultation period

Negotiate and acknowledge the communications and engagement resource required as part of the programme set up. Doing it well takes capacity, capability and dedicated resource. 

The legal duty to involve and engage is at the fore and you must demonstrate evidence of this. It should be part of ongoing activity but needs focusing on the path ahead.

Be clear on governance

Be in key meetings, understand the politics and judgements, who is making decisions, when and how. Particularly when working across multiple organisational boundaries. Do this formally and informally. 

Remember publicly it is all ‘the NHS’; most people don’t readily distinguish between the component parts, but you need to be clear how it fits together. 

Hold the mirror up in those meetings and be the voice that promotes the patient, staff, public and stakeholder perspective. Build patient and clinical reference groups into the governance structure.

Create a compelling case for change – and get a mandate for it

People talk of needing to maintain public confidence in current services and a delicate balance is needed. 

But how many expectant parents knew there was only a consultant obstetrician on the labour ward for 24% of the week in one of the obstetric-led maternity units that recently needed to make changes? 

Who knows national stroke guidelines recommend units see at least 500 stroke patients/year and only one of six sites in a county-wide reorganisation currently does? 

We need to be more open about what’s working, what isn’t and what could be done better. 

Acknowledge that models from the past may have been overtaken with new evidence about what works.

A robust case for change must be evidence-based, led by and agreed by clinicians. Don’t underestimate how long this can take. 

The communicator’s role is to bring the technical document to life. Translate the complex to the simple without losing meaning, paint a clear picture of how things are and how things will be if nothing is done. Focus on what matters to people. 

Don’t stop telling the case for change story. Identify and work with stakeholders. Get a mandate for change when all agree the status quo is no longer an option. Without it people can backtrack. (‘It’s too difficult, things aren’t so bad, let’s just stick with how things are’).

Develop a burning ambition 

A burning ambition is arguably more powerful than a burning platform. 

Coalescing around a shared vision for the future is longer-lasting and more motivating, pulling rather than just pushing people to change. 

Engage widely and co-design with clinicians, patients and the public. Communicate the vision clearly, in a way that resonates with different audiences – what’s in it for them? 

Draw on existing insights and research, there is usually much available, you don’t need to reinvent the wheel.

A new model of care - the importance of clinical leadership, engagement and co-design

Getting the clinical engagement right is paramount. Clinically-led and evidence-based thinking to design new models of care takes time. 

Done best it involves many people (e.g. multi-disciplinary workshops with c100 clinicians from multiple organisations), but recognise the commitment required to do this on top of the day job – evening meetings can work best? 

Involve patients and public representatives from the start. Test the thinking then test it again with identified stakeholders. Be able to demonstrate ‘you said, we did’ feedback. 

Getting people agreed around a model is an important step forward. At this stage people can be objective - it isn’t yet focused on what services could be where. Communicate progress to wider audiences.

FIGURE 1 Overarching approach: A pre-consultation engagement process
(Timeline has many interdependencies not shown here. Example only and can take many months across each of these stages.)


Developing (and communicating) the options – location, location, location

Engage widely in developing and agreeing the ‘evaluation criteria’ used to assess potential options and agree short-listed options for consultation. 

Agreement on the criteria and process (which should include clinician, patient, staff and public representatives) is critical when some people won’t like the outcome. 

Communicating the outputs from this stage requires detailed planning and sequenced messaging to all audiences. People will be waiting for the announcement and to understand what it could mean for them. 

Be clear these are potential options; no decisions have yet been made.

Assurance, check and challenge

Effective pre-consultation engagement can mean you reach a point where impatience sets in, with demands to ‘get on with it’. But a key stage includes necessary and detailed final assurance with regulators. It is ongoing, but the last stage can take some months. 

Keep communicating and planning for consultation and all that entails. There is much to do in demonstrating activity and outcomes from pre-consultation engagement, contributing to the development of the pre-consultation business case, managing multiple stakeholder relations and preparing detailed consultation plans, the consultation document and supporting collateral. 

Sign-off processes for communications material flush out previously unidentified differences of opinion and data. You must get this aligned and have a single version of the truth.

Consultation is not a vote

Be clear what you are consulting on and what you are seeking in response – views, feedback, support, concerns, mitigations, additional evidence, alternative solutions – but it is not a vote. 

Manage expectations. Public meetings are only one strand of your consultation activity. Targeted research (focus groups, polling, surveys); roadshows and outreach work; digital, social and traditional media; staff and stakeholder communications and engagement; correspondence; briefing; and awareness-raising, all have a role. 

Take care not to let the most vocal drown out the quieter voices – all need to be heard. 

Consultation for large-scale change is resource intensive. Don’t underestimate the communications, engagement, clinical and leadership time and resource required.

Be visibly clinically led and work as a team. You will need emotional and physical resilience, an eye for detail, responsiveness, rapid rebuttal systems to prevent misinformation from others becoming accepted truths and a determination to listen as well as to explain. 

It can be relentless. Hold on to the fact that it should lead to improved services and outcomes for patients. If not, why are we doing it?

FIGURE 02 Example consultation activity overview


Activity taking place throughout consultation period

• Supporting materials, survey and information on website and signposted from partner sites

• Weekly topic-specific content shared via existing and partner channels (e.g. website, social media, bulletins / newsletters, staff briefings, etc.)

• Promotion of consultation to and in 3rd party stakeholder organisations’ communications channels

• Presentations to / attendance at key stakeholder meetings / groups

• Information displayed in provider organisations (including staff areas), GP practices, pharmacies, libraries, community centres and other public spaces

• Providing support materials for 3rd party meetings (e.g. animation, consultation documents, FAQs) and speakers where possible

• Proactive outreach to seldom heard and protected characteristic groups and targeted research programme

• Ongoing media, social media and awareness raising activity

• Regular staff and stakeholder engagement and briefings

• Targeted 1-1 stakeholder engagement to generate responses

• Correspondence, briefing and enquiries

Post-consultation phase

Considering the evidence and decision-making

Decision-makers must give thorough and conscientious consideration to the consultation feedback and need to look at all the evidence in the round before deciding the future shape of services. Avoid a communications and engagement void in the months after consultation before decisions are made. 

If there is legal challenge the timeline for change can be long and drawn out. Keep communicating and keep people abreast of what’s happening.


Wrap the communications and engagement work into business as usual, but keep it going. 

Engage on the granular detail of implementation design, communicate early progress, address issues and manage expectations on timescales for delivery. 

Develop clear information for patients. Keep staff and stakeholder engagement at the fore. Keep messaging focused on delivering change to improve outcomes and patient care. 

If the right decisions have been made, over time those with placards might realise everyone has been pushing for a shared, broader goal around best care. 

In my view, better decisions are made when all perspectives – including dissenters and supporters - have been heard, considered and built into the final design of services. Successfully managing large-scale service change in the NHS demonstrates perfectly that excellent communications practice is no longer all about shaping perceptions. It must be about working with audiences to shape realities together. 


Stephanie Hood has advised and supported boards, ministers, policy-makers and senior management teams in the NHS with effective and strategic engagement and communications for 25 years. Working with and across different health and local authority organisations, she has led and delivered communications and engagement and public consultations for a number of high profile NHS service change projects across the country and has developed significant experience and expertise in this area. In 2014 Steph founded Hood & Woolf, a consultancy that helps organisations have effective conversations and productive relationships with the people who matter to them and their business. Hood & Woolf are experts in communicating change, helping clients articulate a clear vision, engage with empathy and impact, tell a consistent story and get results.

Twitter: @HoodSlhood

Real results: The role of Communications in achieving organisational outcomes

By Kerry Barron-Beadling

Demonstrating real results from the efforts of communications has long been the holy grail of the public sector. There is plenty of data supporting clinical work such as the number of referrals, complaints letters, friends and family scores etc. But as a NHS communicator how do we demonstrate the link between our campaigns and the frontline?

You’ll learn:

• Why it’s OK that you cannot prove beyond a doubt that your work was the only factor that resulted in change – and what the one thing is you should be focusing on
• How the data you need is already out there waiting for you
• How this has already been used on two of the big issues facing the acute sector today

How can we prove what difference our actions have made as communicators?

I’ve spent over a decade in NHS communications and in my experience this has been the question that has caused the most consternation.

How do we best show the value of what we do? 

Previously the much maligned AVE was held up. At its best AVE allowed teams to produce impressive looking stats, even if they were irrelevant. Irrespective of that, AVE could not show any sort of result for internal campaigns anyway. Elsewhere good old GF was used: Gut Feel.

In a profession struggling to demonstrate its value, neither of these support our values. For too long, we have struggled because we’ve searched desperately for causation of our actions – actions that could have only related to the campaign or tactics used. 

While that may work in the private sector (where sales act as the direct result of a marketing campaign), in the public sector we don’t have definitive sales metrics to reinforce our work. 

For too long, as we couldn’t prove causation, we stuck to outputs. But there is a third way I would like to discuss: correlation.

A well planned campaign with clear objectives linked to an organisation’s strategic priorities should always be able to demonstrate a level of correlation, whether that is weak or strong.

Working on a familiar front door problem

In a previous role in an acute Trust we struggled with the usual winter pressures and would regularly get the call to put a message out on social media to ask people to use their NHS services wisely. This, it was hoped, would decrease the amount of people coming to A&E unnecessarily.

In January 2017, having seen the increased reach of video on social media sites, the communications team decided to use a video of one of our Emergency Department clinicians asking people to use services wisely, rather than a text-based message. The key messages though were the same.

The video was posed on Facebook on the Trust official page on 4 January 2017. The outputs were impressive – it became the Trust’s most popular post ever with a reach of 149k, 70.3k views, 188 reactions on the post, 1,311 shares and 84 comments on the post itself (200 on shares). 

But did it actually reduce the amount of attendances coming through the front door?

Based on Trust data, on Thursday 5 January 2017, the day after the video was posted, there was a 12.4% decrease in A&E attendances from 4 January 2017. 

As a comparator, between the first Wednesday and Thursday in January 2016 there was a 1.9% increase in attendances. This was data that was already being routinely collected at the Trust. 

Now was this down purely to the video? It’s difficult to say 100%, particularly given that other organisations were giving out similar messages at the same time. However given the size of the reach and the 14.3% difference year-on-year I believe it is possible to show a correlation between the two which demonstrates that the video message did have a short-term (24 hour) effect on reducing the number of attendances at A&E.

How do you recruit from a reducing pool?

Before I started at Sherwood Forest Hospitals, it was highlighted that the largest staff group with vacancies was Band 5 nurses – again a common issue across the acute sector.

Insight work was carried out with recent starters, recently qualified nurses and those who had worked for the Trust for less than one year. 

Staff were asked about where they saw the roles advertised, where they looked for roles, what they looked for in the roles and their perceptions of the Trust. The survey also looked at staff retention and why staff were leaving the Trust. 

With this information, a campaign was developed, which focused on Sherwood Forest Hospitals being a forward thinking, innovative Trust with a friendly and supportive environment that is easy to get to. 

The language used in both adverts and communications relating to jobs was revised using phrases from nurses in the insight results. It was also decided to use social media because the insight work showed that apart from the Trust website and NHS Jobs, social media is where most nurses look for and learn about new opportunities. 

It launched in April 2017 and within the first month, the campaign reached an online audience of 30,939. 

The first two recruitment days resulted in 29 registered nurses being recruited and more than 200 nurses (both internal and external) signing up to the Trust’s internal rota system, known as ‘bank’. The launch of the nursing recruitment campaign was also featured on ITV which reaches 5.5 million adults on a weekly basis.

In terms of outcomes, there was an increase in applications to nursing positions across the organisation, with both recruitment days seeing a 100% employment success rate. 

Overall nursing vacancies reduced from 22% in 2016 to 15.8% and in the first two months of 2017/18 nursing agency spend was £935,000 (representing a potential annual total of £5.6m and therefore a potential £2.8m saving). 

There was also a £97,000 reduction in nurse agency spend in one month from March 2017 to April 2017. We now have more substantive nurses working for us compared to 12 months ago and are one of few acute Trusts to do so. 

This is a clear correlation between this well thought out campaign, the increased substantive nurses in post and reduced spend on agency nurses. And again all the information needed to prove this was already held in the Trust.

It’s OK to correlate

Both these campaigns won awards. It goes to show that no campaign is ever going to be perfect or run in lab-like conditions. Proving causation is always going to be problematic, as it proves problematic for most. 

However a well-planned campaign should always be able to prove a correlation between our outputs, outcomes and then link to strategic priorities. 

If you feel unable to do this, you need to ask yourself: 1) were the objectives the right objectives? And 2) did you measure the right things? 

And 3) if you couldn’t measure the value, why did you do it?


Kerry Barron-Beadling started her working life as a reporter on local newspapers before jumping into NHS comms more than 10 years ago. She’s always worked in the hospital sector covering small district general hospitals, big teaching acute Trusts and is currently Head of Communications at Sherwood Forest Hospitals NHS Foundation Trust, an award-winning organisation covering three sites in Nottinghamshire and a community of 400,000. She is passionate about promoting the strategic importance of communications and is one of the few Heads of Communications in the acute sector to be a member of her Trust’s executive team and Board of Directors.

Twitter: @KBeadlingBarron

Beyond communications: the added value public relations professionals offer to the NHS of the future

By Louise Thompson

Scratch the surface of any inspirational NHS leader and great communication is at the heart of their approach. 

Given this, why is the NHS still such a challenging environment for communications professionals when it comes to flourishing at board level? 

If we are to successfully position communications and engagement skills as crucial to management teams, we must look beyond our traditional portfolio remit. This is where the inherent flexibility, evolving skill set and innovative approach that we communicators possess as standard is of benefit. Proving our leadership, ethical and strategic abilities offers the opportunity to make a real difference to NHS staff and to our patients and communities.

You’ll learn:

• What ‘super powers’ communications professionals possess that make them ideally placed to offer greater strategic value within the NHS
• How those skills can help bridge the gap between the NHS and the local communities we serve, bringing the NHS values to life for local residents
• How communications professionals in the NHS can have a transformational impact on workforce and organisational development issues, such as recruitment, retention and staff wellbeing

Communications professionals can’t afford to be passengers 

I am just three years into my NHS journey and much of my prior experience has come from working with technology start-ups, where virtual reality and artificial intelligence are the norm. But although you may think the UK health service and Silicon Valley are poles apart, there are some valuable lessons I learned during my time in this sector that have shaped the strategic value I believe communications professionals can offer within the NHS.

In the start-up world, in order to sell, you have to be able to tell. Good communications and story telling are at the heart of every successful company. But these skills aren’t just limited to working with the media - they are a vital bridge to building company culture and enabling workforce engagement.

In many start-ups, the organisational structure is fairly flat and there’s no room for passengers, so every employee has to make their contribution count. This is not just in the traditional portfolio they were originally hired for, but across the board. You take on new areas of responsibility that may be a fit for you and you learn with the job. Or you don’t have a job for much longer.

We must do more of this as communications professionals in the NHS. Whilst the governance models are understandably more complex, there is still plenty of scope for us to put our hand up and take on some portfolio areas that make sense for us, given our skills and aptitude, but that are beyond what may be offered to us today. 

This is essential if we want to continue building the case for board level roles and responsibilities within communications.

Honing your communications ‘super powers’ to prepare for a broader role

What are the skills that communications professionals possess that make us fit for broader board responsibility in the future? Here are three that I think make us stand out.

• We can see around corners

Our ability to anticipate, prepare and plan means we can not only manage crises when they arrive, but we can often help prevent them altogether, proving our operational and strategic worth. This is vital when working in the fields of transformational change where every day brings another curveball and the only constant is change itself.

We can ‘speak human’

The NHS is chock-full of compassionate, caring people. But all too often that can be hidden beneath the layers of jargon we insist on adding to very simple messages. The very best communications professionals understand that simple isn’t dumbed down - it requires much more skill to deliver a message in a way that anyone can understand and then act upon. This is supremely helpful when considering adding community relations or workforce activities into your portfolio mix.

We start with ‘why’

It can sometimes be a lonely place as a senior communications professional. We are hard-wired to ask ‘why’ as the starting point for any organisational project, as we are adept at predicting the consequences if strategy or decision making isn’t robust enough. Sometimes, that can mean feeling a little out on a limb, but it is precisely this sense of constructive interrogation that enables us to build narratives that make sense for the organisation and communities we serve, even as that narrative evolves. This, more than ever, is what will be needed as the NHS navigates the transformational change required of it over the coming years.

If we are to move forward confidently, holding real strategic value within the NHS, then we must look at where and how we can best deploy our unique strengths and skills within a broader portfolio. Here are two ideas.

Connecting with your community - beyond the walls of your organisation

Community relations. Corporate social responsibility. These terms can sometimes feel a bit dry. And although laudable in terms of purpose, these activities can often wither on the vine if not placed in more innovative and forward-thinking hands.

Communications professionals are just the people to take up the mantle for community partnerships and engagement within the NHS, connecting with our strategy leads and working together to create real value ‘beyond the walls of our hospitals’ and deep within our local communities.

This is in many ways a natural extension of our engagement remit, but with service transformation and redesign so high on the NHS priorities list, there is a real opportunity now for communications professionals to grab this agenda and really make it count. We need to do this within a robust, outcomes-focused framework, linked with strategy, transformation and operational ‘grit’ that can have a tangible impact on patient outcomes and public health.

Within my local community a member of my team, alongside transformation and clinical colleagues, is working in close partnership with a local homeless charity to offer basic health checks out in the community, as well as give advice on securing GP care for those that are without a place to call home. A pilot project at the moment, there is a will to make this work at scale, which would not only start to improve population health, but could also help reduce local pressures on our busiest emergency departments. 

What started initially as community relations in the traditional sense (fundraising support offered by our hospital staff to the charity), is evolving into something deeper and more patient-centred. We started with the ‘why’ and linked this work back to core strategic objectives, then used specific skills in communications and engagement (including encouraging our transformation and clinical colleagues to come on board), as well as engagement on a very human level with the local people the charity supports.

Transforming the NHS outlook on workforce and workplace issues

This is a biggie. One of the most useful attributes NHS communications professionals have is our ability to grasp the bigger picture - we have to juggle it all the time when talking with the media about anything from waiting time targets to Christmas babies, to service redesign and car park woes. 

There’s generally nothing we don’t know about the inner workings of our organisation, or about how the public feels when we get it right, as well as when we get it wrong. 

This perspective is incredibly valuable when considering workplace and workforce issues and when combined with our natural inclination towards innovation, our engagement skills and our ability to ‘speak human’, we can have a real impact.

Think about the potential when there is a true partnership between Communications and Organisational Development/Workforce Transformation. Here are a few examples:

Staff health and well-being

By partnering with a fitness tracker company, my team launched a series of simple yet effective fitness challenges for staff within our organisation. These activities led to expected positive outcomes for our people (improvement in fitness levels, sleep quality etc) but also some surprising ones, such as forming new bonds at work due to the group activities and lasting behavioural changes such as parking further away from work in order to walk a bit further. It made complete sense for the communications team to develop and launch this (including liaison with the tracker company to get the partnership off the ground), as staff engagement was paramount. We needed to ensure all staff understood why we were doing this, how they could get involved and what the benefits would be. We were also able to map the results back to organisational workforce priorities such as reducing staff sickness and improving morale, which was an important part of the discussion at board level.

Recruitment and retention

These areas really benefit from deep cross-portfolio working and it’s essential that communicators get involved as a core part of the strategic offer around these issues, not just in the ‘bit at the end where we need a poster/video’. Again, our ability to start with ‘why’ and work back from there to a meaningful set of priorities and objectives, is invaluable to this essential and difficult work. Not to mention the benefits our innovative and creative approach can deliver. There is a clear opportunity for communicators to step up and lead these initiatives on a cross-portfolio basis, as critical yet supportive friends to our HR colleagues, leading to enhanced outcomes.

Use your super powers for good in your organisation

By at first recognising and then marshalling our specific talents, skills and super powers, we can lend real strategic oomph around the NHS Board table.

We can use our deep empathy and understanding of human behaviour to connect the corporate strategy with a narrative that speaks to people’s needs and wants, in terms they understand and can connect with.

We can peer around corners and offer advice and strategies for the plethora of transformational change projects that are now a feature of our NHS.

And we can keep starting with ‘why’, in order to make sure that our priorities are the right ones for the people and communities we serve, including our valued staff.

By looking beyond our traditional remit, we can offer so much more to the NHS as it navigates its future.


Louise Thompson is the Director of Communications at Burton Hospitals NHS Foundation Trust. She joined the NHS in 2015 following an extensive career in the private sector, advising companies on corporate and consumer communications strategies both in the UK and internationally. Her current portfolio includes communications, stakeholder relations, staff engagement and community partnerships. 

Twitter: @MsLouiseT

Employee engagement and culture

By Alicia Custis

Firstly, culture eats strategy for breakfast. Secondly, if you are aspiring to have a uniform culture across the entire workforce, then join a cult. And thirdly, employee engagement does not equal organisational culture. 

So, let’s cover employee engagement first and the golden key. Then look at how engagement fits in with culture. And finish with the tricky, but widespread challenge of sub-cultures.

You’ll learn:

• That culture creates behavioural norms that can take a long time to shift
• About countercultures versus subcultures
• Why line managers are critical to a strong culture and should be invested in

Culture Club – part of the family, not an annual visitor

Organisations that lack a strong, energised culture may still have employees who are engaged in their work (though they’re probably unlikely to remain engaged for long). 

On the other hand, organisations with dynamic, inspiring cultures almost can’t help but have engaged employees. 

“The way things work around here” should therefore mean a place where people can participate in the decision-making process and voice their opinions, ideas, concerns, or even criticisms. 

Somewhere where employees are valued, supported and appreciated, with opportunities to be innovative and grow professionally. And of course, an open culture that embraces individuals for their diverse backgrounds. 

The list goes on, but the point is that we can’t rely on things like the annual NHS staff survey to measure achievements or shortcomings. We need pulse surveys, employee sentiment and culture assessments and real-time monitoring to rapidly assess when we’re on a high and when problems are arising. 

And we need to know what we’re measuring. That means breaking the behaviours down into activity that can be measured, with dashboards that show how behaviour and engagement alignment is tracking over time. Then using these results to focus attention and culture change efforts on problem areas.

It should be part of business, with a leadership style and communication system that reflects the corporate culture. 

We discuss our values at every opportunity in our organisation, with our value-based behaviours woven into annual appraisals and rewards for those who remember, understand and practice the principles. 

We recruit against our values, looking for attitude and fit to our corporate culture as well as ability. And, we tell inspiring stories that illustrate the mission, culture and values of our organisations. 

Culture does not make people, people make culture. It’s the people, stupid. 

Culture Club? What about subcultures….

Who are Mr and Mrs Average in an NHS organisation? 

Yes, we’re all firmly committed to the values of compassion and care, with a safe, high-quality health service for patients and good patient experience. But the NHS contains many powerful professional groups with associated subcultures which are often in conflict. 

These groups come together in multi-disciplinary teams, with sometimes multi-directional goals, particular attitudes and practices. We can have also other subcultures, based on geographic locations or level.

Its countercultures that are bad, not subcultures. That’s why we need to focus on creating the right environment for professional activity to thrive, within agreed standards and guidelines. Not make them feel that their way of working is undervalued or misunderstood, which could tip into counterculture territory.

We need to recognise our subcultures, consider them when planning organisational-wide initiatives, watch for signals of subculture shifts and disrupt the cynicism spiral.

Yes, that takes time and effort. But that’s the way to achieve integrity of purpose across an organisation. 

Present and engaged – why the line manager is king

It’s a feeling. Yep, employee engagement is the feelings that individuals have towards their work. It reflects how motivated and bought-in they are to the organisation and their role.

Culture manifests in deeply engrained behavioural norms that take a long time to shift, but engagement can be easily affected by temporary ‘climate’ factors, such as a bad manager, challenging project or organisational change. These factors can change from week to week, day to day and even hour to hour!

So, basically our work is never done and never ends when it comes to engagement. Plus it’s too important. 

It’s linked to staff health and well-being, patient satisfaction, effective decision making, innovation and clinical outcomes. Pretty big stuff and that’s without an era of heightened transparency, greater workforce mobility and severe skills shortages thrown in.

We recognise that effective communication from senior leaders is absolutely vital for employee engagement. But the golden key is line managers. Senior leaders need to set the tone at the top by being visible, approachable and accountable. They need to ensure there is regular and effective two-way communication with frontline staff. 

But line managers must be empowered, supported and trained to better engage their teams. They have a much more direct relationship and the evidence shows that their teams want to hear from them.

Our six-monthly communications survey with our 5000 staff consistently show that they would rather be kept informed, updated and engaged by their line manager. Those at the ‘coalface’ might not even come into contact with the intranet, newsletters and other corporate communications channels. Their manager is therefore pivotal in ensuring that information flows effectively both up and down the organisation. 

One of the peculiarities of the NHS is the fact that although only three percent of employees are officially classed as managers or senior managers, more than 30 percent of staff have responsibility for managing people. Most combine this role with clinical or other responsibilities, but wouldn’t necessarily see themselves as managers. But they have a critical role to play in engaging employees.

So, we’re putting our efforts – through management training programmes, coaching, quality materials and content and cascade and feedback systems – into them. Moving from ‘command and control’ to ‘coach and enabler.’

The line managers are encouraged to hold regular, face-to-face team briefings to feed key messages down to their staff and involve them in discussions about the priorities, challenges and potential improvement both for the team and for our organisation as a whole. 

We’re giving both support and the autonomy to deliver their messages in their way. 

Trying to ‘control’ messages means that levels of engagement get weaker and weaker the further down information is filtered. Not only do managers need to be given the trust and autonomy to shape and communicate messages in the way that they know is right for their teams, they also need input into what the messages should be. 

They will know if something is going to provoke a negative reaction and what needs to be done to reassure people. We need to empower middle managers to be able to say what, where, when and how things need to be said.

Trust is transitive. If our managers believe a message then the people who work for them are going to be more inclined to believe it.


Alicia Custis is a multi-award winning communications specialist, with over 20 years’ experience working in PR agencies and the NHS. Alicia was asked to work at Stockport NHS Foundation Trust immediately after the saline poisoning murders at Stepping Hill Hospital in 2011, to lead on communications around the incident and develop and implement an overall communications strategy for the organisation. She was previously head of communications at The Christie Cancer Centre for 10 years.

Twitter: @AliciaCustis

Managing internal comms within a complex web of organisations

By Kate Henry

Internal comms is often overlooked and undervalued but in a vast network of organisations like the NHS it is invaluable. Critically it helps employees buy into a shared vision and values.

You’ll learn:

• How to manage internal comms across a vast array of disparate organisations
• The type of challenges faced by internal communications practitioners
• How investment into internal comms can help an organisation of any size achieve its objectives

1.7 million staff and counting

The NHS is the UK’s largest employer, with more than 1.7 million staff across the UK. [1] It is the fifth largest employer in the world, behind the US Department of Defense (3.2m), China’s People’s Liberation Army (2.3m), Walmart (2.1m) and McDonalds (1.9m). [2]

That in itself presents a massive internal communication challenge, even before considering that the NHS is not a single entity. It is made up of hundreds of separate organisations – more than 200 of which buy health services and around 250 that provide care. That’s not including nearly 7,500 GP practices across the country. [3]

In England, these organisations are bound by the NHS Constitution, which sets out the core principles and values of the NHS. It also covers the extensive rights of staff along with a series of pledges that the NHS is committed to achieving. These pledges to staff talk about promoting an open culture, engaging staff in decisions that affect them and empowering staff to put forward ways to deliver better services.

Effective internal comms and staff engagement is crucial in healthcare; there’s overwhelming evidence which shows that engaged staff deliver better care: 

“NHS providers with high levels of staff engagement tend to have lower levels of patient mortality, make better use of resources and deliver stronger financial performance. Engaged staff are more likely to have the emotional resources to show empathy and compassion, despite the pressures they work under. So it is no surprise that Trusts with more engaged staff tend to have higher patient satisfaction, with more patients reporting that they were treated with dignity and respect.” [4]

As in any large and complex organisation, communicating effectively isn’t always a simple task; there are endless challenges to contend with. In the NHS, these include vast geographical footprints, varying cultures and sub-cultures, leadership changes, dwindling resources and service pressures impacting on people’s capacity to communicate and engage. 

There’s also the diversity and differing requirements of a large number of professional groups; the NHS has hundreds of different roles, from nurses to analysts, doctors to porters and microbiologists to librarians. 

Comms teams therefore have a significant role to play in any NHS organisation, needing to make sure that internal comms stays high on the priority list. They can make sure there’s two-way comms up and down the organisation, from ward to Board and back again. 

Equally, they’re uniquely placed to encourage and support networks and connect people across all parts of the organisation. Comms teams also have a key role to play in sharing their professional knowledge and skills, helping staff (particularly managers and team leaders) to become better communicators. 

Breaking it down - a case in point

South West Yorkshire Partnership NHS Foundation Trust provides mental and physical healthcare services in hospitals, in local communities and in people’s homes. It covers a population of 1.2 million people living across Barnsley, Wakefield, Calderdale and Kirklees, as well as providing specialist services across Yorkshire and the Humber. To do this, it employs around 4,700 staff. 

In 2015, the organisation identified a need to improve its internal communication. The comms team set about this by firstly doing a stock take and asking people what they thought. 

More than 375 staff shared their views. They were asked general questions on how they felt about internal communications and their satisfaction levels, as well as specific questions on the channels in place at the time. They were also asked about what they would like to see in the future. 

The results were enlightening, with only 57% of staff feeling that they were kept up to date with what was happening across the organisation and 45% feeling satisfied with the way the Trust communicated and engaged with them. There were lots of positive comments, as well as some really constructive feedback about areas for improvement. 

The information was used to inform a channel revamp, overhauling existing channels and introducing new ones to embed a more consistent rhythm of internal communication. These included:

• Revamping the weekly staff newsletter, The Headlines, now emailed every Monday

• Introducing staff huddles with the chief executive – informal discussions that take place for half an hour every Monday, rotating around the Trust’s key sites

• Introducing The View, a more personal, blog-style email sent every Friday from either the chief executive or member of the Board

• Giving the staff intranet a facelift and restructure, in line with a new visual identity implemented

• Introducing a new monthly team brief cascade, that provides updates on key discussions and decisions made by the Board and executive management team. The brief starts at a meeting for senior leaders and is then cascaded to all teams, ideally face to face and within two weeks

• Introducing annual staff listening events, which take place in each of the areas the organisation covers every May / June. These are led by the chief executive and help to communicate the priorities for the year ahead

• Revamping the annual staff Excellence awards to celebrate outstanding teams and individuals. 

It isn’t rocket science - it works

A year later, staff at the Trust were asked for their views again and the results showed an impressive improvement. There was a 26% increase in staff feeling up to date with what was happening across the organisation and a 21% increase in staff feeling satisfied with the way the Trust communicates and engages with them. 

External sources also confirmed improvements. The organisation’s results from the 2016 national NHS Staff Survey showed a statistically significant increase in the number of staff reporting good communication with senior managers. 

In addition, the Care Quality Commission, which re-rated the organisation from ‘Requires Improvement’ to ‘Good’ in April 2017, noted in their inspection report [5] that: 

“Staff at all levels told us how the internal communication within the Trust had improved since the last inspection”

“…increased communication had enhanced the transparent and open culture that existed across the Trust.”

“…staff articulated a change in culture across the organisation and demonstrated a clear understanding of the organisation’s vision and values and the Trust’s direction of travel.”

The work is by no means complete and the comms team continue to listen and respond to staff feedback. This is reflected by the continued improvements seen when staff were once again asked the same questions in December 2017. 

Moving forward, the team will now focus their efforts on supporting managers and leaders to communicate effectively and making better use of technology to support internal comms, such as staff apps and internal social networks.

FIGURE 1 Increase in % of staff feeling kept up to date with what is happening across the Trust

Do you feel that you are kept up to date with what is happening across the Trust?


FIGURE 2 Increase in % of staff feeling satisfied with the way the Trust communicates and engages with them

How do you feel about the way the Trust communicates and engages with you?


So how do NHS communicators reach 1.7 million staff and counting? By breaking it down and taking an insight-based approach to make internal comms manageable and measurable. Oh and by having fun and meeting great people along the way. 


[1] The Nuffield Trust, The NHS Workforce in Numbers, published 30 October 2017, accessed 18 January 2018
[2] Forbes, The World’s Biggest Employers, published 23 June 2015, accessed 18 January 2018
[3] NHS Confederation, NHS statistics, facts and figures, published 14 July 2017, accessed 18 January 2018
[4] The King’s Fund, Staff engagement: Six building blocks for harnessing the creativity and enthusiasm of NHS staff, published February 2015


Kate Henry is Director of Marketing, Comms and Engagement at South West Yorkshire Partnership NHS Foundation Trust. She has worked locally, regionally and nationally in a variety of NHS communications roles over the past decade. 

Twitter: @KateHnry and @allofusinmind

Social leadership: Cultural graffiti and sanctioned dissent

By Julian Stodd

We live in the Social Age, a time of constant change, a new ecosystem within which we must adapt and learn to thrive. The NHS is a massive structure, indeed many different interrelated structures: radically complex and creaking at the seams. But the overloaded system that we can observe, the formal system, which is owned and controlled by politicians and managers is only part of the story.

Suffusing through the whole edifice, held in a dynamic tension, is a ‘social’ system: a democratised network of local bonded-by-trust tribes, tacit wisdom, unheard stories and creative dissent. And the social structure houses many of the stories that we need to hear and holds much of the potential for the NHS to change.

You’ll learn:

• The dynamic tension that exists between ‘formal’ and ‘social’ systems and how we can use it
• The notion of social leadership and how we earn it
• The importance of storytelling and why listening may be a key skill

But first, let’s consider graffiti. Cultural graffiti.

Walk around any city and you will see graffiti: when I walk through Bristol, it’s worn as a civic badge of pride, in Singapore it’s hidden and polite and in New York, raucous and blunt. 

Graffiti is a voice that is claimed, not granted. It’s the last voice taken, when all others are silenced: fully democratised, anyone can pick up a spray can and tag their local wall. 

But graffiti is not equal: whilst it feels subversive, if you interview artists and gang members around how they ‘learn’ it and how they apply it, you will hear stories of induction, prototyping, emergent power structures, socially enforced consequence and leadership.

Graffiti is not limited to underpasses and the back door of McDonalds: there are forms of cultural graffiti within our organisations. Claimed voices, voices that may be anonymised and shared without fear of consequence, anarchic maybe, but often constructive even if rough around the edges. 

This cultural graffiti is written not in acrylic or spray, but in stories and tweets. It does not flow through formal channels but resides solely in the Social. It’s claimed and sometimes hidden, but comes with a badge of high authenticity: it’s often shared by practitioners.

The NHS has seen an emergent tribe of social media savvy cultural graffiti artists: consultants, nurses, patients, all highly connected, operating outside their ‘professional’ formal space, but nonetheless operating to comment on, or improve, the overall system.

In the Social Age, if we want to ‘fix’ the NHS, we will have to do so through the individual agency of the aggregated whole, because the challenges that the NHS faces, at 70, are not solely financial. They are challenges of interconnectivity and complexity. And they are problems that will most likely be solved from within. To solve it, we will need to involve these hidden voices. But how?

Social leadership

In the formal system, you are given formal authority, the type of authority that is backed by a voice saying ‘because I told you so’. Formal power is important, but not limitless. 

In the social spaces, in the spaces where the cultural graffiti is scrawled and shared, your formal power will not reach. To lead in social spaces, we need Social Leaders and I’ve spent the last few years exploring what they look like, where we find them and, perhaps most importantly, how we can become one ourselves.

If the foundation of formal leadership is hierarchy (the system by which organisations are ‘organised’), then what is the foundation of Social Leadership? 

The answer is ‘reputation’. 

Social Leadership is reputation-based authority: we earn our reputation over time, through our actions into our communities and based upon that reputation we are awarded Social Authority. So ‘formal’ leadership is authority grounded in hierarchy, but ‘social’ authority is authority granted to us by our communities. 

This type of power is contextual, consensual, awarded voluntarily, not demanded through position or rank.

Our formal leaders may carry great power but if they have not earned a reputation through their actions, with humility, into social spaces, then they may have no social authority whatsoever.

Our cultural graffiti artists, by contrast, are often practitioners acting with great authenticity and may be awarded high social authority, even though they have virtually no formal power at all.

In the context of the Social Age, all of this is significant because we have seen an overall rebalancing of power - the individual storyteller, acting with strong social authority and high authenticity, is able to hold the formal organisation to account. Social power is favoured, whilst formal power is diminished.

When the NHS started, the challenge was to create a vast formal structure, run with almost military precision.

Today, at 70, the NHS faces a new challenge: to discover, to recognise, to empower and enable its Social Leaders, because it’s these people, deeply embedded within their communities, carrying high Social Authority, who will bring the agency to deliver change. Change, without which the NHS may not last at all.

Story listening

So what is the role of formal leaders in all of this? What message should we carry forth in this age of democratised, socially moderated, amplified, authentic storytelling? How should they respond to the cultural graffiti?

They should listen.

Knowledge used to be power, but today knowledge itself has changed and power may sit not in owning it, but in creating the spaces for knowledge to grow and to be shared. 

Our formal leaders must become expert at creating and holding open spaces for collaboration. Not simple collaboration: complex collaboration. Collaboration outside any formal structure. And to do that they will need to change themselves.

Humility is the foundation of Social Leadership and our leaders need to act with it at heart. They must learn to listen to stories, not to respond, not to counter, not to own them, but to learn from them and to do so with a humility to change.

There is a specific type of story that our formal leaders must learn to engage with: stories of difference. 

It’s easy to build consensus, but that consensus usually takes place within a community of similarity. Similar roles, similar thinking. But the NHS is vast: to become interconnected, we need to build communities not simply of consensus, but of respectful difference and we need to hear the stories that will support them.

When I interview graffiti artists, they understand spaces: they know where a certain type of space exists, a special space, where graffiti is allowed. Certain shop owners, certain landlords, even certain councils, create spaces for dissent. 

In some ways, that is what our formal leaders must learn to do: to hold open spaces for people to come into, to learn to hear the stories that are shared and most importantly of all, to listen to those stories with humility and respect.

When they feel the need to respond, they simply need to offer their thanks and be grateful that the community has chosen to share its images, to paint its cultural graffiti in broad daylight, where we can all benefit from the story that it tells.


Julian Stodd is a writer and explorer of the Social Age. His last two books have explored aspects of Social Leadership and been adopted by organisations worldwide. These organisations share a belief that the organisation of the future, the Socially Dynamic organisation, will recognise democratised storytelling, have high levels of humble Social Leadership and, more than anything, be deeply fair to all.

Twitter: @julianstodd

Why do we need to talk about patient data?

By Nicola Perrin

Personal data is a sensitive subject at the best of times. Confidence in its safety and security is paramount. This chapter uses as a case study to show what can happen without attitudinal insight and open and ongoing two-way dialogue to change public perceptions.

You’ll learn:

• Using patient data could help save lives, but patients must have confidence that their privacy is protected
• The failure of the programme demonstrates how essential it is to communicate effectively with the public and healthcare professionals
• The NHS must lead a full conversation to explain how and why data can be used for care and research and how personal information is kept safe

Learning from

In January 2014, every household in England was sent a leaflet, ‘Better information means better care’. The aim was to collect patient-level data from GP practices and to link this data with information from hospitals, registries and prescribing databases in order to provide better care, inform commissioning and advance research. The leaflet set out how information would be used and the choices people had. 

Sounds good? Within a month, the programme was put on hold, following a backlash in the media. It was finally abandoned two years later. 

The project failed for two main reasons: the governance processes were found to be flawed and the communication strategy was extremely poor. The opportunity to make better use of patient data to improve health, care and services across the NHS has still not been realised. 

Data saves lives

The NHS has a unique resource: patient records for nearly 60 million people, with information about the health of a very diverse population from cradle to grave. 

If small amounts of data from many patients are linked up and pooled, researchers and doctors can look for patterns in the data, helping them develop new ways of predicting or diagnosing illness. The information from patient records is invaluable to help develop new treatments, monitor safety, plan NHS services and evaluate policies. 

For example, researchers have been able to explore why diabetes rates vary between ethnic groups, demonstrate that bowel cancer screening is effective, check the safety of hip replacements and improve the delivery of kidney dialysis services. 

Given the huge pressures facing the NHS, making more effective use of data is crucial to provide the best patient care and to make more effective use of scarce NHS resource.

FIGURE 01 Using patient data to improve health and care


But patient data is sensitive and confidential. The NHS will only be able to realise the potential if everyone has confidence that data is kept safe and secure, with access appropriately controlled. 

Currently, most people – whether the public, patients or healthcare professionals – know very little about how data is used which makes them wary.

Raising awareness

Public attitudes work suggests that more than two thirds of the population feel they do not know how health data is used in the NHS. 

However, the evidence also shows that the more information people have, the more comfortable they are with wider uses of data. The results are fairly consistent: people are generally supportive of the use of data for research, provided there is a clear public benefit. 

There is a caveat: giving only a small amount of information may actually raise concerns. Where people have questions over how data is used, giving too little information leaves them with unanswered questions. It is only by providing further information, about the benefits and the safeguards, that people become more reassured.

That is why it is so important that we get better at talking about patient data and why the National Data Guardian has called for a ‘fuller dialogue’ with the public. 

In response, the Understanding Patient Data [1] initiative has been set up to support better conversations about the uses of health information. Our aim is to explain how and why data can be used for care and research, what’s allowed and what’s not and how personal information is kept safe.

Supporting better conversations

The first priority is to talk about the ‘why’, to explain the benefits of using data. For example, the #datasaveslives campaign has been successful in highlighting the positive impacts of analysing data. 

But the failure of also shows how essential it is to explain more about the safeguards and to be honest about any potential risks. There needs to be more transparency: everyone should be able to find out about how data is used, why and by who. 

The provision of clear communication material will become even more important in 2018. The new data protection legislation, which must be implemented in May, has an increasing focus on fair processing. And the introduction of a new single national opt-out, as recommended by the National Data Guardian, will only be successful if there is a robust comms strategy clearly explaining the choices that people have so they can make an informed decision.

Engagement with healthcare professionals will be crucial to help achieve this. Doctors and nurses are the gateway to the public. 

The Wellcome Monitor found that doctors, nurses and other medical practitioners emerge as the most trusted (64%) source of information about medical research, both because they are the experts and there is no reason to doubt them. [2]

Engaging the NHS workforce must be a key priority to ensure they have the resources to explain to their patients how data is used and to help implement the changes. 

New digital technologies

A single conversation will not be enough. As the NHS turns 70, data-driven technologies are advancing rapidly. Machine learning algorithms can already differentiate between cancerous and healthy tissue more accurately – and more quickly – than the human eye. There is significant potential for artificial intelligence to transform healthcare and to help ensure a more sustainable NHS. 

But there is also the risk of a public backlash if technology firms are seen to be processing vast quantities of data, in unexplained ways, at the expense of privacy. There must be meaningful public dialogue to help people understand the risks and benefits and to ensure that everyone can have confidence that data is being used in a responsible way. 

Unlocking patient data will help improve health and care for us all. Data really can save lives. But if we are to achieve real improvements, patients, the public and healthcare professionals must have confidence that access to patient data is appropriately managed. 

Part of demonstrating a trustworthy system is to provide clear, accessible and accurate information. We must learn from the mistakes of to ensure effective communication. Together, we can champion responsible uses of patient data.


[2] Ipsos MORI (2016) Wellcome Trust Monitor, Wave 3. London: Wellcome Trust


Nicola Perrin leads the Understanding Patient Data initiative, focusing on supporting better conversations about uses of health information. Previously Head of Policy at the Wellcome Trust from 2007-2016, she was responsible for leading Wellcome’s policy development and advocacy work, with a particular focus on research base funding, data sharing and innovation in the NHS. Before joining Wellcome, Nicola worked at the Nuffield Council on Bioethics and at the Science Museum. She is a Trustee of the Association of Medical Research Charities and was included in the list of 50 Movers and Shakers in BioBusiness in 2017.

Twitter: @NMRPerrin

What’s next for the future of the healthcare communications profession and how do we benchmark progress?

By Daniel Reynolds

Good communication sits at the heart of how the NHS engages with its patients, local communities, staff and other key stakeholders. The leadership and expertise provided by NHS communicators has a vital role to play in improving the patient experience.

You’ll learn:

• Some of the greatest challenges facing the NHS require expert communications skills and knowledge but, despite this, the NHS communications profession is often regarded as a service-level function
• Part of the solution lies in communication leaders developing a compelling narrative on why strategic communications must be invested in as well as better measures for demonstrating impact and return on investment
• The success NHS communications leaders have in this will go a long way to helping elevate the profession to the strategic function it aspires to be

PR is a strategic management function

NHS communicators need to be involved at a strategic level if they are to play as effective a role as possible in the running of their organisations. 

However, too often communications in the NHS is not regarded as a strategic function and instead considered by many to have a second-class status compared to other board-level positions. 

A new benchmarking study published by NHS Providers provides valuable insights into the NHS communications profession and where it sits as we enter the health service’s 70th year. It offers both hope and concern for the future. 

There is much to be positive and proud of as it reveals communications professionals at their best – whether that is delivering high profile campaigns that lead to desired behaviour change, leading public engagement strategies as part of initiatives to transform the way care is delivered or providing high quality information to patients. 

Progress has been slow but there is a growing awareness among NHS leaders of the key role communications can play.

Getting a place at the top table

However, comments from the 130 communications leaders that were surveyed for the NHS Providers study show there is still a long way to go before the profession rightly takes its place at the NHS top table. 

Despite many communications leaders enjoying good access to their chief executive, less than half formally report into the chief executive and less than a quarter sit on the board of their organisation. This is about more than line reporting arrangements as many communications leaders report into roles beyond those in the traditional C-suite. 

More worryingly, the report paints a picture of a highly pressured and over-worked profession, with fewer staff, too many demands and not enough opportunities for professional development. 

As with other parts of the NHS, communications leaders face budget cuts as part of their contribution to efficiency savings. Many communicators fear this is eroding their ability to contribute most effectively to helping their organisation achieve its strategic objectives. 

These funding constraints and workload pressures are forcing some leaders to move towards smaller teams based on more generalist roles and fewer specialists. Again, many fear this will have negative consequences, in particular by leaving their organisations short of specialist expertise. 

These factors undoubtedly present both opportunities and challenges for NHS communications leaders. We now have a useful baseline against which we can assess future progress but there are several issues that need to be front and centre of our collective efforts to become strategic advisers and recognised as such. 

Investment and support in NHS communications

With the temptation to make cuts to so-called back office functions, especially when every penny not deemed to be spent directly on patient care is increasingly scrutinised, communications leaders need to develop a compelling narrative on why communications must be invested in. 

We are not spin doctors and we are not there to simply defend and manage organisational reputation, though that is of course part of the job. What NHS communicators do often has a direct result on the patient experience and, when done well, will help to improve it. 

Some of the greatest challenges facing the NHS require expert communications skills and knowledge, not least in terms of managing the engagement challenge presented by Sustainability and Transformation Partnerships (STPs) and the changes to services they will deliver. 

We must make the case for communications leaders and their teams to retain the resources they need to play a leading role in helping the NHS to respond effectively to these challenges. 

Demonstrating strategic value

One theory as to why communicators do not always enjoy parity with other NHS professions is that, individually and collectively, the profession may not be doing enough to demonstrate strategic value. 

There is significant variation in how much time, energy and focus communicators are putting into this, with impact assessment often sacrificed when teams are short staffed and over-worked. 

This challenge is made harder by a lack of budgets for formal impact assessment. Communications leaders, with support from the national bodies, need to make better use of formal evaluation frameworks to show their activities lead to tangible returns on investment. 

The need for more formal career pathways

Despite the number of communications staff employed by the NHS and the vital role they play, the profession lacks a clear career structure and development pathway for communicators at all levels. 

This is regarded by many communications leaders as an increasing barrier to future recruitment. 

Despite the strategic importance of what we do, there is no requirement for professional qualifications for most communications roles and staff do not need to belong to a professional body, such as the CIPR, to practice. 

If we are to be taken as seriously as we want to be, then developing more formal career pathways is an important step in the journey. 

Safeguarding training and development

We know that budgets for training and development for NHS communicators are being eroded. We need to find creative ways of enabling greater numbers of staff to benefit from training – whether that’s through more online learning and sharing of best practice, or more regional workshops (backed by CPD points). 

Both would enable more communicators to benefit from training and development at minimal cost to the NHS. 

In a welcome development, NHS Improvement and NHS England have renewed their focus on supporting communications development with a new programme. We need to build on this in 2018 and beyond to ensure a generation of communicators now coming through are not deprived of vital developmental opportunities. 

Sharing communications capacity and expertise and partnership working

More collaborative working between communicators working in Trusts and other parts of the NHS and social care presents one potential solution to the capacity gaps and deficit in specialist skills that many health organisations are experiencing. 

For example, neighbouring Trusts sharing communications capacity and expertise on a more informal basis may help to plug gaps and lead to better outcomes. 

As part of this, there is an opportunity to build better links with our counterparts in local councils as focus shifts to an increasingly placed-based approach. 

This will be important where Trusts and their local partners need to engage effectively with an often sceptical public when it comes to the major service changes that are likely to result from STPs. And it may well prompt conversations on how we ensure that we have the right communicators with the right skills working in the right places. 

The NHS communications profession has made much progress, but the success its leaders have in responding to challenges outlined above will go a long way towards elevating the profession to the strategic function it aspires to be.


Daniel Reynolds is Director of Communications at NHS Providers, the membership body for 99% of NHS Trusts in England. He is a former director of communications at the Nuffield Trust, deputy director of communications at The King’s Fund and started his career as a journalist, including working for Sky News.

Twitter: @DanielReynolds4

Leadership and professionalism

By Claire Riley

Strong leadership is transformational for an organisation. Leaders with a clear vision and purpose take their employees on a journey, empowering everyone to work towards the same objectives and helping them achieve their potential. Today in the NHS, teams face big challenges and need champions who recognise and promote the value offered by strategic communications.

You’ll learn:

• That the silver bullet of leadership lies within you
• What you should consider on the road to leadership
• Why we must stop allowing people to refer to the ‘cost of communications’ as opposed to the ‘value of communications’ and collaborate to prove PR’s worth

Aspiring to authentic leadership

‘The role of leaders is not to get other people to follow them but to empower others to lead.’ 

 Bill George, Discover Your True North 2015.

Much has been written about leadership – in fact in 2015 leadership paperback books were coming out at a rate of more than four per day! 

Searching on Amazon ‘leadership books’ will give you nearly 300k options to choose from. That’s a lot of leadership books which will take more than anyone’s life time to read. 

In reality becoming a leader is a journey and not something you can just read in a book. As you move up that leadership ladder, the challenges are more about you as an individual rather than you as a practitioner.

If you are however to read a book about leadership I would suggest ‘Discover Your True North’ by Bill George. This book talks you through leadership and how you really need to understand who you are, your values and the principles you lead by before you can really truly develop as an authentic leader. 

In essence and in contradiction, it demonstrates that the silver bullet of leadership is within you – not in a book. 

Who/what should influence you? 

The facts are we all have opinions on leadership and we have all experiences of the good, bad and the ugly. 

I am lucky to have been and continue to be, influenced by some excellent leaders in and out of the NHS. 

Authenticity is, in my opinion, the most important attribute of an excellent leader – someone who is true to themselves and focused on doing the right thing regardless of the constraints they are working within. 

As examples of best practice I personally would single out two individuals: Jim Mackey, CEO of Northumbria Healthcare and Daljit Lally, CEO of Northumberland County Council and it isn’t just because they are also Geordies.

Like everyone, both have been on their own very different personal leadership journeys. They however remain very clear on who they are and the principles that drive them; their principles, not those created or designed by others. They empower and encourage others to lead and are fiercely determined to ensure their organisation is the best it can possibly be. 

Considerations for aspiring leaders

Regardless of where you are on your leadership journey there are several pointers to bear in mind:

• How to ensure your personal values and deep beliefs influence you as you develop your leadership style and how this influences your own personal brand 

• How you can learn from others (identify those you most admire), but do not try to be someone you are not

• Let your work do your talking – ignore the superficial and focus on the substance

• Less is sometime more – as communicators we are too often on ‘transmit’ mode

• Remember leadership does not equal control – empowerment and supporting others to achieve is key to success

• Be open and honest – when things go wrong tell people, do not try and hide it

• Be resilient – control the emotions

• Maintain integrity and manage your own reputation

Never stop learning

Within the communications, marketing and PR fraternity, not just within the NHS but across all sectors, training and development emphasis is on the ‘practitioner’ element. 

We all must continually invest in CPD - let’s be honest, not enough of us do once we bag the qualifications. 

Very few formal qualifications include leadership development and or management skills yet these are essential for career progression and the successful management of projects and teams. 

You must regularly challenge yourself with the question – when did I last focus on my learning and development? If you struggle to answer this you need to quickly reconsider and take control of your professional goals.

Within NHS Communications

It would be a myth to suggest that communications activity within healthcare in England is something new – yet so many people think it is. 

When the NHS was formed 70 years ago the government at the time embarked on a communications campaign to educate the population on ‘how to access services’. 

Soon after they were educating the public on how ‘coughs and sneezes spread diseases,’ subject matters still high up on the agenda for all organisations today. It is hard to believe that there was not widespread support for the NHS when it was formed!

Seventy years on, like all other areas of the NHS, working within communications remains challenging. 

Trying to navigate the internal politics around the NHS system is like watching Elton John in ‘Tantrum and Tiaras.’ 

Regardless, patients are to be cared for, the public want to have confidence in local services and participate in discussions about any changes to services, staff need to be engaged in the priorities of the organisation and stakeholders involved as services evolve. 

All of this is a statutory duty and therefore a must do, not a nice to have.

Whilst individual organisations are labelled with different names, the public only care for one thing – the NHS lozenge and what it represents. 

We all know that communications and wider engagement has a really important part to play in the success of the NHS yet not all organisations invest in communications at a strategic leadership level.

As an example, around 30% of senior communicators are at director level and only 20% are at Board level. 

Whilst the job title is not the determinant of successful delivery, it is a litmus test on how valued the function is within any organisation. 

Is this positioning of communications the fault of communicators, or systemic of the function itself?

Arguably I would suggest the answer to this question is both. As professional communicators we do not always help ourselves. 

Other chapters in this book share examples of the added value communications can bring to organisations yet not enough of us invest time and effort in evaluation of activity. 

From recruitment campaigns to campaigns linked to clinical safety, such as the latest one on Sepsis, there are tangible and, more often than not, cost benefits of such activity. 

But we are poor at promoting ourselves and such positive outcomes.

How many of us allow people to refer to the ‘cost of communications’ as opposed to the ‘value of communications’? Let’s face it, organisations do not talk about the cost of Finance or HR functions in this way. 

Leaders of communications cannot devolve responsibility of the positioning of the communications function to others, we should take control and act together to demonstrate the value the function offers to organisations. 

What can all communicators do to support this?

There is much we can achieve if we collaborate. 

Here is a checklist of actions communicators can follow:

• Plan activity with purpose, tangible outputs and with clear ‘call to actions’

• Do not overcomplicate plans and over design communications activity as if it is art as opposed to a means to an end

• Measure and evaluate work regularly and formally report to executive teams and where possible Boards

• Maintain strong relationships across the whole organisation and ensure you provide a service for all as required

• If you sit at the leadership table ensure you contribute and add value, supporting the development of solutions rather than creating problems

• Understand the numbers and know how to analyse and interpret them

• Work as part of a leadership team not just as a communications team

• Do not procrastinate – deliver what you say and within the time and budget agreed

Finally, let’s stop apologising for working in communications and be proud of the added value and outcomes we achieve. If we appreciate our own worth, others will too. 


Claire Riley is Director of Communications and Corporate Affairs for Northumbria Healthcare NHS Foundation Trust and also works nationally with NHS Improvement on the communications development programme. Claire is a qualified marketer and experienced lecturer and has a post graduate diploma in Marketing and a BA (Hons) in Business Management & Organisations with extensive experience in business, marketing and communications across public and private sectors. Claire holds the Freedom of the City of London and is married with two girls. She is a long-suffering Newcastle United supporter and a life-long Wham! fan.

Twitter: @thefourrileys

Continuing professional development in the NHS

By Anne Gregory

Question: How do you stay up to date in the fast moving, complex, communication hungry, resource-strapped world that is the NHS where every moment counts? Answer: you can’t afford not to be, it’s the mark of a true professional.

You’ll learn:

• About the continuing and growing need for strategic, trusted communications advisers
• How a lack of resource drives innovation and creativity, particularly in the NHS
• Pooling CPD resources also provides an opportunity for the public sector to consider ‘joined up’ public communication on some of the big issues facing society

What’s happening in NHS Communications?

Pre 2012 the NHS was centralised. It was run directly by the Department of Health and most of the Continuing Professional Development (CPD) for communication professionals was designed and provided by them. 

It was my privilege then to be involved in a project called NHS Evolve, a competency framework which provided a comprehensive catalogue of the knowledge, skills and standards needed by all NHS communicators. 

Since the Andrew Lansley reforms of 2012, the NHS has become much more fragmented. Hospital Foundation Trusts have more autonomy, Clinical Commissioning Groups (CCGs) decide what local populations need and fund services, GPs are still relatively independent and the Regulator(s) have a big role in quality assuring and monitoring the funding of the NHS system. 

And that is what it is, a system. There are many other organisations in the system, such as Health and Well-being Boards, Public Health England and NHS Blood and Transport. All these moving parts means it is complex and difficult to navigate.

Health needs have also changed. People are living longer and as they age they become frailer and suffer from more health issues, often all at the same time. 

Concurrently information demands are higher, from the press, from the public and increasingly from other parts of the fragmented system. 

In a world dominated by sound bites and ‘keep it simple stupid,’ it is increasingly challenging to communicate the complexities involved while keeping it intelligible. 

The need for strategic, trusted communication advisers operating at the highest level has never been greater.

Being a communicator, particularly if you are in a small team of two or three people, because that is how it is in many hospitals, means you face huge demand and challenges. Rather like the NHS itself. 

So what is there to help you keep up to date and at the forefront of professional development?

Against the stereotype, my experience of working with public sector communicators demonstrates they are ahead of their compatriots in the private sector. 

The fact that they are always publicly accountable means that they are highly skilled advisers. Their lack of resources often drives innovation and creativity: they are adept at using all channels available and devise content that is relevant and important.

Gaining access to training and development

With no central resource available, how do NHS communicators gain CPD?

There have been a number of initiatives over the last few years and they are gaining momentum after a bit of a slow start.

Since 2015 NHS Improvement (NHSI), the system regulator and NHS England which has overarching responsibility for commissioning through the system, have been running a post-graduate certificate in Health Care Communication with Buckinghamshire New University. It is for aspiring Communication leaders in Trusts and now for CCGs.

According to Alison Brown, Head of Communications Development at NHSI, there was a need to standardise, raise standards and enhance the strategic capability of communication staff to deliver the objectives of their organisations.

This joint body is also providing seminars on the issues challenging Trusts and has re-launched CommsLink. This is an online resource and network for all NHS communicators populated with case studies, campaign materials, lessons learned: all aimed at sharing good practice and for learning. 

Some of the larger NHS organisations have developed training based on their own expertise. For example NHS Digital has built a series of case studies aimed at enhancing digital capability throughout the system.

NHS Providers, which is a ‘trade association’ of healthcare providers including ambulance, mental health and hospital Trusts, runs a Communications Leads Network offering a forum for sharing ideas, learning best practice and addressing the issues facing health communicators.

The Association for Healthcare Communications and Marketing is yet another network for communicators working in the system supporting training and professional development and also running a prestigious annual Awards event that celebrates best practice.

Many health system communicators also access CPD programmes from the professional body, the Chartered Institute of Public Relations and the UK trade body, the Public Relations Communications Association.

Sensibly, the health communications community has been linking up with other parts of the public sector which have more highly developed CPD programmes.

LG Communications is a national body made up of an association of authorities working to raise the standard of communications in local government. LGComms has a full and sophisticated offering of CPD including their own Academy, a seminar programme, a Future Leaders programme and a resource bank including good practice guides.

The Government Communications Service (GCS) which is the professional body for those working in Government, also allows access to their whole range of development courses, tools, guides and best practice.

On offer here is the GCS Curriculum which provides 1600 free training places on a range of courses and at a variety of levels. The Early Talent programme and the Senior Talent programme, a Masters course run with the University of Huddersfield for those with high potential, are two year structured offerings which develop leadership capabilities.

Importantly the GCS offers a Personal Development Plan template that helps communicators build a planned approach to their own professional progress. This can be used in conjunction with a professional Competency Framework that captures all the knowledge and skills required to operate as a competent professional in public service.

That the NHS taps into all these initiatives in different parts of the public sector is good. Public sector organisations are having to work more closely together on a range of issues including health and social care, housing and homelessness, loneliness and social exclusion – the root of many health problems.

As they learn and develop their professional skills and knowledge together, they also have the opportunity to consider ‘joined up’ public communication on some of these linked ‘wicked’ problems. 

What about CPD into the future?

While it’s true to say that a coherent, consistent, systematic CPD offer in NHS communication is a work in progress, there are other moves in the communication space that will help. As the whole profession rises to the challenge of a more fast moving, complex, interconnected and demanding communication environment, new initiatives are being developed. 

The Global Alliance, the international confederation of professional associations, is developing the Global Capability Framework. This establishes the key capabilities that all communicators should have wherever they live and work but can also be customised and added to for particular employers, sectors and even countries and regions around the world.

The work is being led by the University of Huddersfield and will be launched in April 2018. At that stage NHS communicators, like those from any other organisation, will be able benchmark themselves against the framework. 

Software will enable them to plan their own development future. Maybe at that stage the NHS will be able to leapfrog intermediary developments and go straight to be a leader in CPD. With NHS Digital being one of the interested parties in this development, it looks like it certainly could be.


Professor Anne Gregory is Chair in Corporate Communication at the University of Huddersfield. She is a former President of the CIPR, former Chair of the Global Alliance and currently leads the worldwide Global Capability Project. Anne is a non-executive Director of Airedale NHS Foundation Trust.

Twitter: @GregsAnne

NHS: The ultimate superbrand?

By Nick Ramshaw

The NHS Identity is the most instantly recognisable brand in the UK. Yet its use in England over recent years has been inconsistent, leading to confusion amongst the people who value it most. This chapter tells the story of how a better understanding of what the brand means to patients and the public has helped to inspire a new NHS Identity Policy. The Policy in turn has helped increase consistency, maintained public trust and will ultimately help the NHS to save money.

You’ll learn:

• Why understanding your audience is key to brand success
• Why testing branding with users and the public is so important
• Why making it as easy as possible is your best chance of implementation success

Why is the NHS Identity important?

The NHS Identity is one of the most cherished and well known in the world. When applied correctly and consistently it evokes exceptionally high levels of emotional attachment, trust and reassurance. 

The NHS blue lozenge logo is instantly recognised and its application directly affects how patients and the public think and feel about the NHS. 

All users of the NHS Identity have a responsibility to protect it and ensure they achieve the national standard that the patients expect from it.

FIGURE 1 NHS lozenge


Why is the NHS Identity important?

The NHS Identity is one of the most cherished and well known in the world. When applied correctly and consistently it evokes exceptionally high levels of emotional attachment, trust and reassurance. 

The NHS blue lozenge logo is instantly recognised and its application directly affects how patients and the public think and feel about the NHS. 

All users of the NHS Identity have a responsibility to protect it and ensure they achieve the national standard that the patients expect from it.

A need for new guidelines

A single NHS Identity was introduced in England in 1999 to help signpost people to NHS organisations and services and to help them identify information which has come from an official NHS source. 

The famous blue lozenge had been around since the early 1990s, but its use hadn’t been reviewed since 1999. 

A new NHS structure had been introduced with Clinical Commissioning Groups (CCGs) and Foundation Trusts, but guidance had not been updated to reflect this. 

The existing guidelines (spread over 19 documents) also didn’t include guidance for digital communications – they were seriously outdated. 

Some NHS organisations had also introduced their own identities, leading to confusion amongst patients and the public. 

With NHS services now being delivered by different organisations, including private sector operators, a new approach was required to provide patients with clear signposting to their NHS services. 

New guidelines were also needed to bring consistency and clarity on how to use the Identity in modern communications. Taking a professional and consistent approach is important to the public and helps to create a visual mark of quality. Achieve all this and the NHS would achieve savings in the cost of communications throughout England.

The need for audience insight

For any brand to operate effectively, it has to understand its audience and know how it influences how they feel about the brand. 

In the case of the NHS, the audience is extremely broad – everyone in England – which currently stands at a population of 54.3 million people. 

The internal audience comprises the 1.2 million people who work directly for the NHS, as well as the third party providers who are entitled to use the NHS Identity.

To understand how the public felt about the NHS Identity, we carried out an extensive engagement programme. This consisted of focus groups, interviews, questionnaires, workshops and vox pops, with both internal and external audiences and stakeholders. 

The programme was key to us understanding how people think about the NHS Identity and what they would feel about potential changes in the future.

They’ve got the blue, we can trust them. - Public research, 2015

What we learnt from the public, was that we should tinker with the logo at our peril! When people see the blue NHS logo, they automatically associate it with high quality, free services. The use of colours other than blue and new logos were clearly opposed, as it was very confusing. 

The public is generally more brand savvy now than ever before and it understands how identities like this work.

Developing an Identity Policy

To help the 600+ NHS organisations achieve the consistent, national standard that patients expect, we developed a comprehensive Identity Policy. 

The new Policy is based on a set of over-arching principles, designed to ensure the interests and needs of patients and the public are considered first and aligned to the NHS Constitution. It also covers who can and can’t use the NHS Identity, how the core elements should be used and the responsibilities for ensuring correct implementation.

The Policy was kept intentionally simple, to help ensure implementation was successful. The Policy principles are clear and easily understood:

1. When applying the NHS Identity, the interests and needs of patients should always be considered first.

2. All applications of the NHS Identity should support the NHS values and the principles of the NHS Constitution.

3. All users have a duty of care to protect the NHS Identity.

4. The NHS Identity is the single, clear way to signpost patients and the public to NHS organisations and services and should be used universally and consistently.

5. The NHS Identity Policy applies to all services which the NHS is accountable and responsible for, regardless of the provider.

6. The NHS Identity itself cannot be used to generate profit outside the NHS.

7. The Policy is mandatory for all organisation that use the NHS Identity. There will be no exceptions.

Ensuring compliance between the Identity and new Policy

With the Policy approved, we carried out a major overhaul of the NHS Identity elements.

The public’s exceptionally high awareness told us we shouldn’t change the core lozenge, use of the Frutiger font or the core colours of blue and white. 

What was needed though was a more consistent system for logomarks, a much more comprehensive colour palette with implementation advice and specific help with things like logo positioning and use online. 

Practical guidance was also required on the naming of existing and new services and partnerships (of which there are increasingly more), the use of the NHS Identity by primary care providers and the appropriate tone of voice for internal and external communications.

Engaging with brand users

Given the limited resources of many NHS organisations, we found the best way of helping would be to make things as easy as possible. 

Our solution was to provide practical tools and assets that users required to achieve higher levels of consistency in their work. 

This included the creation of more than 100 visual examples of the Identity in use, logomark asset packs for over 600 NHS organisations and a comprehensive set of online Identity guidelines. 

These guidelines are rich in detail and focus on the types of scenario we know the stakeholders face on a day-to-day basis. Everything was designed to make the users’ job easier, to help save time and money as well as improving consistency. 

You can find these at

The guidelines themselves were extensively tested with users in groups and individually. By asking actual users of the Identity to test the Beta version of the guidelines, we identified not only the usability issues within the website, but also the practical issues in the guidelines’ content itself.

Once the assets had been circulated and the new guidelines launched online, the NHS Identity Team provided help and assistance via a hotline and face-to-face sessions throughout the country.

Have the new guidelines been successful?

The new approach will be implemented over the long term, with materials only rebranded when due for natural replacement. This and the use of the new asset packs, a more consistent approach generally and a new culture of sharing artwork will lead to a significant reduction in the total NHS design spend. 

“I’m struggling to put into words just how valuable this experience has been, for us and for the entire NHS organisation. My job is to help everyone implement the NHS Identity more effectively and the early signs are that the guidelines, assets and examples are proving to be an enormous help.”

Julie Haddon, Head of Identity, NHS England

Following an informal launch in late 2016, a number of NHS organisations, Trusts and CCGs are already using the new assets and guidelines, finding them very helpful. The new NHS Identity website was formally launched on 4 January 2017.

Key learnings

In conclusion, this project has helped us to better understand the NHS Identity and how it is regarded by patients and the public. 

Knowing what is in the hearts and minds of the public is key to providing reassurance and clear signposting. And of all Identities, the NHS really matters!

A professional and consistent application of the NHS brand helps patients and the public see the NHS as a visual mark of quality.

It was very important then to test our hypothesis and prototypes, in real life conditions with real users, to fully understand the user journey. And finally, once we developed the assets, Policy, guidelines and examples, to make it as easy as possible, in order to achieve better results and higher levels of consistency.

We are proud to have helped in the development of the best known and most loved brand in the country and look forward to helping it grow from strength to strength.


Nick Ramshaw has over 25 years of experience working at a senior level in leading brand and design agencies in London, Edinburgh and Leeds. He is a past President of trade body Design Business Association, a Common Purpose graduate and a governor of Leeds Arts University. Nick led the team at Thompson Brand Partners that carried out a recent fundamental review of the NHS identity in England, creating a comprehensive use policy and detailed online guidelines.

Twitter: @ThompsonBP

Public trust and the NHS

By Alan Maine

At a time when trust in business, government, NGOs and the media is at an all-time low, hospitals and clinics continue to perform well, helped by direct and ongoing relationships with patients. 

You’ll learn:

• That the fact hospitals and clinics present a human face helps to build trust with the public
• Employees are more trusted than CEOs or senior business executives to communicate information
• The top five trust-building behaviours for organisations

The NHS: A much-loved institution

The NHS is woven into Britain’s DNA. A recent King’s Fund study showed that almost four out of five Britons believe ‘the NHS is crucial to British society and we must do everything to maintain it.’ [1]

Clearly, it is one of Britain’s proudest and most loved institutions. But do the public trust it? And how is trust critical to the future of the NHS?

We think there are three reasons:

1. The pace of change is moving faster than ever before. Britons are now living much longer; advances in technology and genomics are changing how health professionals advise; and big data is revolutionising the future of healthcare. Do Britons trust that these advancements can help us lead healthier – and happier - lives?

2. Patients are doing their own independent research – thanks to ‘Dr Google’. What happens when a patient finds information online that conflicts with their doctor’s recommendation?

3. Service reconfiguration. With potential closures of local hospital services and clinics, do Britons trust that the goal is to improve patient care and outcomes?

Edelman has studied trust for 18 years and we are now in our seventh year of surveying an extended sample of the general online population. This year, we spoke to more than 33,000 respondents in 28 countries. We ask them a series of questions to gauge their trust in the institutions of business, government, NGOs and the media. 

The 2018 findings revealed that Britons mistrust all four institutions. In an era where trust is distinctly lacking, one would hope to be able to say that the public ‘trusts’ the NHS.

The good news is that our findings are encouraging. As one might expect, comparatively, ‘Hospitals/Clinics’ have consistently remained the most trusted healthcare sub-sector since this category was added to our global study in 2015.

FIGURE 1 Globally, Hospitals / Clinics Remain Most Trusted

Trust in the Healthcare sub-sectors, 2015-2017, (27-country global total), General Population


We believe their continued and growing levels of trust are due to:

• Patient Relationships: Hospitals/Clinics have always had a trust advantage given their direct and ongoing relationship with patients. In the US, we believe this is because more of the population are receiving access to Hospitals/Clinics thanks to public reform.

• Benefit of Real People: As opposed to other segments of the healthcare industry where employees are many steps removed from the patient or consumer, hospitals and clinics have a human face and real people on the frontlines of treatment and care.

Who can build trust?

The data helps us form some thinking around who in the NHS can help build trust. Who should represent the NHS to communicate its strategic policies; talk about change; and outline its future?

Our survey found that employees are the most credible voices - more than leaders and more than experts. 

Across the board, employees are more trusted than CEOs or senior business executives to communicate information. This includes information about financial earnings and operating performance, how to handle a crisis and - of course - how to treat employees and customers.

FIGURE 2 Employees Most Credible
Most trusted spokesperson to communicate each topic


Healthcare communicators should also be interested to find out that along with academic and technical experts, ‘a person like yourself’ is seen as credible by most people. This reinforces that people want to be spoken with, not talked at.

Engaging the public with the public health agenda – critical to the sustainability of the NHS – is another area where trust is key. 

Interestingly, The King’s Fund found that two-thirds of the public (65 per cent) agree that keeping healthy is primarily the responsibility of the individual, while just 7 per cent put this responsibility on the NHS.

This links to another finding of the Trust Barometer. Globally, 7 in 10 people agreed with the statement ‘I am confident in my ability to find answers about healthcare related questions and make informed decisions for myself and my family.’ This points to the increased availability of health information across non-traditional platforms, including online sources, social media and companies’ owned media channels.

Building trust in institutions 

In our dialogue with businesses globally on trust, Edelman identifies five top trust-building behaviours: 

1. Ensure quality control and protect consumer data
2. Be transparent and authentic in how you operate
3. Contribute to the greater good
4. Develop innovations that have a positive impact on people’s life and the world
5. Show leadership that effectively represents the interest of all stakeholders.

It goes without saying that the NHS should own points three and four. Also, transparency remains high on the agenda of the NHS, particularly with initiatives such as ‘My NHS’ on performance data.

Protection of consumer data - or in the case of the NHS, patient data - remains an area of public debate and often concern. As technology advances, along with our modern lifestyles, it is critical that the NHS builds the public’s trust in NHS safeguarding and use of personal data. 

Who should lead that debate? Certainly not the politicians. Our findings show the public trust in ‘people like me’ and ‘employees’, however. This could point the way to organically building the public trust and understanding in the NHS’s future use of their health information. 

Some steps are already being taken. Setting out her vision of the use of genomics in the NHS, Sally Davies, Chief Medical Officer, notes ‘as members of clinical teams we must engage patients and the public and develop real partnerships. […] To achieve this we need to maintain patients’ and the public’s trust and make genomics everyone’s business.’

More leaders must adopt this approach.




Alan Maine is Senior Director for UK Health Public Affairs at Edelman. Alan has worked in healthcare and science policy public affairs for 15 years. Before joining Edelman he was Head of Policy and Public Affairs at Pfizer and he also worked for Wyeth and Merck Sharp and Dohme. Prior to his time in the life sciences industry he was head of the foreign affairs section of the Conservative Research Department.

Twitter: @edelmanuk

A journalist’s perspective: The good and bad of NHS comms

by Denis Campbell

Public relations practitioners and journalists need each other but without trust, honesty and an open line of communication, relationships can soon get strained. This chapter looks at the good, bad and ugly of NHS comms, focusing on engagement with the media.

You’ll learn:

• How the NHS, by being more honest about its situation, could potentially make greater in-roads into securing greater investment into its services
• How positive, compelling journalism results from journalists and NHS PRs working closely together
• Why stonewalling reflects badly on an organisation because the story will find its way into the public domain anyway

A poisoned chalice

To be asked to write about how NHS PRs engage with health journalists like me is the professional equivalent of being offered a cyanide pill. 

As the health policy editor (main NHS reporter) of the Guardian and the Observer I seek these people’s help daily; I couldn’t do my job without them. So why would I say anything at all, lest even a smidgeon of criticism alienates those whose goodwill, determination and professionalism I routinely rely upon? 

Because from my experience of covering health for almost 11 years, while some NHS comms officers are superb (creative, resourceful, at least as keen as me to make the story work), others display behaviours which are unhelpful, unbecoming of their profession and, most importantly, ultimately damaging to the NHS. 

I need the former to win out over the latter, for both my sake and also to help the service itself. 

Be honest and hold the line

The health service’s well-rehearsed weaknesses – too little money, too few staff, a fragmented system, rising demand involving epic amounts of avoidable illness – mean it is increasingly, visibly unable to do the job it wants and citizens expect.

Any health system that seriously considers rationing chemotherapy to newly-diagnosed and existing cancer patients, as Oxford University Hospitals Trust did in January, is clearly in very serious trouble and breaching its social contract with the nation, albeit involuntarily. 

So dissembling or downplaying the NHS’s many problems, or going along with the government’s fantasy version of events – part Big Lie, part cruel blame game, part Yes, Minister amateurishness – is unforgiveable. 

Yet in my view, worryingly many NHS bodies, local but especially national and their leaders are making that mistake, for example by pretending that understaffing isn’t the disaster that it clearly is. 

NHS public relations professionals are inevitable handmaidens in that disgraceful and dishonourable mission, which is itself partly the product of pressure from government. 

I exempt NHS England chief executive Simon Stevens from that criticism. His speaking of truth unto power about the NHS’s budget, even at the cost of antagonising Theresa May, has been bold, necessary and very impressive – not to mention effective. 

A mixed bag of talent

The baffling, atomised nature of the NHS in England – 240-odd Trusts, 200-odd Clinical Commissioning Groups and array of NHS arm’s length bodies – makes it impossible to talk in any meaningful way about how good or bad ‘NHS PRs’ are. 

There are so many of them: thousands of them, compared to a few dozen health journalists in national media outlets. And working as a PR for an NHS Hospital Trust, with its primarily local focus, is clearly very different to working for national bodies such as NHS England, Health Education England or NHS Improvement. 

Overall, I find them a mixed bag: some brilliant, some appalling and many perfectly average. 

In early 2016 the Guardian ran a month-long series called This Is The NHS. 

It was the most in-depth look ever attempted by any media outlet at the work and superb staff of what is, rightly, the country’s most-loved institution. We couldn’t have done that without the help and trust of NHS England, who helped open doors for us and NHS Trusts, who gave us access to people, places and sometimes mind-bogglingly amazing work, like heart surgery on babies performed in utero. 

The result was compelling journalism about fascinating things, facilitated by a virtuous circle of journalists and NHS PRs working closely together to mutual advantage. 

Guiding principles

So why don’t things work like that more often? Well, the NHS Constitution sets out seven ‘principles that guide the NHS in all it does’. 

According to this fine, thoughtful document, these seven are ‘underpinned by core NHS values which have been derived from extensive discussions with staff, patients and the public,’ like care being free at the point of use. 

These principles sound great: honourable, uplifting, in spirit with what most of its bosses would say were the service’s values. For me as a journalist the most important is the seventh principle. 

This specifies that ‘the NHS is accountable to the public, communities and patients that it serves…The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff.’ 

In my view that principle should guide and bind the behaviour of NHS PR practitioners too. 

Moving from good to bad

The accountability described above involves board meetings, annual reports, appearances at the local health scrutiny committee and – crucially – engagement with the media. Some NHS bodies I deal with take such responsibilities seriously. 

Yet almost daily, sometimes hourly, I encounter examples of how NHS organisations don’t so much as drive a coach and horses through their constitutional duty – to explain and answer honestly for what they do – as ignore it altogether, such is the level of opaqueness, evasion and outright denial of information which I encounter. 

I cannot tell how much NHS PRs themselves are to blame and how much of it is them simply implementing media-unfriendly policies dictated by their bosses. 

But I do tear my hair out at how bland, opaque and evasive replies to simple queries I submit to NHS organisations often are. 

I marvel at the effort senior managers and clever PRs put into coming up with entirely irrelevant answers. Do they think that will stop the story appearing? 

I am appalled at receiving so many Whitehall-style non-response answers – a refusal to respond to the evidence or opinions that are the basis of the story – that deliberately refuse to engage with concerns raised by doctors, researchers, health charities and grieving relatives. 

Because they have no good answer, presumably. In a health service of all things, why are those doing this not ashamed of themselves? 

And I know that, obviously, if the issue is something that will embarrass an NHS body, even a little bit, too often the seventh principle means nothing and damage limitation all that matters. 

When I was looking into understaffing and compromised patient safety at North Middlesex hospital in London, the hospital deserved an Olympic medal for stonewalling and denial of basic facts. 

Happily, previously-unpublished documents circulating within the wider NHS, which outlined the troubled Trust’s many problems in graphic detail, rendered their unhelpfulness irrelevant. Given that 99% of the time the story is still going to get out there, why not just be honest instead? 

Transparency is key

I despair, too, at the NHS’s addiction to secrecy: over the rationing of care, Strategic Transformation Plans, the creation of ‘Accountable Care Organisations’, plans to reshape local hospital services and much more. 

These things are always controversial, I appreciate. But when the truth gets out, as it nearly always does – via local campaigners, 38 Degrees, the BMA, people submitting FOI requests and so on – that secrecy makes things worse, because people (MPs, councillors, local people, the media) have been taken for fools and don’t like it. 

NHS PRs’ background and talents lie in communicating. So why not spend more time and put more creative energy into communicating what their bit of the NHS does and who the staff are that make that possible? 

And why not be routinely honest with the media – and thus the public – about the pressures the service is under and not be afraid to acknowledge that that can cause problems? Why not trust journalists much more to do a decent job and not be so suspicious all the time? 

I know these are all in NHS terms risky behaviours. But they might just help – people like me and people like you - and so the NHS itself. 

As the NHS turns 70, these are my NHS birthday wishes. 


Denis Campbell is the health policy editor of the Guardian and the Observer.

Twitter: @denis_campbell

Outside looking in: An external perspective of the NHS

By Roy Lilley

The NHS occupies a special place in the public’s heart and politicians are keenly aware it can win or lose them votes. Life in the NHS is more challenging than ever but the NHS has one huge benefit on its side – amazing staff and strong communicators who recognise that transparency is the only way forward.

You’ll learn:

• Good comms centres all around transparency
• Why staff are your greatest asset
• That organisations must avoid becoming corporate and distant if they are to maintain goodwill

An NHS is crisis

As I write, making my contribution to this book, the NHS is under siege.

It’s early January and the NHS is dealing with what has to be the worst winter crisis since the ‘90s.

Patients in A&E are on trolleys, ambulances are lined up outside and wards are fuller than full with sick people. For the first time in my 30 plus years, in and around the NHS, the Secretary of State for Health has appeared, voluntarily, in front of the cameras and said... “Sorry”.

A day later the Prime Minister did the same. She was sorry for the cancelled operations and praised the hard work of the staff.

We are so used to the Department of Health press office dissembling and camouflage, it came as something of a surprise. For senior politicians to apologise for failings (you can’t call it anything else), is unheard of.

You can bet the policy wonks, ministers, the lawyers and probably the Cabinet and the communications experts would have had a say in the decision to fess-up.

It truth, there wasn’t much else they could do. The usual bluster and conflation, the barrage of statistics, wasn’t going to wash. Take it on the chin. Admit it on your terms and dilute it, best you can, with lavish praise for the ‘hard working staff’ at the front line of health care.

A public communications case study if ever I saw one. A hollow confession, a plastic apology and a dollop of sickly praise. 

‘Oops, sorry and luv ya!’ What’s not to like!

Nowhere to hide

This winter thing isn’t over yet and already NHS communications teams are struggling to know what to do. Generally their job is to put on a brave face, be sunny-side-up and polish the cow pat.

It’s difficult to do that when the evidence of the system melt-down is all around you. Staff are taking to social media to say how ‘third world’ it all is and the public are only too willing to go on the telly to share bad experiences.

How do you handle all that? What are the lessons learned?

The first; there is no hiding place. The good old days of issuing a press release and going home at five o’clock are over. The press are more intrusive and the public more demanding. Second, the media has a 24-7 avarice.

Communicate openly and honestly

There is only one word that comes to mind. It’s a painful word, rapier-like and hurts. The word is transparency. The only defence is transparency. The only comfort transparency. This is the only answer.

In times of crisis and heightened public interest, there are three things to do, communicate, communicate and communicate. 

Tell ‘em what you’re going to tell ‘em... tell ‘em... and tell ‘em again.

It’s not rocket science and it certainly isn’t new. To answer the question, how often should I communicate, the answer is before somebody else does and in a global, 24-7 media world that’s tricky.

A clear idea of what you want to communicate is no bad idea. 

In the current crisis the only approach can be:

‘Our hospital has 600 beds, when they are full, they are full. We are moving people through the system as fast and as safely as we can but we depend on colleagues in primary care to keep people at home and our colleagues in social care to get them back home. They are struggling too. We all are. There is unprecedented demand and people are having to wait, sometimes for hours. Please don’t come unless you are very ill...’

In dealing with frustrated staff, taking to social media and creating hell with their smart phone, communicators have to be smart. It’s part of the new repertoire of communications management that was certainly not on the agenda back in 1948, when the NHS was born.

Finding the line between freedom to speak, getting the facts straight and not alarming the public is the job of a diplomat and a colleague who is trusted to make sure the truth is told.

A brand like no other

The enduring love affair the public has with the NHS, the undying affection, poses a question of its own. Is the NHS such a strong brand it doesn’t need communications strategists fussing over it?

The NHS runs out of money. The public gives it more. Piles people up in waiting rooms, stacks them up in corridors. The public comes back for more. Makes terrible mistakes. The public are forgiving. Why?

Because the NHS is the only show in town? There’s no choice? The same is true of the trains and look at the stick they get.

The NHS survives because of the amazing talents and vocational skills of the front line of health care. They are the communications department’s greatest asset. The evangelists, disciples and best advert. What other ‘business’ is there with such an enduring brand, public affection and committed workforce.

Of all the public services and the impatience users have with them the NHS is the one that politicians are the most nervous of. History tells us the health service can make or break careers and win or lose elections.

Time to close the corporate gap

If we think the NHS is a special case and a one off there is a risk to that. 

At the birth of the NHS hospitals were part of the community, funded by charities and public generosity. Local, up-the-road and ‘part of us’. 

Increasingly, they are bigger, more remote, management more distant. Social media gives health communications professionals the opportunity to connect with service users, talk to them directly, listen to their thanks and pay attention to their concerns.

It’s a lesson the NHS was slow to learn and is a warning for corporations everywhere.

The disgruntled no longer write in and complain. They take pictures and plaster them over social media for a global audience to gawp at.

Lessons for the wider communications community? The people who deliver the product are your case studies and ambassadors. Equally there is no substitute for a good product.


Roy Lilley has a background in business and as a Trust chairman. He now writes and broadcasts on the NHS and social care. He is the author of 27 books on healthcare management.

Twitter: @RoyLilley

Communications offers the NHS its Greatest lifeline

Editors analysis by Sarah Hall

“The NHS will last as long as there are folk with the faith to fight for it.” Nye Bevan, founder of the NHS.

#FuturePRoof edition three is a story of an NHS striving hard to modernise as it navigates through the toughest challenges of its lifetime, challenges that can only be overcome if it embraces an honest dialogue with the public.

An aging population with complex heath needs, underfunding, political agendas, privatisation, parochial self-interest, healthcare that doesn’t consistently meet quality standards and questions over the type and location of delivery, are just some of the huge questions its leaders face.

There are no easy answers.

Facing the challenges with integrity and transparency

Seventy years after it was first established, the NHS has grown beyond all expectations; a behemoth which comprises a network of organisations, occasionally with competing agendas, but all fighting with one aim: to maintain healthcare that is free at the point of treatment.

Daily life for NHS employees is a juxtaposition of medical and technological innovation within buildings and infrastructure that are in some cases no longer fit for purpose. World class frontline teams of doctors and nurses prop up a system that is creaking at the seams.

There is widespread recognition that the NHS is on a knife edge.

The greatest challenge is not where the money comes from, but how to have an honest conversation with the public about what future healthcare should be and to educate the wider population about the change that is needed and create demand for this to happen. 

Public engagement is the most powerful form of advocacy

Professional communications has never been more critical to the future of the NHS. 

Public relations in its truest sense is needed not just to speak truth to power, but to engage with NHS users who think that an injection of funds will suffice to fix the issues. The NHS will stand or fall on its relationship with the public. As public engagement is the bread and butter of what we do, the power is in our hands.

Investment alone is not the solution. A much more radical overhaul is urgently required that engages both the workforce and the public. 

Difficult conversations need to be had and decisions taken, not at the behest of politicians or NHS management teams, but following true collaboration and engagement with members of the public who must accept that the care they receive needs to revolutionise and fast. 

While the general populace may be wedded to having doctors’ surgeries and hospitals on every corner, this is not where a sustainable future lies. 

Instead, technology is already empowering online consultations and self-care within the home setting.

Non-urgent treatment is moving from hospitals into the community. Apps are providing better access to healthcare advice focused on prevention rather than cure.

This is the new reality and UK society needs to embrace this. 

So what is the role of professional communicators in the NHS?

The story of NHS communications is an evolving one. The comms role is more linked than ever to the organisation’s viability, sustainability and longevity. 

Speak to any NHS leader involved with the drive to professionalise the marketing and public relations function and they will tell the tale of an up and down journey of quick fixes, pockets of mediocrity and a mixed bag of talent. 

They will equally laud the communications excellence within its teams today, particularly those demonstrably showcasing best practice and trailblazing the way digitally, as evidenced by this book.

Fall out from the mass recruitment of journalists to improve its media relations service continues to reverberate. The skills vacuum related to integrated communications and reputation management is felt across the network and managing this is a clear priority.

Thankfully short-term decision making has been replaced by a long-term strategic approach which sees professional development as paramount. 

Despite - perhaps due to - the fragmentation of the system, the introduction and use of capability frameworks is finally ensuring communicators within the NHS are being measured against the same knowledge, skills and standards and that their work is aligned with and delivers against organisational objectives. 

Ensuring its communicators have the experience, skillset and ability to step into the strategic adviser role may be well overdue but comes at the perfect time in the history of the NHS. It may well prove that these people will be its saviour. 

In times of crisis, the answer is often the most simple and obvious. 

Those in the communications space offer the NHS its greatest lifeline if they have the courage to speak the truth. 

Not just about rising demand versus lack of investment, understaffing, or how the whole system fails if one of its connected services falters (think hospital bed shortages and how patients move - or don’t - through the network) but about the pressing need for change and how a better service can be achieved for those who have the privilege of using the NHS. 

The risk is now greatly outweighed by the reward

Research shows that the NHS remains one of the most trusted institutions in the UK. According to the Commonwealth Fund healthcare thinktank, whose international partners are the OECD, WHO and European Observatory on Health Systems and Policies, it is the best, safest and most affordable healthcare system out of 11 high income countries analysed. Much of its credibility comes from the human face and skills of its employees, who interact with the public every day.

With this in mind, perhaps the biggest lesson for its management teams, communicators and the wider public relations community is to embrace transparency, invest in skills and use real people to lead the debate.

For the NHS this means fielding doctors and nurses and others within the care setting to start the discussion about what the future of healthcare holds, what the journey there looks like and the impact for modern society.

Not just this, it means taking one approach at scale and talking about the true cost of treatment and the value of the service that the public receives. 

Educating people about what they might have paid privately is potentially one solution to reducing non-urgent attendances at A&E.

Explaining the benefits to a total overhaul of the system, while recognising the challenges this will create, could mobilise an army of vocal supporters prepared to lobby the government for what the NHS needs.

Right now, it needs all the support it can get. 


Sarah Hall is a pioneer of best practice in the PR industry. The holder of the CIPR’s Sir Stephen Tallents Medal 2014 for exceptional achievement in public relations practice, she has established a reputation as an ethics tsar and diversity and inclusivity champion.

She is a strong advocate of accountable leadership and women in business and believes in helping young talent break through. 

Sarah is the CIPR’s President for 2018, a member of the Northern Power Women Power List, features in the PRWeek UK Power Book and is a regular speaker at industry events. She is one of Lissted’s top North East England digital influencers.

Sarah is proud to be on the Athena40 Global Committee, an initiative launched by the Global Thinkers Forum to discover and acknowledge the work of the 40 most dynamic, active and fearless female thought leaders, columnists, commentators and activists across all industries and from all over the world.

Sarah Hall
Managing Director
Sarah Hall Consulting Ltd

Mobile: 07702 162 704
Twitter: @Hallmeister

Happy 70th NHS

By Antony Tiernan
Engagement and Communications Director NHS 70
NHS England

The NHS is turning 70 on 5 July 2018. It’s the perfect opportunity to celebrate the achievements of one of the nation’s most loved institutions, to appreciate the vital role the service plays in our lives and to recognise and thank the extraordinary NHS staff – the everyday heroes – who are always there to greet, advise and care for us.

The birthday is also an opportunity to look at the radical thinking that led to the creation of the NHS, the breakthroughs which have transformed our health and well-being and how the service is evolving to meet our future needs, including the wide array of opportunities being created by advances in science, technology and information.

Communications professionals are an important part of the NHS family and play a vital role in telling the story of the NHS to the public, patients and staff. A story where we’re getting healthier, but we’re using the NHS more. A story where the quality of NHS care is demonstrably improving, but we’re becoming far more transparent about care gaps and mistakes. A story where staff numbers are up, but staff are under greater pressure. A story where the public are highly satisfied with the NHS, but concerned for its future.

This can be a difficult story to tell. However, we have three powerful factors on our side.

First, we are a passionate and versatile breed and we work hard. We have adapted to the changing world of communications and regularly go above and beyond.

Second, the NHS is one of the UK’s most recognisable ‘brands’ which is renowned far beyond our shores. We uphold this brand with pride. A brand which is much more than the famous blue lozenge. 

Third, we work with people who do some of the most amazing things as a day job. The midwives who deliver us into the world, the GPs and pharmacists who advise and treat us, the nurses, doctors and other clinicians who come to our aid when the unexpected happens, the porters who keep our hospitals moving, the support staff that make appointments happen, the researchers at the forefront of innovation and so many others. Their stories and those of the one million patients we see each day, bring the NHS to life.

This book tells the story of NHS communications and communicators. The things we do well and the things we need to be better at.

I am a proud NHS communicator and it is great to see our role being celebrated as part of the NHS’s 70th.


Antony Tiernan joined NHS England in 2015 and, working with a wide array of partners, is leading on plans to celebrate the NHS’s 70th birthday. Prior to this, he worked at a senior and director level in a number of NHS Hospital Trusts including Guy’s and St Thomas’ NHS Foundation Trust. 

Twitter: @AntonyTiernan