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

#FuturePRoof: Edition Three shines a spotlight on NHS comms best practice

Using real people to lead the debate, transparency and investment in skills are the three key learnings for comms practitioners as #FuturePRoof Edition Three hits the shelves.

#FuturePRoof is a labour of love for me and never more so when it comes to this special edition celebrating the NHS at 70, launched today.

Like hundreds and thousands of people across the UK, I owe the complex system that is the NHS a huge debt of thanks. 

It has been a permanent fixture throughout my lifetime. It’s an organisation which is remarkable for the high level of trust we place into it and its dedicated and talented staff who have treated and cared for me, my family, friends and colleagues.

I will always be grateful for the NHS.

So this book, The NHS at 70 with Lessons for the Wider PR Community, is dedicated to all the hardworking communications professionals whose excellent work often goes unrecognised and unsung.

Within this special edition, 25 new essays explore key themes including the role of comms in achieving organisational outcomes; how organisations can secure and maintain trust; planning and data; digital-first strategies; how to address barriers to technological innovation; and the role of practitioners in managing major change.

As you’d expect it is jam-packed with expertise from a forward-thinking cohort of comms leaders and advisers, striving to reinforce the strategic value of public relations within their organisations.

I'm very grateful to each and every contributor for sharing their time and expertise. 

There are some very clear take outs and perhaps the biggest lesson for management teams, communicators and the wider public relations community is to embrace transparency, invest in skills and use real people to lead the debate.

The book comes at a critical point in the NHS’s history. The organisation is a living breathing case study of comms innovation as it manages competing political agendas and stretched budgets, while communicating ever more frequently with an increasing number of people with complex needs.

How its many teams join forces to implement one approach at scale is a pressing challenge as the face of healthcare as we know it changes radically.

You can get your hard copy or Kindle version of #FuturePRoof here.

I hope you enjoy reading it as much as I enjoyed curating and editing it. And if you'd like to get involved, please do follow @weareproofed on Twitter and join the Facebook group. The more, the merrier!

All the best,

Sarah Hall
Founder and editor, #FuturePRoof

When Two Tribes Fail to Jaw

By Michael Greer

Why is it that experienced public relations professionals in the UK dislike, or fail to understand, the role of publicists? Did the unethical behaviour of Max Clifford tar every publicist with the same brush, or is it because publicists are perceived to be ‘one trick ponies’ specialising only in media relations? The only certainty is that our profession is made of two tribes with one looking down on the other.

You'll learn...

  • Why it is offensive for the PR profession to think all publicists are like Max Clifford.
  • Publicists are more than 'one trick ponies' specialising in media relations.
  • What publicists actually do, a little bit of publicity history and some suggestions for legendary publicists to follow. 

They are all like Max Clifford.

Max Clifford described himself as a PR man, but many thought he was a publicist. He was reviled by some, tolerated by many and liked by a few. He cemented his role in public relations with a column in PR Week and was the go-to-guy for any scandal dodging celebrity or TV programme looking for a “PR expert”. 

Max Clifford was very good at publicising himself and clients, but his conduct had a corrosive effect: the reputation of publicists within the PR profession suffered, and the public’s perception of the PR industry became more negative. When an audience of PR pros voted in favour of his motion that fabricating news on behalf of a client was okay, the ethical image of publicists and the PR profession took another hit.

Veteran publicist and strategist Mark Borkowski accurately described Max Clifford as “An anomaly. Not a PR operator - more a dark alchemist - part agent, part deal-broker, a one-man news agency with a twist. He was invented to exploit the voracious tabloid news agenda.”

PRCA Director General Francis Ingham said of Max Clifford: "He did our industry a disservice by pretending to be part of it. I note that most media outlets are describing him today as having been a publicist. That is - finally - an accurate description of his career."

To class Max Clifford as a publicist is debatable, but to pigeon-hole all publicists with Max Clifford is both ignorant and insulting. Publicists working for great brands like the BBC, Walt Disney, Universal Films, Channel 4, Random House and many award-winning PR agencies deserve better from many in the PR industry.

One trick ponies.

Whilst some PR people believe publicists are cut from the same cloth as Max Clifford, others believe publicists specialise in media relations only, and are therefore less qualified with a narrower skill set. In reality, a publicist works in-house or for an agency within the film, broadcast, music, entertainment, publishing and fashion sectors and employs the full range of PR skills. 

Before a story is even pitched to the media, a PR plan is drawn up that will include objectives agreed with the client, financial and budgetary considerations, strategy, goals and real-time measurement, research and data analysis to understand and identify audiences, creative activity, distribution channels, timing and resources needed.

Additionally, the strategy might also include integrating digital PR, advertising, experiential events, sponsorship and other elements. Spokespeople or celebrities might need to receive media training and their agents included for the exploitation of cross-promotion opportunities. If the objectives are controversial or have the potential to generate negative publicity, crisis management and reputation protection will be prepared. 

The great showman PT Barnum would measure the success of his event publicity by counting bums on seats, cash in the till and press clippings. If Barnum was a publicist today, his post event review might also include analysis of all offline and online media coverage, sentiment monitoring, market research and measurement of digital media activity.

What does a good publicist look like?

If Edward Bernays was “the father of public relations” then Jim Moran, PT Barnum and Harry Reichenbach are the legendary three wise men for publicists.

James Sterling Moran was a publicist and a press agent for film studios, manufacturers, retailers and Washington politicians from the 1930s to the 1980s. In 1989, Time ranked him as "the supreme master of that most singular marketing device - the publicity stunt." His many PR stunts included selling a refrigerator to an Eskimo and walking a bull through a New York City china shop. 

Phineas Taylor Barnum was an American showman and businessman remembered for promoting celebrated hoaxes and for founding the Barnum & Bailey Circus. Barnum was also an author, publisher, philanthropist, and for some time an anti-slavery politician.

Harry Reichenbach was a US press agent and publicist who dreamed up sensational publicity stunts to promote films. He worked both for actors, as an agent, and for the studios as a promoter. He promoted the ‘Return of Tarzan’ by sneaking a lion into a hotel and tipped off the management by ordering 15 pounds of raw beef through room service.

Three new stars to follow

Barbara Charone was an early champion of Madonna and cited Seal's elevation to stardom as a satisfying result in her PR career. The Guardian included her on its list of "The 20 most powerful celebrity makers" and dubbed her "Britain's most powerful music PR" after revitalising the careers of Madonna and Neil Diamond, and establishing those of Duffy and Mark Ronson. 

Alan Edwards is the founder of The Outside Organisation. Over the last 40 years, he has managed the publicity for some of the biggest names in the music business, such as: The Rolling Stones, The Spice Girls, Amy Winehouse, Prince, Michael Jackson, Blondie and The Who. Alan has been named the number 1 entertainment PR in the UK by PR Week magazine for three consecutive years (2015, 2016 and 2017). The one constant in his life as a publicist was nurturing David Bowie’s reputation from the very beginning.

Dotti Irving is the Founder and Chief Executive Officer of Four Colman Getty, established in 1987 after a decade spent at Penguin Books. With an extensive address book that spans arts, culture, business and the media, Dotti also handles high-level sponsorship and partnership deals on behalf of Colman Getty's clients. She has been instrumental in profile development of clients including the Booker Prize, Harry Potter author JK Rowling and domestic goddess Nigella Lawson.


Publicists are by nature storytellers. They like to start with a blank sheet, create opportunities that intrigue journalists and capture their attention with something irresistible that makes news. A picture is worth a thousand words and a stack of press clippings ‘on message’ is a job well done. Talent is to be nurtured, and it is a fine art to develop it into celebrity.

If you still think publicists are just like Max Clifford, or lesser than PR professionals, just remember it was entertainment publicists that turned Star Wars into a business delivering box office receipts of $7.52 billion.

Think about what could be achieved if the two tribes – PR professionals and publicists – had a greater understanding of each other. I wonder how many publicists are members of the CIPR and PRCA? There is more that unites us than divides us.


Once a retail ops troubleshooter and Manager of Primark’s flagship store. Former PR wizard for JK Rowling. Very experienced at managing A-List celebrities, consumer events and PR campaigns. Now searching for the next big PR challenge, when I am not organising the #EalingTweetup - probably London’s longest running Twitter gathering.

Twitter:     @MGreer_PR


#FuturePRoof edition 3: The NHS at 70 with lessons for the wider PR community

2018 marks seventy years of the NHS. To celebrate, #FuturePRoof is publishing a special edition aimed at showcasing best practice in comms by teams within one of the UK's best loved brands.

#FuturePRoof launched in 2015 to tackle issues facing the public relations profession and celebrate best practice. Edition three is designed to celebrate the innovative and pioneering work undertaken by practitioners within the NHS on its seventieth birthday. It will be published in the New Year.

Below is the chapter spec list (in no particular order). As you'll see, authors are still being sought for some chapters. If you'd like to get involved, please email editor Sarah Hall at with the chapter you're interested in and a précis of your proposed content.

In terms of the commitment involved, authors are asked to supply 800-1200 words by 12 January.  The style requires 3 chapter 'take outs’ and dynamic copy written for the screen with sub heads as per this example.

If your pitch is successful, you'll also need to supply a 2-3 line bio containing any relevant links, a Twitter handle and a pic when it comes to submission.



Strategy setting - Where is the NHS heading and how will it get there? Aligning comms and marketing with the organisational objectives. Transitioning to prevention over cure. AUTHOR APPROACHED


Leadership and professionalism - What does good look like and what’s the benchmark? CLAIRE RILEY


Managing complexity - Simplifying and communicating how the NHS system operates; organisational complexity, hierarchies and managing competing agendas. STEVEN POLLOCK


Political safeguarding - Competing political agendas and the impact on NHS business planning and commsROY LILLEY


The NHS at 70 - Outside looking in; an external expert’s perspective. AUTHOR APPROACHED


The power of the NHS brand - The story of the NHS identity and brand and how sub brands are using the association to diversify and scaleNICK RAMSHAW


Trust in the NHS - Public trust and the NHSKAYLEIGH RYAN


Doing digital - Managing the public and patient interface through technology. RACHEL ROYALL


Employee engagement and culture - Best practice with particular reference to strong sub-cultures within the NHS (such as The Christie in Manchester). AUTHOR NEEDED


CPD - Establishing a common competency framework across teams. AUTHOR NEEDED


Cash strapped and resource starved - Doing more with less; how NHS comms teams are respondingROSS WIGHAM


Integrated comms and content marketing - Moving away from a reliance on media relations to integrated comms featuring strong visuals and multi-media contentCAROLINE LATTA


Innovation through technology - The TEL programmeALEX DRINKALL


Crisis planning - Planning for the worst; politics, privatisation and data breaches. AUTHOR NEEDED


Safeguarding data - Understanding patient data and managing conversations about its use with the programme as an exampleNICOLA PERRIN


Planning and insight - Winter bed shortages; how to use data to inform future campaigns and change the media narrativeLIZ DAVIES


Internal comms with 1 million people and counting - Managing internal comms within a complex web of organisationsAUTHOR NEEDED


Motivation and mental wellbeing - Supporting employees in the face of organisational criticism and pay freezesAUTHOR NEEDED


Hello, my name is - Putting the patient first; what comms pros can learn from the ‘Hello, my name is’ campaignCHRIS POINTON