Strategic communications should be at the heart of all effective organisations, including NHS trusts. The leadership and expertise provided by communications professionals has a vital role to play in supporting the NHS to improve the patient experience and deliver more effective engagement with local communities, staff and key stakeholders.

This report offers both hope and concern for the future of NHS trust communications. The positive aspects are the growing awareness among senior NHS leaders of the critical role strategic communications can play in enhancing the patient and public experience; ensuring trusts engage more effectively with their staff; helping to achieve desired behaviour change; and in helping to manage the communications challenge presented by STPs and the move to accountable care.

However, the rich feedback provided to this report shows that there is still a long way to go before the communications profession takes its place at the NHS ‘top table’ alongside other professions. For example, despite many communications leaders within trusts 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. More worryingly, the report paints a picture of a pressured and over-worked profession, with fewer staff, too many demands and not enough opportunities for professional development.  

The leadership and expertise provided by communications professionals has a vital role to play in supporting the NHS to improve the patient experience and deliver more effective engagement with local communities, staff and key stakeholders.


On the basis of what we have heard from our survey and interviews, there are several important issues that require focus and attention from national NHS bodies, those leading trusts and communications leaders themselves:

  • Investment and support in NHS communications: there is a continued need for investment in communications and support for its leaders to ensure the profession does not slip from being a strategic function to a more service-level one. The danger is that – in the rush to deliver against highly challenging cost improvement plans – some roles are downgraded, resources are stripped back, and communications leaders are left without the resources they need to achieve parity with other board-level positions.  
  • Demonstrating strategic value: the pressure is on communications leaders to demonstrate the impact of what they do as any funding not deemed to be spent directly on patient care is increasingly scrutinised. This challenge is made much harder by a lack of budgets for formal impact assessment and evaluation. Trust communicators need to be supported by national bodies and others to make best use of formal evaluation frameworks, such as the Government Communication Service’s evaluation framework. Organisations such as NHS Improvement, NHS England and NHS Providers should continue to share best practice in this area and support those leaders who are particularly struggling to measure and demonstrate impact.
  • Safeguarding training and development: staffing and other budget cuts are leaving little or no funding or time for professional development for many communications leaders and their teams. In a welcome development, NHS Improvement and NHS England have renewed their focus on supporting communications development with a new programme launched in 2017. These activities have been well received but the support is often beyond the reach of many communicators. Two practical measures recommended by many communicators involved in this report are: more workshops to be held in regions outside of London, and for more online workshops to be hosted (backed by CPD points). Both would enable more communicators to benefit from training and development at minimal cost to trusts.
  • More formal career pathways: combined with a more demanding workload and a lack of training and development opportunities, the absence of a career structure and clear development pathway for communicators is regarded by many as an increasing barrier to future recruitment. 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. Many senior communicators believe a more formal career pathway needs to be developed for NHS communicators. This is something that could be explored as part of the NHS communications profession developing closer links with bodies such as the CIPR and CIM. 
  • Protecting specialist skills: it is important that any benchmarking exercises being undertaken by NHS Improvement into trust communications expenditure – as part of a wider look at ‘back office’ functions within trusts – take a holistic view of the value of strategic communications and the impact it can deliver. It is vital that these exercises do not compound the capacity and skills gaps that have left many trusts with shortages in some key areas – it is notable that only 12% of respondents to this survey said they did not have any gaps in their teams. With a lack of non-staff budgets to be able to commission in this expertise, it is essential that specialist communications skills are not eroded further.
  • Sharing communications capacity and expertise and partnership working: one potential solution to the capacity gaps and deficit in specialist skills that is being experienced by some trusts may lie in neighbouring trusts sharing communications capacity and expertise on a more informal basis. More generally, there is a need for greater partnership working on communications between neighbouring trusts, as well as between trusts and their CCG and local authority counterparts. This will be particularly important when trusts and their local partners need to engage effectively with an often sceptical public when it comes to major service change. As part of this, we need to find ways of supporting hard-pressed communications leaders in trusts to play an active role in supporting the communications and engagement work of STPs. Given the lead role trusts are playing in transformation initiatives, there is a strong onus on trust communications leaders themselves to play a key role in their STPs as they begin to gather pace. They represent some of the NHS’ most talented communicators and need to be actively involved as STPs move from plans to concrete proposals for service change.

The success communications leaders in trusts, the national bodies and other parts of the heath system have in responding to these challenges will go a long way towards helping elevate the NHS communications profession to the strategic function it aspires to be.