In this section we explore the staffing and budget constraints that senior communicators are operating under and the impact this is having on their teams. A common picture emerges of trust communicators having to meet growing demands and a more complex workload with fewer staff and resources at their disposal.

Staff capacity  

The size of communications teams varied significantly, with the lowest number of (full-time equivalent – FTE) communications staff employed by trusts being one person and the maximum 22. This represents an average of seven FTE staff per communications team. The average vacancy rate within trust communications teams at the time of the survey was 15% of FTE staff – this is one person per team on average. .

Not all communications staff working in trusts necessarily report into the most senior communicator. In just over half of trusts all staff providing marketing, communications and engagement services report into the most senior communications professional. However, this is likely to be an underestimate as a number of respondents who selected ‘no’ then commented that they report into a deputy who then reports in to the most senior communicator. Where not all communications staff report into the most senior communications professional at the trust, the comments received in the survey suggest it is staff working on public engagement activities who are most likely to report into a different manager within the organisation.

The financial pressure facing NHS trusts is well documented and this is unsurprisingly having an impact on staffing numbers for communications teams. As with other parts of the NHS, communicators are having to make efficiencies which has put pressure on their staffing numbers. Four in 10 respondents said their staff budget had been reduced over the past year. Only 14% reported that their staffing budget had increased. 

Figure 5

Non-staff budgets

These findings are mirrored in the impact on non-staff budgets, with over half of respondents having seen their discretionary (non-staff) budget reduced.

Figure 6

Do communications team have the right capacity, skill mix and resources?

Roughly the same number of senior communicators are worried about capacity, skill mix and resources as those who are confident about them. There is some variation by trust type, with almost half of respondents at acute trusts worried, compared to 22% at major acute teaching trusts. There is also variation regionally, with trusts in London more confident than those working in other regions.

Figure 7

As such, comments varied between those that are content with the resources they have at their disposal and those that are concerned. However, the responses to the survey were striking in that even those communicators who were relatively content with their staff and non-staff budgets felt that they could contribute far more effectively to their trust achieving its strategic objectives if they had more resources. Major concerns were expressed over the need to make further reductions as part of cost improvement programmes.

One communicator said: “We have the right skills and resources but ideally increased capacity would help ensure we were able to support successful delivery of our trust’s strategic objectives even more than we currently do.”

Many communicators pointed to increasing demands on their teams from operational pressures and new initiatives, such as the need to support their local STP. This is resulting in senior communicators having to be more robust when it comes to identifying their priorities:

One said: “I have the right skill mix but not the right resources. With more and more changes to services (STP, temporary closures, operational pressures) the organisation needs to proactively communicate and engage more. And these lead to more fire fighting and need for more media liaison, reputation management etc. My team is stretched and we don't get opportunities for marketing, social marketing, staff campaigns, and time to seek out good news.”

Many communicators pointed to the impact of cost improvement plans having resulted in reductions to their staffing numbers and budgets which is making it very difficult to keep up with the demands placed on their teams. At the time of the survey some trusts were also undergoing a benchmarking exercise by NHS Improvement to compare their communications and engagement expenditure with other trusts, which some feared would result in further reductions. Comments provided by NHS Improvement to this report emphasise that these exercises are not intended to lead to reductions in spending but instead to map out where capacity gaps are and how best to fill them. 

One communicator said: “CIPs have taken out 45% of our budget for comms and engagement over the last four years, while at the same time the ask has increased exponentially.” Another said: “We are a high-profile, complex trust and investment in the communications team has not kept pace. The team was last restructured in 2013 to ensure we could make year-on-year savings, rather than looking at the communications support the trust needs and the skills within the team that we need to develop.”  Some communicators said this would result in short-term decisions that would result in a poorer outcome in terms of the quality of communications work they were able to undertake, for example one respondent said: “I have concerns about the benchmarking exercise being undertaken by NHS Improvement and the negative impact that may have if all trusts are asked to reduce comms spend rather than more innovative approaches being adopted e.g. demonstrating ROI [return on investment] and creating 'hubs' of comms expertise.”

Many communicators pointed to the impact of cost improvement plans having resulted in reductions to their staffing numbers and budgets which is making it very difficult to keep up with the demands placed on their teams.


One common concern that came through was the frustration senior communicators are experiencing when seeking to recruit new staff. One respondent said: “It is proving impossible to recruit staff with enough experience and ability to help us manage an incredibly fast-moving, news-heavy agenda in mental health. So we have constant vacancies, as staff join and find the job is not for them due to work pressures, or we find applicants are under qualified/experienced. Literacy skills are also a huge concern. This is the worst I have found comms recruitment to be after 30 years working in comms and journalism.” Another said: “There isn’t enough of a pipeline of skilled people coming through to be a part of the team. Recruitment has been difficult.”

Implications: shift to a more generalist model? 

With senior communicators expressing increasing concerns over capacity, skill mix and resources, the vast majority reported that they regularly have skills and areas of expertise missing from their teams. Only 12% of survey respondents said they did not have any gaps. The most common areas of deficiency are: digital, social media, marketing and design. In particular, a number of communicators said their teams lacked expertise in public engagement techniques. Given the service changes likely to be taken forward in the NHS in the next one to two years as part of developing STPs, this is likely to present a vital skill gap.

Several communicators said they were having to restructure their teams due to financial constraints and growing workload pressures. In particular, a number of senior communicators either had, or were in the process of moving towards, teams based on a smaller number of generalists who could each cover a broader range of activities, rather than having larger teams with more specialist roles. Many suggested this was leaving their trusts short of specialist communications skills and expertise.  

One respondent said: “I have restructured the team, putting in place a deliberately flat structure of communications generalists, to deliver more integrated comms working across channels – rather than having a media lead, internal comms lead etc.”