Let’s get to the heart of the NHS 10 Year Plan

Summary

Blue Lozenge responds to the NHS 10 Year Plan announcement, arguing that strategic communication and engagement are essential to delivering the plan’s proposed shift to neighbourhood health services. The piece contends that transformation of this scale requires communication that builds community trust, facilitates genuine listening, translates complex policy into accessible information, and aligns multiple agencies and stakeholders around shared goals. Blue Lozenge positions its HEART model as a framework to support delivery of the plan, presenting strategic communication not as a supplementary function but as a primary enabler of meaningful healthcare reform.

 

We need a real conversation about the strategic role of communication and engagement in making the neighbourhood health service a reality. 

At the heart of today’s NHS 10 year plan announcement are people. The plan marks a pivotal moment for healthcare transformation. But ambitious plans need more than good intentions – they need strategic communication and engagement that involves real people. The type of engagement that truly listens to hear and from that information, important insights inform practical policy ideas. That realistic policy can then be put into practice, through impactful campaigns and communication activity. 

The shift to neighbourhood health services isn’t just about reorganising care delivery – it’s about fundamentally changing how communities, healthcare professionals, and local authorities work together. This requires communication that builds trust, explains complex changes clearly, and engages diverse stakeholders authentically. Without it, even the most well-intentioned reforms risk becoming isolated policy documents rather than lived community experiences. 

At Blue Lozenge, we believe strategic communication and engagement isn’t an add-on to transformation – it’s the critical lever that makes change possible. From helping communities understand new services to aligning multi-agency teams around shared goals, communication shapes whether ambitious plans become meaningful improvements to people’s lives. 

Next week, we’ll be sharing how our HEART model can support the NHS 10 Year Plan’s delivery. Because when communication is truly at the heart of transformation, everyone benefits.

Welcome NHS communication leader Alenka Daniel

We’re delighted to strengthen our growing team with the appointment of NHS communication leader Alenka Daniel as Account Director.

Alenka, currently Head of Communications at Barts Health NHS Trust, joins us from Monday 23 June, bringing over a decade of frontline NHS communication experience to support our growing portfolio of healthcare clients. She will be working with our public health clients, driving behaviour change campaigns and building on our work to help reduce violence amongst children and young people. 

Alenka formerly led communications for one of the UK’s largest NHS trusts, overseeing the development of the communications strategy for five hospitals and advising executive leadership through complex system-wide challenges. Her expertise spans internal and digital communications, media relations, crisis communication, and stakeholder engagement. 

Her work has earned national recognition, including accolades from the Nursing Times Workforce Awards, Comms2Point0 UnAwards, and the Medical Journalists’ Association, as well as contributing to the BAFTA-nominated series Operation: Live.

Alenka Daniel commented:

“Blue Lozenge represents the future of strategic healthcare communications: bold, compassionate, and expert.

“I’m proud to be joining a team that’s making a tangible difference across the health and care sector.

“I look forward to helping our clients improve patient care and navigate the complex and evolving health landscape.”

Rachel Royall, CEO of Blue Lozenge, added:

“We’re really excited about Alenka joining our team. She is hugely values driven and a great personality to be around. She has an excellent track record In delivering impactful campaigns and I can’t wait for her to meet our clients.”.”

Alenka’s appointment reflects our continued investment in senior healthcare communications talent, if you’re looking for your next move we’d love to hear from you. And if you’re looking for strategic healthcare communication expertise to design and deliver your next campaign, view our services and get in touch hello@bluelozenge.co.uk 

Read the Press Release in PR Week

Supporting Excellence in Medical Journalism

Author: Maya Anaokar, Account Director

This year marks a special milestone for Blue Lozenge – we’re sponsoring the Medical Journalists’ Association Awards for the first time, specifically the Feature of the Year (Broadcast) award. 

Why the awards matter to us 

The MJA Awards matter because excellent health journalism saves lives. The best health reporters don’t just inform – they scrutinise, challenge and ultimately drive improvements that make care safer for everyone. For all the specialist communicators who work in-house across the health system, you know journalists rely on your ethics, energy and expertise.  

At a time when there is so much debate about the value of NHS communication, we want to champion the role communicators play in supporting journalists. Especially those journalists who go beyond soundbites and who dig deeper, research thoroughly, and transform complex health information into content that genuinely serves patients and communities. 

The power of stories 

Healthcare communication can be unnecessarily complex. We chose to sponsor the Feature of the Year (Broadcast) award to shine a light on the simplicity of storytelling. This award celebrates journalists who can distil intricate health stories into accessible, engaging content in just two minutes – a skill that’s both rare and vital. 

Our challenge to the sector 

We believe transparency, accountability and scrutiny make healthcare stronger. That’s why we support journalism that challenges the system to do better. We, therefore, have one ask for health journalists: stop accepting ‘a spokesperson says’ and demand named accountability from real people in senior positions across health and care.  

The public deserves transparency, and transparency drives better outcomes. 

Looking ahead 

In today’s healthcare environment, leaders face mounting responsibilities and relentless pressures. Strategic communication isn’t about spin – it’s about creating space for healthcare leaders to focus on what matters most: improving lives. When done well, it embraces scrutiny rather than avoiding it. 

We look forward to congratulating all MJA Awards nominees. Your work matters more than you know so get your entries in by 1 June. 

Blue Lozenge specialises in strategic healthcare communication and engagement. If you’re facing communication challenges that require transparency, accountability and trust, we’d love to help: corrine@bluelozenge.co.uk 

#HealthJournalism #NHSCommunications #MJAAwards #HealthcareCommunication #BlueLozenge 

Blue lozenge 25: Strategic Healthcare Communication

Summary

Blue Lozenge marks the 25th anniversary of the national rollout of the NHS Blue Lozenge brand, drawing on research showing that by 2015 the NHS logo had achieved 98% public recognition in England. The piece argues that strategic communication in healthcare is a cost-saving investment rather than a cost pressure, citing the consolidation of over 600 NHS identities into a single corporate brand as a measurable example. Evidence is presented across four communication domains: internal communication and workforce retention, operational communication and reduced hospital mortality rates, patient feedback and quality improvement, and community engagement in COVID-19 vaccine uptake. The article positions effective communication as directly enabling more time for frontline care.

 

The NHS brand is a masterclass in demonstrating the power and value of professional, strategic communication in healthcare. 25 years ago this month the national roll out of the NHS blue lozenge began. Healthcare communication professionals across the land were equipped with a new set of national guidance explaining how they should use the new corporate identity. 

The NHS blue lozenge very quickly became one of the most recognisable logos, not only in England, but across the world. A study by NHS England found that, by 2015, the NHS logo had, at 98%, almost universal recognition[1]. People felt that it had existed “forever”. The study found that, “for the general public, the NHS is broadly understood as a single entity with an overarching ethos: the NHS logo is a signifier of consistent, high-quality healthcare, and it is also – and independently – a signifier of the public purse.” 

The NHS brand has powerfully shaped the English public’s perception of its national healthcare service. This wasn’t always the case. When the NHS was created at the end of the 1940s, a hospital was just your local hospital; the larger structure behind it was less tangible. The People’s History of the NHS explains [2]: 

“Even the NHS acronym had not yet become widespread. In many instances, people were told about the ‘new health service’, not even the ‘National Health Service’. Labelling was far less consistent and less important than it was to become.” 

Effective communication helps to make the complex simple. This was well understood when the NHS brand was introduced, it brought together over 600 variations into one compelling corporate identity, an identity that resonated with every single member of the public. The values of that identity were later embodied into the NHS Constitution. And the recent report, the British Social Attitudes Survey, found that the public commitment to the underlying principles of the NHS are as strong as ever [3]. 

The NHS brand evokes purpose and trust, and in a world where public trust in the NHS is declining and there are huge challenges with the health and care workforce – proactively managing communication has never been more important. The reputation of the NHS is based on three factors, performance, behaviour and communication. This is known as the reputation equation: 

The NHS brand provides a single identifier for healthcare – the double-edged sword of an effective brand is that public perception is often polarised. Therefore, an individual’s experience of performance, behaviour and communication at a local NHS service means that they conclude that the whole of that service is either evangelically good or wholly inadequate. Neither of which are likely to be true.

Effectively managing communication in healthcare leads to more time to care

What is true is that there are huge benefits in proactively managing your brand and communication. In healthcare we believe that the ultimate benefit is that it provides more time to care. Rolling out one effective brand saved millions of hours of local time and budget, where previously hundreds of variations existed. Time and money that could be spent elsewhere. One, strategic, powerful programme of communication still helps a workforce of over 1.4 million people and a population of around 56 million understand the goals, strategic approach and direction of our health service. 

Branding isn’t the only place where the power and value of communication can be seen in healthcare. 

  • For internal communication there is a positive correlation between better healthcare, employee communication and engagement and work-related commitment; a negative correlation with turnover intentions [4]. 
  • For operational communication there is a positive correlation between higher levels of workforce engagement and reduced mortality rates in hospital [5].
  • For patient communication there is a positive link between the use of online patient feedback and better-informed quality improvement projects [6].
  • For behaviour change communication effective community engagement underpinned the success of the Covid-19 vaccine campaign in improving uptake in marginalised groups. 

This is why we and hundreds of communication professionals in health and care turn up to work each day – not to pretty a poster or draft a powerpoint. Let’s be clear that investment in well thought through communication is never a cost pressure it is always a cost saving – and if we need a reminder let’s just look at the power of the NHS brand!  

As part of our celebration of 25 years of the national rollout of the NHS blue lozenge we’ve asked some well-known experts their views on the NHS brand and why think it’s endured and what the future will hold. Take a look. 

References

[1]  NHS England, 2016. https://www.england.nhs.uk/nhsidentity/wp-content/uploads/sites/38/2016/08/NHS-Identity-Research-phase-one-and-two.pdf 

[2] https://peopleshistorynhs.org/encyclopaedia/branding/

[3] Nuffield Trust, British Social Attitudes Survey March 2024

[4] University of Greenwich Greenwich Academic Literature Archive – Evaluating the evidence on employee engagement and its potential benefits to NHS staff: A narrative synthesis of the literature

[5] Hospital Workforce Engagement and Inpatient Mortality Rate: Findings from the English National Health Service Staff Surveys | Journal of General Internal Medicine (springer.com)

[6] University of Oxford Using online patient feedback to improve NHS services: The INQUIRE multimethod study – ORA – Oxford University Research Archive

Blue lozenge 25: Strategic Importance of Brand

Summary

Blue Lozenge examines the strategic rationale behind the 1999 national rollout of the NHS brand, which unified over 600 visual identities into a single corporate identity under the Labour government’s Primary Care Group model. The piece argues that the investment in branding was a cost-saving measure rather than a cost pressure, as core design elements already existed and trusts were asked to update assets incrementally. It traces the pre-1999 absence of a consistent visual identity for publicly funded healthcare, including a breach of the Geneva Convention when the Red Cross emblem was used to represent the NHS in the 1980s. The article positions the NHS brand as a strategic communications asset serving a workforce of 1.4 million and a population of approximately 56 million, despite declining public satisfaction recorded in the British Social Attitudes Survey.

 

We’re celebrating 25 years since the national roll-out of the NHS brand. Following an intelligent rebranding exercise in 1999 the NHS ‘blue lozenge’ has been synonymous with one NHS and a symbol of national pride.  

Branding is a vital part of any business or organisation. It goes way beyond the visual elements of a logo and typography and begins to tell a story in the minds of the public about the values and purpose of the organisation it represents. Investing in your brand is an investment in perception and trust. It is a mechanism to influence how your audience perceives your service or business – creating an emotional connection that resonates, builds trust, credibility and a sense of belonging in the hearts of the public and the workforce. 

This was well understood by the Labour government in 1999 when they introduced the Primary Care Group model in the NHS, and mandated the use of a unified corporate identity across the NHS. The single identity brought together 600 variations into one compelling corporate identity. 

Prior to this the government had no visual shorthand to refer to the publicly funded health service. They were not able to easily distinguish between publicly funded provision, the private or the charity sector.  

This caused a problem in the 1980s when the opposition Labour party used the Red Cross identity to represent the NHS, breaching the Geneva Convention. After 1999, governments had an incredibly easy way of referring to the health service. 

How taxpayer’s money should be used in the NHS is rightly scrutinised, however, at the time of the national rollout of the branding exercise the investment was mistakenly criticised. Like any well considered communication exercise, the investment was a cost saving not a cost pressure. The core design elements of the NHS blue lozenge already existed and as part of the national rollout these were formalised. By using one logo with clear guidelines there was not a requirement for further investment in brand development. Trusts were asked to replace existing artwork as part of natural refreshes of signage and information rather than replace assets immediately.

As part of the brand identity the simplicity of the blue lozenge was and still is a core strength. It is neutral, contains no political signifiers and is neither particularly progressive nor traditional in its design elements. The simplicity meant that it was straightforward for communication professionals in local organisations to implement. This helped the new identity gain support even though many organisations were being asked to replace beloved and historic logos, the logic was undeniable. 

Whilst recent results from the British Social Attitudes Survey from the King’s Fund suggests that public satisfaction in the NHS is at an all time low, the strategic importance of the NHS brand still stands today. The double edged sword of an effective brand is that public perception is often polarised. The service is considered either evangelically good or wholly inadequate. Neither are true. The NHS brand remains, as it was in 1999, representative of a tapestry of complex services, systems and cultures.  

Image of the Red Cross

The Red Cross is an internationally protected emblem and its misuse constitutes a breach of the Geneva Convention

The NHS brand is however a masterclass in how to forge identity and purpose and how to help a workforce of 1.4 million people and a population of around 56 million have a clear understanding of goals, strategic approach and direction. It is an example of the value of investing in professional strategic communication.  

We’ve asked some well known experts their views on the NHS brand and why think it’s endured and what the future will hold. Take a look. 

 

References:

[1] https://peopleshistorynhs.org/encyclopaedia/branding/

[2] Public Satisfaction With The NHS And Social Care In 2022 | The King’s Fund (kingsfund.org.uk)

Blue lozenge 25: Celebrating 25 years of the national rollout of the NHS brand

Summary

Blue Lozenge marks the 25th anniversary of the national rollout of the NHS brand, which launched in April 1999 and replaced over 600 individual brands and sub-brands with a single corporate identity. The piece traces the brand’s origins in the Labour government’s shift towards integrated care, its survival through successive structural reorganisations from Primary Care Groups to Integrated Care Boards, and its cultural prominence including its appearance in the London 2012 Olympic opening ceremony and COVID-19 public health communications. Research cited from a 2015 NHS England study found that the public perceived the logo as having always existed, reflecting the depth of its recognition. The agency draws a direct connection between the NHS brand values of collaboration and integration and its own company identity.

 

This month we’re celebrating 25 years since the national rollout of the NHS brand.  Following an intelligent rebranding exercise in 1999, the new identity replaced 600 brand and sub-brands to create one corporate identity. The NHS ‘blue lozenge’ became synonymous with One NHS and it became a unifying symbol of national pride.  

It is from this that we developed our own company name as we seek to personify the same values of collaboration and integration. But how did the NHS brand become so iconic?

How did such an iconic brand come into being?

NHS Logo and brand details

NHS logo

Whilst the blue Pantone 300 lozenge and the Frutiger bold italic ‘NHS’ lettering came into being much earlier, the national rollout of the NHS brand began in earnest in April 1999. Since then, it has endured and has been the centrepiece of government healthcare policy. 

In 1999, Labour formalised the move away from a healthcare model that aimed to treat people on an illness-by-illness basis and towards a system that can handle complex needs that require cross-departmental co-ordination. It replaced the internal market with 481 Primary Care Groups (PCGs). These PCGs were to operate under a unified NHS identity. 

It can be hard, even for those of us old enough, to remember how we viewed the national health service before the unified NHS identify was introduced. It was likely that we simply thought of our own local doctor and hospital. A 2015 NHS England study found that people viewed the NHS logo as having been there “forever”, when in fact it had been a common sight for the public for less than two decades at that point.[1] 

Since the logo’s introduction, the NHS model has evolved numerous times. Over time, PCGs became Primary Care Trusts (PCTs), which then became Clinical Commissioning Groups (CCGs) before the introduction in July 2022 of Integrated Care Boards (ICBs). Through all of these evolutions and successive governments, no parliament has made any fundamental changes to the NHS identity. 

The appearance of the NHS logo in Danny Boyle's Olympics opening ceremony

Source: BBC

Film director Danny Boyle understood the power of the NHS brand and featured it prominently in the London 2012 Olympic opening ceremony. During the COVID-19 pandemic, the logo and its design elements were used to rally the public around social distancing rules and provide visible public support to England’s healthcare workers. 

Today, the national corporate identity of the NHS brand has endured for 25 years more or less unchanged, a 2017 tightening of usage guidelines aside.[2] In a world where corporations undergo rebranding exercises every few years, the NHS logo, like the health service it represents, has held remarkably steadfast and dependable.  

At the time of the national rollout, as is often the case, the investment in communication and branding in the NHS was mistakenly criticised. However, the longevity and impact of that brand cannot be underestimated. It is a testament to the power of simple, powerful strategic communication in healthcare.  

We’ve asked some well-known experts and members of the public their thoughts on the brand, why they think it’s endured and what they think the future holds. Take a look. 

References

https://www.england.nhs.uk/nhsidentity/wp-content/uploads/sites/38/2016/08/NHS-Identity-Research-phase-one-and-two.pdf

https://threetenseven.co/work/nhs-england-nhs-identity/

Planning Effective Winter Pressures Campaigns

Summary

Blue Lozenge examines the challenges facing NHS winter communications campaigns, noting that evaluations of such campaigns, including NHS Wales’ multi-year Choose Well initiative, have consistently shown minimal impact on reducing urgent care demand. The agency argues that effective behaviour change requires deeper audience insight than communicators are typically given, and outlines three evidence-informed approaches: co-designing campaigns with patients, communities and frontline staff; applying behavioural nudge principles through timely digital interventions; and integrating data analysis with communications planning to optimise campaign performance in real time. Case studies include a targeted Google search campaign redirecting users to NHS 111 Online at an estimated cost of under £1 per redirection.

 

If pressures on NHS services could truly be alleviated by posters in waiting rooms urging people to “choose the right care” or “think first before you go to A&E”, winter would be a walk in the park for NHS communications professionals. 

But the reality is that winter communications campaigns are a really tricky thing to get right. 

And to be clear, when we say “right”, we aren’t talking about the graphics looking slick and sign-off coming through from the Executive team on time. 

We’re talking about having a tangible impact on operational pressures. Reducing the 20% or so of A&E visits which are clinically unnecessary. Trying to reverse last year’s trend of falling flu vaccine uptake rates in older adults and frontline healthcare workers.  

Despite all the work that goes into them, sadly there isn’t a lot of evidence that many winter communications campaigns have the impact intended. Where thorough evaluations have taken place, most of the results are disappointing. Take NHS Wales’ multi-year Choose Well campaign; an evaluation by Audit Wales suggested the true impact of the activity on reducing urgent care demand was “minimal”.  

At Blue Lozenge, our perspective is that while the objectives of winter campaigns tend to be easily understood, the underlying behaviours they seek to change are often fiendishly complex. Understanding of these behaviours is fundamental to influencing them, yet the briefs communicators are asked to work from are almost always light on detailed insight – putting communications professionals on the back foot right from the outset. 

For example, an often-targeted group for urgent care “demand management” campaigns is parents of younger children; up to 90% of A&E attendances related to this population result in no further treatment. 

But helping this group to make more appropriate care choices is likely to take much more than simple signposting. An excellent “realist synthesis” of evidence about the root causes of over-usage of urgent care by younger parents identifies at least six distinct (but interrelated) mental mechanisms at play. These range from system-induced frustrations about the lack of appointments in primary care, through to cognitive biases related to risk perception which are heightened in parents. 

Every NHS communicator will have their own hard-learned experiences of what works and what doesn’t work with regards to winter campaigning. At Blue Lozenge, we’ve found three key ingredients for planning effective behaviour change activities which might be worth considering as we head into winter: 

1. Co-design your campaign with patients, communities and staff 

One of the biggest success stories of the pandemic for NHS communicators was harnessing the power of people, communities and frontline staff to change behaviours. From engaging with religious leaders to drive vaccine uptake rates in local communities, through to the power of staff stories to encourage people to #StayAtHome, Covid-19 emphasised that communications really is a collective activity. 

We believe that bringing patients and carers together with communicators and frontline staff to develop creative campaigns is an approach that is perfectly suited to the multifaceted problems we face over winter. Meaningful engagement and involvement activities offer the chance to build an understanding of target audiences impossible through secondary research alone. Going further, co-design and co-production have the potential to deliver new types of public health intervention, blurring the lines between communications, engagement and community-led health and care. 

Some striking examples of this type of this type of work include recent piloting of blood pressure testing in barbershops and HEAL-D, a south London diabetes programme co-designed with the African and Caribbean communities. 

Understanding that often the barriers to effectively involving people and communities in planning and delivering campaigns are practical – especially during the frantic winter period – we have designed our own framework for bringing people together to power change. This framework, which we call BlueShift, is intended to easily flex and scale to different behaviour change briefs, as well as bearing in mind NHS England best practice on involvement. 

2. Find the opportunities to nudge rather than shove 

“Nudge theory” has rather fallen out of favour in public sector communications in recent years, but there is still plenty of inspiration that NHS communicators can take from its principles. 

We know that trying to get the public to do a 180 on deep-seated health behaviours is a big ask. So why not take a more nuanced approach and bring the levers of psychological science into play. 

For example, we’ve seen that the timing of interventions can be crucial in making them a success. 

Working with a large ICS, for the past two winters we’ve run campaigns encouraging people to use 111 Online instead of heading straight to urgent care. So far, so familiar? 

Our point of difference has been the timing of when people see our messaging. Using Google search marketing, we redirect users towards the 111 triage service at the very moment they are searching for urgent care services near them. 

The results have been remarkable; tens of thousands of users have chosen to click onto the 111 Online service from our ads. Using local system data, we estimate that each redirection away from A&E towards community or self-care has cost less than £1.  

3. Operationalise and optimise 

Communicators and data analysts have different superpowers; we’ve found that bringing them together to tackle winter is a bit like being able to assemble your own team of Avengers (or X-Men, if that’s the comic-book-verse you prefer). 

Being able to analyse and interpret the NHS’s vast datasets unlocks a new perspective on behavioural and tactical insights. Whether it’s cross-referencing Census information against your targeting to make sure you’re reaching underserved populations, or digging into Hospital Episode Statistics (HES) data to figure out which conditions local people are actually presenting at A&E inappropriately with, data helps you make better decisions. 

And during the campaign, a close working relationship between operations and communications teams gives you the best chance of reacting effectively to the curve balls which winter tends to throw at us all. 

Digital advertising gives us the option of responding in near real-time to emerging operational pressures; in recent years we’ve worked closely with NHS teams to pivot activity to focus on particular hospital catchment areas as they experience capacity challenges. And likewise, the data we get about how audiences are responding to campaign messaging can be fed back to hospital or ICS teams to inform planning and operational decisions on the fly. 

Whatever your brief this winter, we’re here to help. We’ll be running a “Chatham House rules” workshop with NHS communicators from across the country to discuss best practice on winter campaigns. If you’d like to attend, or if you want to find out more about any of the case studies mentioned in this article, please get in touch.

Communications for Fairer Healthcare Access

Summary

Blue Lozenge responds to the Care Quality Commission’s annual State of Care report, which identifies rising risks of inequitable access to health and adult social care in England, described as “unfair care.” The piece argues that effective strategic communication has a central role in addressing the report’s findings across four areas: transparency and accessibility of information, internal staff communication and workforce retention, collaborative stakeholder engagement, and reducing health disparities for ethnic minority groups and those with long-term conditions. The piece concludes that communication is a foundational tool in working towards a fairer healthcare system.

 

The Care Quality Commission (CQC) has today released its annual State of Care report, revealing the challenging landscape of health and adult social care in England. In the face of a cost-of-living crisis and mounting workforce pressures, there’s a growing risk of “unfair care”. This term encapsulates the concern that individuals who can afford private treatment might receive quicker access and better care, while those unable to pay could experience longer waiting times and reduced access. Given this context, it’s important for us to consider how effective communication can play a pivotal role in helping to address these issues.

Transparency and accessibility of information are essential for a fair healthcare system. Communication can bridge information gaps between healthcare providers, policymakers, and patients. This includes providing clear guidance in a format that is easy to understand and available to those with accessibility requirements. Well-informed individuals are better equipped to make healthcare decisions that suit their needs. It also means being honest and transparent with all stakeholders so that the right people can provide scrutiny. Media relations and a robust PR approach are key tools to ensuring that happens.

Effective internal communication within healthcare organisations is essential in addressing the challenges outlined in the CQC’s report. Staff members are at the heart of delivering quality care, and they need clear and open lines of communication. Ensuring that healthcare professionals are well-informed about organisational changes, patient needs and safety protocols is crucial. It’s equally important to provide a platform for staff to voice their concerns, suggestions and insights. By fostering a culture of open communication and active listening, healthcare organisations can create a safe and supportive environment for their workforce. The outcome of this directly affects workforce challenges by improving staff morale and increasing retention, ultimately enhancing the quality of care provided to patients.

The challenges in healthcare require collaborative efforts from all stakeholders to co-produce solutions. Effective communication facilitates dialogue between providers, policymakers, and the public and ensures that their voices are heard and their experiences are valued. By bringing these groups together, we can identify innovative solutions while considering the needs and challenges faced by all groups. Collaborative partnerships enable collective problem-solving and the development of initiatives that benefit all.

The CQC report highlights disparities in healthcare, particularly for those from ethnic minority groups and individuals with long-term conditions. Effective communication can be a catalyst for change by shedding light on these disparities and using best practice to ensure seldom-heard groups are included. By advocating for cultural awareness, addressing racial stereotypes and improving accessibility and inclusion we can work towards eliminating healthcare disparities.

While the report identifies challenges, it’s important to celebrate success stories in healthcare. Communication can highlight the dedication of healthcare professionals and organisations working tirelessly to deliver high-quality care under challenging conditions. Recognising their achievements can inspire others and instil a sense of pride and purpose in the healthcare community.

The Care Quality Commission’s State of Care report serves as a critical reminder of the challenges facing health and social care in England. In this complex landscape, effective communication is not just a tool but a cornerstone for achieving fairer access to healthcare. By raising awareness, listening to experiences, bridging information gaps, fostering collaboration, challenging disparities, and celebrating success, we can work towards a healthcare system that ensures quality care for everyone, regardless of their financial means. In doing so, we honour the dedication of health and care professionals and advance the well-being of all those who rely on the system.

For information about the services Blue Lozenge provides, click here.

For information about past work we’ve done, check out our case studies. 

More time to care

Summary

Blue Lozenge has developed a reputation framework designed to support health and care boards and leaders in proactively managing organisational reputation. The framework applies an adapted reputation equation to the health and care sector, assessing risk and opportunity across six key areas. It positions reputation management as encompassing performance, behaviour and communication rather than media management alone. Evidence cited includes links between workforce engagement and reduced hospital mortality rates, the role of online patient feedback in quality improvement, and community engagement in COVID-19 vaccine uptake. Blue Lozenge offers an audit and board development process for individual providers and integrated care systems.

 

The Blue Lozenge health and care reputation framework

In a world where public trust in the NHS is declining and there are huge challenges with the health and care workforce, proactively managing reputation has never been more important. We’re therefore building a reputation framework to support health and care boards and leaders.

Reputation is not about keeping negative stories out of the news media, or a lack of transparency when things go wrong. Managing reputation is about performance, behaviour and communication. It is about being honest about what’s working and what isn’t, explaining performance in a way that people understand and listening to understand what needs to be improved, then making those changes.

At Blue Lozenge we’ve adapted something called the reputation equation and applied it to health and care. It is our belief that the effective management of reputation in health and care gives all those who work in health and care more time to care.

There are huge benefits for health and care providers if they proactively manage their reputation, workforce and population experience. An integrated communication strategy can help to maximise the opportunities and mitigate the risks, whether this is an individual organisation or an entire integrated care system.

Whilst these benefits are myriad, some examples include:

  • A positive correlation between better healthcare employee communication and engagement and work-related commitment; a negative correlation with turnover intentions;
  • A positive correlation between higher levels of workforce engagement and reduced mortality rates in hospitals;
  • A positive link between the use of online patient feedback and better-informed quality improvement projects;
  • South London Listens – an NHS-led project engaging communities in improving services in south London – leading to the co-development of innovative and effective new clinical interventions to support mental health;
  • Strong community relationships underpinning the success of the Covid-19 vaccine campaign in improving uptake in marginalised groups.

We’ll look at each of these areas in depth in the coming months and the evidence sources behind them.

The ultimate consequence of a poor reputation in health and care is that there is less time to care. Anyone who has worked in a provider organisation supporting their improvement journey will have noticed that organisations with low public trust receive more complaints and the workforce are unwilling to advocate for the organisation. In many cases morale is sometimes so low that even those working in caring roles remove their name badges and do not want to be associated with the organisations they work for. Once communication has broken down with the public or with the workforce it raises stress and anxiety and impacts on the safety of care. Organisations and their leaders are no longer given the benefit of the doubt.

Once communication has broken down with the public and the workforce, organisations and their leaders are no longer given the benefit of the doubt.

The reputation opportunity in health and care is immense because improved communication leads to organisations and whole health systems having more time to care. This is because there is honesty and realism in interactions, people taking pride in their work, services and organisations listening and implementing change, boards spend less time focused on national or regulatory interventions.

Our Blue Lozenge health and care reputation framework and approach assesses reputation risk and opportunity across six key areas. We provide an audit and board development process to support individual providers and integrated care systems. Reputation risk and the mitigating actions you need to take are a core part of your board assurance framework. We can help you implement an actionable plan and demonstrate how strategic communication and engagement can help your organisation and system have more time to care.

If you would like more information, a copy of our full framework or a conversation about how we can support you please get in touch. hello@bluelozenge.co.uk

NHS 75 – Leah Morantz Covid-19 Welsh communications and inequality

Summary

Leah Morantz, Head of Communications and Stakeholder Engagement at Public Health Wales and leader of the Welsh COVID-19 communications response, is interviewed as part of Blue Lozenge’s NHS 75 series. Morantz discusses the role of strategic communications in addressing wider health determinants, influencing policy and empowering the public. She reflects on leading communications during the pandemic, describing approaches to building trust through consistency, managing misinformation and disinformation, and a targeted campaign to increase vaccine uptake among pregnant women. Morantz also addresses health inequalities, community engagement, lessons from the private sector on internal communications and brand consistency, and the ongoing need to establish communications as a strategic function within public health organisations.

 

In the fourth part of our NHS 75 series celebrating leading healthcare communicators, we spoke with Leah Morantz. Canadian-born Leah is Head of Communications and Stakeholder Engagement at Public Health Wales and led the Welsh communications response to COVID-19. 

Leah shared with us her experiences as a high-level public health communicator, handling the “infodemic” and what the public sector can learn from the private sector. 

Q1: Why should the NHS care about strategic communications? 

Leah Morantz: Yeah, really big question. I don’t think it’ll be a surprise to anyone watching this interview that the NHS is facing an existential challenge. The pressures are absolutely massive, and it feels like every day there are more headlines about waiting lists and the ongoing financial pressures on the NHS and staffing and everything else. 

Within that context we also have a UK population that’s declining in overall health. Life expectancy isn’t increasing anymore but the reality is that situation isn’t all down to healthcare and healthcare provision. The NHS can’t fix that in and of itself. It’s not a case of having more surgeons and more doctors and more nurses. We’ve got to be thinking about the wider determinants. 

What are the things that affect people’s health and well-being on a day-to-day basis? And that’s about having healthy communities, about having meaningful work, about having safe housing, a good clean, safe environment to live in. And all of those things contribute to not only well-being, but to good health and to longevity. When you bring that into the context of strategic communications, it’s really important that the public has a good enough knowledge and understanding of this narrative specifically for them to know and do what they can to keep themselves healthy. So there’s definitely a role for strategic communications in empowering people. 

But also the other aspect of that is helping to empower the general public to be able to influence politicians towards making more favourable policies, policies that favour health and well-being. I see those as being two really, really important strands to how strategic communications can help the NHS and I think that’s not specific to any particular health trust or any particular NHS organisation, it’s really about how as a health comms community we hold those principles in some of the work that we do. 

Blue Lozenge: So there’s a political aspect to it? 

I think there’s a political aspect to it, but I also think that we have to tread the line on a daily basis between the politics and the reality. Health is a devolved portfolio. So, in Wales, it’s Welsh Government that sets health policy for NHS Wales. But we have a role in influencing health policy by providing health intelligence, and by providing really good research that helps policymakers to understand how changing the policy landscape could lead to better health and well-being for people in Wales. We also have a role in helping to shape the public discourse – what is the conversation that’s happening in the media, and how do we shape the stories so that we’re influencing the general public through the use of media as well as other channels. And I think in the context of public health, and the context of influencing the wider determinants and in terms of influencing policy, because we’ve got an evidence-based public health aim, that role of strategic communications can help us achieve where we’re trying to get to in the long term. 

Q2: You led the Welsh COVID-19 communications response — what were the biggest challenges you faced and how did you handle them? 

LM: In one sentence, I would say the scale and the pace of change. But when I think back on my leadership experience through that time, I think of the term VUCA, [which] stands for volatile, uncertain, complex and ambiguous. Originally it was a set of terms that was set out by the American military following the Cold War when they had to reestablish how they were going to deal with this really rapidly changing global landscape. 

[VUCA] basically says that those four different things, you can devise different responses to those scenarios based on precedent. But actually my lived experience of the COVID scenario was that it was like VUCA on steroids! Everything was more volatile, more uncertain, more complex and more ambiguous all at the same time. We expect to deal with that in our roles, but it was just the amplification of all of that, all at once, that made it so, so challenging and it was just like everything was turned up to 11. 

The way that I chose to approach it was to really lean back on my training, really lean back on the work that we’ve done in the years leading up to the pandemic and getting our team into a really good place. 

Relying on my knowledge – I know what I’m doing, my team knows what we’re doing. We’ve got really good skills and capability. Relying on the relationships of the people around me, I think that was really, really critical. And specifically within that, really finding myself being more authentically vulnerable in my leadership role than I’d ever been called upon to be in any other context. And so learning that it was OK to share my emotional state, not to the extent that it would negatively affect others, but actually that I’m human too. Sharing that humanity I think really helped the people around me, and particularly the people in my team. 

Q3: Sticking with the COVID theme, how did you work to build trust and confidence in Public Health Wales’s communication efforts, particularly during those times of uncertainty and rapidly changing circumstances? 

LM: Consistency is a really big thing for me in terms of building trust, and also sticking to our territory. Sticking to the things that we’re responsible for having a message on for the public and being clear and consistent about those things. And really doing the best that we could to proactively get on top of as much of the information as we could and reassuring people when we didn’t have the information necessarily. 

And some of that is reflected in the decisions that we made on a tactical level. So decisions that we made about how we published our stats on a daily basis at a specific time so that we could set expectations, deliver with consistency and make it so that people knew what to expect on a day-to-day basis. 

We also reflected what was happening in the public’s mind and how people were thinking and feeling by keeping a close eye on what was happening in the social media space. That that allowed us to respond to what was happening out there in the in the world around us. And I think that also had a big role in how we developed a level of trust. It was making sure that our messaging and talking to people was on the level that people were at at that moment in time. One of the things that we did quite early on in the pandemic when the first lockdown came around was we were really fortunate to be able to work with some quite famous faces in Wales who were happy to work with us to help us reinforce the messaging. 

And rather than coming out and saying you must stay home, you should do this, you should do that, we turned it around and used the principles of social norming to say thank you to people and say, actually, we know that most people are complying with the rules and thank you for doing that. And this is why it helps. So we were really, I think, human about the way that we communicated some of the messages through that that COVID period. But yeah, I think that consistency and our sense of honesty was really important. 

And then finally I would add, we were very fortunate to have some really competent spokespeople and we were quite consistent in how we used those spokespeople through the pandemic period and that builds up a lot of trust in those individuals that then translated in trust in what we were saying as well. 

Q4: A big challenge for many people during the pandemic was grappling with a deluge of information – some accurate, some inaccurate and some intentionally misleading. How did you work to guide Wales through this information overload? 

LM: So I think what you’re asking me is two questions. One is how did Public Health Wales respond to the concept of the infodemic, [i.e.] the flood of information coming from all angles of people. And then secondly within that how do we respond to the misinformation and disinformation that became part of the public discourse and became something that really emerged as a significant issue? 

About the infodemic piece, working within the context of Wales we were able to work across the whole of the public sector to use the same overarching campaign mechanism to get our messages across. Along with public sector partners across Wales, we used the Keep Wales Safe brand architecture to deliver a lot of the messages themselves. 

The other piece, and I talked about this a little bit earlier, was around consistency. That’s about being consistent and owning your territory and knowing what you can speak on as an organisation. And then, secondly, sticking to the messaging that has been approved and cleared and reiterating it so that we’re not coming out with a different version of a press release every day. We were reiterating the same messages over and over to try to gain cut-through. 

The WHO has a whole piece of work they’re doing around Infodemic and that whole set of concepts, which is available on their website. In terms of misinformation and disinformation, I think we would all agree it was one of these really big emerging themes that hit us as communicators and we were all sort of going, wow, that was maybe bigger or worse or more challenging than some of us might have expected so a response was definitely required. 

It’s really challenging to come up with rapid on-the-minute responses when you’re a large organisation that typically would operate with lots of layers of approval. That creates a bit of a challenge from a corporate messaging perspective. But as a communications team, what we could see around us was definitely that the misinformation strands were quite real. 

We took the approach of [keeping] all of our channels open during the pandemic. So I think that’s the first thing to say. Not every organisation did or was able to do that so we had hundreds of thousands of direct messages and hundreds of thousands of comments on our channels and that called upon us to make some decisions. We made a decision [to be] open and transparent and accessible, which is why we kept all our comments on. 

But there were certain times and certain topics where we took decisions to close the comments. Some of that was because we did not want to elicit the pile-on of mis- and disinformation. Some of it was because we had to manage our mental health. There are times when you just need to be able to step away from the social media channels on a Friday night at 5:00 PM and not worry that the whole weekend is going to run away with you or that the person who’s working the on-call shift on Saturday is going to have to deal with a massive mess. 

There were some practical considerations as well, but that misinformation/disinformation piece was [about] trying to come up with methodologies and tactics, [such as] setting out frameworks for how and when we would respond. We set out clear house rules on our social media channels. We called people out for disinformation or misinformation. If there were known actors that would purposely put incorrect information into the channels we would issue a warning and after three strikes ban people from commenting on streams.  

We did a specific piece of work back in November 2021. We knew from the clinical evidence that a disproportionate number of people in intensive care were pregnant women, and of those many of them hadn’t had their vaccination. We were really trying to understand [their motivation] and we were under some pressure as well from the clinical side to encourage people to take up that vaccination offer in pregnancy because of the increased risk from diminished immune response. 

Some of the reasons for pregnant women not getting the vaccine was to do with fear, the fact that it was a new vaccine, the fact that the evidence was emerging and also this whole concept of disinformation and misinformation that was out there. To approach that problem, we used our social media channels to undertake some research to try to understand the barriers and what was influencing people’s decisions about whether to take up the vaccine offer or not. 

And we also wanted to understand who the influencers were in that context. What we found was that, in pregnancy, women are looking in the main to the midwife to give them advice about whether they should or shouldn’t take up the vaccine offer. That was a key finding, which led us down the road of trying to understand the conversations that midwives were having with pregnant women 

It turned out that the midwives themselves weren’t entirely comfortable with giving that clear advice to take up the vaccine offer. So, we had to work with that group to understand their barriers and understand what was happening there. We did two pieces of work as a result. One specific piece of communications was targeted at the midwives to help give them the facts and information and walk them through how to have a conversation about vaccination with a family coming in talking about their pregnancy. 

And then the second piece was directed specifically at women in pregnancy and helping them to be able to find information that they would need to make decisions. We also made sure that we stayed on top of our social media community in that topic area to reduce the influence of the people on the fence or disinformation. So, there are people that are putting out purposeful misinformation and then separately there’s people that are sort of, Oh well I heard that this isn’t such a good idea is this true kind of stuff. That actually they don’t necessarily have ill will or ill intent, but they’re misinformed or they’re putting out information that isn’t actually true because they don’t necessarily have the facts to hand. 

So, we did a lot of work to moderate that community closely on our social media space. And then we worked with closed community groups on Facebook and elsewhere to help to make sure that we were disseminating the correct messages. And we did see a measurable uptake in vaccination in pregnancy from the launch of that campaign onwards, which was really encouraging and really helped us to think through putting in place methodologies and tactics and frameworks. That helped us to build the case for why that was important and gave us a bit of confidence to keep doing it moving forward. 

Q5: So moving away from COVID now – how has comms and engagement helped to reduce health inequalities in Wales? And what further progress do you think needs to be made? 

LM: Well, I know you set this question up by saying moving away from COVID but actually the whole COVID experience gave us a really important opportunity to think really hard about health inequalities and how we needed to really make sure that we were including as many communities as possible in the messaging and helping to understand what barriers people were facing to taking up the behaviours that we’re asking them to do. So, what’s standing in the way of people taking up their vaccine offer? What’s standing in the way of people using masks when required or staying home when ill? And all of those things. 

The first and most important thing for us is around listening and trying to understand the challenges and barriers. It’s not about just going out there and blasting the messages out. We’ve got to give due consideration to what the lived experience of people is in their context. So, an example of how you can help to encourage people to stay home when they test positive for COVID is providing them with financial help if they’re going to be facing financial hardship as a result. 

Adapting our channel approach was also really important. What we’ve tried to do is to develop trusted relationships within our stakeholder networks and within communities. Because even though we like to think that we’re a trusted NHS body, some people trust their local community leaders or people that they know more than they trust us. So, we’re able to put our messages in the voice of those trusted community partners to help the messages land more effectively. I think those are probably two of the key ways. I think it’s really important to put this on the table – engagement takes a lot of time and effort. It’s not just about setting up a WhatsApp group and blasting some stuff out. It’s about building relationships and making it a two-way situation where you can hear what’s working, what’s not working and what peoples’ needs are. It definitely takes time and energy to build and then retain that trust. 

Q6: You’ve got a background in the private sector. Are there any lessons or working practices from the private sector that you’d like to see brought into Wales’s health system and public sector or vice versa? 

LM: What I’ve seen work really well in the private sector is that they take comms seriously, especially internal communications. In my experience that has been a part of the mix that’s really well invested in and really well understood to have a significant positive impact on productivity, on staff well-being, on the bottom line. 

There’s definitely some work to do to help internal communications be better understood as a lever for positive change. I think that that’s because private sector organisations — particularly large corporates — understand the value of engagement and so they translate that into investment in those activities. In the health sector in particular it’s often very difficult to make the case for things that could be perceived as less tangible. 

And I think the other area is around consistency. So really demonstrating a deep commitment to your brand proposition, whether that’s a public sector brand proposition or private sector, You’ve got to be really, really clear about what your business is, what you’re doing, what is the need of the population or your customer or your service user, what’s the need that you’re intending to meet. And really sticking to that, like ruthless consistency and that’s what good brand proposition work is about. It’s being clear about it and working to deliver towards that. I think that’s something that is done really well in a lot of private sector contexts and which we could learn and adopt much, much more in the public sector for sure. 

Q7: A big part of the NHS 75 is looking forwards. As communications leader, how do you see comms and engagement involving over the coming years? 

LM: Here in Wales in particular, but elsewhere I expect as well, we need to continue to build our case for strategic communications. And I mean really high-calibre public campaigning [and] internal communications. The heady days of the pandemic where leadership looked to communications to solve a lot of the problems are over and we’ve gone back to a bit more business as usual where different parts of the business forget to loop comms back in. 

So I think that, whilst in many places communications teams, communications directors or heads of functions have won a place at the table, we really need to keep working hard to stay there. To do that you’ve got to be really committed to your professional development as a leader in communications, really committed to maintaining standards both for yourself and for your teams. I’m a big believer in membership of professional bodies as a demonstration of that, and also really trusting that communications can be an important lever for change and also for being the voice of the patient. 

It’s not necessarily a new challenge ahead, but I think it’s really holding on and keeping on, driving forward, making that case for communications as a strategic function, as a strategic partner in really making a difference for users and for patients. 

 

You can follow Leah on X.