Summary

Blue Lozenge introduces the HEART model, a strategic communication and engagement framework developed for NHS and healthcare organisations, positioned as a practical tool for delivering the NHS 10 Year Health Plan for England. The model comprises five components: Hear with empathy, Explain with transparency, Accelerate operational impact, Reputation through trust, and Transform through communication. The piece argues that healthcare transformation projects across technology, workforce and clinical domains frequently fail due to inadequate communication rather than flawed policy intent. Evidence is cited linking effective communication to improved patient outcomes, reduced operational costs, staff wellbeing and behaviour change across the three plan shifts: hospital to community, analogue to digital, and sickness to prevention.

 

The Blue Lozenge HEART model provides a framework for impactful communication across the NHS.

The 10 Year Health Plan for England represents the most significant plan for healthcare transformation in decades. Yet history tells us that strategic plans succeed or fail based on one critical factor: communication.

Across healthcare, the standard and quality of communication is variable. Many people don’t understand the purpose and value of communication or how it can genuinely make a difference to people who work in healthcare and those who benefit from it. Poor communication doesn’t just cause frustration; it wastes precious time for both staff and patients, and when you have limited time to live, every moment matters.

That’s why we developed the HEART model for healthcare communication and engagement: a proven framework that can help teams transforms ambitious policy into lived reality.

Impactful healthcare communication and engagement matters more than ever

All kinds of healthcare transformation projects fail, technology, workforce, estates and clinical. They fail not because they aren’t good ideas but because of inadequate communication and engagement. The 10-Year Health Plan for England demands three fundamental shifts:

1. Hospital to community care
2. Analogue to digital system
3. Sickness to prevention

Each shift requires millions of individual behaviour changes across patients, staff, and communities.

When communication breaks down, the consequences ripple through the entire system. Communities and healthcare teams resist changes they don’t understand. Patients miss appointments because they don’t understand what’s expected. Staff spend hours explaining processes that should be clear from the start. Clinical teams repeat the same information because systems don’t talk to each other.

This is why strategic healthcare communication and engagement is essential. The HEART model, developed specifically for NHS and healthcare organisations, provides a comprehensive framework for communication excellence that drives real operational impact. It outlines the purpose of strategic communication and engagement in healthcare and has been developed from Government Communication Service best practice.

Effective communication doesn’t just improve patient satisfaction, it directly impacts operational efficiency. When people understand their care pathways, they come prepared. When staff have clear internal communications, they work more effectively. When communities understand service changes, they support rather than resist transformation.

The HEART model

H – Hear with empathy

We listen to and deeply involve diverse communities and people. We go beyond surface level listening to truly understand the perspectives, concerns and experiences of different stakeholders. We create meaningful, two-way dialogue that demonstrates genuine commitment to understanding.

E – Explain with transparency

We craft clear, honest communications about policies and decision-making processes. We build trust through open, accessible explanations that provide context, rationale and potential impacts. Our audiences are often diverse we therefore check understanding and deliver messages at times that help people to understand.

A – Accelerate operational impact

Strategic communication is a critical lever for operational performance. We connect operational goals directly to meaningful outcomes for our workforce, communities and stakeholders. We support the delivery of key shifts in care delivery – from hospital to community, analogue to digital, and sickness to prevention. We proactively measure and evaluate communication impact.

R – Reputation through trust

We manage reputation by consistently demonstrating progress, reliability, integrity and commitment. We build credibility through transparent communication, delivering on promises and aligning actions with values and needs. We strengthen trust through patient choice and empowerment. When things go wrong, we own mistakes and rebuild trust through honesty.

T – Transform through communication

We create transformative communication that drives positive behaviour change with our workforce, patients and citizens. We use strategic storytelling, evidence-based messaging and targeted engagement to inspire action, build understanding, and support meaningful change across healthcare ecosystems.

More time to care and more time to live

Strategic healthcare communication and engagement isn’t about apps, posters, messages, prettying things up, it’s about creating the conditions where healthcare works more effectively for everyone. When communication is done well, it:

Gives healthcare workers more time to care by:

• Reducing the need to repeatedly explain processes and procedures
• Improving patient preparation and compliance
• Streamlining referral and discharge processes
• Building stronger team collaboration and understanding
• Reducing complaints and crisis management workload

Gives patients and citizens more time to live by:

• Helping them navigate healthcare systems more easily
• Enabling them to make informed decisions about their health
• Reducing anxiety and uncertainty about their care
• Empowering them to take control of their health journey
• Creating services that actually meet their needs

Implementing the HEART model for NHS transformation

The neighbourhood health service won’t emerge from policy papers, it requires communication that helps people navigate integrated care with confidence. Digital-first care needs more than technology; it needs communication that builds capability and trust. Prevention strategies must inspire people to understand why healthier choices matter for their own lives.

Healthcare communication professionals who understand operational realities aren’t just storytellers, they’re performance improvers. They create measurable improvements that reduce costs, enhance outcomes and free up clinical capacity where it’s needed most.

The evidence is clear: effective communication in healthcare settings improves patient satisfaction, reduces costs, promotes better health behaviours, and enhances staff wellbeing. When people understand their care, trust their healthcare providers, and feel empowered to make healthy choices, the entire system works more effectively.

Making the 10 Year Health Plan work

The 10 Year Health Plan for England gives us the ambition. Strategic communication and engagement provide the means to achieve it. The HEART model offers healthcare leaders a practical framework to move from policy analysis to transformational action.

Every communication choice either builds or erodes trust. Every stakeholder interaction either strengthens or weakens reputation. Every conversation either accelerates or hinders the operational changes our communities desperately need.

Communication isn’t the nice-to-have that comes after strategy—it’s the engine that drives healthcare transformation. The question isn’t whether healthcare communication matters, but whether we’re using it strategically enough to deliver the change our patients and communities deserve.

When we get communication right, we create the conditions where healthcare teams can focus on what they do best: providing excellent care. We help patients become partners in their own health journey. We build communities that support rather than resist positive change.

This is how strategic communication and engagement gives everyone more time to care and more time to live.

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.

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.  

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)

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.