NHS 75 – Jude Mackenzie on building trust and reputation amongst health providers

In the second part in our series celebrating the NHS and its leading communicators, we spoke with Jude Mackenzie, and expert in trust and reputation. Amongst many other accomplishments, Jude was instrumental in the re-branding of the NHS’s “Blue Lozenge” logo, which gives us our name. 

Here’s what she had to say about the creation of the NHS logo, the arguments that the NHS has to win, the role of communications in the NHS and much more… 

Q1: Why should the NHS care about strategic communications? 

Jude Mackenzie: I think any organisation can benefit from strategic communications because it’s about dealing with the people issues. If an organisation gets the people issues right then their objectives are much easier to achieve. So the NHS is massively a people organisation, isn’t it? And it’s not only that, but it’s about life and death as well. There are many people [and] groups that are really invested in what’s happening with the NHS. So if the NHS manages to make sure that those groups of people with their various interests have a better understanding of what we’re trying to do, the way the organisation wants to go and how they can improve their own health, then the objectives of the NHS are going to be much easier to achieve. 

I’m making it sound simple, which of course it isn’t. And the strategic side of that is prioritising. Any communications professional can be busy, but being busy and effective is the magic solution. So if you manage the strategic side better, that’s when you are going to be at your most effective. 

Q2: The NHS’s Blue Lozenge is one of the world’s most recognised logos. What roles does branding play in building public trust? And why is it important? 

JM: A brand is always the signature for the service, so it’s a way for people to understand where that service comes from.  So the NHS at the at the time that I was asked to create a single branding policy the government at the time very much wanted to stress One NHS. So having one consistent branding policy was very important for underlining the strategy that they had. 

Actually, one of the challenges we had at the time was deciding which organisations could use the NHS logo and which couldn’t. Clearly there are some in the centre of the service who it’s very clear that they’re NHS, but there are other services around the periphery that we had to really think about “could this service use the NHS logo?” Because if it did, then the then the public would ascribe a set of values and an understanding to that service, which perhaps isn’t true. Is the NHS genuinely accountable for the service that that organisation provides? I also think every public service needs to think about how it’s communicating with its various audiences and it needs to do that as well as it can. A single branding policy enabled us to set pretty high standards for how things like signage etcetera were created for the for the benefit of everybody.

Q3: What lessons did you learn from being involved in the creation of the NHS’s Blue Lozenge logo? 

JM: Loads, yes. I learned a huge number. The NHS logo, the little box actually was already in existence, so it was part of the logo of the NHS Executive, which was the headquarters of the NHS at that time. But we were given the job of taking that existing small logo and creating an entire branding policy for the whole of the NHS. 

Now everybody that works at any kind of head office knows that, particularly with the NHS, you can’t just kind of pull a lever at Head Office and automatically everything changes across the service, so the main lesson was to make sure that people across the service who were going to have to implement the new branding policy understood why we were doing it and were on board with the overall strategy. We did roadshows across England, talking to communications directors and heads who were the people who were going to need to implement it, to demonstrate to them why this single-branding policy supported the overall strategy of the NHS. 

And I think I’ve got to give massive credit to all of those communications professionals that were around at the time because they were the ones that did the hard work in their trusts and health authorities and groups and other organisations to get their own staff teams on board and to make the change happen. So on a big change management level, that was one of the most important lessons. 

On a very practical level, there were all sorts of little things that I learnt and if I did the job again, I probably wouldn’t have used an existing typeface, we would have created our own typeface. I wouldn’t have used that blue because many printers at the time told me it was actually a very awkward blue to print. But we had to do it quickly, we had to do it cost effectively and it has survived the test of time even though those little issues have been there. But yeah, I think we did, we got most of it right. 

Q4: What are the challenges of creating ICSs which are understood, respected or loved by the public they serve in the same way that the NHS is nationally? 

JM: Having spent so many years in and out of NHS management, I think that the larger cooperative structures are the most effective in the NHS and across the social care system for bringing about change. So actually I’ve got a lot of positive feelings about the integrated systems. 

Whether they need to be known and loved by the public, I’m not sure. I think what people want from their health and care services is they just want that local service to work really well for them. And then there are obviously interested parties that really do want to be part of creating the local services or influencing the local services. And the ICSs need to be able to engage with those people properly. And I think part of that is, I guess I would say this, but I do really think that really good communications and engagement at integrated service level is massively important.  

The opportunity to do this well across a bigger geographical patch with cooperation amongst all the different parties, both on the care and health side and in the voluntary sector and in other public services, it offers such opportunities. But I know it’s really difficult to get it right. 

They need to have a consistency to their brand because every organisation needs that and they need to be able to show who they are. So they are cooperative, larger structures or they’re not always organisations in their own right, they are organisations that are working together for the benefit of the public and people need to understand what that is.  

But I definitely think for the vast majority of the general public getting a decent service from their local NHS and their local council and their local voluntary organisations is what really, really matters. So I wouldn’t put the investment into being a highly known brand, I’d put the investment into building trust with the people that you’re serving, but also the people who want to influence the way that those services are provided. 

Q5: What must the NHS do to preserve its place in the civic consciousness for the next 75 years? 

JM: The obvious answer is at a strategic level it has to demonstrate that a single taxpayer-funded service is still the most efficient way to support the health of the population. It has to continue to show that that’s still the case even though populations’ needs are changing etc etc. And I do think the NHS can do that. 

The benefits of scale I think can be massive so long as there’s that cooperation with and advanced planning, strategic planning across the service, I genuinely think that the way that the NHS is constructed is the best way to deliver a health service. 

So that’s at the strategic level. At the operational level, I think the immediate challenges are clearly workforce and workforce planning. Helping people to live healthier lifestyles to make healthier choices. Mental health — probably every government has underfunded mental health. It’s not as politically a hot potato as other services, but the impact that poor mental health has on the total well-being of the society is massive. 

And social care — we’ve seen that over decades if social care doesn’t work very well, then healthcare gets choked up and doesn’t work very well. And the social care crisis is massively connected with the fact that people are living longer and no government knows how to solve that. 

But that doesn’t mean that it doesn’t need solving. We need to continue to work on that, and the ICSs are a part of that. And as is the workforce plan that’s been announced this week and many other initiatives that people are working on to deal with people being able to be looked after at home etcetera. So yeah, some huge kind of massive challenges and also some fairly thorny but immediate problems. 

Q6: One of the key themes of NHS 75 is looking forwards. What do you see as the challenges and opportunities for strategic comms within the NHS in the coming decades? 

JM: In some senses, they’re not going to change in 75 years because strategic communications are always going to be important. Health is always going to be something that people care about and therefore people are going to want to understand what their health service is about and will be engaged in that. Politicians will always be interested in what’s happening in the NHS. So strategic communications is going to have to carry on working with people, engaging people, informing people in the way that it has done for 75 years. So that part doesn’t change. 

I guess the way that the health service is going to deliver its services in the future is what’s going to change. So inevitably we’re going to see far more services delivered digitally, potentially patients who don’t interact with a human being at all, but who interact with a service that’s provided digitally let’s say. And how do we make sure that the communications that goes alongside that is good to give the person confidence to enable them to deal with any issues that come up and to enable them to feel that this is the way that their service should be provided. 

So providing those checks and balances around those developing services I think will be important. AI, artificial intelligence, is going to play a massive role in the future for communications and how we a) embrace the opportunities that that provides but b) also put the necessary safeguards in I’m sure is something that the whole communications industry is thinking about. Everything becomes extremely focused when it’s about health, [it’s] life and death. So those issues I’m sure would be massive for strategic communications professionals. 

I’ve always hoped that communications as a profession in the NHS could have more development, training [and] career pathways and attempts have been made over the years to do that. But I still don’t think we’ve reached a place where the sheer value of having communications around the top table is realised, not just by those positions and jobs existing, but by the fact that that person who’s in that role has been through a process of professional development and career support that enables them to be at their very best. 

I think the ICSs, if I ruled the world, would have brilliant and well-resourced communications and engagement functions. I do genuinely think that having a higher level of expertise across a bigger geography can pay massive, massive dividends. Many, many years ago I saw it a little bit in what were called Regional Health Authorities, and whilst those had their pros and cons, you were able to have a level of expertise there that wasn’t present in every individual trust when those structures were dismantled. So I do think that the integrated systems, whilst at the moment they still feel fledgling — I know that they’ve been around for a long time — but they still in some instances feel a little bit like they’re finding their feet. I do think if they can be made to work then the opportunities are massive, and I would love to see in 75 years’ time a hugely integrated social care and health system, probably integrated further into housing and criminal justice as well, so that the total well-being of the population is the focus. That would be brilliant.