NHS 75 – Leah Morantz on leading the Welsh COVID-19 comms response and reducing inequalities

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.