NHS 75 – Rachel Royall on the role of strategic communications in the NHS

In celebration of NHS 75, the 75th birthday of our national health service, we begin a series of interviews with some of the leading lights in UK healthcare communications. In the series, we ask communications experts across the domains of trust and reputation, changing public health and innovation and technology about the role of communications in meeting the opportunities and challenges facing the NHS.

First, though, we asked for the perspectives of Rachel Royall, Founder and MD of Blue Lozenge…

Q1: Why should the NHS care about strategic communications? 

Rachel Royall: Strategic communication has a massive impact on public service, not just the health and care service. So that’s one of the reasons why I think it’s important. But essentially, I think effective strategic communication can help with listening and engaging and hearing the voices of the local population. I think it can help in explaining policies and decisions that might be being taken about care. 

I think it can help in achieving operational improvements and excellence in services. It can help in building reputation and it can also help in transforming behaviour. At Blue Lozenge, we’ve developed something called the Heart Model, which is our strategic framework for the health and care sector for strategic communications. 

Strategic communications can also be used as an early warning system. I think for the people who apply effective strategic communications a key part of that is listening to [your audience] and understanding what their concerns are. And I think very often whether or not you work in an acute hospital trust or as part of an integrated care board team, listening to and hearing issues as they develop, if you intervene quickly enough and feed that information and intelligence back into your organisation it can actually help to prevent crises and prevent things before they become big issues. So I think it’s a really key part of reputation management. 

Q2: What have we learnt as communicators from the pandemic? 

RR: The biggest thing that I think we’ve learned as communicators throughout the pandemic is clarity of purpose and vision. I don’t think ever before I’ve seen so many people work towards a common goal and a common outcome. And what I often see when it comes to communication is not that people are trying to do the wrong thing, it’s often that they’re trying to do too many things or they’re trying and attempting for the communication to achieve too many things. And I think the biggest thing that we learn about the pandemic is that once you’ve got clarity of purpose, then funding, finance, communication and tech all work together towards a common goal. We can really achieve amazing things. 

Q3: How is the comms environment changing with the new focus on integrated care? 

RR: I think it’s fascinating. We work with a large number of integrated care boards as well as individual health and care providers and charity organisations and local authorities. So we’ve worked with so many different people. I think it’s fair to say that it’s very much early days. I think we see some really fantastic examples where teams work together, where teams work collaboratively and they work towards common goals. 

But I also think that we also see some behaviours which disappointingly don’t always necessarily put the patient or the citizen first and they still do often put individual organisations’ interests first. So whilst I do see some glimmers of hope and some optimism, I think we’ve got a long way to go on people genuinely and collaboratively working together on communications across systems. 

Q4: Where does Blue Lozenge think the NHS needs to go to rebuild trust and reputation? 

RR: I think there are many ways that we think communication can help the NHS to rebuild trust and confidence. This isn’t about the NHS as anonymous kind of whole or one kind of large entity– we have to acknowledge that the NHS is made-up of lots of disparate parts and lots of individual organisations and therefore as such it’s about setting a culture and a tone around communication.  

First and foremost, I think that communication needs to happen with the interests of patients and the workforce at the heart of it. One thing that’s been in the media recently, for example, is the workforce strategy and how the workforce strategy is potentially being briefed to the media before being talked to the NHS workforce. I think we would go a long way if we invested in internal communications and workforce communication strategically. So I think that’s definitely one big thing.  

The second thing for me is I feel that with the context of industrial action and general unrest, unfortunately I think individuals and organisations have got into a very negative position in terms of being critical of each other. And I think one of the things where communication can add a great deal of value is helping to break down some of those boundaries and some of those barriers. And I think we need people to be positive and optimistic and to kind of remember that they’re on the same team and working towards a common purpose. 

Unfortunately, it’s sometimes exacerbated by social media, but there are very extreme perspectives and points of view which sometimes focus too much on the differences that we have between each other rather than the similarities. And I think we should do more on focusing on what we have in common and what we want to achieve in common for our patients and the citizens. 

And then the third thing that I would say — I’ve commented recently on a couple of tech companies that have been very well, one tech company’s been very critical of its competitor on social media and it has decided on a very adversarial communication approach. I don’t think that’s helpful in the NHS. We’re not working in the banking system. We’ve got people that work in the public sector and we’ve got people that work in the private sector both again who need to collaborate and work for the collective interests of patients and citizens. 

So those are the big three broad areas that I think if we made some progress on, we could start to rebuild trust and confidence in the health and care system and the fantastic people that work in it. 

Q5: What can the NHS do to improve communication with underrepresented groups and help ensure communications are accessible? 

RR: I think what many providers and more broadly integrated care systems can do is start to look at their populations across a certain geography. Sometimes it’s quite difficult to find the resource to focus on targeted communication. But I think if we collaborated more and if our teams worked more effectively together across the broad spectrum of the workforce that we employ in communications, there are certain people that we can lean on for certain specialist skills. 

And by that we need people who are representative of the local community. I’m a huge advocate for — and one of the things that I think the NHS could introduce for professional communicators — apprenticeship schemes whereby supporting local NHS organisations to introduce rotational roles that better reflect the local community. So there’s something about ensuring that the comms teams themselves have a broad representation of the communities that they serve. 

And then the second big thing for me around this and around accessibility is probably around technology and communication channels and how we use them. Unfortunately we see far too often that many channels are not set up for effective kind of accessibility. Whether or not it’s background settings that are turned to the right format to help people with screen reading, whether or not it’s hashtags not in the right format for people to be able to understand the information that they can receive. So I think there are some fantastic examples [from the] Cabinet Office and government communication, I think we should run more of that out and adopt that within the NHS. 

Q6: The 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? 

RR: In relation to looking forward and what do I see as the challenges and opportunities for NHS communications, I think the biggest opportunity is 1 where communications and communicators and people working in communication roles can truly demonstrate leadership through collaboration and working together. So that means that we get involved in the really tricky issues that affect people. It means that we’re part of the solution for example around the workforce strategy. It means that we’re supporting the teams around things like recruitment, around employee engagement. 

So I think the biggest opportunity and challenge in relation to strategic communication actually probably relates to workforce communication in its broadest sense. How do we make sure the tone of talking about the NHS is good enough that we want to attract a global workforce? And then how do we make sure that we’ve got the channels in place to bring people into the NHS and to make them feel welcome and loved once they are in the NHS. 

And I think as communicators we have a massive role to play with our HR colleagues to make sure that we make sensible decisions and have sensible insight into things like flexible working, into things like terms and conditions. And I think that’s at a national level in relation to influencing workforce policy from the Department of Health and Social Care and at a local level in local providers. 

I think you can make a difference at all of the different levels of the health and care system.