The Cut That Revealed the Problem
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On 1 April 2025, NHS England issued a letter that did more than initiate another phase of reform. It revealed a fundamental misunderstanding.
Penned by Chief Executive Sir James Mackey and sent to NHS trust leaders and Integrated Care Boards (ICBs), “Working together in 2025/26 to lay the foundations for reform” called for a 50% reduction in ICB running costs. The instruction was clear: administrative functions seen as “duplicative” should be scaled back. Among them, Communications and engagement.
The framing was stark. Comms, alongside other back-office roles, was grouped as overhead—non-essential, easily trimmed. For many, it read like a cost line. But for those within the system, it sounded like something else: a warning that we’re still underestimating what it takes to lead change in a complex, people-led service.
If we cut comms now, what exactly are we cutting? This blog argues it’s not messaging—it’s the very infrastructure of culture, trust and change leadership.
It’s easy to read the letter’s message as purely financial. In fact, the pressures are undeniable: integration of NHS England into DHSC, severe funding constraints, and calls for greater simplicity.
But the letter included a stark message: communications and engagement functions were identified among several areas “where there was duplication”—with a clear instruction to review them for efficiency alongside assurance and performance functions. For many communication professionals, that signalled their work was seen as peripheral rather than fundamental to culture, trust and transformation (Healthcare Leader, 2025).
This phrasing—deliberately non-specific—nonetheless triggered sector-wide concern. Communications teams were left questioning their future, and the value placed on their role during one of the most significant periods of system reform in NHS history.
And that’s the heart of the issue. By labelling comms among potential duplications, the letter exposes a deeper problem: communications is still seen as a bolt-on. A service. A megaphone. Something to use once decisions have been made, rather than a function that makes decisions more effective, implementable and legitimate.
And that matters—because NHS communications professionals are doing far more than shaping narratives. They’re shaping culture.
We sometimes forget: communications is not just what is said—it’s what people believe. In a system as vast as the NHS, belief is the binding agent. Without it, reform becomes fragile.
If communications capacity is cut just as we ask ICBs to reform pathways, shift funding models, and engage communities more deeply—what story are we telling? And who’s left to tell it?
The April 2025 letter, in its call for cost reduction, ignored this essential truth: reform without trust collapses. And trust is built, held and recovered through communications.
Let’s not forget where we’ve just come from.
During the COVID-19 pandemic, communications teams were not writing press releases—they were leading public health messaging, debunking misinformation, managing incident protocols, and supporting the emotional wellbeing of frontline staff.
They set up digital forums, translated complex science into everyday understanding, and worked round the clock to hold the line of public confidence. Internal communications helped shift behaviours overnight—mask protocols, redeployment, vaccination uptake.
NHS communications teams are embedded as part of formal emergency response, not optional extras. This is mandated by national guidance such as the NHS England Emergency Preparedness, Resilience and Response (EPRR) Framework, which states:
“Effective communication with staff and the public about an incident will minimise its wider impacts and increase the confidence in the NHS response… Any incident is likely to generate significant media interest… this coverage needs to be managed as effectively as possible as speculation can quickly become presented as fact and mislead key audiences.”
NHS England (2015). Emergency Preparedness, Resilience and Response Framework.
London: NHS England.
Available at: https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf
Local NHS organisations routinely operationalise this guidance. For instance, East of England regional EPRR planning specifies that communication plans, including social media and media engagement, must be tested alongside incident exercises—ensuring that crisis comms forms a core arm of response. NHS England
These plans aren’t theoretical—they’re actioned in real events. For example, during the global EMIS IT outage in July 2024, NHS England’s comms team issued a coordinated holding statement reminding primary care systems to switch to contingency paper systems and assuring patients their care wouldn’t be disrupted. This rapid, multichannel update brought clarity, reduced inbound calls, and helped maintain public confidence.
This demonstrates that comms teams:
Formally activate as part of incident Gold command structures
Lead multichannel messaging to staff, patients, media and the public
Prevent misinformation and maintain trust during emergencies
Are operationally critical, not just media managers
Removing or reducing communications capacity isn’t saving money—it’s eroding emergency resilience. This isn’t PR. It’s infrastructure.
So how did we end up here?
Too often, communications in the NHS is misunderstood as a tactical afterthought, rather than a strategic influence. It’s seen as reactive—writing press releases and issuing updates—rather than shaping policy, culture, and behaviour. But emerging evidence makes it clear: comms is much more.
A 2024 NHS Confederation report emphasises that “strategic and effective communications is at the heart of high performing organisations in the NHS,” enabling engagement with patients, staff, and communities, and crucially supporting service delivery and resource utilisation.
NHS communicators are the translators and integrators, bridging boardroom decisions and on-the-ground delivery.
Caroline Latta, a member of the CIPR Health Group and co‑founder of Stand Consultancy, wrote in Communicate Magazine (6 June 2025):
“Comms in the NHS isn’t a nice‑to‑have. It’s not about glossy leaflets or reactive media lines: it’s about making the NHS system work… They reduce risk. Build trust. Drive behaviour change.” (communicatemagazine.com)
The Government Communication Service’s (GCS) Strategic Communications: a Behavioural Approach guide positions communications as one of five policy levers—alongside legislation, regulation, taxation, and spending. Alex Aiken, then-Executive Director of the GCS, states:
“Communications is one of the vital levers government uses to realise its objectives … the success of that policy inevitably involves people starting, stopping or changing behaviours.”
NHS communications increasingly adopts behavioural tools—using COM-B and EAST frameworks to design campaigns with measurable outcomes.
A GCS “MCOM Function Guide” (2021) clarifies that strategic communication teams aren’t just producers—they are architects. They:
This methodology is reflected in modern NHS trusts that embed comms leads into programme teams, not just in Press Releases.
The Health Foundation’s report Spreading Improvement Ideas (2018) analysed 477 empirical research studies focused on improvement initiatives across healthcare systems. It concluded that effective communication is consistently identified as a critical enabler of successful spread. Key success factors included early stakeholder engagement, contextual sensitivity, and sustained, coherent messaging throughout the improvement process. These findings reinforce the strategic importance of communications in delivering and embedding change across complex systems.
When communications is sidelined or underfunded, strategies and reforms risk failing at the moment of implementation. Without comms:
As NHS Providers’ Caroline Latta warns: reducing communications capacity “risks undermining the very changes the system is trying to deliver.”
Communications in the NHS is not noise—it’s navigation.
When NHS England called for sweeping cost reductions—including in communications—it ignored a vital truth: transforming the NHS in 2025 requires trust, culture, and engagement more than ever.
In their BMJ Opinion piece “Culture should be a strategic priority amid the changing landscape of the healthcare system” (8 May 2025), Isabelle Brown and Laura Turner of NHS Providers wrote:
“The NHS workforce… is under considerable operational pressure … In addition, seismic shifts are on the horizon … The level of change the NHS is facing … makes culture a strategic priority. To achieve the ambition behind these changes, we need an engaged, motivated workforce and a supportive, enabling environment.”
Similarly, a recent BMJ editorial warned:
“If we are to drive change and deliver a truly reformed health system, focusing on people and culture is non-negotiable.”
These statements are not abstract—it’s a call to action. Cuts to comms risk eroding precisely the foundations needed for reform to succeed.
Drawing on the Berwick Review and NHS England’s Culture & Leadership Programme:
“Culture is the norms, rituals, expected behaviours and unwritten rules … Culture is vital because it shapes our behaviour and values at work.”
More so, data shows that a 0.12 increase in staff engagement correlates with a 0.9% reduction in agency spend—worth around £1.7 million per trust. Communications lies at the heart of that outcome.
Reform without trust collapses—and trust is built by comms
Peter Drucker famously said, “culture eats strategy for breakfast.” There’s a reason: without the belief and energy that comms generates, no change will stick.
One NHS Providers blog on integration warns:
“Left to its own devices, culture can become … a master saboteur, evaporating even the best-laid plans into thin air.”
It’s communications that gives shape, voice and credibility to culture—especially in times of structural change.
The Government Communication Service’s latest thinking reminds us:
“Communications is one of the vital levers [that government uses] to realise its objectives … success … involves people starting, stopping or changing behaviours.”
This is precisely why modern communications is not noise—it is a strategy to influence audience beliefs and actions.
A system primed for reform is a system that holds on to its capacity to communicate. Without comms, culture goes quiet, change loses its meaning, and the strategy loses its centre.
Communications isn’t expendable. It is essential—especially now.
“NewZapp has transformed our internal communications. Before, we were constantly facing issues with delivery and engagement. Now, not only are our open rates up, but staff engagement with surveys and nominations has skyrocketed. The support team has been fantastic, always there when we need them, making sure everything runs smoothly.”
— Laura Favell, Communications Manager, Royal Papworth Hospital NHS Foundation Trust
The April 2025 letter may have been about savings. But its real impact was cultural. It reminded us just how easily communications is misunderstood—and how essential it actually is.
Because the truth is this: the NHS doesn’t just run on policies, pathways and protocols. It runs on belief. And belief is built through communication.
Cut that, and we cut the thread that holds it all together.
Why is NHS communications considered a strategic function in 2025?
NHS communications has evolved beyond media relations. In 2025, it plays a central role in culture change, staff engagement, behaviour influence, and public trust. Strategic communications is embedded in transformation programmes, making it essential to safe, effective reform.
What did the April 2025 NHS England letter say about communications teams?
The letter stated that “administrative functions, including communications and engagement, should be reviewed for duplication and efficiency opportunities.” This led to concern across the sector that communications was being undervalued during a critical reform period.
How do NHS comms teams contribute to behaviour change?
NHS comms professionals apply behavioural insights (e.g. COM-B, EAST frameworks) to campaigns—driving outcomes like vaccine uptake, digital adoption, or reduced emergency department use. These approaches align with Government Communication Service (GCS) behavioural science guidance.
What is the risk of reducing communications capacity in the NHS?
Cutting comms capacity can erode staff morale, weaken public trust, and increase risk during change programmes. Communications is key to aligning staff, responding to crises, and embedding cultural values—removing it can undermine transformation efforts.
How can NHS leaders protect and elevate the comms function?
Leaders can embed comms early in strategic planning, align it with people and OD functions, invest in behavioural training, and use impact case studies to demonstrate value. This ensures communications is seen as a lever for delivery, not a cost line.
Berwick, D. (2013). A Promise to Learn – a Commitment to Act: Improving the Safety of Patients in England. London: Department of Health.
BMJ. (2024). Focus on culture not structure during NHS reform. BMJ, 389, r928. https://www.bmj.com/content/389/bmj.r928
Brown, I. & Turner, L. (2024). Culture more important than ever at a time of transformation. NHS Providers. https://nhsproviders.org/resources/culture-more-important-than-ever-at-a-time-of-transformation
Department of Health and Social Care. (2025). Working together in 2025/26 to lay the foundations for reform. NHS England letter. https://www.england.nhs.uk/publication/working-together-in-2025-26-to-lay-the-foundations-for-reform
Government Communication Service. (2022). Strategic Communications: A Behavioural Approach. London: Cabinet Office. https://gcs.civilservice.gov.uk/publications/strategic-communications-a-behavioural-approach/
Government Communication Service. (2021). MCOM Function Guide. https://gcs.civilservice.gov.uk/publications/strategic-communication-mcom-function-guide/
NHS Confederation. (2024). The State of NHS Communications. https://www.nhsconfed.org/publications/state-nhs-communications
NHS England. (2021). Culture and Leadership Programme: Overview and Evidence Base. https://www.england.nhs.uk/culture/culture-leadership-programme/
NHS Providers. (2025). Why cuts to NHS communications teams are a strategic mistake. Communicate Magazine. https://www.communicatemagazine.com/features/2025/why-cuts-to-nhs-communications-teams-are-a-strategic-mistake
Peter Drucker Institute. (2007). What Makes an Organisation Effective? https://www.drucker.institute/resources/
Public Health England. (2018). Behaviour Change: Guide for Local Government. London: PHE.
The Health Foundation. (2018). Transformational change in NHS providers. London: The Health Foundation. https://www.health.org.uk/publications/transformational-change-in-nhs-providers