In April 2025, a letter from NHS England reignited a familiar debate—are communications functions in the NHS a strategic asset or a disposable overhead? As calls for transformation intensify, this article argues that communications is not a luxury but a cultural infrastructure. From navigating reform to shaping trust and behaviour, NHS comms teams are critical enablers of change. Drawing on new research, major system reviews, and expert commentary, we make the case for protecting and elevating this essential function—before the system learns the hard way what happens when it’s missing.