How Internal Communications Can Drive Trust During NHS Reform and Reorganisation
newsletter automation
newsletter automation
Major structural changes are nothing new to the NHS. From Integrated Care Systems (ICSs) to digital transformation programmes, workforce redesigns, estate reconfigurations, and centralisation of commissioning structures, change is part of the NHS’s operational DNA. Yet with every reform—regardless of its policy merit—comes a significant cultural risk: loss of trust.
Internal communication is a strategic enabler of trust. It fosters shared understanding, mitigates fear, encourages engagement, and preserves morale during periods of high ambiguity. Without it, reforms risk confusion, disengagement, and even resistance. With it, NHS organisations can deliver transformation with people, not simply to them.
Periods of reform are notorious for generating information vacuums. As outlined by FutureProofing Comms (2025), when formal communication lags behind decision-making, speculation fills the space. Staff begin to create their own narratives, driven by rumour, misinformation, and anxiety. Uncertainty becomes the dominant organisational emotion.
This risk is magnified across large, complex NHS organisations—particularly those with:
High proportions of shift or part-time workers
Multi-site delivery
Siloed directorates or underdeveloped comms functions
Digital inequality among frontline and support staff
According to a 2024 Leeds Teaching Hospitals NHS Trust communications review, the absence of timely, tailored internal messaging during change leads to “a breakdown in confidence across bands and professions.”
“In times of transformation, communication speed and sincerity are the clearest drivers of staff trust.” — Public Digital, NHS England Change Insights, 2025
Research from VivaPR and Trueman Change (2025) highlights that organisational trust directly impacts:
Staff retention during turbulent periods
Line manager confidence and role modelling
Patient safety and clinical decision-making
The success of wider engagement and behaviour change initiatives
Furthermore, Communicate Magazine (2025) found that transparent, emotionally intelligent communication was a key factor in public and workforce confidence during major healthcare reforms.
Without a structured internal comms strategy, change programmes struggle to move from theory to reality. People simply disengage—or worse, actively resist.
Trust is not simply a desirable outcome of change communication—it is a strategic asset in itself. According to the Institute of Internal Communication (IoIC), excellent internal communication is integral to the development and sustainment of trust, particularly during periods of change, crisis, or uncertainty. When staff trust their leaders, their organisation, and the information they receive, they are more likely to remain engaged, resilient, and aligned with organisational goals.
A 2025 article by Trusted Delivery, The Role of Internal Communication in Strengthening Trust within NHS Trusts, emphasises how consistent, credible communication creates a psychological safety net for staff navigating disruption. Similarly, HRinspire (2025) argues that internal comms, when done well, supports long-term engagement by recognising the emotional and social needs of employees—not just operational ones.
As highlighted in JK Design’s guide to cultivating culture through internal communications, transparency and storytelling are particularly powerful. When staff are treated as stakeholders rather than spectators, trust becomes embedded within the organisational fabric.
The IoIC’s 2025 research synthesis also links trust to communication attributes such as:
Clarity and consistency of tone
Frequency and reliability of updates
Opportunities for two-way engagement
Leadership visibility and approachability
In line with these findings, All Things IC notes that “trust is built in moments”—through micro-interactions, honest messages, and the credibility of leadership.
This is especially important in NHS settings, where reform is rarely experienced equally. As the IoIC reminds us, “change is a constant challenge,” but the way it is communicated determines whether it becomes a threat or a shared journey.
“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
Even when not all the answers are available, early communication signals respect. Leadership silence is quickly interpreted as secrecy. Staff appreciate honesty, humility, and vulnerability from those leading change. “We don’t know yet, but we’re listening” can be more effective than a polished non-answer.
In practice:
Share ‘first draft’ plans with staff before public announcements
Publish regular updates—even brief ones—on timelines or governance
Use first names, conversational tone, and local voices wherever possible
Different roles experience change in very different ways. A centralisation of IT services may feel distant to clinical staff but threatening to digital teams. HR integrations can evoke different questions from band 3 administrators versus senior nurse leads.
Trusted Delivery allows NHS organisations to segment internal communications by:
Site or region
Directorate or service line
Shift pattern or employment status (e.g. bank, agency, permanent)
Role or digital access level
Reforms must be understood, not just implemented. Share the “why now?” behind changes. Ground messages in national NHS priorities such as the Long Term Workforce Plan or equity commitments. Use real NHS voices—patients, staff, leaders—to share benefits and implications.
Effective formats include:
Mini case studies: “A day in the life after the new system”
Video explainers from transformation leads
Infographics mapping changes to patient outcomes
As Leeds Teaching Hospitals notes, “Narrative-based comms break down policy jargon and humanise strategy.”
Communication is not broadcast. It is dialogue. During change, staff need to feel heard—and believe that their views can shape the process.
Trusted Delivery supports:
Pulse surveys with live dashboards
Anonymous comment links
Response-enabled emails with filtering by theme or role
Organisations can also align with HRA and NHSE’s EDI plans by using lived experience feedback as a core part of governance design.
Track the performance of comms in real time. This isn’t just about open rates—it’s about reach, resonance, and responsiveness. Use Trusted Delivery’s analytics to compare:
Which shifts or roles are most/least engaged
When key messages are read or acted upon
Where changes in staff sentiment correlate with communications activity
Make adjustments based on the data. Abandon “one and done” newsletter culture in favour of agile comms cycles.
The current wave of reform must also be understood in the context of broader systemic pressures and historical precedents. The National Audit Office (NAO) report Managing the Transition to the Reformed Health System (2013) highlighted the complexity and risks involved in reorganising large-scale healthcare systems, including the erosion of institutional memory and loss of leadership continuity.
More recently, the NHS Productivity Puzzle report by the Institute for Government (2023) emphasises that system change alone is not a guaranteed lever for efficiency. Instead, it stresses the importance of operational stability, staff engagement, and improved communication in achieving sustainable outcomes.
The NHS Confederation’s New Operating Model for Health and Care (2023) also points to the need for integrated and flexible local systems—supported by clear, timely internal communication between national bodies, ICS leaders, and frontline teams.
These documents reinforce the argument that internal communication is not a ‘soft’ discipline—it is a critical enabler of reform resilience, cultural alignment, and long-term impact.
Public Digital (2025) emphasises that the NHS’s pace of reorganisation is outstripping its communications capability. Their guidance encourages “radical simplicity” in messaging and ongoing staff listening loops.
Four Communications Group highlights the risk to public credibility when government reforms are delivered without strong internal communications. “Trust collapses when staff feel used rather than informed.”
SBS NHS (2025) underscores that digital transformation within the NHS is at risk when frontline staff aren’t brought along with changes. “Without internal buy-in, transformation becomes transaction.”
Trusted Delivery is the only email communications platform built specifically to NHS digital standards. It enables:
Targeted delivery by shift, role, department, or location
Scheduled sending aligned with clinical workflows
Engagement tracking at team and Trust-wide level
Full compliance with NHS Digital Governance and IG policy
By reducing manual list building, delivering secure mobile access, and offering audience insights, Trusted Delivery allows NHS teams to focus on the content of transformation—not just the admin.
For related case studies, visit: From Frustration to Efficiency: Replacing Legacy Systems
Because it ensures transparency, supports emotional engagement, and reduces organisational risk during complex transformation programmes.
Loss of staff trust—leading to morale decline, attrition, confusion, and operational inefficiency.
By segmenting communication using platforms like Trusted Delivery, and by integrating digital and physical channels.
Visible, empathetic leadership sets the tone. Leaders should communicate regularly, acknowledge staff concerns, and share personal reflections.
Infographics, short videos, FAQ sheets, roadmaps, and relatable stories from peers or patients.
With openness. Negative feedback is valuable insight and a signal to review your message or strategy—not silence it.
By being strategic: avoid overload, prioritise core messages, and stagger content across channels.
Weekly at peak, biweekly for routine, and always when something materially changes.
Yes. Town halls, team huddles, and leadership walkarounds remain essential, especially when paired with digital comms.
Visit Trusted Delivery to explore tools, templates, and expert guidance tailored for NHS teams.
FutureProofing Comms (2025). FP5: Chapter 13 – Internal Communication. [online] Available at: https://www.futureproofingcomms.co.uk/thelatest/fp5-chapter13 [Accessed 20 Oct. 2025].
Leeds Teaching Hospitals NHS Trust (2024). Communications Strategy Report. [pdf] Available at: https://www.leedsth.nhs.uk/wp-content/uploads/2024/10/Communications.pdf [Accessed 20 Oct. 2025]. Public Digital (2025).
Navigating Changes at NHS England. [online] Available at: https://public.digital/pd-insights/blog/2025/03/navigating-changes-at-nhs-england [Accessed 20 Oct. 2025].
VivaPR (2025). The Importance of Internal Communication in Healthcare. [online] Available at: https://www.vivapr.co.uk/importance-of-internal-communication-in-healthcare/ [Accessed 20 Oct. 2025].
Communicate Magazine (2025). Communicating Major Healthcare Reforms. [online] Available at: https://www.communicatemagazine.com/features/2025/communicating-major-healthcare-reforms-how-to-maintain-public-trust-and-keep-transparency/ [Accessed 20 Oct. 2025].
Sabercom (2025). NHS Internal Communication. [online] Available at: https://www.sabercom.co.uk/nhs-internal-communication/ [Accessed 20 Oct. 2025].
Four Communications (2025). DHSC Comms Cuts Test Credibility. [online] Available at: https://www.four.agency/news-insights/dhscs-communications-test-cuts-credibility [Accessed 20 Oct. 2025]. Trueman Change (2025).
Why Internal Communication is the Key to LGR Success. [online] Available at: https://www.truemanchange.co.uk/our-resources/why-internal-communication-is-the-key-to-lgr-success [Accessed 20 Oct. 2025]. NHS SBS (2025).
Digital Transformation Under Pressure. [online] Available at: https://www.sbs.nhs.uk/news/digital-transformation-under-pressure-sustaining-momentum-amidst-nhs-reorganisation/ [Accessed 20 Oct. 2025]. The MJ (2025).
Improving Engagement and Communication in NHS Crisis. [online] Available at: https://www.themj.co.uk/improving-engagement-communication-nhs-crisis [Accessed 20 Oct. 2025].