Lack of diversity and deteriorating NHS reputation key concerns for communications leaders: new report

One of the most comprehensive reports into the state of the NHS communications profession is published today.

5 March 2024

One of the most comprehensive reports into the state of the NHS communications profession is published today.

The benchmarking report from leading national membership bodies the NHS Confederation and NHS Providers, alongside the Centre for Health Communications Research, provides unique insights into the diversity of NHS communications leaders, their capacity and resources, ways of working, and what they regard as the key challenges for the NHS in an election year. The report is published in partnership with communications consultancies Freshwater and Grayling. 

It shows the vital role communications professionals play in helping local people understand how to access NHS services and how to prevent illness, as well as leading on engagement with the NHS’ 1.4 million staff. The findings are based on a survey of almost 200 communications leaders, including 130 who identified as the most senior communications professional in their organisation (just under half of those working in England’s NHS trusts and integrated care boards*).  

Communications leaders report that the biggest challenges they have faced over the last year have been constrained budgets and restructuring, lack of staff, burnout and the impact of industrial action. Looking ahead, they say the two biggest challenges will be responding to the worsening reputation of the NHS locally and nationally, and, secondly, dealing with the impact of budget cuts and staff reductions at a time of expanding workloads.

The key findings from the survey are: 

  • The most senior NHS communications leaders are likely to be female, white, have an undergraduate degree, and three quarters have a specific communications qualification.
  • Like the wider communications profession, the NHS has an ambition to improve the ethnic diversity of its communications workforce. This survey indicates the profession is going backwards, with less than 5% of the most senior NHS communicators from an ethnic minority background. In addition, almost two thirds (61%) say they do not have a communications workforce that is representative of the local communities they serve.
  • Turning to gender, 72% of the most senior communicators are women compared to 28% who are men. However, a higher proportion of those senior communicators who are men (31%) are on the NHS’ highest pay band (VSM) compared to the proportion of women (20%).
  • With NHS finances under strain, it is not surprising that over a quarter (26%) say their budgets for staff have been cut over the past year, with a third (34%) reporting a reduction in non-pay budgets. Many referred to significant upheaval caused by restructuring.
  • Training and development budgets are being hit: almost two thirds say they do not have adequate training budgets, increasing the risk that communications staff won’t be supported to learn new skills and maximise their potential. This may have an impact on retention, which is a problem given four in 10 (39%) say they find it difficult to fill vacancies. 
  • Just under half report directly into their chief executive; less than half (46%) are on the executive team; while the vast majority (78%) are not on their organisation’s Board. 

Concerns about the reputation of local NHS organisations and for the NHS at a national level in an election year also feature strongly. The main reasons for this are: deteriorating finances and reduced performance against key waiting time targets; the risks posed by upcoming changes to local services, such as planned reconfigurations that are likely to meet with resistance from the public; and the impact from high profile failings in care and other scandals. Developing effective communications strategies to explain what the NHS is doing to tackle these issues and how local services can improve quality and access to care are considered major priorities.

One other area of emerging concern is both the opportunities and risks posed by artificial intelligence (AI). There are various uses of AI in communications that have the potential for reducing the time communicators spend on relatively low impact but labour-intensive tasks, but over three-quarters (77%) say they do not feel equipped to make effective use of AI to enhance their team’s work. 

The report calls for the creation of a taskforce to explore the root causes of why so few of the most senior NHS communicators are from an ethnic minority background, and to make recommendations for how a more ethnically diverse leadership can be achieved. This taskforce should consist of communications leaders from local NHS organisations; NHS Providers, NHS Confederation, NHS England and other national bodies; and experts in the field of diversity and inclusion who can provide guidance on how other sectors have tackled this issue. This and other recommendations will be explored further at the NHS Communicate conference on 6 March. 

Commenting on the findings, Daniel Reynolds, director of communications at the NHS Confederation said: “This is the most comprehensive analysis of the NHS communications profession ever undertaken. It shows the vital role communications professionals play in helping local people understand how to access services as well as leading on engagement with the NHS’ 1.4 million staff. However, the findings reveal communicators are being asked to manage higher and more complex workloads with fewer resources. This increases the risk of burnout and communications teams feeling they cannot achieve their strategic objectives as they are often in crisis management mode.” 

Adam Brimelow, director of communications at NHS Providers said: “We continue to see a concerning lack of diversity among our most senior roles, particularly when it comes to ethnicity. This survey provides a more accurate baseline that we can assess the profession’s progress against in future years, but it’s clear that we are less ethnically diverse than the wider profession and that we are probably regressing. A renewed focus is required to help change this.”

John Underwood, Director of the Centre for Health Communication Research said: “Senior communicators are understandably concerned about the reputation of the NHS given declining performance and satisfaction levels. The NHS is ranked as the second most important issue of concern to the public, which means the NHS will be a key battleground issue in the election. Communicators will need to work effectively alongside their executive colleagues – both locally and nationally – to demonstrate to the public how the NHS is responding to the challenges it faces.”

Nick Samuels, director of healthcare at Freshwater said: “This comprehensive benchmarking exercise is an important next step in the professionalisation of health communication. It is time for communicators to have their place recognised as valued NHS professionals, to exert greater influence at board level to achieve greater impact in the interest of patients.”

Natalie Andrews, Associate Director at Grayling said: “Effective strategic communications can bring significant and measurable benefits. This report demonstrates there is a need for better understanding within NHS boards and management of the importance of NHS communications teams and for continued investment. Effective communications does not have to be expensive, but it does need to be strategic and respected by senior NHS leaders.”

Notes to Editors

  1. The survey was launched on 16 January 2024 and closed on Tuesday 30 January. In total, we had 194 responses to the survey; 130 of those individuals identified themselves as the most senior communicator working in their organisation. We asked that the most senior individuals completed the survey to ensure that the benchmarking data provided was as accurate as possible. For the purposes of this report, we have therefore primarily analysed the sample of the most senior communicators. 
  2. The 130 senior communicators are primarily from NHS trusts and ICBs. By our estimates, this represents just under half the total number of the most senior communicators working in NHS trusts and ICBs. 
  3. The findings from the report, The State of NHS Communications, will be launched at the NHS Communicate conference on Wednesday 6 March. For further details about NHS Communicate, please visit and follow us on X @NHSCommunicate