Communications in a restructured NHS: How ICBs can keep communities onside during change

The NHS is undergoing one of the most significant transformations in its history. The creation and ongoing restructuring of Integrated Care Boards (ICBs) is intended to bring health and care services closer together, improve efficiency, and focus resources where they are most needed. Yet for patients and the public, these shifts can feel confusing, unsettling, and even threatening if the right communication strategies are not in place.

For ICBs, effective communication is not just a nice-to-have, it’s a vital tool to build trust, foster collaboration, and maintain public confidence during times of structural change. At Grey Sergeant, we specialise in helping healthcare organisations shape their message, manage their reputation, and keep communities engaged.

Why communication matters in a restructured NHS

The NHS Long Term Plan outlines three fundamental shifts: moving care from hospitals into communities, prioritising prevention over treatment, and accelerating the move from analogue to digital. Each of these shifts requires cultural, structural, and behavioural change, not just from the system, but from patients and staff.

When organisations merge, rebrand, or restructure, the risk of public scepticism and stakeholder resistance is high. Local communities may fear the loss of services, while staff may worry about job security or altered roles. Poor communication in these moments can create a vacuum, leaving rumours and negative narratives to take hold. Conversely, clear, consistent, and transparent communication helps ICBs take their communities with them on the journey.

Building trust through transparency

Trust is the foundation of any successful healthcare system. For ICBs navigating change, openness must sit at the heart of communications. This means:

• Clear messaging on the “why”: Explaining not just what is changing, but why the change is necessary, and most importantly, how it benefits patients.

• Honest acknowledgment of challenges: Communities respect honesty. If services face pressure or compromises are needed, acknowledging this builds credibility.

• Consistent updates: Regularly sharing progress prevents speculation and reinforces accountability.

A transparent approach reassures patients and partners that ICBs are acting in their best interests, even during periods of uncertainty.

Engaging Communities in the Process

One of the most powerful ways ICBs can keep communities onside is by involving them in shaping the future. Engagement must go beyond consultation exercises and become a two-way conversation.

• Listening events and forums give patients, carers, and staff the opportunity to voice concerns and propose solutions.

• Community ambassadors - local leaders, faith groups, and patient representatives can help bridge the gap between the boardroom and the public.

• Digital platforms such as online surveys, social media Q&As, and interactive webinars allow for broader participation and reach.

By demonstrating that feedback directly influences decisions, ICBs can strengthen legitimacy and build shared ownership of the change.

Internal communications: Supporting NHS staff

Change can be equally unsettling for staff. Without effective internal communication, morale drops, productivity declines, and frontline staff struggle to advocate for the organisation.

ICBs should prioritise:

• Clear cascades of information so every staff member understands what is happening and why.

• Safe spaces for staff feedback to raise questions and voice concerns without fear.

• Celebrating success stories to keep teams motivated and highlight positive outcomes of change.

When staff feel informed and valued, they become powerful advocates for the changes taking place.

Reputation Management During NHS Restructuring

Restructures often generate negative headlines, especially when linked to service closures, funding pressures, or redundancies. A proactive reputation management strategy can mitigate these risks.

Grey Sergeant advises ICBs to:

• Identify risks early: Map out where resistance may come from and prepare responses in advance.

• Build media relationships: Proactive engagement with journalists ensures balanced reporting and provides opportunities to tell success stories.

• Highlight patient benefits: Case studies and real-world examples can shift the narrative from organisational complexity to patient outcomes.

A strong reputation allows ICBs to navigate criticism while keeping the public focused on improvements in care.

The Role of Digital and Data in Communication

The NHS Long Term Plan emphasises digital transformation, and this applies equally to communications. Digital tools offer ICBs powerful ways to reach audiences quickly and measure impact.

• Targeted campaigns: Social media advertising and email campaigns can reach specific demographics with tailored messages.

• Data-driven insights: Analytics tools measure which messages resonate, allowing ICBs to refine strategy in real-time.

• Patient-centred design: Digital communication should be accessible, inclusive, and reflective of diverse communities.

By embracing digital, ICBs can ensure communications are not just heard but understood.

Case Example: Communication in Action

Consider an ICB that recently restructured local urgent care services. Instead of leading with technical language about “integration” or “pathways,” communications focused on the patient story: “You’ll be able to see the right professional faster, closer to home.”

The ICB launched a multi-channel campaign, using community radio, local newspapers, and targeted Facebook ads. They held open forums and worked with GP practices to distribute leaflets. Importantly, they followed up with progress updates, demonstrating promises made were promises kept.

The result? Reduced anxiety among patients, improved attendance at the new urgent care centre, and a more positive media narrative.

How Grey Sergeant Supports ICBs

At Grey Sergeant, we understand that communications in the healthcare sector require a careful balance of empathy, clarity, and authority. We help ICBs and NHS organisations to:

• Develop strategic communications plans aligned to organisational goals.

• Provide stakeholder engagement frameworks to strengthen partnerships with communities, local authorities, and providers.

• Deliver reputation management strategies to protect and enhance public trust.

• Produce creative content - from social campaigns to patient stories that brings the benefits of change to life.

Our consultancy exists to ensure that NHS organisations do not just survive change, but thrive by keeping communities informed, engaged, and onside.

Final thought

The NHS is built on public trust, and as ICBs continue to restructure, communications will be the key to safeguarding that trust. Transparent, engaging, and proactive communication can turn potential resistance into support, uncertainty into confidence, and complexity into clarity.

By working with specialist PR and communications partners like Grey Sergeant, ICBs can ensure they not only deliver structural change but also maintain the vital connection with the communities they serve.

About the author

Michael O’Connor is a partner at Grey Sergeant, specialising in PR, communications, and engagement across the healthcare and non-profit sectors. Through his consultancy Grey Sergeant, he helps primary care networks, GP surgeries, and healthcare organisations define their brand, strengthen their reputation, and communicate with clarity. For more information, contact michael.oconnor@greysergeant.com