Driving the next era of NHS Leadership: How communications can prepare Trusts for Advanced Foundation Trust status

I recently attended the NHS Providers Conference 2025 in Manchester and one theme rose above all others: the NHS is entering a new chapter defined by Advanced Foundation Trusts (AFTs) and Integrated Healthcare Organisations (IHOs). These models will shape how quality is delivered, how systems collaborate, and how local populations interact with their health services.

Yet the technical structures weren’t what leaders were most concerned about. What they truly wanted to understand was how to take their people with them. They asked how to bring clarity to complex transformation, how to build trust with staff and patients, how to create a sense of purpose across organisational boundaries, and how to demonstrate the credibility required to lead not only their Trust, but their wider system.

In almost every conversation, the answer came back to one thing: communication.Not communication as broadcast, or as marketing, or as corporate messaging but communication as strategic leadership.

Preparing for Advanced Foundation Trust status isn’t simply about governance, quality metrics or digital maturity. It’s about whether leaders can craft a compelling narrative, build confidence, engage people meaningfully, and shape a reputation that inspires trust at every level of the NHS. Communications and PR will play a decisive role in whether Trusts succeed.

Here I explore how leaders can use communications to prepare their organisations for AFT status, strengthen their profile in the system, and navigate the complexity of integrated care with confidence.

Why reputation and communications now matter more than ever

Advanced Foundation Trusts will be expected to operate at a higher standard of leadership, integration and public accountability. They must demonstrate not only clinical and operational excellence, but also a maturity of culture, stakeholder engagement and system influence.

In this environment, reputation becomes a strategic asset. A Trust with a strong reputation gains:

• Greater confidence from regulators

• More effective partnerships with ICBs

• Stronger internal morale

• More constructive relationships with local authorities and ICS partners

• Better media coverage

• Higher public trust during change

• Greater influence over system priorities

But reputation does not build itself. It grows through clear communication, consistent leadership, and a compelling narrative about where the organisation is going and why.

A Trust cannot become an AFT without becoming a high-performing communications organisation. And leaders cannot expect transformation to succeed if they are not prepared to lead it visibly, transparently and confidently.

Sir Jim Mackey talking at NHS Providers Conference 2025

What AFT leaders need: Insights from NHS Providers 2025

Throughout the conference, I heard recurring messages about what leaders need to succeed in this next era.

First, they need visibility. Staff, patients and partners expect leaders to be present, open and engaged. Silence creates confusion, and confusion undermines trust. Leaders who communicate regularly, through video updates, written reflections, staff conversations and system-wide briefings, create stability.

Second, they need a strong transformation narrative. If people don’t understand the “why” behind change, they will resist it. Trusts preparing for AFT status must articulate not only what will change but why it matters, how it will improve care, and what the journey will look like.

Third, leaders must communicate beyond their organisation. The NHS is now a system, not a collection of organisations. AFT-level leadership requires influence across ICBs, primary care networks, local authorities, voluntary partners and academic institutions. Leaders must speak in a way that resonates across the entire ecosystem.

And finally, leaders need a communications function capable of supporting major transformation. That means internal communications that are grounded in staff insight; media relations that build confidence rather than fear; digital communications that understand public sentiment in real time; and PR strategies that position the Trust as forward-thinking, credible and collaborative.

How communications can prepare Trusts for Advanced Foundation Trust status

1. Creating a clear, compelling narrative for transformation

Transformation fails when there is no clear sense of direction. Trusts that are serious about AFT readiness need a narrative that explains where they are now, where they are going, and how this aligns with the evolution toward integrated, population-focused care.

This narrative needs to be more than a strategy document. It must be woven into everything: board papers, staff conversations, patient communications, media interviews and cross-system discussions. When this narrative is consistent, staff feel part of the journey. When it is absent or fragmented, transformation becomes an uphill battle.

AFTs will be assessed on leadership and culture as much as performance. A strong narrative brings coherence to both.

2. Using internal communications to build belief and ownership

Staff engagement is the engine of transformation. You cannot deliver organisational maturity without staff understanding the journey and feeling that their role matters.

Good internal communication is not a cascade of information, it is a conversation. Leaders should use a mixture of channels: in-person briefings, digital Q&As, video messages, regular updates from the executive team and opportunities for staff to raise concerns openly.

Insight should drive content. Pulse surveys, digital sentiment tracking and staff engagement platforms can help leaders understand where barriers exist. When people feel they are heard, they become advocates for change rather than obstacles.

3. Building a stronger public reputation through strategic PR

Trusts aiming to become AFTs must demonstrate credibility to the wider public. This requires proactive communications that highlight success, improvement and leadership.

Positive patient stories, transparent reporting, collaborations with local media and clear commentary on system priorities all shape perception. The public, and the media, must see the Trust as reliable, innovative and honest.

During NHS Providers, several leaders noted that the Trusts gaining the highest external confidence were simply those communicating most consistently. Visibility doesn’t just share information; it builds trust.

4. Listening before communicating: digital insight and reputation monitoring

One of the most powerful tools available to Trusts today is digital listening. Before leaders can communicate meaningfully, they must understand what their communities and staff truly think.

Digital listening tools provide insight into patient concerns, community expectations, workforce morale and media narratives. This protects trusts from reputational risk, helps shape messaging, and allows leaders to respond before issues escalate.

For Trusts aiming to become AFTs, this insight is invaluable. It ensures that communication is grounded in reality, not assumption.

5. Strengthening relationships with journalists and the media

A Trust’s reputation is significantly influenced by its relationship with the media. Leaders who engage openly with local and national journalists create a culture of transparency. Trusts that avoid the media, or only appear during crises, quickly lose control of the narrative.

Preparing for AFT status means building a confident media strategy: regular briefings, positive news stories, well-prepared spokespeople, and a clear line on performance and improvement. When the media trusts a Trust, the public follows.

6. Communicating confidently across the system

Advanced Foundation Trusts must demonstrate leadership that extends beyond their organisational boundary. That requires strong communications across ICBs, local authorities, PCNs, voluntary sector partners and academic institutions.

Communications should reinforce shared goals, highlight integrated initiatives, and support the development of place-based care. Trusts that communicate well across their system are seen as credible, collaborative and ready for the responsibilities that AFT status demands.

7. Strengthening relationships with political and community stakeholders

AFT status requires strong partnerships at both local and national level. Leaders should actively engage MPs, councillors, ICS executives, community organisations and research partners. This engagement should be ongoing, transparent and focused on shared outcomes for local people.

Political and civic stakeholders can become powerful advocates for a Trust’s leadership if the communication is open, consistent and grounded in evidence.

8. Positioning the executive team as visible thought leaders

Reputation starts with people. A Trust’s executive team must be visible, vocal and credible. Platforms such as LinkedIn, panel discussions, opinion pieces, conference contributions and podcasts are powerful ways to strengthen leadership profile.

The Trusts that succeed in this next era will be those whose leaders are not just good at running services but good at communicating vision, partnership and purpose.

9. Creating internal brand alignment to support cultural change

Brand may look like a marketing concept, but in the NHS it is fundamentally about identity. AFTs require a culture of empowerment, partnership and clarity. Communications can bring this to life by aligning values, embedding consistent messaging and helping staff see themselves as part of something bigger.

When everyone understands the identity of the Trust, they understand what is expected of them and what they can expect of leaders.

10. Building a crisis-ready communications capability

A hallmark of organisational maturity is how well a Trust manages crises. AFTs must demonstrate readiness, responsiveness and reassurance when challenges arise. Crisis communications plans, clear escalation routes, trained spokespeople and rapid media protocols are essential.

A Trust that can communicate effectively under pressure is seen as responsible, resilient and trustworthy, exactly the qualities an Advanced Foundation Trust needs.

Conclusion

The journey toward Advanced Foundation Trust status is not purely operational or structural. It is fundamentally about leadership and communication. Trusts that succeed will be those that place communications at the heart of transformation, not as an afterthought, but as a strategic function that shapes culture, reputation and credibility.

If the NHS is to move confidently toward integrated, population-focused care, leaders must be able to articulate a clear vision, build trust, foster meaningful engagement and show visible, values-driven leadership. Communications is not support work in this context — it is the connective tissue that holds transformation together.

Advanced Foundation Trusts will be distinguished by the strength of their leadership. And leadership will be defined by how well they communicate.

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 healthcare organisations define their brand, strengthen their reputation, and communicate with clarity. For more information, contact michael.oconnor@greysergeant.com