Since its inception more than 60 years ago, the UK National Health Service (NHS) has become the world’s largest publicly funded health system. With 1.5 million staff, this complex system is also the fourth largest employer in the world. Through the Health and Social Care Act, the UK Government initiated the most profound change in the NHS since its formation. The change for the NHS is said to be driven by three key principles:

1. Putting patients at the heart of the NHS. This means a transformation of the relationship between the NHS, public and patients, who will be newly empowered by the provision of information and able to exercise choice. The decision of ‘no decision about me without me’ is central to this aspiration.

2. Ensuring local organisations and clinical professionals lead the health service. This involves making services more directly accountable to patients and communities, but also requires cutting bureaucracy and encouraging innovation.

3. A focus on clinical outcomes. This means a move away from targets and processes to high-quality care outcomes.

To be successful this complex reform programme requires a change in culture, behaviours, relationships and ways of working. An ethos of service, customer orientation and improved clinical outcomes will need to permeate the whole of the NHS. This has profound implications for communicators working in the system at the same time that communicative capacity in the NHS has been cut by 40 per cent.