About This Case Study
This is a retrospective strategic analysis of a real communications challenge, not actual Comms Threader output. It illustrates how strategic scaffolding structures thinking from problem to narrative.
Real Threader outputs depend on your context, uploads, and decisions. See actual tool usage in the Boeing case study or explore best practices.
NHS England
The Expectation Gap After COVID
The Golden Thread
Problem: This is not a waiting list problem. It is an expectation recalibration problem. COVID elevated the NHS to the status of national religion, and the gap between that reverence and the reality of 7.6 million people waiting for treatment is unsustainable.
Tension: The public clapped for the NHS during COVID and now feels betrayed by waiting lists, staff shortages, and visibly struggling services. The emotional contract has been broken.
Message: For a public whose expectations of the NHS were set by a crisis that made the service feel sacred, NHS England must redefine the relationship between what the public expects and what the system can deliver.
Platform: Replace hero worship with an honest account of capacity, demand, and the choices society must make about what the NHS can realistically provide.
Story
The Brief: Post-COVID, NHS England faces record waiting lists (7.6 million), widespread industrial action, chronic staff shortages, and a public whose expectations were elevated by the pandemic’s clap-for-carers solidarity. The gap between public reverence for the NHS as an institution and public frustration with the NHS as a service is the defining communications challenge.
Challenge Reframe: This is not a waiting list problem. It is an expectation recalibration problem. COVID elevated the NHS to the status of national religion, and the gap between that reverence and the reality of 7.6 million people waiting for treatment is unsustainable.
Sector Convention: The NHS communicates through hero narratives (our amazing staff), operational updates (waiting time targets), and defensive statistics, while avoiding any honest conversation about what the system cannot do.
Audience
Priority Stakeholder: The General Public as Patients-in-Waiting
Stakeholder Tension: They believe the NHS should be there when they need it because they were told it always would be. They are discovering it is not, and they do not know whether to blame the government, the system, or themselves for expecting too much.
Message
Message Hierarchy: For a public that was promised universal healthcare and is experiencing rationed access, NHS England is the institution that tells the truth about what the system can and cannot deliver, because honest expectations are the foundation of sustainable public trust.
What We Won't Say: Our staff are heroes. The NHS is there for you. We are working hard to reduce waiting times.
Plan
Comms Direction: Shift from heroic reassurance to honest capacity communication, helping the public understand what the NHS can deliver now, what it cannot, and what choices would change that.
Frame: Narrative Territories
The Honest Waiting Room
Publish real-time, localised capacity data. Let patients see what is available, what is not, and why. Replace opaque waiting with informed waiting.
Feel: Practical, transparent, empowering
The National Conversation
Facilitate a public dialogue about what the NHS should prioritise. Make rationing decisions visible and democratic rather than hidden and administrative.
Feel: Democratic, brave, society-facing
The People Behind the Numbers
Tell specific, local stories of staff and patients navigating the system. Replace aggregate statistics with human reality.
Feel: Human, intimate, documentary
What Actually Happened
NHS England’s communications have largely continued the pre-existing pattern: hero narratives about staff, statistical updates on waiting list progress, and defensive positioning against government criticism. Industrial action by nurses, junior doctors, and ambulance staff dominated the narrative in 2023-2024. The public increasingly distinguished between the NHS as beloved institution and the NHS as struggling service. Satisfaction surveys hit record lows while support for the NHS as a principle remained high.
Why It Failed
- Hero narratives from COVID created expectations that could not be met, and continuing them felt increasingly disconnected from patient experience
- Waiting list statistics became the dominant metric, reducing a complex systemic challenge to a single number that only went in one direction
- Industrial action by “heroes” confused a public that had been told NHS staff were selfless, not workers with legitimate grievances
- The absence of honest capacity communication left a vacuum filled by political narratives from all sides
- The case demonstrates that public institutions cannot sustain reverence and rationing simultaneously without honest conversation about trade-offs