Across NHS organisations, a critical challenge persists: ensuring that internal communications reach frontline clinicians reliably. While messages may be carefully developed and approved at leadership level, there is no guarantee they are received, read, or acted upon by those delivering care.
This “last mile” problem is not unique to the NHS, but its impact is amplified in healthcare. Research shows that ineffective communication is a contributing factor in up to 70% of serious adverse events in healthcare settings (The Joint Commission, 2015). In environments where timing and clarity are critical, communication failure is not simply an operational issue—it is a patient safety risk.
Key Takeaway
The “last mile” problem in NHS internal communications refers to the failure of critical messages to reliably reach frontline clinicians. This gap is caused by fragmented systems, email delivery failures, and workforce complexity—and directly impacts patient safety, staff engagement, and operational efficiency.
Why NHS Communication Systems Struggle to Reach the Frontline
Traditional NHS internal communication channels—including email, intranet, and cascade briefings—are not designed for a modern, distributed workforce. With over 1.5 million NHS staff in England alone, many working shifts or in community settings, ensuring equitable access to information is inherently complex (NHS Digital, 2023).
At Salisbury NHS Foundation Trust, changes to NHS security protocols prevented critical communications from reaching staff inboxes. Essential updates—including COVID-19 information—were blocked, highlighting how email delivery failures within NHS systems can disrupt frontline communication entirely .
Bridgewater Community Healthcare NHS Foundation Trust faced similar issues across a dispersed workforce. Staff operating across homes, clinics, and schools relied on fragmented systems, leading to duplication, inefficiencies, and limited engagement visibility. This reflects wider findings that only 29% of employees feel they receive the information they need to do their job effectively (Gallup, 2023) .
At Royal Papworth Hospital NHS Foundation Trust, unreliable legacy systems resulted in inconsistent delivery and engagement, with open rates around 50%. This demonstrates a broader issue across healthcare: information may be sent, but not seen .
The Impact on Staff Engagement and Patient Outcomes
The consequences of poor healthcare communication systems extend beyond operational inefficiency. NHS England has identified staff engagement as a key driver of patient outcomes, with more engaged staff linked to lower mortality rates and improved patient experience (West & Dawson, 2012).
However, communication overload presents an additional barrier. Research indicates that knowledge workers receive an average of 120 emails per day, making it increasingly difficult to identify and prioritise critical information (Radicati Group, 2023). For frontline clinicians, this overload is compounded by limited time and access to digital tools during shifts.
This creates a paradox: while more information is available than ever, less of it is effectively reaching those who need it most.
Solving the Last Mile: Guaranteed Delivery in NHS Communications
Addressing this challenge requires a shift from volume to reliability—ensuring that critical communications are not just sent, but delivered, accessed, and understood.
Trusted Delivery, powered by NewZapp, addresses this gap by providing a secure, NHS Digital governance-compliant internal communications platform designed specifically for healthcare environments.
Evidence from NHS organisations demonstrates measurable impact:
Salisbury NHS Foundation Trust achieved guaranteed email delivery, ensuring all staff received critical updates consistently
Bridgewater Community Healthcare NHS FT reduced communication production time from several hours to under two, improving efficiency and engagement
Royal Papworth Hospital NHS FT increased open rates from 50% to 60%, with additional uplift through targeted resend functionality
In Dorset, Trusted Delivery also enabled targeted communication across diverse and rural populations, improving both engagement and recruitment outcomes—demonstrating the importance of segmentation and inclusivity in NHS communications.
From Communication to Clinical Confidence
For NHS leaders, solving the last mile problem is not simply about improving communications—it is about strengthening the link between strategy and frontline delivery.
When clinicians receive timely, relevant, and accessible information, organisations are better positioned to deliver safe, effective, and equitable care.
In a system as complex as the NHS, reliable communication is infrastructure—and ensuring that every message reaches the frontline is foundational to everything that follows.
1. What is the last mile problem in NHS communications?
The last mile problem refers to the failure of internal communications to reach frontline clinicians reliably, even when messages are successfully sent.
2. Why do NHS emails fail to reach staff?
Emails can be blocked by NHS security filters, lost in high inbox volume, or inaccessible to staff without regular email access.
3. How does poor communication affect patient safety?
Poor communication contributes to up to 70% of serious adverse events in healthcare by delaying or preventing critical information from reaching clinicians.
4. What is NHS Digital governance in communications?
NHS Digital governance ensures that communication systems meet strict standards for data security, privacy, and information management.
5. How can NHS organisations improve internal communications?
By adopting platforms that guarantee delivery, centralise messaging, and provide analytics to track engagement.
6. What is guaranteed email delivery in the NHS?
Guaranteed delivery ensures that emails bypass filters and are successfully delivered to all intended NHSmail recipients.
7. Why is staff engagement important in healthcare?
Higher staff engagement is linked to better patient outcomes, including reduced mortality and improved care quality.
8. What challenges do community NHS teams face in communication?
Community teams often lack access to central systems and rely on fragmented channels, increasing the risk of missed updates.
9. How does information overload impact clinicians?
High volumes of emails and alerts make it difficult for clinicians to identify and prioritise critical information.
10. What is the best communication system for NHS organisations?
The best systems are secure, NHS-compliant, guarantee delivery, and are designed for frontline accessibility and engagement.
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References
Gallup (2023) State of the Global Workplace Report 2023. Washington, DC: Gallup.
NHS Digital (2023) NHS Workforce Statistics. Available at: https://digital.nhs.uk (Accessed: 7 April 2026).
Radicati Group (2023) Email Statistics Report, 2023–2027. Palo Alto: Radicati Group.
The Joint Commission (2015) Sentinel Event Data Root Causes by Event Type. Oakbrook Terrace, IL: The Joint Commission.
West, M. and Dawson, J. (2012) Employee Engagement and NHS Performance. London: The King’s Fund.
