Providing high quality patient information is a national priority for the NHS. Good quality information is an integral part of good quality healthcare.  It is needed in order to:

• improve care and communication with the public, patients, relatives and carers
• help people manage their own health and wellbeing
• support informed decision making by patients and their carers in respect of consent to interventions and treatment
• help patients to become well informed partners in their own care

The Better Health Better Care: Action Plan, published in December 2007, included a commitment to ensure patients, carers and the public are provided with the information they need at the time they require it and in a form that meets their needs.

Every day, health service staff use a number of different ways to communicate with patients and the public, for example:

• Face to face
• Telephone
• Near Me/Video conferencing
• Letter
• Email
• SMS Text
• Leaflets about treatments and services
• Posters and Information sheets giving advice or advertising events
• Social Networking & Social Media

Poor health literacy affects a significant portion of the population. It is often a hidden problem that affects the safety, effectiveness and person centredness of delivery of care. 

In Scotland, the average reading age is around 11 years old.   Around 250,000 people have communication support needs which may include difficulties with talking, seeing, hearing, literacy, numeracy and understanding.  Historically, written information produced by health service staff was presented in a formal style using “professional” language. Research has shown that many people have difficulty understanding this and new ways of communicating need to be considered and used; this includes the use of a variety of formats, media and technologies.

A number of steps have been taken to address equity in health literacy, this includes:

• ‘Fair for All - Scotland’ published in 2002 to address access to and use of NHS Scotland services for people from black and minority ethnic communities It clearly states ”The NHS must be sensitive to the cultural, religious and language needs of ethnic minority groups and to issues of gender and sexuality”
• Patient’s Rights (Scotland ) Act 2011 stated that patients have the right that the health care they receive should consider their needs and what would be of optimum benefit to them, encourage them to take part in decisions about their health and wellbeing, and provide information and support for them to do so
• ‘Making it Easy’ published The Scottish Government’s in 2014, set out the health literacy action plan for Scotland. The second plan, ‘Making it Easier’ published in 2017 built on lessons learned and moved closer to removing barriers and improving how services are designed and delivered

All written communication should reflect the standards set by the Scottish Government and those of the Disability support organisations.

Attention should also be made to the following:

• Disability Discrimination Act (DDA) (1995 & 2005)
• Mental Welfare Commission, “The same as you?”
• Equality Act (2010)
• Health Inequalities Impact (HIIA)

Healthcare Improvement Scotland (HIS) monitors the provision of information to patients and carers through the peer review process.

Written information about NHS Borders services, treatments and interventions will be made available to patients and others.

• it is the right of all patients to receive good quality, accurate information on services, treatments and intervention If Information provided is not supplied in a manner and format that can be understood by the person receiving it, informed consent cannot be given
• it is the responsibility of each department/ward to identify and develop the information needed for their patients
• the web based system, Right Decision Service (RDS) launched in 2021 allows all local patient information leaflets to be created using the RDS system. RDS is accessible to patients, the general public and staff and provides access to all NHS Borders leaflets and other relevant NHS Scotland leaflet resources.

Further information about RDS is provided in Appendix 1

The development or revision of patient and public information will follow an agreed process.

• all locally developed public information leaflets will be held on a register by Clinical Governance & Quality
• all public information will be developed and reviewed following the agreed process at Appendix 2
• Clinical Governance & Quality will offer support and guidance in development and review of patient information and the use of RDS
• further information on the development of patient information leaflets is attached at Appendix 3

The quality of all NHS Borders information for the public will comply with national standards and guidance given by disability groups.

The important points included are:

• Understandable
  • 20% of UK adults are functionally illiterate. That is, people whose reading level is below that needed for most basic jobs
  • 9% of the population is deaf or hard of hearing. Those who have been deaf since early childhood are more likely to have reading difficulties
  • where valid consent is being sought the use of inappropriate information can lead to unlawful treatment
  • patient information is written in plain English avoiding where possible the use of medical terms and professional language
• Accurate
  • all information provided, must be up to date, accurate and where appropriate evidence based
• Meaningful
  • for patients to get the most from information, thought must be given to when is the best time to provide information. This should be based on the individuals information needs at each stage in their episode of care/ treatment
• Current
  • all information produced will have a publication date and a review date clearly displayed
  • information including contact details provided will be accurate and up to date
  • Reflect differing needs:
    • people with a learning disabilities, older adults and those with other disabilities, will be provided, as required, with information in alternatives to standard format e.g. audiotape, Braille, large print, symbols
    • people whose first language is not English will have access to translation services. It is also important that account is taken of the different meaning words may have for people from different backgrounds and cultures

For further information in relation to equality and diversity issues including translating leaflets into other languages, please refer to  Equality  and Diversity microsite on the NHS Borders Intranet.

Printing of Leaflets

Information can be printed directly from RDS or can be downloaded by Clinical Governance & Quality into agreed templates using the following format

• Font type (text style)
  • people with visual impairment find plain fonts easier to read. That is those without flicks (sans serif)
  • all general NHS Borders’ leaflets and posters will be produced using the Century Gothic font. This font is one of the few plain fonts we have that uses the contemporary plain form of “a”, rather than the traditional “a” which the visually impaired find difficult to make out
  • Paediatrics and the Learning Disability Service will use Comic Sans when producing information for children and people with a learning disability. This is a less formal font
• Font size
  • leaflets for the public will be written in, at least, size 14 font
  • using size 14 font allows most people with a visual impairment to be able to read the text although the current recommendation from
  • Royal National Institute for the Blind recommend size 16 font
  • headings should be 2 sizes bigger than the body of the text
• the minimum for all other written text (e.g. letters) for patients and/or the public will be size 12

Information on view to patients and the public will be suitably displayed.

• 3% of the population (2 million) has a visual impairment. Half of these qualify to be registered partially sighted
• if your target audience cannot read the information you have developed it has no purpose
• ensure that as far as possible when producing information for display that the needs of people with a visual impairment are considered. Further guidance is given in Appendix 3

The document has been reviewed regularly since 2009 by Clinical Governance & Quality Facilitators, Clinical Governance Administrators and Communications Manager as follows:

2009                                      No changes made               

2012                                      No changes made

2015                                      Move from BISSY to Health Information Portal (HIP)

2017                                      No changes made

2020                                      No changes made

2024                                      Move from HIP to Right Decisions Service (RDS)                                       

Review Group 2020

Laura Lang                           Communications Manager

Justin Wilson                       Quality Improvement Facilitator – Clinical Effectiveness

Diane Laing                         Clinical Effectiveness Administrator

Review Group 2024

Laura Lang                          Communications Manager

Justin Wilson                       Quality Improvement Facilitator – Clinical Effectiveness

Diane Laing                         Clinical Effectiveness Administrator

Louise Wright                      Quality Improvement Facilitator – Primary & Community Care

RDS is the name given to the NHS Borders web based patient information management system. It has two components:  

The Right Decision Service is a 'Once for Scotland' source of digital tools that enable people to make safe decisions quickly ‘on the go’, based on validated evidence.

It provides health and social care organisations with tools to build decision-ready guidance, pathways, risk scoring tools, shared decision aids and other decision support resources.

These tools are all delivered through this Right Decision Service website and mobile app.

• the site has a clear process for producing information, from draft to consultation, to production, taking guidelines for writing information into account

Support and guidance will be given to staff using the site to develop their information.

• RDS hosts all locally produced patient information leaflets, as well as links to other NHS Scotland patient information resources
• RDS provides the opportunity to feedback on user experience allowing NHS Borders to continue improving the quality of patient information

All information produced by NHS Borders will ultimately be held in a library on RDS system. It will become the main focus for our responsibilities under the Freedom of Information Act for such information; the responsibility of holding an archive of departmental leaflets lies with the specialty.

Well produced written information supports what people are told verbally.  It has been shown that being provided with good written information improves people’s experience of the health service, and will help people to:

• take an active part in their healthcare
• discuss their care with health staff
• choose between possible treatments

Process

When developing information it is important to involve a range of people. However, only one person should have responsibility for writing the information.  Those involved will include:

• Staff
• Clinical Governance & Quality
• Service Users - involve users from the start, do not wait until the consultation stage

Be clear about

• The subject matter - what is your information material about?
• The target group - who is it aimed at?
• What is the evidence base?
• Timing - what stage of treatment will the information deal with?
• All points to be covered - list everything you want to include
• Organise - put the list into the order they will be in your information material

 Points to consider

• Relevance
  • be clear who it is you are writing for
  • patients using services will have different needs for information than their carers and the wider public
  • timing is very important – even the best information is of little use if given at the wrong time
  • information needs to take into account the special needs of people who have disabilities, elderly people and those whose first language is not English, information will need to be given in a different way to that for the general population
• Written in plain language
  • keep it simple – this does not mean childlike, just clear. Think about the words you use:
    • avoid jargon and medical terms, unless you explain what they mean
    • avoid abbreviations wherever possible, this also applies to ones that are considered “commonly used” as even these are not understood by everyone. If abbreviations are used, write them in full at the beginning of the text followed by the abbreviation in brackets
• Monitor and review
  • information material will be reviewed regularly to ensure it is up to date and remains relevant
  • each department is responsible for reviewing its information in line with the patient information review process (appendix 2)
• Involving the public
  • where possible, members of the public will be involved in all stages of developing and reviewing patient information materials

The Plain English Campaign encourages organisations to communicate clearly with the public.  They offer advice on clear communications, and run training courses in writing in plain English, including a course on simplifying medical jargon.

Checklist

When writing patient information, the following points must be followed:

• write titles as in sentence That is, only use capitals for the first letter
• have all headings in the same size font – two sizes bigger than the body text
• have the body text in the same size font
• write information in manageable sections, with a logical link
• align text to the left (justify is difficult for the visually impaired)
• leave plenty of “white space” between section It makes reading much easier.
• use everyday words where possible (the simplest form for example use, not utilise: start not commence)
• give explanations for medical terms
• use short, simple sentences, no more than 20 words – less is best
• be concise - do not try to fit too much information into one leaflet. It may be appropriate to have more than one leaflet for different parts of a service/ treatment
• use "active" rather than “passive” verbs (for example “the nurse will give you….,” rather than “you will be given…”)
• say what you want the reader to do, not what you do not want them to do
• using lists and bullets makes information clear and breaks down the information well

Do not use

• jargon - if you do have to use a medical term, explain it
• italics or underline - highlight important information in bold, remembering not to use capitals
• abbreviations - such as e.g. and etc
• shiny paper –  this causes a reflection
• boxes – do not use boxes around sections of text

Before you use anything such as pictures, photographs, video and sound recording you must obtain:

• the consent of the copyright owner/artist/author or publisher
• negotiate and pay any fee – usually nil if you “credit” the artist/autho Be clear – can you use it just once, or in several publications
• acknowledge permission e.g. “this graph/diagram has been reproduced with permission from “xxx” (do not use their logo)

Drawings/sketches

• get the artist’s permission, acknowledge permission e.g. “this drawing/sketch has been reproduced with permission from “xxx” (do not use their logo)

Photographs

• always check who owns the copyright © with the photographer
• when commissioning work – be clear where it will be used – ask for copyright © to be assigned to NHS Borders so that you can use it over and over again
• acknowledge permission as above
• try to avoid using patients in photographs – if you do, ensure you get the patient’s permission
• if you have used a patient’s photograph, consider whether it is still appropriate to use it before each re-print

To use the work of others without permission and acknowledgement can lead to charges of plagiarism and/or to infringe copyright. Infringing copyright carries very heavy penalties and the onus is on you as the defendant to prove that you did not copy the item in question.

Usually authors are happy for you to use their work when

• you tell them what it is going to be used for
• that an acknowledgement will appear in your work
• you send them copy(s) of the work (preferable at the proof stage so that they can comment on the inclusion of material)

If you have copied the majority of the text of your patient information leaflet from another one, you should change the wording 'author' to 'adapted by' in the section where the date written and review date is at the end of the leaflet.

For example:  'Adapted from a leaflet produced by…'

Protecting Copyright Belonging to You

Every effort should be made to effect and protect your own copyright. Although it is an automatic right, it is recommended that all original work should be marked with a notice clearly indicating that copyright exists. All patient leaflets should contain the following:  © NHS Borders