Making it easier: a health literacy action plan 2017-2025

Action area 1

Share the learning from Making it Easy

Headlines from this section

• Organisations should embed the key learning points from Making it Easy to support safe, effective, person-centred care.
• Tools and techniques tested through our work in NHS Tayside should be used to support spread and adoption of the learning points.
• Our network of health literacy champions will continue to promote progress against actions locally and nationally.

Based on the work reported in Making it Easy – Progress Against Actions ^[8] , our key learning areas to share across the system are:

• health literacy tools and techniques ^[9] for professionals to use, such as Teachback,
• clearer information shared with people before they attend and leave hospital. This includes improved appointment letters, making them more considerate of people’s communication needs, and
• improved safety and support for people on high-risk treatments, promoting the involvement of pharmacists and their support staff.

These align with the quality aims of effective, person-centred and safe ^[10] healthcare set out in the Healthcare Quality Strategy for NHSScotland.

Videos to raise awareness of the hospital experience

What? Why? Children in Hospital is a charity that makes videos to help children and parents prepare for hospital and answer some of their questions starting with What? and Why?

These films have been helpful in reducing anxiety both for children and parents ahead of hospital treatment.

One of their recent videos shows what happens when your child is admitted
to the Cancer Centre in Glasgow – https://www.whatwhychildreninhospital.org.uk/glasgowcancercentre

The next phase will move these actions on from ones that improve communication to responses that better support people to self manage their health and wellbeing:

• We will further embed Teachback to check that people have received information clearly from their practitioners. NHS Tayside will take the lead in this work, with learning spread to other sites across Scotland.
• We will promote the What Matters to You? ^[11] approach to support people to ensure that their practitioners have understood what matters to them.
• We will promote walkthrough and wayfinding approaches. These will enable people to access health and care more easily by removing barriers such as inconsistent signs and confusing pre-visit information.
• We will work with the Living Well in Communities workstream on Anticipatory Care Planning and Scotland’s House of Care ^[12] programmes to develop and test more health literacy sensitive approaches to care and support planning.
• We will continue to contribute to development of the Scottish Social Services Council ( SSSC) outcomes focused support planning resource which is being developed in the context of the Carers (Scotland) Act 2016.
• We will promote a universal precautions ^[13] approach in all decision-making steps, with appropriate use of decision aids and scenario thinking to trace the best options for people. NHS Lothian will lead on work to improve the appointment process, including improvements to appointment letters, with learning spread to other sites across Scotland.

Awareness
We will increase the public awareness of health literacy issues. This will include use of the Health Literacy Place ^[14] website and social media. Part of this will include continued involvement with the global Health Literacy Month ^[15] campaign, which takes place in October each year. Wider strands such as the ‘What Matters to You?’ ^[16] movement and Our Voice ^[17] framework will have a useful role in both enabling members of the public to speak out and raise issues around health literacy with staff, and provide new ideas to improve the current design and re-design of services.

Links to the Our Voice approach

The Our Voice citizens’ panel ^[18] asked panel members (who are a broadly representative sample of the Scottish population) what they think makes for a good doctor, and what things combine to make for a good consultation.

59% of panel members said a good doctor needs to be a good listener. In the words of one panel member, a good consultation takes place “when both patient and doctor are satisfied they have been heard and are in agreement with prognosis or way forward”.

Over 91% of panel members felt comfortable asking a nurse about their treatment or care options. One said: “they are professionals and are sometimes easier to contact than a doctor.” Another: “these other care professionals tend to be more willing to listen and be more supportive to your decision.” Also: “practice nurses are part of the normal routine so easy to communicate with.”

An Our Voice citizens’ jury ^[19] will explore how we further strengthen relationships between healthcare professionals and individuals – a key theme of the Chief Medical Officer’s report Realising Realistic Medicine ^[20] . Findings will shape how we progress this action plan.

Expand on successes and deepen the work in Tayside

The work in Tayside ^[21] started under Making it Easy will continue. The learning will be broadened to new areas that place barriers to improved health literacy. It will be helpful for other sites across Scotland to:

• learn from Tayside’s journey,
• learn from Tayside’s plans for ‘what to do next’, and
• see an illustration of what the ‘next phase’ looks like.

Hospital walkthroughs in NHS Tayside

A range of people – adult learners, students, healthcare workers – walked through Ninewells Hospital in Dundee to see what the journey was like from the front door to their clinic location.

They found the information on the appointment letter and on signs was different. For example it read “Children’s Outpatient Department” on the letter, and “Tayside Children’s Hospital” on the signs. The signs on the way to the clinic also used different terms for the same place.

Volunteers at the hospital were helpful but the directions they offered were too complex.

There were few details on how to travel to the hospital. It would be helpful to know that parking at the hospital may be some distance away from the front door. The appointment letter could also include some indication of the time it takes to reach the clinic from the car park or the front door.

It is a core action for other parts of the health and care system to undertake walkthroughs to inform their drive to better health literacy responsiveness.

Building networks of health literacy champions

As part of Making it Easy, we trained more than 90 trainers across the health and care system to promote skills for better health literacy practice. We have also worked with groups such as the ALLIANCE’s Self Management Network Scotland ^[22] and the Scottish Public Health Network ^[23] . Through the NHS Education for Scotland ( NES) practice nurse and practice manager networks, we have promoted health literacy tools and techniques, in particular the idea of walkthroughs and wayfinding.

We have the chance to align with work on accessible information and inclusive communications through the Royal College of Speech and Language Therapists ^[24] , as well as pharmacist networks through the Royal Pharmaceutical Society ^[25] to embed health literacy responsiveness in many key parts of the system.

We will develop this set of networks to sustain positive health literacy attitudes and behaviours across all health and care workers. The networks will have clear tasks to spread good health literacy practice across Scotland.

In addition, there is a global community of practice ^[26] through the World Health Organization ( WHO) that we will play an active role in.