Why the NHS needs to make digital communication crystal clear

I lead digital communications for a large NHS integrated care board in Essex, where a significant part of my responsibilities includes ensuring compliance with accessibility standards and digital accessibility regulations. 

Put simply, this means that everything from websites, apps, and videos to more traditional forms of communication needs to be accessible to everyone. And whilst my primary focus is on external communications—making sure the public can access healthcare information without barriers—internal services like staff emails and intranet also need to meet the same accessibility requirements.

Each touchpoint should be as welcoming and accessible as a hospital’s physical facilities. For instance, if you haven't had much interaction with the NHS recently, you might be surprised to learn that you can now order a repeat prescription via a mobile app. So, the scope of what needs to be accessible is broad and constantly evolving.

Better comms equals improved health outcomes

The paradigm of healthcare has been redefined in the digital age. As the NHS takes robust strides in digital communication, one fact stands out: digital accessibility is a collective responsibility, demanding attention from all.

The UK has a diverse population, each with distinct communication needs — from language preferences to sensory impairments and cognitive challenges. Regardless of these differences, every individual has the right to understand medical advice and make informed decisions about their health. Effective communication is crucial. When patients clearly grasp their medical conditions, treatments, and aftercare instructions, they're more inclined to follow medical recommendations, leading to improved health outcomes. 

Furthermore, when patients feel understood, their trust in the healthcare system amplifies. Accessible communication, therefore, not only aids in information dissemination but also fortifies the patient-provider relationship, enhancing overall patient satisfaction.


The misconception of accessibility

Embarking on the journey of accessible communication initially appeared overwhelming. Introducing changes to a vast workforce, many of whom were entrenched in their methods, has been a test. Advocating change wasn't universally met with enthusiasm, often because of long-standing misconceptions such as:

• It's only for disabled people Many people think that accessible communication only benefits people with disabilities. However, everyone can benefit from clearer and more accessible ways of presenting information.
   
• It's complicated: The principles of accessible communications are often straightforward and based on common sense. They can usually be implemented with planning and some basic training.
   
• Accessible means boring: Making something accessible doesn't mean stripping away all creativity or personality. It simply means making that content usable for as many people as possible.
   
• Text alternatives are enough: While adding alternative text to images is essential, true accessibility is multifaceted, encompassing audio descriptions, accessible PDFs, and more.
   
• If no one complains, it’s not a problem. Lack of feedback doesn’t necessarily mean that your communication methods are accessible. Some people may not speak up due to stigma or lack of awareness about their rights.
   
• It's expensive: While there may be initial costs to setting up accessible systems, the advantages often offset these, such as reaching a broader audience and reducing legal risks.

Helping staff to overcome these misconceptions means that organisations and individuals make their communications more inclusive and effective. And the subsequent positive impact on patient care or customer satisfaction if you are outside of the NHS, can quickly become evident.


Accessibility training made simple

To help us, we adopted SCULPT, a training platform designed by Helen Wilson at Worcestershire County Council, to educate our staff about creating accessible content. 

SCULPT is a simple acronym of six basics, a visual identity, and an underlying framework to introduce digital accessibility in a bite-sized, approachable way. Letter by letter, SCULPT outlines the importance of some simple adaptions to content or documents that anyone can understand and apply at a basic level, whatever digital skills level they are at. The six areas of SCULPT are: 

• Structure: Use headings for easy navigation.
• Colour and contrast: Ensure high contrast between text and background. Avoid using colour to convey meaning.
• Images: Use meaningful alt text to explain images, charts, and infographics.
• Links: Opt for descriptive link text and avoid long URLs or generic terms like "click here."
• Language: Use plain English and avoid jargon.
• Tables: Reserve tables for data presentation, not layout

We promoted this through staff briefings and a 'lunch and learn' webinar. Our director of communications also championed the platform, emphasising its significance through direct emails to staff. 



Upskilling, retraining, and overcoming resistance have become integral to our mission. As tangible examples emerged from direct user feedback, the reasons and methods for digital accessibility are starting to gain traction and acceptance across our organisation’s teams. 

One of the biggest challenges has been the time commitment. It can take months of dedicated effort to fully audit existing digital content, not to mention the time needed for staff training. Staff often find that they learn most effectively from real-world anecdotes and direct user feedback, making the issues come alive in ways theoretical learning cannot. 

Looking back, if there's something we would do differently, it's starting the education process much earlier. To this end, one of the key areas I am working towards and lobbying our executive team for is to make accessible communications a mandatory learning module for all new starters in the organisation. This not only reinforces the idea that digital accessibility is a shared responsibility but also ensures that the ethos of inclusivity is embedded from day one. 

Involve service users

While I and my comms team lead by example, we firmly believe that digital accessibility is a shared obligation across the NHS.

When redesigning our website, we prioritised accessibility. Crucially, we involved service users with accessibility needs right from the planning phase. 

Our eyes were truly opened when we consulted with service users with varying accessibility needs. One user, who relies on a screen reader, pointed out the difficulties they faced with the busy flashing carousels and sliders on our prototype website. They explained how these features make navigation a nightmare when using screen readers and can even trigger sensory overload. 

Based on this feedback, we either eliminated such elements or made sure to include a 'stop' or 'pause' button to make the experience more user-friendly. Another user mentioned non-descriptive link text and inaccessible PDF files, leading us to a comprehensive site revamp. 

These direct interactions have led us to conduct accessibility training sessions to ensure everyone understands their role in maintaining digital accessibility. After all, why wouldn’t you want everyone to access your website and have a positive digital experience? This hands-on learning from our service users hasn't just fine-tuned our tactics; it has fundamentally altered our ethos, driving home the understanding that the core purpose of accessibility is universal inclusivity.

 The Equality Act 2010 mandates that it is reasonable to expect organisations to proactively think about the difficulties disabled people may face when accessing information. For the NHS, this translates to inclusive communication at every touchpoint, digital or otherwise. Adherence to standards like the Web Content Accessibility Guidelines (WCAG) or the 2018 Public Sector Accessibility regulations is not just a moral obligation but is also legally imperative. 

While the financial risks of non-compliance are significant, the reputational risk looms larger. The NHS is a beacon of trust and care; any shortfall in its accessibility commitment can erode this trust. While we've made commendable strides, we recognise that the world of digital communication evolves rapidly, and with it, the ways we can make it more inclusive. It's a continuous process of learning, adapting, and innovating.

For others embarking on or navigating this transformative path, my recommendation is twofold: First, always involve your service users, particularly those with accessibility needs, at every stage. Their insights will prove invaluable. Second, view digital accessibility (and accessibility in general) not as a box-ticking exercise but as a dynamic commitment to inclusivity, trust, and collective responsibility. Ensuring no one is left behind isn't merely a goal; it’s an ongoing commitment.

James Sharp is senior communications manager (design and digital) at Mid and South Essex NHS.