Health Literacy Matters Poster available from Patient Safety Learning Hub

https://www.pslhub.org/learn/patient-engagement/health-literacy-matters-poster-r4496/

At last there is movement to use simpler words for bowel movement

This article in the Guardian newspaper sets out NHS moves to change the default words used for bodily functions to those which are more easily understood.

https://www.theguardian.com/lifeandstyle/shortcuts/2019/mar/19/why-nhs-wants-patients-to-poo-pee-be-sick

NHS Digital Health literacy resource

It is really encouraging to see NHS Digital providing advice on writing content for users with poor Health Literacy.
https://beta.nhs.uk/service-manual/practices/create-content-for-users-with-low-health-literacy

How you can create better content

You can help reduce the problems caused by low health literacy by making sure your content is written at a level most users can understand.

You can do this by:

• using a readability tool to help prioritise your content
• following the NHS design principles when you create content
• following our advice how to write for NHS digital services
• doing user research with users who have low health literacy

We’ve found that doing these things benefits all users, not just those with low health literacy.

Read more about this

• Health Education England: health literacy toolkit
• Learning and Work Institute: How to produce clear written materials for a range of readers (PDF, 377kb)
• Patient Information Forum: Toolkit for creating health information that works
• US Office for Disease Prevention and Health Promotion: Health literacy online

Great Video and summary of Accessible information from Solent NHS trust

https://www.solent.nhs.uk/page_sa.asp?fldKey=615

Solent NHS Trust have produced a DVD and Summary

Words that annoy - BMJ blog and tweet chat

The British Medical Journal have a features section BMJ Opinion which is open access, and as part of that they host blogs on patient perspective. Link to it here

Tessa Richards, Patient partnership editor, The BMJ has written a blog about words that healthcare professionals use which annoy - well worth a read.

/bmj/2017/04/07/tessa-richards-words-that-annoy-phrases-that-grate

The problem of “Did Not Attend”s

The problem of “Did Not Attend”s

Why do people miss their Health care appointments? As an NHS staff member I know that there is a large problem with patients who “Did not Attend” their appointment (DNA) as it can mean that patients are waiting longer than they need to for appointments. There are often notices on view at reception desks about the need to cancel appointments and the cost to the NHS of missed appointments. There has also been talk of charging people for missed appointments.

This is an area where there is a real opportunity for the NHS to save money, and also to help patients receive better care but having done a very quick search to look at NHS DNA improvement efforts, there was no obvious evidence base being drawn on as to why patients miss appointments in the examples I came across. The main assumptions seemed to be patients forgetting or not caring. There was some work testing interventions to help patients remember their appointment which showed good results, and behavioural change interventions which showed having the cost of a missed appointment in a text reminder helped a little, however I can’t help but wonder if these are totally irrelevant for many people. 

Some research I found into why NHS appointments were missed in mental health service users in Surrey showed that reminders and then choice and ease of access were the preferred improvement options in this group of patients, but I expect that the reasons will vary between different patient groups and different locations. Surely more effort should be made to understand why people miss appointments before making wholesale changes?

There has recently been a move to acknowledge the issue of those who need to be brought to appointments such as children or vulnerable adults, and to change from DNA to “Was Not Brought” (WNB), as there may be safeguarding issues. In an abstract I came across looking at reasons for US family’s not attending appointments, the main reasons cited were transportation problems, wait times, and not knowing the reason for the appointment.

Personally I hate the “ x Missed appointments at this surgery has cost the NHS £xxx” message which seems to be up at every reception area. The people reading these ARE attending (or trying to), and it makes me feel like I should not be taking up valuable time going at all. Is that really the message the NHS should be sending out? In fact one of the improvement projects I came across tested changing these signs to instead show the high number of appointments used instead, and recommended this approach as more effective.

In the past I have been so late that I have missed appointments due to being stuck in traffic and not being able to park anywhere near (and when phoned to let them know this, being told  it will be the end of the clinic by the time I get there so won’t be able to be seen). My initial thoughts on how to help reduce missed appointments would be to improve parking and transport, but this doesn’t seem to be considered an issue by the NHS.

Do people understand enough of the information about when and where the appointment is, and why they need to attend? Could they be getting lost or have the wrong time?  Is it true everyone can or will use the telephone to re-arrange an appointment? What if that person does not have the opportunity to make a private telephone call during working hours? What if they have no credit on their phone? What if they are too ill to phone? What if they are being prevented from attending? Surely we should not be quick to judge, but instead try to understand what is going on.

https://arms.evidence.nhs.uk/resources/qipp/915463/attachment

http://www.porthosp.nhs.uk/for-outpatients/cancel-or-rebook-your-appointment/reduction-in-did-not-attend-appointments.htm

http://persuasion-and-influence.blogspot.co.uk/2016/04/reducing-missed-appointments-at-health.html

http://www.behaviouralinsights.co.uk/trial-results/reducing-missed-appointments/

http://www.telegraph.co.uk/news/health/news/11858339/Patients-less-likely-to-miss-NHS-appointments-if-they-warned-of-cost.html

http://www.sabp.nhs.uk/professionals/journal/editions/issue2/journal_issue2_article7

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6332

J Pediatr Health Care. 1999 Jul-Aug;13(4):178-82.

Just who is this an improvement for? 

Why designing ‘better services’ needs user input.

A recent Kings fund blog talks about pressures on GP services, specifically the problem of providing both rapid access and continuity of care reminded me that the need to treat patients as individuals is important at a system level. Here are some of my personal experiences and opinions of accessing NHS services.

Personally I have had so many changes in staff at my GP’s that there is little hope of continuity of care, and for most of the time it has not mattered in the least to me, but for other people this will be a different story. We are all different with different needs and priorities: while my elderly neighbour with a complex medical history is happy to fit around her GP’s availability, I would rather that appointments fit around my busy life. I have a feeling that trying to provide services to meet pre-conceived ideas of what patients want just leads to causing problems elsewhere. In the days when I had a long commute to work I wished that my health records could be shared or held by me, and I could visit a GP near work sometimes and near home at other times, I was not at all bothered by who I saw.

 One of the recent changes at my GP’s is to have a call back from a member of staff if you have an urgent problem as not all patients can be given appointments on the day. This sounds great, but it seems to assume that you will be able to take a phone call at any time. My experience was that firstly despite me requesting that my mobile number was used the home phone was called and I missed it and spent all day in a cycle of missing and trying to return calls. I would have much preferred to go and sit in the waiting room for a few hours actually.

This made me wonder about some of the reasoning behind the changes – what are the assumptions at work here? When coming up with the new ways of working is there an assumption that if you need an appointment with GP or nurse that you won’t have responsibilities like dropping kids off at school, having to go out and buy things, another appointment to go to, or even work and leisure activities perhaps? I understand that services cannot take into account every individual situation, but without user involvement there is a risk that despite best intentions new ways of working eg telephone triage will make it even harder for some patients.

https://www.kingsfund.org.uk/blog/2017/02/how-can-gps-provide-rapid-access-alongside-long-term-continuity-care?utm_source=twitter&utm_medium=social&utm_term=thekingsfund

https://arms.evidence.nhs.uk/resources/qipp/915463/attachment