Document

Patient Information Policy and Procedure

Responsible Directorate: Provider Services

Responsible Director: Robert Flack

Date Approved: 8 August 2008

Committee: Governance Committee

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Version Control.

Document Title Provider Services Patient Information Policy and Procedure

Document number 1 Author Gwen Ruddlesdin Contributors Provider Services Management & Staff Version 2 Date of Production June 2008 Review date August 2010 Postholder responsible for revision

Gwen Ruddlesdin

Primary Circulation List Provider Services staff Web address Restrictions

Standard for Better Health Map.

Domain Patient Focus

Core Standard Reference C16 Performance Indicators 1. Dissemination of policy to Provider services

staff 2. Patient information discussed within Quality

Group in appropriate format

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Contents

Section Page Policy Statement 3

1 Introduction 3 2 Associated Policies & Procedures 3 3 Aims & Objectives 4 4 Scope of the policy/procedure 4 5 Accountabilities and responsibilities 4

5.1 Quality GP 4 5.2 Authorship and ownership of patient information 5 6 Patient information process 5 7 Reviewing 6 8 Monitoring 6

8.1 Patient information database 6 8.2 Archiving patient information 6 9 Publication on the provider services internet 6

10 Sponsorship and advertising 6 11 Photography and video recordings policy 6 12 Developing patient information websites/pages 7

Appendices

A Equality impact assessment 8 B Stakeholder consultation 9 C Training needs analysis 10 D Monitoring compliance with this policy/procedure 10 E References 10

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Policy Statement.

Kirklees PCT Provider Services will have a systematic and planned approach to the development and management of patient information.

This will ensure that all patient information produced within the Provider Service is of high quality and that the ratification and review processes are clear to all.

1. Introduction.

Patient information can be defined as information about conditions, investigations, treatments, procedures, examinations and services specifically for patients, generally given to support and supplement verbal communication. It can take various forms, including leaflets, booklets, sheets or posters, videos, tapes, websites, CD Roms and PDF files. It is important to note that patient information also includes information for people who may not be ill, such as health promotion information or information for carers.

Information is an important part of the patient journey and a key element in the overall quality of the patient experience. Good patient information can give patients confidence so that their overall experience as a patient is improved allowing them to make informed decisions about their health. It involves patients and carers in their treatment and empowers them over their condition.

The Provider Services will establish a Quality Group to advise and guide staff in the production of high quality, accessible information for patients.

Any information being produced (ie leaflets, flyers, posters and booklets etc) by Provider Services staff for NHS patients, their carers, staff and the wider public should be routed through this panel.

This document is written to support staff through the production and approval process for patient information.

2. Associated Policies and Procedures.

This Policy / procedure should be read in accordance with the following Trust policies, procedures and guidance.

• Code of Business Conduct and Commercial Sponsorship • Confidentiality Policy

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3. Aims and Objectives.

This policy has been developed to ensure that Kirklees PCT Provider Services patient information is consistently developed and produced to the highest standards, in a well presented style that is accessible to all.

High quality patient information will have accurate and evidence based clinical content, reflecting best practice; it will meet the requirements of patients and carers; it will have a clear format and be easy to understand and will conform to the Provider Services Patient Information Guidelines.

This policy, in conjunction with the Patient Information Guidelines, describes a systematic process for developing, reviewing and monitoring patient information, based on recommendations from the Department of Health.

Kirklees PCT Provider Services will achieve these aims through the Quality Group, who will develop policy around patient information and ratify patient information produced by Provider Services staff.

4. Scope of the Policy / Procedure

This policy is intended to:

• Define ‘patient information’, describing what it is and what it is not

• Define the role of the groups involved in ratifying patient information

• Provide a framework for the development, review and monitoring of patient information

• Raise awareness of the process for developing, reviewing and monitoring patient information within Provider Services.

This policy / procedure must be followed by all PCT Provider Services employees and staff on temporary or honorary contracts as well as bank staff and students.

5. Accountabilities & Responsibilities

Quality Group

The Quality Group will ensure that members of the public and service providers are able to, or know how to access high quality information about health issues or Kirklees PCT Provider Services in a format that is accessible and appropriate to all.

The objectives of the group, with regard to Patient Information, are to

• Map existing sources of patient information

• Ensure that health information is of an acceptable quality in that it is evidence based and in an accessible, acceptable and appropriate format for the target audience

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• Ensure that a coordinated approach is taken to the provision of health information within the Provider Services

• Develop, maintain and implement policy and standards around the provision of health information

• Review and approve the content of patient information before distribution to patients and ensure that such content adheres to the Provider Services policy and guidelines for producing patient information

• Make recommendations, if required, to improve patient information

• Provide guidance, support and training for Provider Services staff around the provision of health information

• Identify resources required to establish a strategic approach to health information across Kirklees PCT Provider Services

The quality group will include representatives from Provider Services and be supported by staff from the Communications team.

Authorship and Ownership of Patient Information

The author(s) of the patient information will be the individual(s) writing the patient information. However, the author(s) may leave the Provider Services or change posts. Therefore the owner of the patient information will be the Services Manager, who will be responsible for signing off the patient information before production and for ensuring that the patient information is reviewed on a two-yearly basis.

6. Patient Information Process

The Patient Information guidelines expand upon the patient information process in more detail and should be consulted when producing all patient information.

It should be noted that the Quality Group must approve all patient information bearing the ‘Kirklees PCT Provider Services’ title to ensure that it meets the standards set out in the policy and guidelines. This includes information developed in partnership with other bodies. All patient information bearing the Kirklees PCT logo must go through the Graphics Team for design advice.

Patient information regarding conditions, treatments, procedures, services, medication and any general health information will be developed by doctors, nurses, allied health professionals or managers. Authors will have appropriate knowledge of the condition, treatment, procedure or service.

Authors must ensure the content of patient information is evidence based and reflects current best practice. They should bear in mind that patient information does not replace verbal information, but should be complementary and supportive.

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7. Reviewing

Patient information will be reviewed every two years following the publication date; this means that patient information published in January 2008 will be due for review in January 2010. It is the responsibility of the Service Manager to ensure that any patient information produced by their team is reviewed every two years, or sooner if new services or treatments are developed. If no changes are made to the patient information it will be published for a further two years. If changes are made to the patient information, it will require review by the Quality Group.

8. Monitoring

Patient Information Database

A patient information database will be created and maintained by the Quality Group. The database will contain a list of all patient information produced within Kirklees PCT Provider Services and will include the publication and review dates of each piece of patient information.

8.2 Archiving Patient Information

All patient information produced by Kirklees PCT Provider Services will be made available on the Provider Services intranet. It is the responsibility of Service Managers to ensure that the patient information for which they are responsible is reviewed every two years and updated on the intranet accordingly.

9. Publication on the Provider Services intranet

When the patient information has been ratified by the Quality Group, it will be published electronically on the Provider Services intranet.

10. Sponsorship and Advertising Policy

Authors intending to use sponsorship or advertising must contact the Quality Group in the first instance to discuss. Authors should also refer to the NHS Commercial Sponsorship standards and the Trust’s Code of Business Conduct and Commercial Sponsorship.

11. Photographs and Video Recordings Policy

Authors intending to take photographs or make video recordings of patients, staff and the general public must refer to the Kirklees PCT Confidentiality Policy and the Consent policy. Consent must always be obtained from patients who must be advised on the intended use of the images.

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12. Developing Patient Information Websites / Pages

Staff developing websites / pages containing patient information should contact the Quality Group to discuss the development of content and will adhere to the relevant principles of the Patient Information Policy and Producing Patient Information guidelines. The Disability Discrimination Act requires that reasonable adjustments are made to public authority websites if they are unreasonably difficult or impossible for disabled people to access. The NHS Identity Guidelines for Websites provides guidance on all aspects of NHS website design, including accessibility.

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Appendices

A. Equality Impact Assessment

The Provider Services Patient Information Policy has been written to enable staff to follow agreed standards when producing information for patients.

All patient information, in whatever format, should

• Have a title

• Include the PCT name and logo, and the Provider Services title

• Be typed in Arial or non-serif font at least 12 pitch

• Be written or recorded using plain English with no jargon

• Have medical or technical terminology clearly explained

• Use simple and relevant illustrations / graphics

• Have a date of publication and date for review

• Include contacts for further information

Patient information will be reviewed using a checklist and formally approved by the Quality Group prior to publication.

This policy is intended to benefit patients, relatives and carers; general public; staff.

Equality Group

Positive Impact

Negative Impact

No impact

Reasons for decision

Age

Disability Advice is provided in the policy on writing and producing patient information in a range of formats.

A template is provided stating that the information is available in other formats.

The policy recommends that relevant patients and public are contacted when producing patient information.

Faith & belief

Race

Sexual orientation

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B. Stakeholder Consultation

Involvement and participation of others in the process of developing these guidelines as shown below:

Stakeholders name and designation

Key participant Feedback requested

Feedback accepted

Julie Livesey, Head of Localities

X X

Joan Booth, Head of Localities

X X

Catherine Smyth, Professional development nurse

X X

Sam Royal, Clinical Governance

X X

Policy Development Group

Chair: Tina Quinn X X

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C. Training Needs Analysis.

The Quality Group will ensure that all staff within Provider Services have an awareness of this policy and procedure. Specific support will be given to staff undertaking the development of patient information.

D. Monitoring Compliance with this Policy / Procedure.

• The Quality Group will be responsible for monitoring compliance with this policy and procedure

• The checklist for the approval of Patient Information will be used to ensure that due process, as set out in this document, has been followed

• A quarterly review will be undertaken of the Provider Services database of patient information to ensure that no documents are approaching or passed their review date without work being undertaken to review them

• An action plan will be developed and further work undertaken should it become apparent that there are problems in a particular area of non-compliance

E. References

1 Department of Health (2000) The NHS Plan: A Plan for Investment, A Plan for Reform, CM4818-1, London: Stationery Office

2 Department of Health (2002) The Report of the public inquiry into children’s heart surgery at the Bristol Royal Information 1984-1995: Learning from Bristol, CM5207-1, London: Stationery Office

3 NHS Litigation Authority (2007) Risk Management Standards for Primary Care Trusts, http://www.nhsla.com/RiskManagement/PCTStandards

4 Department of Health (2004) Better Information, Better Choices, Better Health: Putting Information at the Centre of Health, London: Stationery Office

5 Department of Health (2003) Toolkit for Producing Patient Information, London: Stationery Office

6 Great Britain (2005) Disability Discrimination Act, Chapter 13, Section 2, London: HMSO, http://www.opsi.gov.uk/acts/acts2005/20050013.htm

7 Department of Trade and Industry (1999) Read me again: accessibility publication guidelines, London: Department of Trade and Industry

8 Great Britain (1998) Human Rights Act: Schedule 1, London : HMSO

9 Department of Health (2000) Commercial Sponsorship: ethical standards for the NHS, London : Stationery Office http://www.dh.gov.uk/assetRoot/04/07/60/78/04076078.pdf

http://www.nhsla.com/RiskManagement/PCTStandards

http://www.opsi.gov.uk/acts/acts2005/20050013.htm

http://www.dh.gov.uk/assetRoot/04/07/60/78/04076078.pdf

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Provider Services Patient Information Procedure

Responsible Directorate: Provider Services

Responsible Director: Robert Flack

Date Approved: 8 August 2008

Committee: Governance Committee

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Contents 1 Introduction

1.1 Duties 1.2 Reporting arrangements

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2 Function and responsibilities of Quality Group 14 2.1 What information should be filtered through the Group? 14 2.2 How do I access the Quality Group? 14

3 Developing Patient Information 14 3.1 Determining Content 15 3.2 Literature Review 15 3.3 Operational team(s) involvement 15 3.4 Drafting 15 3.5 Investigation and treatment information 16 3.6 Dissemination, monitoring and reviewing 16 3.7 Archiving arrangments 17 3.8 Process for reviewing published patient information 17 4 Appendix 1 Publications proforma/checklist for the production of patient information

18

5 Appendix 2 Presentation 19

References Toolkit for producing patient information’ (Department of Health, 2003) Rotherham PCT Patient Information Policy and Procedure Katherine Taylor, Knowledge Management Specialist, on behalf of the Health Information Editorial Group Oct 2006 Bury PCT (2007) Patient Information Policy and Procedure Archiving arrangements Process for reviewing published patient information

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Introduction

Patient information can be defined as information about conditions, investigations, treatments, procedures, examinations and services specifically for patients, generally given to support and supplement verbal communication. It can take various forms including leaflets, booklets, sheets or posters, videos, tapes, websites, CD Roms and PDF files. It is important to note that patient information also includes information for people who may not be ill, such as health promotion information or information for carers. Information is an important part of the patient journey and a key element in the overall quality of the patient experience. Good patient information can give patients confidence so their overall experience as a patient is improved allowing them to make informed decisions about their health. It involves patients and carers in their treatment and empowers them over their condition. The Provider Services will establish a Quality Group. Part of this group’s remit will be to advise and guide staff in the production of high quality, accessible information for patients. Any information being produced (i.e. leaflets, flyers, posters and booklets etc) by Provider Services staff for NHS patients, their carers, staff and the wider public, should be routed through this Group. This document tells you more about the Quality Group and its function and will guide you in the production of patient information.

1.1 Duties The Provider Services Head of Governance will be responsible for:

• ensuring the development of this policy and procedure • the secretariat functions of the Quality Group. • ensuring clinical advice is acquired on the content of patient information • the formal link to the Trust’s Reader Panel; • the maintenance of the monitoring, review and archiving of patient

information. 1.2 Reporting Arrangements The Quality Group will report to the Provider Services Governance Committee which has oversight of, and responsibility for, all of the Kirklees PCT Provider Services Governance arrangements.

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2 Function & responsibilities of the Quality Group The Quality Group will:

• Aim to raise the standard of written information for patients, their carers and people who use NHS services to make sure that material produced is based on best practice, and is clear, concise, relevant, accurate, honest, respectful, cost effective, in plain English and meets corporate identity guidelines.

• Review the necessity for translation into other community languages

• Ensure that information for patients supports the Provider Services’ key

values, bringing quality and equality to our services.

• Develop user friendly guidance for staff in the development of effective patient information.

• Implement an effective support network for the production of evidence based

quality patient information for people in Kirklees.

2.1 What information should be filtered through the Group? Any Provider Services patient or staff information which bears the NHS Kirklees corporate identity logo (as on the front of this document) should be routed through the Quality Group for approval (e.g. posters, flyers, leaflets, booklets). This includes information developed in partnership with other bodies.

2.2 How do I access the Quality Group? Staff are asked to complete the publications proforma/checklist (see Appendix 1 below) and submit this together with the material for assessment to the Provider Services Head of Governance (on behalf of the Group). The Quality Group will review the material and aim to feedback to the author of any material within one month. It may be necessary, depending on the level of expertise required, for the Group to seek expert advice from within and/or outside of the organisation. It will be the responsibility of the person/service producing leaflets to ensure that all old versions of publications are withdrawn from use and destroyed appropriately. 3 Developing Patient Information The need for health information materials can be suggested by:

• new treatments • altered or new procedures • introduction of new equipment • changed trends in healthcare • repeated patient/client and/or staff requests

A crucial first step in the process is to check existing resources and assess their suitability within the service team for use in Kirklees Primary Care Trust Provider Services . The detailed process for developing patient information is described below.

4

Identify the need for the patient information

Gather information on the target audience
Is print material themost appropriate?
S

NO
Does the materialalready exist?
Conduct rapid literature review
Discussion in Service Team
s

Review 2 yearly

NO

Revision

Approved by Quality Group

Archive old version & communicate need to destroy all material with rest of Provider Services

Disseminate and use material while monitoring and gettingfeedback

Get specialist help

YE
Is the existing material adequate?
Develop a draft copy**

Feedback from colleagues specialist staff users

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User group views/pre-testing

NO

YES
Continue to use
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3.1 Determining Content This needs a consideration of:

• The target population and the essential information that is required to meet their needs

• The material’s purpose – specific messages conveyed and their benefits

• Who the target audience is and any specific characteristics they may have,

such as material translated into other community languages

• How the target audience use this material and what it will achieve

• When they will receive this information e.g. during a visit to particular services, at home post discharge

• The best medium to use e.g. printed materials, audio-visual material etc

3.2 Literature Review A literature review looking at available literature on the topic that material is being developed for is required to ensure that relevant information being provided is evidence-based, reflecting current best practice. It will also help in the awareness of differing opinions and controversies in the topic. In addition to journal articles, the internet can also be useful, but sources need to be evaluated for reliability. Advice and help is available from the Quality Group. 3.3 Operational team/s involvement The proposals to develop patient information need to be checked with the operational service teams involved. The service manager should approve the proposal and can provide advice and support. Different members of the team can contribute a range of important perspectives and a small working group to develop the patient information may be useful. 3.4 Drafting Information should be written using the guidelines as described in the Department of Health “Toolkit for Producing Patient Information”. This document gives guidance on how to write patient information and provides several checklists. Material should be dated with information on whether it updates a previous version and it should also be in keeping with Trust’s information governance policy. Quality patient information should be evidence based, clearly communicated and involve users. It should present the benefits and risks of all procedures, treatments and courses of action in an unbiased, non-directive way to enable informed choice. This would include giving all options, including non-intervention and being explicit about areas of uncertainty.

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Clear communication will be helped by:

• stating the aims and intended target audience

• using everyday language and avoiding jargon

• writing content in a logical, step-by-step fashion, introducing one idea per paragraph

• using sub-headings

• question and answer format or building in answers to frequently asked

questions The involvement of users makes the material produced more relevant for their needs. This can occur in different ways, ranging from a focus group from the intended audience about their opinion on the topic to a voluntary group looking at documents from a patients’ point of view, and providing feedback. Thought should be given to language and cultural content. It can be helpful to address quality of life issues and consider using case studies or patient anecdotes. It may also be useful to consider reference to the PALS service and the use of maps and/or travel directions. The Kirklees PCT Readers’ Forum can help with providing user / patient involvement. 3.5 Investigation and treatment information Patient information regarding investigations and treatments should also consider the following:

• An explanation of the clinical condition

• An explanation of the procedure

• An explanation of the risks as well as the benefits

• An explanation of any surrounding areas of uncertainty

• An explanation of the effects on quality of life

• An explanation of the possible investigation, management and treatment options available, including non-intervention

3.6 Dissemination, monitoring and reviewing On approval by the Quality Group, details of the patient information will be added to the Provider Services database. The database will contain a list of all patient information produced within Kirklees PCT Provider Services and includes the publication and review dates of each piece of patient information. This will allow staff to know where all produced information is located and they can easily access it, thus helping in its effective dissemination. The operational service

involved should keep a list of dissemination contacts so that updated information can be sent out. Consideration should be given to how the information will be provided to users e.g. sending it with appointments to clinics, availability to staff etc. The patient information produced needs to be reviewed on a regular basis and it is the responsibility of service managers to ensure that the patient information for which they are responsible is reviewed as necessary, at least every two years, and updated. The Quality Group will monitor the two year period and send a reminder (see figure below). Some changes will require a shorter review period. These include information from a service review, changes in access arrangements, end of a pilot project and start of a new service. Service managers should also consider reviewing the effectiveness of information provided before revision. This should incorporate user feedback into the process. 3.7 Archiving Arrangements The Quality Group will, following the reviewing process, be responsible for maintaining an archive of previous versions of patient information media which have been updated and published. 3.8 Process for reviewing published patient information

Informatio

Ame

Quality Group

Contact Service Manager for service that produced leaflet for review

n needs to be altered

Information remains the same

ndments made

New review date entered

Ratified by Quality Group
Ratified by Quality Group
Page 18 of 23

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4 Appendix 1 - Publications proforma/checklist for the production of patient information

Please consider this checklist in conjunction with the information noted above. Please complete this checklist and submit this to the Quality Group with your draft material for consideration.

Item Your comments

Do you have an identified budget for the production of this information?

Have your communication materials been developed within the boundary of the NHS Identity Guidelines? Eg logo positioning, colour palette, typeface and size

Have you avoided the use of clipart and opted for NHS photo library professional images?

What other relevant information already exists in the PCT or from other outside sources eg NHS Direct, generic information leaflets, Department of Health, regarding this issue?

What is the information about and who is/are the target audience?

Does the information conflict with other existing information ie from other partners in the NHS?

What research or other evidence exists to support the message?

Is the information written from the patient’s point of view?

Is the information written in everyday language – ie avoiding jargon and acronyms, using plain English to make it easier to read?

Is the information patient friendly ie with the use of personal pronouns such as ‘we’ and ‘you’?

Does the information reinforce information/messages that patients have been told already?

Does the information signpost readers to other relevant information, resources and support that is available ie Patient Advice and Liaison Service (PALS)?

Is the information helpful – does it help people to make decisions by giving them facts about the risks, side effects and benefits etc (if applicable)?

If giving instructions, are the instructions fully explained?

Is the information going to be available in other formats? (Written information is not appropriate for all groups and some languages are spoken but not written)

Thank you for taking the time to complete this proforma. Please forward this completed proforma together with your draft material for consideration to the Provider Services Quality Group via the Head of Governance.

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5 Appendix 2 Presentation NHS Identity Guidelines – a helping hand The following information has been taken from the NHS Identity Guidelines, available in full at http://www.nhsidentity.nhs.uk/ and may help to guide you in the production of patient information. The information summarises the dos and don’ts in terms of adhering to the NHS identity including the use of logos, fonts and colours. It also encompasses the aim higher checklist which might be helpful when considering a communications project to judge whether it supports NHS identity. Logo 1 Colour and printing The NHS Blue logo is the cornerstone of the NHS identity, it needs to be used consistently and correctly. In general, the logo should be NHS Blue or black. The logo may not be reproduced in a tint or altered in any way. Original digital graphic files of the PCT logo in both Blue/black and black are available on request from the Corporate Services team on tel: 0161 762 3129. Printing on a white or yellow background, the logo may be reproduced in NHS Blue or black. On other coloured backgrounds, the logo should preferably be printed as ‘white out’ of the background. 2 Positioning Wherever possible the NHS logo should be positioned in the top right corner of the page, if this is not possible, then it may be positioned at the bottom right corner. 3 What about when working in partnership? Our identity cannot be lost amongst those of other organisations. We should strive to ensure our identity is shown in equal proportion to other identities. Where possible, our identity should sit to the top/bottom right of any other identities, to fulfil our cornerstone objective. 4 Typeface In order to establish a recognised and professional identity we should use consistent typefaces that are clear and easy to read. NHS Kirklees preferred typeface is Arial 12, however larger font sizes (14 or larger) may be required for some patients. For versatility and targeted communications, it may be more appropriate to use alternative typefaces. Alternative typefaces may be used for publication titles and headlines only, the typeface must, however, conform to use principles of clarity and accessibility. 5 Colour The consistent use of standard colours helps people to recognise NHS communications. A colour palette has been specifically developed that supports our straightforward, clear and cost-effective style. The range of colours allows for diversity while still serving an NHS look and feel.

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For background colour, any colours within the NHS colour palette may be used as solid colours or as tints (the NHS logo must never appear as tints). When printing typeface in one colour, only NHS Blue or black are the preferred colours. The balance of the NHS colour palette may be used as a typeface colour, except NHS Yellow and NHS Light Green which read poorly as text only. Other colours (not included in the palette) may be used in NHS communications, but only as an exception. The full NHS palette can be found within the NHS Identity Guidelines (pg 29) together with instructions on how to create them manually on your personal computer, through manipulation of red, green and blue hues. 6 Using images to convey the right message The NHS photo library has an abundance of NHS endorsed images which can be used in any NHS publication. For information about suitable images please contact the PCT’s communications team. 7 Finally, some top tips Use short sentences. Use bullets to divide up complicated information. Avoid long paragraphs. White space makes the information easier to read. Avoid upper case letters, italics and underlining as they make text more difficult to read. The use of clipart does not add to the reputation of a professional organization – a wide selection of NHS endorsed images are available from the NHS Photo Library. The above information summarises the NHS Identity Guidelines which can be found in full at http://www.nhsidentity.nhs.uk/ 8 Aim higher checklist The following checklist will help you to consider whether a communication meets NHS identity guidelines. The basics

• Is the NHS logo, or your logotype, in the correct position and at the correct size?

• Does it sit in the right amount of clear space?

• Are the colours chosen from the NHS colour palette?

• Are the typefaces Adobe Frutiger, Garamond, Arial or Times New Roman -

Arial is the PCT’s preferred font (or is there a good reason for not using them)?

Meeting our values and principles Does the communication support these NHS values…

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For Health Does it reinforce (or not contradict) our support for health and healthy lifestyles? Caring Does it show respect for the audience and avoid unfair stereotypes? Does the tone of the wording show care and empathy? Professionalism Does it demonstrate pride in what we are doing? Are the spelling and grammar right? Are we able to challenge poor standards in any existing communications? Efficiency Is the budget right for the task? Are the tone and style right for the audience you are speaking to? Equality The NHS is for everyone. Do the images span ages and cultures (where appropriate)? And increasingly, Choice and Responsiveness Does the communication support these principles… Clear Is it easy to read and easy to understand? Cost–effective Has the budget been used wisely? Straightforward Does it avoid gimmicks and over-complicated design or wording? Modern Does it support new NHS developments and aspirations? Accessible Has it been tested with the target audience? Do they understand it? Are versions in other languages, symbols or formats needed? Is it easy to obtain? Honest Does it avoid misleading information and false promises? Does it withhold information that the receiver has a right to know? Respectful Does it show respect for the receivers’ feelings and beliefs? Does that "funny" drawing or headline risk offending anyone? Does this communication support a positive reputation for the NHS?

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