Then

Twenty-five years ago, my colleague Agnes Allan (Senior Logistics Officer), worked at Heath Education Board Scotland (HEBS) and had just turned 45.

The publishing team, were all based in one large room within our previous Woodburn House offices in Edinburgh. 

Everyone had their own (albeit sizeable) desktop PC, there was a lightbox for images and big flat plan drawers to store all the artwork.

The kinds of publications they were working on were campaign materials for stopping smoking, cutting back on your drinking, improving your diet and being more physically active. 

These campaigns mostly encouraged individuals to take responsibility for their own health behaviours. 

The materials also included informed consent materials to support screening and immunisation programmes of work, such as measles.

Agnes discovered that none of the staff working in patient information, across the then 15 territorial health boards, knew each other and there was a lot of duplication of information across the system.

Now

Twenty-five years later, we still have Agnes – she has just turned 70!

Apart from the fact we are all mostly still working at home, the offices now are modern and open plan, everyone has a laptop and the publishing workflow is entirely digital with files stored in The Cloud.

HEBS became NHS Health Scotland in 2003 and then on 1 April 2020, during a global public health pandemic, we became part of Public Health Scotland.

Now the kinds of patient facing publications we are work on have shifted away from the traditional healthy living topic areas, promoting to individuals. 

Our focus now is on the fundamental causes of ill health such as poverty, poor housing and education.

We are still producing patient information particularly around maternal and child health and informed consent materials, such as flu, childhood immunisation, cancer screening and, of course, COVID-19.

Over the last year, we have produced 129 print and online resources and printed and distributed 25m units to support the COVID-19 vaccine roll out in Scotland.

All of our publications are now available digitally and most are digital only, with no print version produced.

Our COVID-19 data dashboard received 49 million visits last year. Whilst not specifically aimed at the public, it was clear that this was of huge public interest.

Agnes organised her 25th resources officers conference last year; it was virtual this time round.

Digital: an opportunity and a challenge

There has been an explosion in digital as the main channel most people use to access information and health information is no exception. 

Despite this, some people can’t or won’t access digital, particularly for their health information, and there remains a risk these people will be excluded if other channels such as print are not also offered.

According to the Scottish Household Survey 2020, only 87% of households in the 20% most deprived areas had access to the internet compared to 99% in the 20% least deprived areas.

Recent research PHS commissioned into our health information for the public found that those people who are less likely to access digital were also those most at risk of experiencing health inequalities and so are the very people we most need to be reaching. 

To go totally digital at this stage risks leaving some people behind.

We continue to provide informed consent materials in print (they are sent out along with the invitation letter) and many of our early years publications are given out by health visitors as part of the pregnancy journey. 

There are now some pilots looking into offering informed consent digitally and we will continue to review this along with partners in the delivery of these services.

Not all digital public health information is provided by PHS. 

In Scotland, the main source of digital health information for the public is NHS Inform (NHS inform – Scottish health information you can trust | NHS inform). 

Our role in public health is to provide accurate content that is delivered to our users and readers through this national health information website.

Increasing importance of other formats

The pandemic highlighted the importance of other languages and formats in widening out access to information.

For the COVID-19 materials, we provided information in 41 different languages and formats, including specific languages like Yoruba and Langala to target African communities

We are seeing an increase in uptake of both our audio and easy read formats, which have a wide appeal with audiences beyond people with disabilities. 

Our feedback tells us that they can be very useful for those for whom English is not a first language or people who are not regular readers.

We recently produced an easy read edition of our Ready Steady Baby publication in house, which goes out to every pregnant woman in Scotland.

Our recent research highlighted that one of the main barriers to uptake of other formats and languages is lack of awareness, so we are working with local boards, local authorities and other partners to raise awareness of what is available and how to request other formats.

Evaluating our impact

Our recent research found that our public facing health information is:

  • Recognised by both end users and health care professionals as providing public target audiences access to trustworthy, evidence-based health information
  • Particularly important for those who are less inclined to proactively seek formal health information through other channels (primarily audiences experiencing greater inequalities)

For these audiences in particular, the value of the resource is reinforced when it is given to the patient by a health care professional, especially where this involves active reference to it within the consultation.

Other things to note from our research were that the reassuring and non- judgemental tone of our information was welcomed and the NHS brand is recognised and seen as a trusted source.

Future opportunities and challenges ahead

Increasing use of digital is both an opportunity and a challenge ahead, especially to ensure that no one is left behind and being more targeted and intelligent about our use of print and other languages and formats, which also need more awareness raising of their availability.

There is an increasing emphasis on co-production of patient information with partner organisations and members of the public. 

We are currently piloting a new way of producing health information for African Caribbean communities with third sector organisation MECOPP and the Scottish Government.

Life expectancy in Scotland is still amongst the lowest in Western Europe – this isn’t new – but in recent years improvement to life expectancy have stalled and the gap between rich and poor has widened. 

These are the challenges we are all still facing in Scotland and patient information has a key contribution to make to addressing this.