A Health Literacy Action Plan For Scotland - Scottish Government

How has the context changed since Making it Easy?ContinuedTo achieve this we need to engage better withpeople no matter what skills they currentlyhave. For any of us to be a lead partner inour care, we do not want to be held backby systems or words that are confusing orunclear. All health and care workers can help.Some of the changes needed may be smallbut make a big impact; others need a longerterm shift in approach and mind-set. This planwill strengthen culture and practice basedon a human rights approach founded on:equal access,shared decision-making, andpeople supported to live and diewell on their own terms with thehealth conditions they have.Making it Easier A Health Literacy Action Plan for Scotland 2017-2021Supporting people to be in the driving seatof their health and care is widely known asself-management. A key element of supportfor self-management is ensuring that peoplehave the skills to access, understand andengage with the systems and sources ofsupport that keep them well. This challengewill be met through three action areas:Share the learning from Making it Easy.Embed ways to improve healthliteracy in policy and practice.Shift the culture by developingmore health literacy responsiveorganisations and communities.This will ensure we design supports and servicesthat better meet people’s health literacy levels.

Action area 1Share the learning from Making it EasyHeadlines from this sectionOrganisations should embed the key learningpoints from Making it Easy to supportsafe, effective, person-centred care.Tools and techniques tested through our workin NHS Tayside should be used to supportspread and adoption of the learning points.Our network of health literacy championswill continue to promote progressagainst actions locally and nationally.Based on the work reported in Making it Easy– Progress Against Actions 8, our key learningareas to share across the system are:health literacy tools and techniques9 forprofessionals to use, such as Teachback,clearer information shared with peoplebefore they attend and leave hospital.This includes improved appointmentletters, making them more considerate ofpeople’s communication needs, andimproved safety and support forpeople on high-risk treatments,promoting the involvement ofpharmacists and their support staff.8 www.gov.scot/Publications/2017/07/78069 s/techniques/14/15

Action area 1ContinuedThese align with the quality aims ofeffective, person-centred and safe10healthcare set out in the HealthcareQuality Strategy for NHSScotland.Videos to raise awareness of the hospitalexperienceWhat? Why? Children in Hospital is acharity that makes videos to help children andparents prepare for hospital and answer someof their questions starting with What? andWhy?These films have been helpful in reducinganxiety both for children and parents ahead ofhospital treatment.One of their recent videos shows whathappens when your child is admittedto the Cancer Centre in Glasgow – owcancercentreThe next phase will move these actions onfrom ones that improve communicationto responses that better support people toself manage their health and wellbeing:We will further embed Teachback to checkthat people have received information clearlyfrom their practitioners. NHS Tayside willtake the lead in this work, with learningspread to other sites across Scotland.We will promote the What Matters toYou? 11 approach to support people toensure that their practitioners haveunderstood what matters to them.We will promote walkthrough and wayfindingapproaches. These will enable peopleto access health and care more easily byremoving barriers such as inconsistentsigns and confusing pre-visit information.We will work with the Living Well inCommunities workstream on AnticipatoryCare Planning and Scotland’s House ofCare12 programmes to develop and testmore health literacy sensitive approachesto care and support planning.11 www.whatmatterstoyou.scot/10 www.gov.scot/Resource/Doc/311667/0098354.pdfMaking it Easier A Health Literacy Action Plan for Scotland 2017-202112  cial-care-support-andservices/house-of-care/

We will continue to contribute todevelopment of the Scottish Social ServicesCouncil (SSSC) outcomes focused supportplanning resource which is being developed inthe context of the Carers (Scotland) Act 2016.We will promote a universal precautions13approach in all decision-making steps,with appropriate use of decision aids andscenario thinking to trace the best optionsfor people. NHS Lothian will lead on work toimprove the appointment process, includingimprovements to appointment letters, withlearning spread to other sites across Scotland.AwarenessWe will increase the public awareness of healthliteracy issues. This will include use of the HealthLiteracy Place14 website and social media. Part ofthis will include continued involvement with theglobal Health Literacy Month15 campaign, whichtakes place in October each year. Wider strandssuch as the ‘What Matters to You?’16 movementand Our Voice17 framework will have a usefulrole in both enabling members of the public tospeak out and raise issues around health literacywith staff, and provide new ideas to improvethe current design and re-design of services.14 www.healthliteracyplace.org.uk/15 www.healthliteracymonth.org/16 www.whatmatterstoyou.scot/13 ontent/heading2.html17 www.ourvoice.scot/16/17

Action area 1ContinuedLinks to the Our Voice approachThe Our Voice citizens’ panel18 asked panel members (who are a broadly representative sampleof the Scottish population) what they think makes for a good doctor, and what things combineto make for a good consultation.59% of panel members said a good doctor needs to be a good listener. In the words of onepanel member, a good consultation takes place “when both patient and doctor are satisfiedthey 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 careoptions. 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 moresupportive to your decision.” Also: “practice nurses are part of the normal routine so easy tocommunicate with.”An Our Voice citizens’ jury19 will explore how we further strengthen relationships betweenhealthcare professionals and individuals – a key theme of the Chief Medical Officer’s reportRealising Realistic Medicine 20. Findings will shape how we progress this action plan.18 www.ourvoice.scot/citizens-panel19 www.ourvoice.scot/citizens-jury20 www.gov.scot/Publications/2017/02/3336Making it Easier A Health Literacy Action Plan for Scotland 2017-2021

Expand on successes and deepen the work in TaysideThe work in Tayside21 started under Makingit Easy will continue. The learning will bebroadened to new areas that place barriersto improved health literacy. It will behelpful for other sites across Scotland to:learn from Tayside’s journey,learn from Tayside’s plans for‘what to do next’, andsee an illustration of what the‘next phase’ looks like.21  w /19

Action area 1ContinuedHospital walkthroughs in NHS TaysideA range of people – adult learners, students, healthcare workers – walked through NinewellsHospital 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 onsigns was different. For example it read “Children’s OutpatientDepartment” on the letter, and “Tayside Children’s Hospital” onthe signs. The signs on the way to the clinic also used differentterms for the same place.Volunteers at the hospital were helpful but the directions theyoffered were too complex.There were few details on how to travel to the hospital. It would be helpful to know thatparking at the hospital may be some distance away from the front door. The appointment lettercould also include some indication of the time it takes to reach the clinic from the car park or thefront door.It is a core action for other parts of the health and care system to undertake walkthroughs toinform their drive to better health literacy responsiveness.Making it Easier A Health Literacy Action Plan for Scotland 2017-2021

Building networks of health literacychampionsAs part of Making it Easy, we trained more than90 trainers across the health and care systemto promote skills for better health literacypractice. We have also worked with groupssuch as the ALLIANCE’s Self ManagementNetwork Scotland22 and the Scottish PublicHealth Network23. Through the NHS Educationfor Scotland (NES) practice nurse and practicemanager networks, we have promoted healthliteracy tools and techniques, in particularthe idea of walkthroughs and wayfinding.We will develop this set of networks tosustain positive health literacy attitudes andbehaviours across all health and care workers.The networks will have clear tasks to spreadgood health literacy practice across Scotland.In addition, there is a global communityof practice26 through the WorldHealth Organization (WHO) thatwe will play an active role in.We have the chance to align with workon accessible information and inclusivecommunications through the Royal Collegeof Speech and Language Therapists24,as well as pharmacist networks throughthe Royal Pharmaceutical Society25 toembed health literacy responsivenessin many key parts of the system.22 http://smns.alliance-scotland.org.uk/23 www.scotphn.net/24 www.rcslt.org/governments/scotland25 www.rpharms.com/making-a-difference/scotland26 acy20/21

Action area 2Embed ways to improve health literacy inpolicy and practiceHeadlines from this sectionWe will embed health literacyimprovements into policy and programmedevelopments across sectors throughoutthe lifetime of the action plan.We will have a specific focus on building thecommon skills of connectors across all sectors.Library and information services have a keyrole to play.We have made many useful links across thehealth and care system during the developmentof Making it Easy. Many of these links benefittedfrom being quick, simple and agile, butthere’s an opportunity to better target ourefforts in the next phase. This section setsout a range of policy and practice areaswe’ll work with to embed our learning.Making it Easier A Health Literacy Action Plan for Scotland 2017-2021Primary carePrimary care is where many people first seekadvice when they have a health issue. It’s agood place to get things right from the start.There is much work underway to ensure peopleare better informed, with access to the rightperson at the right time so they receive thebest care in the most appropriate setting.All members of the team have a role to play.Through primary care’s developing skillsand roles of non-clinical staff improvementprogramme, we will include health literacyskills within training. In addition, we willwork with the Royal College of GeneralPractitioners (RCGP) Scotland’s PatientPartnership in Practice (P3) network topromote and develop greater health literacyresponsiveness in general practice.Dentists have long made efforts tocreate positive environments in theirsurgeries, particularly to reduce anxietyfor young children and parents. Thereis much to learn from this work.

Childsmile programmeThe Childsmile toothbrushing programmeaims to provide very young children withknowledge and skills which should stand themin good stead for looking after their teeth forlife, saving them from unnecessary pain andsuffering. It relies on bespoke resources whichhave been developed with, and for childrenand their carers and involves the children inthe practical process of brushing their teeth innursery school every day.The combination of involving the childrenand their carers in the project and ensuringresources are accessible and appropriate hassignificantly improved child oral health overthe last 10 years.A recent Our Voice citizens’ panel reportshowed where we should target our efforts tosupport people in understanding more aboutpharmacy services. It also showed how we canhelp pharmacists meet people’s informationneeds. We will work with a variety of patientinterest groups to progress this work.We will work through the Modern OutpatientProgramme27 to give people at all levels ofhealth literacy confidence to access the systemwhenever necessary, and ensure they havethe skills and support to self manage theirconditions when clinically appropriate. This willhelp to reduce health inequalities and minimiseunnecessary demands on current services.Urgent care servicesIn line with recommendation 25 of the NationalReview of Primary Care Out-of-Hours Services28,there is an opportunity to develop out-ofhours and urgent care services that respondbetter to people’s health literacy needs. Manyof the challenges are the same in all caresettings, but we will explore the best way tomake changes in this particular area that meetthe needs of people and their practitioners.27 www.gov.scot/Publications/2016/12/237628 rpcooh22/23

Action area 2ContinuedThe role of NHS inform as ‘go-to’ source of online informationNHS inform is Scotland’s national health information service.Its aim is to provide people with accurate information to help them make informed decisionsabout their own health and the health of the people they care for.Inform has engaged with people on the development of information and resources to supportself-care. A good example is the Musculoskeletal (MSK) Help app – nd-appsIt has also produced self-help guides. These allow people to access information about commonconditions and provide suggested outcomes based on the answers given, for example ‘contacta pharmacist’. The self-help guides can be accessed at www.nhsinform.scot/self-helpguidesWork is underway under action 14 of the Mental Health Strategy for Scotland 2017-202729 toimprove NHS inform’s online material for people with urgent mental health care needs.29 www.gov.scot/Resource/0051/00516047.pdfMaking it Easier A Health Literacy Action Plan for Scotland 2017-2021

Mental HealthThe new Mental Health Strategy for Scotland2017–202730 (action 11) reaffirms the ScottishGovernment’s commitment to improve theresponse for people presenting in distressin Scotland, through the implementationof the Distress Brief Intervention31 (DBI)programme. This aims to build a frameworkfor connected, compassionate support.A DBI is a time limited and supportiveproblem-solving contact with someonein distress. It is a two-level approach:DBI level 1 is provided by front linestaff and involves a compassionateresponse, signposting and offer ofreferral to a DBI level 2 service.DBI level 2 is provided by trained thirdsector staff who will contact the personwithin 24 hours of referral and providecompassionate community-basedproblem-solving support. This will includewellness and distress managementplanning, supported connections andsignposting for a period of up to 14 days.We will embed health literacy learning intopractice through the DBI programme32 bysupporting the associated training programmes,building knowledge and skills, supportingthe use and testing of the available tools,and influencing the evaluation framework.Supported decision-making at times ofimpaired capacitySupported decision-making is the term usedto describe the process of assisting a personwith cognitive disability to make decisionsfor themselves. Anyone may need support indecision-making but people with a learningdisability, dementia, or mental ill health, faceparticular challenges while having the samerights as anyone else. Support is neededto ensure that they can make decisionsabout their lives, while recognising barriersin society such as stigma, paternalisticattitudes, and discriminatory systems.30 www.gov.scot/Resource/0051/00516047.pdf31 www.dbi.scot/32 rogramme-overview/24/25

Action area 2ContinuedThere are many examples of good currentpractice across the health and social care sectorin Scotland. We should build upon this to createthe right environment for the types of goodconversations that are the basis of supporteddecision-making. This will ensure that everyonein Scotland who needs support to makeimportant decisions can access it, or be giventhe opportunity to have their wishes heard.Information about medicinesSome of the most common interactions thatpeople have with health and care servicesrelate to medicines information. One of thekey statistics from Making it Easy was the highproportion of people (43%) who lack the skillsto calculate a dose of childhood paracetamol.Making it Easier A Health Literacy Action Plan for Scotland 2017-2021Not sure? Just ask!To help people understand their medicines theScottish Patient Safety Programme promotesNot Sure? Just Ask! cards. The cards wereoriginally developed by NHS Tayside with inputfrom patients, carers and members of thehealthcare team.

There is an excellent opportunity to improvesupport for people who are taking complexmedications by using clearer medicinesinformation. At a Europe-wide level wecan link to the SIMPATHY 33 programmeto improve people’s knowledge andskills in managing their medicines.At points where people are having theirmedicines reviewed, there’s a goodopportunity to check understanding and beclear in communication. This video34 offers anexample of what good practice can look like.Workshop with the Scottish Commissionfor Learning Disability’s (SCLD) expertgroupA key theme about the need for clearerinformation about medicines emerged duringa workshop with SCLD’s expert group.People like information in picture format, witheasy words and clear explanations of “whatit’s for”. What are the differences betweencapsules, tablets and caplets? What doesthat mean for how we take the medicine?Clearer packaging with no smallprint is vital.Reminders of when to take medicines wouldbe helpful.Pharmacists can help by giving more clearinformation about taking our medicines.Including a person with lived experience oflearning disability in pharmacists’ training maybe a good idea. Th

Promoting health literacy, a key determinant of health 1. Access and utilisation of healthcare 2. Interacting with health service providers 3. Caring for one's own health and the health of others Mainly located in clinical settings Mainly found in community settings 4. Participating in health debates and decision-making Health literacy is .