Simplify!

What this means 

The health and social care systems are complex. Anything to help counter this – from clear explanations, to advocacy, to taking action to simplify forms and processes – is an important part of sharing power as equals. Create a variety of ways that people can access services and information, and always check understanding. 

Don’t just create an Easy Read version of something and think, ‘job done’.

The research 

In 2015, it was found that 42% of working-age adults in England are unable to make use of everyday health information (Public Health England, 2015). This rises to 61% when numeracy skills are also required in order to understand the information. This demonstrates the obvious importance of making every effort to simplify. 

This theme is found in many of the key changes – for instance, in the Communication and confidence theme in Leading The Lives We Want To Live, and The importance of accurate and reliable information in Living In The Place We Call Home. However, in this key change, the idea of clear explanations was explicitly linked to the sharing of power. Beadle-Brown et al. (2012) found that this power is deep-rooted and goes back to how research which forms the basis of policy is conducted. The study found this research privileges the viewpoints of those who are able to respond to standardised questionnaires that have been developed by the researchers – and excludes others who may have alternative communication needs or preferences. 

It’s important to co-produce, or at least road-test, Easy Read information with its target audience (Chinn & Homeyard, 2017; Turnpenny et al., 2018). For example, when piloting an Easy Read of the Adult Social Care Outcomes Toolkit (ASCOT), researchers found that their original version was too open to different interpretations, that the black and white line drawings caused confusion, and that the scales involved in the questions presented difficulties (Turnpenny et al., 2018). As a result of the input from people with learning disabilities, the questionnaire was substantially changed, including by using pictures that people found relevant and attractive. 

This example from the research illustrates how a paternalistic approach to providing information will often miss the mark. This is the case not only in learning disabilities, but in all aspects of health and social care. It is also true when thinking about co-production - information presented in simple ways, that in itself has been co-produced, can support inclusive and diverse projects, particularly for people with different communication needs.
 
Co-production, and organisations accepting that they don’t know it all, can lead to not only simplifying existing information, but can also be transformational in the types of knowledge produced - reflecting what people really want and need to know (Filipe, Renedo, & Marston, 2017). 

What you can do 

If you are in senior management: Think about the information, guidance, and methods of delivery that your organisation provides. Consider the variety of alternative formats - British Sign Language, written information in languages other than English, Easy Read, etc. Are these provided and, most importantly, are they co-produced and road-tested with the target audience? 

You might also consider how language and information can be understood in different communities. Culturally sensitive information isn’t simply about providing translation and interpretation services – have you co-produced information with different community groups, understanding how different cultural identities may impact on how information is heard and interpreted?

However, accessibility around language is not only for people who communicate in other ways than written or spoken English. Everyone will benefit from clear and concise information, backed up with accessible phone and email contact options to check understanding. A simple way to evaluate the clarity of your information is to consult the Accessible Information Standard and Plain English Campaign’s free guides – particularly the A-Z of alternative words. How many of the complicated words are in your communication? How can you co-produce clearer versions? 

You may also find the section on digital access in the Communities Where Everyone Belongs key change helpful when thinking about digital communication. 

If you are in direct practice: Part of your role is to help people understand what is being asked of them, what decisions affect their lives, and what rights they have. Invite questions and check understanding - not only once, but more than once! Don’t wait for someone to tell you that they don’t understand. 

Further information

Watch

Dean Thomas, a member of the Sharing Power As Equals group, starred in a video with Nottinghamshire County Council explaining how jargon and over-complicated language can be tackled via co-production. 

Read

The Patient Information Forum has practical support for co-producing health information, much of which can also be used by social care organisations.

Although there is no consistent standard for creating Easy Read information, NHS England has produced a guide, Make it easy!, with examples and pictures. You can also find an example of co-produced Easy Read information with the Digital inclusion. Using digital technology positively and safely: Practice Tool from Research in Practice – in which all the images and words are from people with a learning disability, a learning difficulty, and/or autism.