Guidance

PHE Screening publications production and review

Updated 21 December 2018

1. Introduction

Public Health England (PHE) publishes a large number of documents, in a variety of formats, to support the NHS Screening Programmes in England. We publish the majority on GOV.UK. In line with the government’s digital strategy, we publish documents in electronic format only wherever possible. However, we print items such as public information leaflets where there is a clear need to do so in order to support personal informed choice and minimise inequalities in access to screening programmes.

In order to support screening providers and commissioners, reduce duplication of effort and protect and enhance the reputation of screening in England, it is important that anyone reading a screening publication can be confident it is fit for purpose. This means it should:

• be developed according to the established publication user need(s) and acceptance criteria (see section 3.3)
• provide the most important information early in the publication (reflecting research into reading practices)
• follow the principles of plain English, while recognising the need to use technical and medical terminology
• be based on evidence from appropriate sources
• aim to be suitable for the UK average reading age of 9 (for public information)
• be tested and, as far as possible, acceptable to users
• be consulted on by stakeholders

It is important to note that there can be a discrepancy between the information users want and the information PHE must provide due to the requirements to present all aspects of the screening programmes.

Guidance on writing in plain English is available from the Plain English Campaign website. Guidance on writing content for GOV.UK is available via a writing guide and a style guide. PHE Screening also runs writing workshops which we encourage all members of staff to attend.

This document provides guidance on the development or revision of PHE Screening publications, including guidance and standards documents, public information leaflets, online content and training publications. A separate process covers documents produced by the UK National Screening Committee (UK NSC).

2. Principles for content development

2.1 The Information Standard

The processes outlined in this guidance aim to conform to the requirements of The Information Standard. This standard, run by NHS England, is specifically designed for the creation of health and care publications. It outlines 6 principles which should be used in the creation of information.

Information production

You have a defined and documented process for producing high quality information.

Evidence sources

You only use current, relevant, balanced and trustworthy information sources.

User understanding and involvement

You understand your users and you user-test your information.

End product

You double-check your end products.

Feedback

You manage comments/complaints/incidents appropriately.

Review

You review your products and processes on a planned and regular basis.

PHE Screening is committed to following these principles and is seeking accreditation by The Information Standard.

2.2 PHE Publications Standard

PHE has introduced a Publications Standard which covers both professional and public-facing materials. It aims to ensure we produce all content in a high quality, consistent and evidence-based way. The standard states publications must:

• align with the organisation’s core purpose, functions and priorities
• meet the known need or needs of stakeholders
• have clear descriptions of their scope and methods, and be transparent about how content is produced or commissioned
• use an appropriate methodology for their purpose, and the type of question they seek to answer
• not duplicate effort either within PHE or with partners

The processes outlined in this document are consistent with these principles.

2.3 Accessible information standard

By law, NHS screening providers must conform to the Accessible Information Standard (AIS). This means they should provide people who have a learning disability or sensory loss with information about screening in a way they understand. People with a learning disability or sensory loss should also receive appropriate support to help them to communicate.

Local screening services have a duty under AIS legislation to:

• find out if a person has communication or information needs because of a disability or sensory loss
• record those needs in a clear way
• make sure those needs stand out whenever that person’s records are checked
• share information about a person’s needs
• act to ensure people get information they can access and understand, and get communication support if they need it

The AIS states that reasonable provision should be made to enable access to information.

PHE Screening supports local providers in meeting the AIS by providing publications in alternative formats (see section 4.3) and sharing best practice.

2.4 UK National Screening Committee information development guidance

The House of Commons Science and Technology Committee published a report on National Health Screening which highlighted a number of challenges including:

• communicating risks and benefits of screening
• producing public information about screening
• the potential benefits of sharing best practice resulting in a consistent approach to developing public information across all countries, and all screening programmes

The report made a number of recommendations relating specifically to the development of public information about screening.

As a result, a pan-UK public information and professional development (PIPD) group was set up by the UK National Screening Committee (UK NSC) to share best practice and resources across the 4 countries. This group produced guidance for the development, production and review of information to support UK population screening programmes, including a standard definition of personal informed choice.

The processes described in this document are in line with the UK NSC guidance. Appendix B outlines the principles developed by PHE Screening to address the committee’s recommendations.

3. Content development

3.1 The development process

The publication development process should be no longer or more complex than it needs to be. The process for developing publications is summarised in appendix A. You may not need all the steps for some smaller, more straightforward publications and should take a common sense approach.

3.2 Subject leads and content designers

Each publication project should have a subject lead and a content designer working in collaboration. Most publications will include additional input from experts and stakeholders to help inform content.

The subject lead will come from the relevant team within PHE Screening. They provide:

• in-depth knowledge of the screening process
• information on the risks and benefits of screening
• the evidence upon which screening is based

Subject leads should consider if they need to set up an editorial group, including external experts and stakeholders, when reviewing or developing publications. Using such a group can help ensure the finished publication is authoritative, credible and useful (see section 3.4).

The information and education for public and professionals (IEPP) team in PHE Screening will identify a content designer to provide advice and support on the formatting and content of publications. The IEPP team works closely with the PHE publishing team and the Government Digital Service (GDS) to make sure content meets the necessary requirements for publishing.

3.3 User needs and acceptance criteria

All publications and information must start with clearly identified user needs. This is important to ensure content meets the requirements of the people reading it. The user need(s) have to be demonstrated in order to publish content on GOV.UK. Once the user need(s) have been established, acceptance criteria should be agreed.

User need example

As a screening provider I need to order national screening leaflets, so that everyone offered screening can make an informed choice.

Acceptance criteria

The above user need is met when the user:

• can order leaflets
• knows which leaflets they can order
• knows how many leaflets they can order at one time
• understands when leaflets can be ordered for free
• knows who has to pay and how
• understands why national leaflets must be used

User need(s) and acceptance criteria inform the development of the structure and content of a publication. They should also inform the format of the publication. When deciding the most suitable format for the information you should consider if:

• the information needs to be printed (such as public information leaflets)
• the information is to be hosted online and whether it should be a HTML or PDF document (see section 4.3)
• additional formats are needed, such as easy read or translated versions

3.4 Editorial input

Subject leads should identify appropriate individuals and/or groups to ensure the publication meets the identified user needs. This can be done in various ways, including:

• informal meetings (general content discussion)
• feedback via email on draft content
• semi-structured telephone interviews
• focus groups (targeting specific issues)

Subject leads should consider which individuals and/or groups to involve in any review or development process. These may include:

• clinicians
• academics
• members of the public/representatives from patient groups
• third sector organisations
• statisticians
• experts in specific fields such as risk communication

The UK NSC may be consulted to identify appropriate experts in the field.

All public-facing information must present a fair and balanced description of the condition being screened for. It should also signpost to NHS.UK for supporting information and link to relevant charities and support organisations.

3.5 Focus groups

We usually need focus group work when developing any new public information materials. Professional publications may also benefit from this approach, so this should be considered on a case by case basis. Publications undergoing routine review will not normally require focus group input unless there are likely to be fundamental changes.

Input from users must be proportionate.

3.6 Consultations

PHE aims to meet the government’s consultation principles. In general, open consultations run for a period of 4 weeks.

For major projects a consultation period of up to 3 months may be considered. For such projects, an online consultation process will generally be the most viable approach.

The subject lead will document the consultation process and resulting comments. This information will be stored electronically for future reference.

3.7 Surveys

Surveys of existing information users may be required, depending on the publication type. When reviewing an existing publication, an online survey can be useful in generating evidence to inform changes. Subject leads and content developers should work together to ensure that surveys are fit for purpose. Stakeholders such as charities may be able to help disseminate surveys.

3.8 Evidence

As part of the Information Standard requirements, the subject lead should document evidence used to develop publications and retain it for future reference.

3.9 Statistics

All public bodies that produce official statistics designated as national statistics have a statutory duty to comply with the UK Statistics Authority code of practice. The subject lead must ensure compliance with this code of practice. The PHE Screening data team can provide advice and support.

4. Publication production process

4.1 Development/review schedule

Review of existing publications should normally take place every 3 years. In some cases, a shorter or longer timeframe may be required – for example, due to a policy change or new evidence.

4.2 Types of publication

Public information leaflets

These are developed to support the ethical requirements of the screening programmes to enable people offered screening to make personal informed choices about whether to accept the offer.

In line with the government’s digital strategy, PHE Screening works with local screening providers to minimise leaflet printing as much as possible.

Professional documents

Professional documents include:

• operational guidance
• standards
• training materials
• equipment guidance/reviews
• quality assurance reports
• data reports and templates

4.3 Publication formats

Digital HTML format by default

All PHE Screening publications on GOV.UK should be published in HTML format unless there is a proven need for an alternative. Exceptions include public-facing information leaflets that are printed free of charge for local screening providers. See leaflet ordering guidance.

HTML documents are specifically designed for online use and are more accessible and searchable than alternatives such as PDF.

Printed documents and leaflets

We use specialist design software to produce publications requiring professional printing so that print-ready artwork can be produced. In most cases, we use pre-existing templates to ensure consistency across the screening programmes.

We add unique identifiers to every printed leaflet, usually in the form of a barcode and number, plus a product code. This enables accurate ordering, management and delivery of products and meets the requirements of fulfilment companies that send out screening letters.

Alternative formats

PHE Screening aims to provide local screening services with high quality easy read versions of screening information to meet the needs of people with learning disabilities.

Production of invitation/results letters in alternative formats will also be considered.

The AIS states that reasonable provision should be made to enable access to information. PHE Screening currently recommends the following formats are made available for public facing documents (leaflets):

• large print (download only)
• braille (printed on demand: 2 to 3-week timeframe)
• easy read (download only)
• audio (to be considered according to demand)

Non-text content

Consideration should be made to provide information in interesting and accessible ways, such as diagrams, pictures, photographs or infographics.

PHE Screening has a library of screening images for use in patient information leaflets.

Co-authorship of documents

PHE Screening prefers to solely own publications relating to elements of the population screening pathways, rather than co-authoring or co-branding documents. Publications relating to elements outside a screening pathway, but relevant to screening providers, will normally be owned and branded by the relevant professional or clinical body and published and hosted on their own website. We can then link to this from GOV.UK. PHE Screening has a standard form of words to provide for such publications.

5. Sign-off

The subject lead and content designer should both agree the content.

Any high-profile publications or materials likely to generate significant stakeholder interest, such as programme standards or key performance indicators (KPIs), will need to be signed off by the Director of Screening or a designated deputy from the PHE Screening Strategy and Management Group (SMG).

Every effort will be made to reach consensus on publication content. In the event of disagreement, the SMG, chaired by the Director of Screening, will make final decisions.

Professional documents that are routinely produced using an established format do not need to be signed off individually. The template and content summary for such publications will be signed off once, and then applied for each subsequent document. Examples include quality assurance and data reports.

All content will also be subject to external sign-off either via the PHE Publications or Digital teams prior to publication.

6. Gateway and comms grid process

Subject lead sends to IEPP team (iepp@phe.gov.uk):

• signed-off content, preferably in HTML markdown format
• name of the subject lead (usually programme manager) who has signed off the content
• user need(s) and acceptance criteria for the new content
• a completed communications grid form with preferred date for the new content to be published on GOV.UK (the preferred date should be at least 2 weeks in advance, or longer for complex publications)

The IEPP team:

• carries out a final review for clarity and style
• uploads the new content on to GOV.UK
• completes gateway submission using the PHE publishing online form
• submits communications grid request for the subject lead’s preferred publication date
• if necessary, submits publication to PHE publishing to put live on GOV.UK (this is known as the ‘2i’ process)

7. Publication

PHE Screening documents are published on GOV.UK where users can find and search for them easily.

Most publications, except public information leaflets, should be available in electronic format only. Large print, easy read and translated versions of public leaflets will be available electronically via GOV.UK to download in printable format. PHE policy is not to create ‘blanket’ translations of materials. The most used public information leaflets are translated into a small number of the most requested languages.

Any relevant publications which are, or will be, hosted on another website must be linked to, rather than duplicated on GOV.UK.

No printed copies of publications should be produced unless there is a clear business case for them, such as for leaflets accompanying invitations to screening.

8. Communications

New publications or major revisions to publications should be announced on the PHE Screening blog. This is the default PHE Screening communications channel, in line with GDS policy.

In certain circumstances, a national email may also be sent to specific stakeholder groups linking to the relevant blog to ensure they are made aware of the new document. This should be done via the existing PHE Screening email cascade process.

8.1 Impact on pre-existing information

You should consider whether the publication of a new or revised document will require the updating of related information (such as GOV.UK or NHS.UK content). Discussions should start with NHS.UK in enough time for changes to go live at the same time as publication on GOV.UK.

8.2 Publication files

All final versions of publications, together with documentation relating to their development, will be securely filed within PHE Screening.

9. Evaluation and feedback

9.1 Formal evaluation process

All new public information materials will be evaluated post-implementation. This will include user feedback. We are developing the framework for this process and will publish it in due course.

Evaluation of professional publications should be undertaken on an ad hoc basis.

9.2 GOV.UK feedback

Users can comment on any publication on GOV.UK using the feedback link at the bottom of the page. The IEPP team regularly reviews this feedback so that any necessary improvements or clarifications can be agreed.

9.3 Updates to content

All publications will be reviewed at least every 3 years. Published documents must include both the date of production and date of next review. If information needs to be updated or amended in the interim, this will be carried out on an ad-hoc basis as necessary. All historic copies of publications will be archived electronically to ensure content changes are documented.