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, with something like 43 million visits a month. And because it’s used by pretty much everyone, it needs to use down-to-earth and ordinary language.

For lots of people, English isn’t their first language, and there are some who struggle to read and write for other reasons. On top of that, when people come to the website, they might be feeling anxious and panicked, or feel woozy and unwell. So it’s all about conveying the meaning in as clear and concise a way as possible, without room for misunderstanding. “We know that about four in ten people struggle to read typical health information,” says Sara. This is the type of info you might find on a pill packet, for example. “If you add in numbers it’s about six in ten people.”

If people have poor health literacy it can actually have an impact on their wellbeing: they are more likely to end up in A&E and more likely to have stays in hospital; they tend to miss screening tests and flu jabs and, ultimately, they have shorter and less healthy lives. By making language easy for people to understand and act on, that hopefully goes some way to preventing this. “Our focus is very much on helping people get the right care at the right time,” says Sara.

Although it’s all about keeping things simple, the NHS website does use medical terms. At the end of the day, patients need to understand health symptoms and any treatment or care they're getting. However, the NHS site always explains a medical term using easy to understand language. The term “diuretic”, for instance, might be followed up with: “these are tablets that make you pee more.”

Dr Hugh Rayner is leading an initiative to encourage consultants to write letters to their outpatient clinic patients directly, using clear language, rather than via their GP. Any medical term that they put in a letter to a patient (cc’d to a GP) would always be explained. For example, they might write, “You have an irregular pulse, which is called atrial fibrillation.”

“You have to be careful not to substitute every technical term with a good enough or a close enough lay term,” says Dr Rayner. “These words do mean something very specific.” And the GPs as well as the patients need to understand what's been diagnosed.

3. Bottom

As with the above, the word “bottom” is preferred to “anus” or “rectum”. User testing showed that people understand this better.

You might be surprised to learn that the NHS website uses "fart".

4. Fart

You might be surprised to learn that the NHS website uses “fart”. They do have a page all about “flatulence” but they explain that this means farting.

The NHS website avoids “passing wind” or “breaking wind” because these euphemisms can actually be quite difficult for people for whom English isn’t a first language. “Pass” and “wind” are simple words on their own, but put together the meaning can be missed.

5. E.g.

The site doesn’t use “e.g.” for a number of reasons. For people who use screen readers it might get read out as “egg”, and that’s very confusing! Also, some people don’t understand what it means. So instead they use words and phrases like “such as”, “including” or “like” – whichever works best.

6. Food pipe

The site might use the clinical word “oesophagus” but they’ll explain that it’s the “food pipe”, as people may not understand the medical term. And they don’t use “gullet” as they’ve found that a lot of people don’t understand the meaning of this either.

The term "it cannot be cured" is deemed more sensitive than "incurable"

7. Incurable

They prefer “it cannot be cured” to the word “incurable”, because some people may not understand it. That’s because a lot of negative words in the English language will start with “un”, like “uncommon” for example, whereas in this case it’s an “in”.

And there’s another reason. “It cannot be cured” is deemed more sensitive than describing something as “incurable”.

8. Dosages

They would always use the full word “microgram” rather than the abbreviation “mcg”. This has come from the people who prescribe medicine, like doctors and pharmacists, who won’t use the abbreviation because it can cause errors. They don’t want people confusing “microgram” with “milligram”, which is a thousand times the dose!

Instead of “normally”, they opt for “usually”. This is because, in a health context, “normally” can make people feel that they aren’t “normal”.

To learn more about the language that the NHS uses, listen to Word of Mouth: NHS Language Use.
NHS content designer Sara Wilcox co-ordinates work on .