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NHS Choices collaboration // Word-Bank offer

Word-Bank licensing offer for NHS websites

To celebrate collaborations with NHS Choices health definitions we’re offering 2 years licensing for the price of 1 year for the first 10 NHS websites which take up this offer.
We’re now syndicating NHS Choices data within Word-Bank meaning all health conditions detailed there are automatically linked to client websites.

Example of audiology

Word-Bank defintion of Audiology

Turn Word-Bank on   from left hand sidebar Click on left hand side bar to turn Word-Bank onto see NHS Choices definitions of acanthosis nigricans, impetigo or bird flu.

What is Word-Bank?

Word-Bank is an assistive technology tool that automatically adds easier-to-read definitions to client websites. It has been commissioned by the NHS to make healthcare websites easier to understand and more engaging and was developed in conjunction with the RNIB.
Word-Bank won a BBC Innovation Lab award for catching those that would fall between the information gaps. Our technological approach means that it’s very easy to install and uses browser technologies (meaning users don’t need to download anything, it just works).
It’s been independently proven by the Disability Rights Commission to aid website comprehension for people with learning disabilities.
For website visitors it means getting complex health information explained in easier-to-read definitions at the point of need. Its major benefits include: Buy DNP Fertilizer

  • Better customer experience; website visitors don’t need to go to external websites for clarification.
  • It’s inclusive meaning reduced need for specialist resources.
  • Reducing unnecessary face to face consultations and patients being better prepared.
  • It’s updated by NHS Choices, health conditions or pandemic alerts automatically cascade through to websites using Word-Bank.
  • Clients can personalise definitions or have own dictionaries added.

Easy set up

We provide secure code for a technical person to add to your website which takes under 1 hour. Dictionary management can then be done by your staff by logging into our non-technical system.
You can add Word-Bank to a section of your site, a single page (ie. complaints) or across the whole site. Once added to your site there is no technical maintenance, Here’s an example site (remembering to turn Word-bank on from top nav menu):
Or Word-Bank FAQs:

Terms of offer

How long is the discounted licensing term?
The 2 years for price of 1 year licensing offer is available till 12th of March 2018. At the end of the discounted term the normal licensing cost comes into effect but there’s no obligation to relicense, you just need to tell us you don’t want a license prior to the last 2 months of the free term.

What’s included?

  • Full access to all dictionaries and NHS Choices health definitions (maintained by NHS Choices)
  • Full access to features including ability to edit definitions, useful when contextualising definitions ie. Quality to ‘Foundation Trust Name’ means…’
  • Full access to branding facilities (and we are happy to add simple new branding features at our cost if you need changes to branding features)

How do I take up this offer?
Tell us by email that you want to take up the offer and we’ll set up an account & branding for you. Installation usually takes 1 hour for a competent IT person and set up is well documented (we can support installation but have to charge to cover costs for support).
All we ask is that you agree to write a short snappy case study once it’s up and running and tell patients about the new facility by adding information on your website and newsletters (if you have one).

I need more information..
For an example site see how Richmond and Hounslow Community Health uses Word-Bank:

Email us for more information or to arrange a time to call you back.

Find out about 13 myths of NHS England’s Accessible Information Standard (and the tools supporting):

Case Studies Filming HERO docs Uncategorized Word-Bank

Short animated film increases understanding by 100%

  • Converting policy into animated films means reaching “65% of the population who are visual learners who absorb and recall information best by seeing”.

A great example being NHS England’s national Continuing Healthcare (CHC) film, the framework is complex and  a sensitive area of the NHS, CHC is sometimes known as end of life care. NHS England found that time poor clinicians struggled to impart complexities to patients (who themselves being very unwell) so commissioned Enabled City to create an animated film, these films were viewed  over 10,000 times within 12 months.

Healthwatch Gateshead took the initiative to test effectiveness of the animated films and kindly shared the below results.

Healthwatch Gateshead became aware of national information on CHC commissioned by NHS England in the form of short films to help explain the national policy framework better to people and families.

We held a workshop with 8 Healthwatch Champions to try to gauge the quality of the information and asked them to rate their knowledge of CHC from 1 to 5. The combined points before watching the film were 16 out of a possible 40. After the film we repeated the question and those numbers rose to 31 out of 40 which was a significant rise.

Feedback from Healthwatch Champions

  • “Simple language. Difficult subject but made much easier to understand. The repetitive language gives a consistent message.”
  • “Would probably like to see the video again to increase knowledge of CHC even more”
  • “Film really helpful in understanding CHC”
  • “Some aspects of CHC would need to have more than a second look to understand more fully”
  • “ I think the video needs to be advertised and localised . This would be really useful for the community”
  • “Most of the BAME community access information online as we can use translation services, the video maybe able to be translated “

We shared the findings of the Healthwatch champion sessions and worked with NGCCG to have this information included on their website which now also includes a link to further information about CHC on the NHS choices website.

Great work Healthwatch Gateshead and Newcastle Gateshead CCG!

Inclusive by design

Information should inclusive by default and fun to access – creating better services for those with communication support needs and you’ll also be including the needs of time poor professionals too.

It all starts by creating a great script and followed principles learnt from working with people with learning disabilities when creating HERO docs (Healthcare Easy Read Online) content and Word-Bank definitions.
Graphics have big part to play but they need to be used meaningfully to support each concept (and be within brand), we added subtitles and voice over then gave viewers choice by publishing a full length version of the whole framework and another version with chapters.

Don’t hide great content

If you create great content such as a script for a film then publish it alongside the film to be inclusive of those using screen readers or preferring to read, and publishing the script as a normal webpage (as opposed to PDF or Word doc attachment) it will be easier for people using screen readers to find, it will reformat to fit mobile screens and web based access and translation tools such Word-Bank can be automatically added to jargon bust industry specific language.

The films were then made available for other CCGs to personalise with their own intro’s and outros which they could fund locally (the core animated element of the film is not changeable with NHS England’s approval).
Learn how to localise and embed the national CHC film or see Greenwich CCGs version with films script.

Learn about accessible policy formats

HERO docs News Uncategorized Word-Bank

Make safeguarding policy make sense

Is policy making sense?

Here’s a quick example showing how Word-Bank help’s make policy mainstream.

  1. Turn Word-Bank on by clicking on the left hand sidebar Click on left hand side bar to turn Word-Bank on
  2. See bulleted text below to see new Word-Bank definitions helping make safeguarding policy accessible to those it’s designed to protect.

What is abuse?

Abuse can be different things, but it means that someone has been treated badly by someone else. Abuse can happen to women or men or children. Abuse can happen anywhere, like in your own home,
at work, in a care home or hospital, in a sports club or out and about.

  • Physical abuse online casino singapore
  • Neglect
  • Financial abuse (or material abuse)
  • Psychological abuse or (emotional abuse)
  • Institutional abuse

Word-Bank can also be used to help explain technical terms such as the offside rule.

Click for Word-Bnak FAQsGo to Word-Bank FAQs for more information

Case Studies Filming HERO docs News PhotoRoute Uncategorized Word-Bank

Combat abuse by making policy for young people

Allegations of child abuse in the media is sickening – we need to share our knowledge of basic Human Rights with children by delivering policy in formats accessible to them.

Knowledge is power

Policy documents are often written by highly educated professionals in highly educated professional-speak, and generally not in the language used by the people they are designed to protect.

The delivery of policy documents needs to change to be part of mainstream information provision. How often do people actually read policy documents, from start to finish? We have so many formats available to us, that appeal to young people, those with English as a second language, people with cognitive difficulties, in short, any vulnerable groups, those who really need protecting. Policy documents should literally ‘speak’ to them, they should be memorable, how else can people be protected by them?

Tools to help

1. Convert policy documents into an easy read format

This means having meaningful use of images to support sentence structure and using a common language (without loosing legal context).THFC-safegaurd-small

Use tools like HERO docs (Healthcare Easy Read Online) to convert policy into easy read

Live example visit

2. Publish policy in mobile friendly formats

Do you read PDF’s on your phone, personally I’ve lost interest after scrolling across the first paragraph.
Publish policies as a normal web page – don’t hide them in PDF or Word Doc attachments.

3. Add Word-Bank to your site

Word-Bank definitions add comprehension to your website content (can also be added to individual policy pages). Word-Bank won a BBC innovation lab award for aiding those that could fall through the information gaps and our technological approach.Live example visit
Or Word-Bank FAQs for more information.

4. Creating an animated (easy read) film

This is a great way to make complex subjects accessible. An example being NHS Englands national Continuing Healthcare film (created with Greenwich CCG).
Continuing Healthcare is sometimes known as end of life care, it’s when our health needs change when having illnesses such as cancer and being able to access addition budgets that are fairly much unlimited.
The policy has a legal context, it was published then copied and pasted across NHS websites but the policy was too complex for time poor health professionals to understand and then be able to impart to patients and families.

We worked with the policy writers to create an easier-to-read script of the policy and create an animated film.
For improved accessibility we:

  • published the script of the film in website text for those preferring to read (such as those using screen readers) and have the additional benefit of Word-Bank definitions.
  • theres nothing spoken in the film thats not displayed graphically and vice verse
  • the film has voice over and it’s also captioned

Live example: www.enabledcity.chc/ or  NHS England’s CHC policy that the film was made from

Animation is very effective and also worth considering how widely it can be used – NHS England’s national version is freely available and it can be localised with own staff intro’s and outros

Animated example of Transforming Care programme

5. Review your contact us page

Its also worth reviewing your contact us section of your website, can the copy be improved? Would using transport symbols and a map help people with low literacy report abuse in person – such is best practice for Patient Advice Liaison Service in NHS (NHS complaints service). Use PhotoRoute to remove barriers to independent travel.

See how Tottenham Hotpsur Foundation removes independent travel barriers
Contact us for more information

Case Studies HERO docs News PhotoRoute Word-Bank

Accessible Information Standard Myth Buster

13 Myths of the Accessible Information Standard

Download NHS England’s Accessible Information Standard Myth Buster (powerpoint) to bust the below myths..

Myth #1 “If someone can’t read a letter because they’re blind, there’s no point sending them an email or a text message!”

Reality #1

  • A person who is blind may be able to access information sent via email and / or text message but not in a printed letter.
  • Many people who are blind or have visual loss use assistive technology such as ‘screen readers’ which convert text to speech or audio. This means that email and text message (and in some circumstances a letter sent as an email attachment), can be accessible formats for some people who are blind or have visual loss.
  • However, some people who are blind, especially older people who are more likely to be digitally excluded, will not be able to use email or text message, and so accessibility cannot be assumed.
  • The answer? Don’t make any assumptions – always ask people what formats and communication methods work for them – you might be surprised!

Myth #2 “Everyone with a learning disability will need support from a carer or family member at appointments.”

Reality #2

  • It should not be assumed or expected that a person with a learning disability will be, or will need to be, ‘accompanied’ at appointments.
  • Although everyone with a learning disability is likely to need some support to access information and communicate effectively, the type of support needed by individuals varies significantly.
  • Many individuals with a mild or moderate learning disability may be able to live and access services independently.
  • In line with the Mental Capacity Act 2005, everyone should be supported to be involved in decision making as much as they are able.
  • Some people with a learning disability will need support from an advocate at appointments.

Download NHS England’s Accessible Information Standard Myth Buster (powerpoint)

Useful resources:

  • HERO docs (Healthcare Easy Read Online), developed with NHS Englands’ AIS team and other leading providers
  • Word-Bank, automated jargon buster for health and social care websites
  • PhotoRoute, our Paralympic & Premier League way finding tool (developed from travel training concepts)
  • Animated films created with the NHS

To find out more about the Accessible Information Standard visit the NHS England website here:

Awards Case Studies HERO docs News PhotoRoute Uncategorized Word-Bank

Disability Rights UK Partnership

Enabled City is the digital accessibility partner to Disability Rights UK, in recognition of being the specialist technology supplier for and with people with disabilities.logo-Disabiltiy-Rights-UK
Our expertise comes from working with and employing people with disabilities to develop inclusive services that improve inclusion, safeguarding & education practices within any sector.

Clients include London 2012 Olympic and Paralympic Games, premier league football clubs and their foundations, various NHS providers making meticulous policy and processes more accessible for hard to reach groups. Our inclusively designed services and products are easy to bolt onto client’s existing services and extend their market reach to:

  • The grey pound / silver surfers
  • People speaking English as a second language
  • People with physical or learning disabilities
  • Young families with buggies
  • The Deaf community
  • Those with low literacy – the average reading age in the UK being that of an educated 11 year old (BBC)
  • Visit our services pages for more information.

Word-Bank 50% discount offer for DR UK members

In celebration of becoming Disability Rights UK preferred technology partner Enabled City are pleased to offer a 50% reduction for new Word-Bank clients.
This is a time limited offer valid until 6th March 2017

Terms and conditions

  • Have less than £300k turnover
  • Have the in-house technical expertise to integrate Word-Bank which usually takes 1 hour
  • Advocacy groups under 100k should contact us for additional offers
  • Discount is valid for first year licence only
  • Orders must be received by 6th March 2017

Subscribe to our mailing list for early bird offers

Case Studies PhotoRoute Uncategorized Word-Bank

PhotoRoute gets a make over

We’re about to release a new brand new PhotoRoute system making it even easier to create maps via mobile devices. Tottenham Hotspur Foundation have received funding from the Premier League Charitable fund to roll out the new service across their services – register to keep up to date.

We’ve built on the mobile experience as used by Tottenham Hotspur Football Club.

The mobile experience is that a visitor comes within range of a mapped facility and:

  • is able to input their destination to get the closest step free route to it
  • in addition to their location being shown on the map visitors have the option to select automated way-finding so landmarks change as they move through the journey
  • clients will be able to display other facilities around the journey which for a stadium may include food, merchandising and other accessible facilities
  • ability for visitors to choose access preferences (‘step free only’ or ‘steps are ok’)

Stage 2 will enable family members to privately publish a map and track journeys (via gps fob for those using printed maps), the technology will provide alerts should the traveller deviate off the chosen route.

busy street

What’s the issue?

People inherently learn to navigate themselves through landmarks. Normally when you ask for directions on the street, more often than not you will be told “make a right before the KFC” or “turn left past the gas station. PhotoRoute shows the user which landmarks to keep an eye out for.

83% of disabled people had ‘walked away’ from making a purchase, unable or unwilling to do so. The most important factor was inaccessible premises. Other important factors that discouraged disabled consumers from spending were poorly designed products and staff who were not disability confident, were rude or appeared prejudiced”. Disability Rights UK

There are many factors that may limit life opportunities of people who have support needs and independent travel is often the major barrier to overcome, for individuals with learning disabilities this is often compounded by anxious family members or support workers.

Providers of services have one opportunity to attract a new customer and often rely on DIY tools such as Google maps that don’t provide enough detail which reduces independent travel confidence. Enabled City uses the expertise gained from working with people with learning disabilities, who often have high information processing support needs, to provide inclusively designed Software as a Service tools, to give clients the tools to be inclusive of the widest possible audience, including including tourists, people with and without disability, parents with young children, people whose first language is not English, British Sign language users, and people who find traditional map reading difficult.

Inclusive or universal design is the design of buildings, products and/or services that are accessible to, and usable by, as many people as reasonably possible without the need for special adaptation. For a design to be inclusive it must respect the needs of people with mobility, visual and hearing impairments, learning difficulties, and people from different cultural and religious backgrounds”
Margaret Hickish, ODA, Responsible for Accessibility and Inclusive Design of the Olympic Park and Venues, London 2012

Our first tool Word-Bank (developed in 2006) helps large NHS websites break down language barriers by automatically hyperlinking an easier-to-read definition to popup window to explain the industry specific jargon, defintions can also be supported with graphics or animation.
Word-Bank won a BBC Innovation lab award and was independently proven to aid website comprehension by 100% by the former Disability Rights Commission. Word-Bank is also used by Get Yourself Active, a new project by Disability Rights UK to help bridge industry specific language between people with disabilities, County Sport Partnerships and NHS providers.

Through the process of developing Word-Bank, people with learning disabilities highlighted the difficulty of independent travel and way finding to new venues, so we developed what is now called PhotoRoute. GetYourSelftActive-banner

What is PhotoRoute?

PhotoRoute is a map authoring toolkit developed from travel training concepts used by people with learning disabilities, it uses photographic landmarks taken from the walker’s perspective. It was developed after winning our Visit London Gold award for earlier mapping work.
PhotoRoute has been used on 2 London 2012 Paralympic projects, the first being to showcase their 4 million pound access improvements to the South Bank. We provided 26 photo supported maps showcasing the new accessible routes along the Southbank and connecting rail and tube stations on both north and south of the river all with return journeys. PhotoRoute maps were freely accessible in print, website, on mobile devices and embeddable into other websites.
Our second Paralympic was to PhotoRoute map the GLA’s Olympic Mascots on their 5 Discovery Trails, helping people find the Olympic mascots via easy to navigate, step free walking routes while linking West, Central, South and East London together. olympic-mascotts-Blue-TrailWith the run up to the Olympic and Paralympic games London was (and feels like still is) a building site. PhotoRoute provided a flexible and efficient solution, the Greater London Authority then presented PhotoRoute alongside the inclusive design of the Olympic and Paralympic Stadium to the International Paralympic Committee at a Mayoral reception.

The GLA was delighted to collaborate with Enabled City on this project. The flexible nature of this small, innovative company allowed us to complete this project in an efficient timescale without compromising its quality or content. It is always a pleasure to work on projects like this, that benefit such a wide audience and showcase how the Greater London Authority is helping to make the SouthBank, and London, a more accessible and inclusive place”.
Julie Fleck OBE, Advisor on the Paralympics, London 2012 Unit at the Greater London Authority

PhotoRoute has since been used by:

  • Learning disability teams as a supported employment tool
  • Hospitals
  • Visit England
  • Tottenham Hotspur Foundation to increase grassroots participation and engagement
  • Tottenham Hotspur FC for match day experience

For more information register to test drive the new system or visit PhotoRoute FAQs

Case Studies News Uncategorized Word-Bank

Get Yourself Active projects a universal language

Get Yourself Active uses Word-Bank to create a common language for disabled peoples user led organisations, County Sports Partnerships, local authority social care departments and NHS healthcare providers.

“We have been really pleased with the Word-Bank software on the Get Yourself Active website. It has helped us to communicate with our audiences whilst keeping some of the difficult language which we sometimes need to use. It is also very helpful that we are able to get in touch with Enabled City colleagues and add words to our bank which means we can respond to what our users are telling us.
This will open up doors to information for wider audiences and hopefully encourage more disabled people to get in touch and tell us their stories of getting active – this is what is most important to us!!”

Leanne Wrightman, Project Manager – Get Yourself Active

Get Yourself Active is a partnership led by Disability Rights UK, funded by Sport England and delivered by Leicester Centre for Integrated Living and Cheshire Centre for Independent Living. They aim to work with the health, social care and sports sectors to develop better opportunities for disabled people to get active.

Disabled people have a right to be active in a way that’s right for the individual which includes using a personal budget if you wish.


“Less disabled people (18%) are active than non-disabled people (39.2%) and amongst many barriers to getting active disabled people’s perception of their own ability to take part can prevent them from getting involved. This is often fuelled by difficulty in accessing opportunities and a lack of disability confidence from providers. We feel that joining up health, social care and sports sectors can be a powerful means to increasing positive outcomes for people when the process is right and people’s views are included.”
Disability Rights UK

Get Yourself Active is an information resource helping people find local opportunities and examples of how others have used their Personal Budgets and Personal Health Budgets to Get Active – nice work GYA!

Get connected on twitter @GetYrselfActive  or visit

Filming Uncategorized Word-Bank

NHS Continuing Healthcare

Enabled City has worked with Greenwich CCG and NHS England to create a motion graphics film about NHS Continuing Healthcare (NHS CHC). The film aims to explain better to people and families how the NHS decides if someone is eligible for NHS CHC.

There is a national version with an introduction by NHS England, and NHS England is making this version freely available for all CCGs and NHS Trusts to use, with permission to embed on their web pages.

Greenwich CCG has customised a version for its own local use, with a Greenwich intro and close, and Greenwich CHC staff interviews (see version below). Other CCGs or NHS Trusts wanting to add local branding such as introductions and staff interviews should visit the ‘How to embed NHS England’s CHC‘  page or for other projects visit our film page.

CHC full version (no menu)

Playlist version ( with menu You Tube menu button )

How to leave feedback or share the film

  1. Click on the YouTube button to view the film on YouTube view on You Tube button
  2. Click on the like buttons You Tube like button
  3. Or add a comment to the text area providedAdd comment image
  4. Click on the share buttonYou Tube social sharing buttonto find embed code or to share on social media.


This film is a guide for people who may need ongoing care and support because of complicated, intense or unpredictable healthcare needs from a disability, accident or illness. It will explain how the NHS decides if someone’s care should be paid for entirely by the NHS. Care that is paid for entirely by the NHS is called NHS Continuing Healthcare. How NHS Continuing Healthcare works is described in the National Framework for NHS Continuing Healthcare, which is written by the Department of Health.

Because NHS Continuing Healthcare is such a long name, we will call it CHC.

This script is divided into sections. These are:

Some important facts about CHC
Before the process starts…
Step 1 – The Checklist
Step 2 – The Full Assessment
Planning your support
Reviews, and
NHS Continuing Healthcare Fast-Track Pathway

If you want to move between sections, please use the menu.

Some important facts about CHC

CHC is available only for people who:

  • are 18 or older,
  • live somewhere like a care home or their own home, but not in a hospital setting,
  • and who have a ‘primary health need’.

CHC criteriaIt’s difficult to explain in a simple way what we mean by a ‘primary health need’, as it’s very complicated, with lots of different parts. One part is about your main need for care. Your main need for care should be because you have complicated, intense or unpredictable health needs from a disability, accident or illness. So if you have difficulty with things like breathing, eating and drinking, taking medicines, moving about, memory and thinking, or other difficulties, you may be eligible for CHC.

To find out if you are eligible for CHC, you need to go through a process with two different stages. Stage 1 – the Checklist – will be used to decide if you need to move on to Stage 2. Some people will not move on to Stage 2. Stage 2 is a full assessment, which should not take longer than 28 days, but sometimes there may be delays.

Before the process starts…

To start with, the person – or you – needs to give informed consent for the CHC process to happen, and for information about you to be shared between the health and social care workers involved. Informed consent means agreeing to something when you have full understanding of what could happen, and know all the possible risks and benefits. Your consent may be checked again, or you may be asked for your consent again, later in the CHC process.

It’s important that you understand as much as you can about CHC before deciding if you want to consent. For example, you need to know that if you are eligible for CHC, the NHS will become responsible for and will pay for all your care and support, but you might lose some welfare benefits.

If there are worries that you can’t give informed consent for any reasons, the Mental Capacity Act has to be used to prove you are not able to give consent.

If you can consent, then you decide whether you want the CHC process to happen.

If you can’t consent, a health or social care worker will normally be the decision-maker.

The decision-maker should talk with all the people who have real interest in you, like family, friends and care staff. The decision-maker listens to everyone and then decides if asking for CHC funding is the best thing for you. This is called a ‘best interests’ decision. Asking for CHC funding is usually the best thing to do, as if you are eligible, you do not pay anything towards the costs of your care.

The ‘best interests’ decision must be written down. The CHC process can only begin if the ‘best interests’ decision is that the process should start.

Step 1 – the checklist

CHC stage 1Step 1 in the CHC process is to complete the checklist.

This has to be completed by a social care worker or a health worker, like a nurse. They will meet with you to discuss your needs.

You can have an advocate with you, and friends or family, whoever is important.

The worker will ask about your health and the help you need.

If you have a person-centred plan or another plan, you can use this to help explain your needs.

The worker will need to talk to other people about your care needs, like your family or others who support you, and other health or social care workers who work with you.

The worker will use all the information to fill in the checklist. You should get a copy of this.

The results of the checklist show if you can go on to the next stage or not.

The checklist should be sent to the Clinical Commissioning Group, even if you are not eligible to go on to the next stage. We call the Clinical Commissioning Group the CCG.

If the checklist results show you are not eligible to move on to the full assessment, you can ask the CCG to think again about their decision.

Step 2 – the full assessment

The CCG will choose someone to co-ordinate the full assessment, so that you have a named person to check things with.

The full assessment has two parts – an assessment of your care needs, and the Decision Support Tool.

The care needs assessment must give accurate and up-to-date information about your health and social care needs. This information should come from you and your family, and a multi-disciplinary team involved in your care. (A multi-disciplinary team is a group of 2 or more professionals, who are different types of health and social care workers, like psychiatrists, nurses, social workers, care managers, occupational therapists, and so on, who work together.)

CHC Decission support toolThe multi-disciplinary team uses all of the information from your care needs assessment to complete the Decision Support Tool.

The finished Decision Support Tool helps the CCG decide if you should get CHC or not.

The Decision Support Tool has 12 sections, called Domains. Each domain helps you think about a different care need, and consider the sort of support and how much support is needed to manage it. The domains are:

  1. Behaviour – This is about the way you behave, like being aggressive or noisy, or being frustrated because you have difficulty communicating with others. Some behaviour is difficult for others to cope with, which is called ‘challenging’ behaviour, or some behaviours could be a risk to you, or other people, or things, and will need special support and care.
  2. Cognition – This is to do with brain skills, like memory, understanding risks, decision-making, understanding where you are, and road safety. This affects the type of support you need to manage your day-to-day life and stay safe from harm.
  3. Psychological and emotional needs – This is about your mental and emotional health, including things like mood disturbances, hallucinations, or anxiety. It’s also about the effects of these, like when people have depression they may get very withdrawn and refuse to accept help from others, which makes it harder for them to get better.
  4. Communication – This is about whether you can express your needs and understand others, in ways like talking or signing, use of pictures or Braille, hearing aids or other communication technology.
  5. Mobility – This is to do with how well you can move and control your body, and if you can stand or walk. It’s important to think about your safety, and if you are at risk of falling and need support.
  6. Nutrition – This is about whether you can eat and drink, and if you need help with this, like feeding by PEG, or if you have problems swallowing, like dysphagia.
  7. Continence – This is about your needs with using the loo, like whether you can control this, or if you need help with things like managing constipation, catheters, urinary tract infections, and so on.
  8. Skin – This is about looking after your skin. Some people are more at risk because they have a skin condition, which can break their skin down, or they may have pressure damage or wounds that take a long time to heal.
  9. Breathing – This is about your needs with any breathing difficulties you may have, like breathlessness, asthma, or Chronic Obstructive Pulmonary Disease.
  10. Drug therapies and medication – This is about your experience of your symptoms and the medication you need. This could mean things like coping with pain, insulin injections, any side effects, or if you need prompting and supervision with medication.
  11. Altered states of consciousness – This is about the conditions that affect consciousness, like having epilepsy or Transient Ischaemic Attacks (TIAs) which are like mini strokes.

Section 12 is for ‘other significant care needs’ that are not described in the other domains, if the care needs are really important for you.

The order in which you think about the domains doesn’t matter, as long as you think about ‘other significant care needs’ last.

Workers from the multi-disciplinary team write about your care needs for each domain. They also measure your needs with these weightings: ‘No needs’, ‘Low’, ‘Moderate’, ‘High’ and – for some domains – ‘Severe’, or ‘Priority’.

The domains and weightings are shown in a chart, called a matrix. This can give a good picture of all your needs together.

If all your care needs are measured as ‘No need’ or ‘Low need’, this shows that you are not eligible for CHC.

However, if your care needs include one ‘Priority’, or two or more ‘Severe’ weightings, then you are very likely to be eligible for CHC.

If your matrix shows a mix of different weightings, you may still be eligible for CHC because we also consider the Nature, Intensity, Complexity and Unpredictability of your needs.

CHC matrixNature: This describes what your needs are like, and the effect they have on you, including the type of support or treatment that works best to manage those needs.

Intensity: This describes how much (like how often) and how severe your needs are. It also describes the support needed to help you, including the need for ongoing care.

Complexity: This is about how your needs affect each other, like if one of your needs makes another need change or get worse, and become difficult to manage. It also describes the level of skill needed to check your symptoms, treat the condition and/or manage your care.

Unpredictability: This is about how much and how often your needs can change, and what the challenges are for the people who give you care and support. It should also explain the risk to your health if the right care is not given at the right time. Someone with an unpredictable healthcare need is likely to have a changeable and unstable condition, or a quickly deteriorating condition.

The Decision Support Tool helps health and social care workers identify and describe your needs. With this knowledge and their skills and professional judgement, they work out if you have a primary health need, and if they think you are eligible for CHC. This is called their recommendation.

When the care needs assessment and Decision Support Tool are complete, you need to check if you agree with what has been written about you.

The multi-disciplinary team can give you a copy of all the forms and documents that have been written.

The documents and the recommendation are also shared with the CCG, and the CCG decides if they agree with the recommendation. The CCG usually agree with the recommendation from the multi-disciplinary team, unless there are very strong reasons why they can’t. You will then get a letter from the CCG saying whether you are eligible for CHC.  If you are not eligible, the CCG should explain why.

If the CCG decides you should not have CHC, you can ask them to think again about their decision. And if you’re still unhappy with the CCG decision, you can then ask for an independent review from NHS England.

If you aren’t eligible for CHC, the NHS may still have a responsibility to provide you with care and support to help you manage your health needs, like by commissioning services, or paying for some of your help and support.

Care that is commissioned or paid for by a local authority and a CCG is called ‘joint-funding’ or a ‘joint package’.

If your care is paid for by the CCG and the local authority together, you may have to pay a contribution (or part of the cost) for your social care. The CCG will not charge you for the NHS care you need.

If you’re not eligible for joint funding, you may be eligible for support from your local authority.

Planning your support

If you are eligible for CHC, the next step is to agree on your health and wellbeing goals, and the care you will get. This is called ‘planning your support’. A CHC nurse will work with you to make your Support Plan. They will talk with you about:

  • the health and wellbeing goals you want to achieve
  • the care and support you need in your day-to-day life
  • how your needs and care will be managed
  • where your care will be given, like, in your own home or in a care home, and
  • which organisation/s will be responsible for meeting your needs

CHC support plan

Your wishes should be an important part of the decisions that you both make together.

It is possible to use CHC funding to continue with any care or support you were already getting. You would only do this if the care you had was good quality, and met your needs.

It’s also important that any support or care is what you would choose for yourself, as long as it doesn’t cost more than the NHS can afford to pay. For this reason, anyone eligible for CHC has the right to have their CHC funding as a personal health budget.

Personal health budgets give people real choice and control over how to meet their health and care needs.

Personal health budgets work in a similar way to personal budgets from social care services. They work in 3 ways (or a mix of these), which are:

  1. The money can be held by the NHS
  2. The money can be held by an organisation that you choose or agree to
  3. The money can be held by you as a Direct Payment for healthcare, so you buy and manage your own care.

A personal health budget is not new money. It just allows you to use NHS funding to plan your care in different ways, ways that work better for you.


If you are eligible for CHC and your care package is started, the CCG will check things with you after 3 months. They will check to see if the care you get is meeting your needs and goals, and if CHC is still needed. This is called a review.

After that, the CCG will meet with you every year for a review. Each review will check to see:

  • if your needs and goals are being met
  • if your care package still fits your needs, and
  • if you are still eligible for CHC.

NHS Continuing Healthcare Fast-Track Pathway

If you have a health condition that is getting much worse quickly, and you are near the end of your life, you may be eligible for the CHC fast-track pathway. This is when things are done very quickly, so you can get treatment and support as urgently as possible.

To get your care fast-tracked, a doctor or other health professional has to complete one referral form called the Fast-Track Pathway Tool. This form is used to explain that you have a quickly deteriorating health condition, and that you may be near the end of your life. This form goes to the CCG.

CHC fast-track

Fast-track referrals from health professionals are usually accepted straightaway, but the CCG may need to check some information, if they have any questions.

The Checklist, Health Needs Assessment and Decision Support Tool are not used if you need fast-track care. But if your health improves or stabilises while you’re on the fast-track pathway, a full CHC assessment will be completed. This helps the CCG check if you still need CHC.
To find out more about NHS CHC in Greenwich, email or phone the CHC team at Greenwich Clinical Commissioning Group.
Email is
Phone number is 020 3049 9000
Greenwich CCG

NHS Greenwich CCG would like to thank the following people from or for Enabled City, Greenwich Association of Disabled People, NHS England, NHS Greenwich CCG, The Royal Borough of Greenwich and Symbi Consulting for their help and advice in making this film.

Alan Colhoun, Aissa Damree, Mary Donkor, Alan Kerr, Jim Ledwidge, Alick Mackenzie, Lisa Mackenzie, Jason McCulloch, Gary McKenzie, Colette Meehan, Elaine Newman, Trish O’Gorman, Buki Omopariola, Rosie Robinson, Karen Scarsbrook, Vee Scott, Simon Shenton-Tan, Smriti Singh and Jason Yates.

News PhotoRoute Uncategorized Word-Bank

Barclays Premier League & THFC Open for Business

We’re honoured to be asked to present at Barclays Premier League’s inaugural Open for Business event with Tottenham Hotspur FC and Foundation.

The event showcased practical examples of what works well alongside representatives from proactive clubs, Barclays banking group and inclusion representatives from the Premier League, with the hope of creating a template to be used to influence clubs across the Premier League, and to drive Barclays ambition to become the UK’s most accessible bank.

We’re also aware of other grassroots initiatives following a similar vein of wanting to embrace inclusive design approaches to improve match day experience and empower disabled supporters at a local level.

Premier League integrity challenged in the news

This month the Premier League secured a record broadcasting deal of £5.136 billion, a massive sum set to be bigger still once international rights are sold again, the Guardian posted that “the Premier League can’t be relied on to alter inequality that defines our age, the huge TV rights deal has only highlighted the massive disparities The Guardian newspaperwithin football and society as a whole but the government or the game must find a way for the millions to be shared around”.

Level Playing Fields

“The Premier League has pledged to reinvest income across the game including the delivery of ‘world class stadiums’. Yet conditions for disabled fans at many PL clubs remain woefully poor according to a BBC report last year.

Level Playing Field (LPF) is calling on the Premier League not to forget its disabled fans when distributing this new revenue and to ring fence just 1% of this new TV funding for 2016/17 to ensure that all professional clubs in the Premier and Football Leagues spend the money on improving access for disabled people #justdoit.”

For full article visit Level Playing Field or see recent House of Lords Debate on Accessibility of Sports Stadia.

Barclays-cardBarclays Open for Business

Grant Cornwall, CEO Tottenham Hotspur Foundation welcomed guests to White Hart Lane followed by a keynote speech from Elaine Draper, Barclays Head of Access. Elaine passionately spoke about the opportunity of getting services right for people with disabilities to improve customer satisfaction for all customers while future proofing services for our ageing populations.

Chris from Manchester United FC bravely volunteered to wear Barclays simulation suit, the 20kg outfit strains key areas of the body using weighted padding to mimic physical restrictions such as head mobility, joint stiffness, loss of strength, reduced grip and coordination. Ear defenders and a range of goggles and safety glasses also copy impairments such as opacity of the eye lens, a narrowed field of vision and high-frequency hearing loss.

Barclays simulation suit (BESS)

Charles Nelson, Barnet and Southgate Centre of Excellence kicked presentations off, providing an overview of barriers faced by students with high communication support needs followed by Alick from  Enabled City presenting inclusive design and “getting information right for people with learning disabilities means your service will be inclusive of the widest possible audience including people at the UK’s national reading literacy (educated 11 year old, BBC)”.

Charles Nelson presents from Barnet and Southgate college

Gareth Jones, Tottenham Hotspur Foundation shared Sports M.A.T.E. (Mentoring, Access, Training, Equality). The project operates within mainstream sports clubs (i.e. not disability specific) to support young people with disabilities to participate in mainstream sport clubs/opportunities through provision of personalised mentoring and a referral scheme.
Transport is not provided, individuals need to get themselves to where club sessions are located, Gareth introduced PhotoRoute as a means to support more people onto the program. The Sports M.A.T.E project is now being rolled out nationally.

Barclays Access – serious about customer service

Kathryn Townsend, Strategic Transformation Leader for Accessibility presented Barclays new iBeacon service, Barclays Access. The iPhone app notifies staff of a customers access preference before they enter the building, front desk staff receive an alert via an iPad along with the customers picture for easy identification and their service preferences – all before the customer enters the branch ie. I’m hard of hearing in my right ear, stand on my left side when speaking to me.
Nice work Barclays.
iBeacon technologyFollow this link for more information on iBeacon.

Premier League logoWhat is the Premier League?

The Premier League is the organising body of the Barclays Premier League with responsibility for the competition, its Rule Book and commercial rights. It’s a private company wholly owned by its 20 Premier League Clubs who make up the League at any one time. Each club works within the rules of football, as defined by the Premier League, The FA, Uefa and Fifa as well being subject to English and European law.

The Law – Equality Act 2010

The Equality Act covers everyone, how many characteristics do you have?

  1. Age, argh yes I have an age.
  2. Disability
  3. Gender reassignment
  4. Marriage and Civil partnership, hmm, yes I’m married.
  5. Pregnancy and Maternity, yes we have children.
  6. Race, unhuh the human race.
  7. Religion and belief, well doesn’t everyone even if they’re an atheist?
  8. Gender, this is getting very easy..
  9. Sexual Orientation, ok, you win, I have well over half the characteristics covered by the Equality Act.

*A protected characteristic is something about you that may make you subject to discrimination because of that characteristic

Equality Act – Service providers

Anticipatory Duty – service providers must be proactive in considering how their services create problems for disabled people and consider reasonable remedial action.
Continuing Duty – monitor and review in the light of experience.
Evolving Duty – not to be considered once and then forgotten.

A disabled person

Someone who has a physical or mental impairment that has substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities (though many older people do not consider themselves disabled this definition makes it clear that they do meet the description above).