Case study: Manchester University NHS Foundation Trust

Manchester University NHS Foundation Trust (MFT) is one of the largest NHS trusts in the United Kingdom, providing a wide range of acute services to approximately 850,000 patients across Greater Manchester. With a workforce of more than 28,000 staff, MFT is one of the largest employers in the region, contributing significantly to local healthcare delivery and research initiatives.

Greater Manchester has a diverse population and long-standing health inequalities. The city has higher rates of long-term conditions such as cardiovascular disease, respiratory illnesses, and mental health disorders compared to the national average (Manchester City Council, 2021). Recognising these disparities, MFT has developed strategic initiatives to address health inequalities, including establishing a dedicated health inequalities steering group focused on reducing disparities and maximising social value.

In the Manchester area, literacy and numeracy levels fall below the national average (Manchester City Council, 2025). It is estimated that 71% of the population aged 16-65 would likely have difficulties in understanding or interpreting health information that includes numbers (Geodata, 2025).

Acknowledging the link between poor health literacy among socio-economic groups and widening health inequalities, MFT embedded health literacy into its broader health inequalities work to tackle disparities in healthcare access and outcomes (NHS Providers, 2024c).

Initiative

MFT aimed to drive a fundamental cultural shift in how health literacy is addressed across the organisation. Achieving board buy-in has been key to ensuring organisational direction to health literacy. The chief executive has made efforts to raise awareness amongst board members and has included the trust’s ambitions for improving accessibility of patient information within emails to all staff. By embedding health literacy into governance structures, patient engagement, and staff training, the trust is working to ensure that all patients, regardless of their literacy levels, can access the care and information they need.

Strategy

MFT has integrated a health literacy focus into its annual plans, ensuring that accessibility and clear communication remain a long-term priority within service development. Embedding health literacy as a strategic focus ensures that an organisation-wide approach is implemented and that the initiative is sustainable.

Workforce

A key focus of MFT’s approach has been to raise staff awareness on the impact of health literacy and empower them to support patients to navigate health information more effectively. To achieve this, the trust introduced health literacy training for staff, ensuring that healthcare professionals are equipped with the skills to communicate in clear, accessible ways (Manchester University NHS Foundation Trust, 2025). Training is held monthly via MS Teams and lasts for an hour and is open to all staff. The training is currently embedded in the trust’s children’s hospital induction process, although they are seeking to embed it across wider induction. The training helps staff to recognise when patients may be struggling with health information and provides them with the tools to explain complex medical details in a way that is easier to understand. Currently, over 1000 staff across the organisation have attended training.

At a service level, MFT has sought to embed a sustained culture of health literacy awareness by appointing health literacy champions within each service. These individuals act as advocates for clear communication, supporting their teams in reviewing materials and ensuring that health literacy remains a priority in day-to-day patient interactions. To become a champion, staff members expressed interest to the steering group and received a detailed role specification of key responsibilities. Once agreed with the steering group, they joined the community of practice – currently standing at 18 champions.

Patients

A key pillar of the trust’s initiative has been engaging with patients and the community, to build their perspectives into the initiative and ensure that changes are meaningful and effective. The trust established co-design groups, bringing together patients and service users to review health materials, discuss challenges, and provide input into how healthcare information is communicated. These groups operate off-site and consist of attendees brought together via Manchester College, reviewing and feeding back on materials on an ad-hoc basis.

The trust has undertaken a comprehensive review of leaflets, website content, and other resources, making sure that health information is up to date, accessible, and easy to understand. Alongside this, MFT established a ‘gatekeeper’ process to review patient-facing materials, such as appointment letters and leaflets, ensuring that all written
communication is accessible, free from jargon, and easy to follow.

Recognising that health literacy is shaped not just by individual understanding but also by the environment in which care is delivered, MFT is improving location information in letters and site signage to make its facilities and services more accessible. The trust recognises there is still a lot more work to be done in this space and this remains a long-term project.

By incorporating direct feedback from those who experience these barriers first-hand, MFT has been able to refine its approach and ensure that its interventions meet patient needs. Through these collective actions, MFT aims to drive a fundamental cultural shift in how health literacy is addressed across the organisation. By embedding health literacy into governance structures, patient engagement, and staff training, the trust is working to ensure that all patients, regardless of their literacy levels, can access the care and information they need.

Evaluation and impact

MFT has evaluated its health literacy initiative through workshops, staff focus groups, and follow-up questionnaires, gathering qualitative feedback on effectiveness. The trust has found strong staff support for the agenda, though embedding cultural change remains a long-term challenge and ambition.

Lessons learned include the value of the ‘teach-back’ method, ensuring patients can describe the information presented to them, which MFT plans to integrate further. The trust is also looking to strengthen system collaboration across Greater Manchester, reducing duplication and aligning efforts with partners, particularly primary care. The work
has also highlighted the potential opportunities for other public sector organisations to address the role of literacy in the broader social determinants of health, by improving the accessibility of information such as housing and benefits support.

MFT are planning to further evaluate the impact of their health literacy interventions over the coming year. One of the trust’s priorities as part of its ongoing evaluation process is to establish clear links between these health literacy interventions and improved patient outcomes, particularly in reducing DNA rates.