Case study: South Tyneside and Sunderland NHS Foundation Trust and North East and North Cumbria Integrated Care Board

South Tyneside and Sunderland NHS Foundation Trust (STSFT) serves a patient population of almost half a million, employing over 8,000 people to deliver acute and community care across South Tyneside, Sunderland and parts of Gateshead. The patient population is impacted by some of the highest socio-economic deprivation in the country, with significantly lower life expectancy, higher premature deaths, and lower health access compared to the national average (South Tyneside Council, 2023).

STSFT has developed a population health strategy, which sits alongside the core organisational strategy, as an enabling document (STSFT, 2023a). The population health strategy consists of four key priorities: prevention, health equity, being an anchor organisation, and environmental sustainability. The strategy identifies the key challenges within the patient population, and the enablers to assist the trust in delivering change, emphasising community engagement, system working, credible data and a workforce culture fit to address these challenges.

The trust has taken a leading role in identifying health literacy as a key barrier to access, and tackling the health inequalities that it exacerbates. With 65% of local residents struggling to understand health information that includes words and numbers – placing the North East above the national average in health literacy challenges – the trust has implemented a dedicated programme to address these barriers.

Initiative

STSFT has taken a proactive and strategic approach to improving health literacy, recognising its direct impact on patient outcomes, engagement, and long-term health conditions. By embedding health literacy into its operational and strategic framework, the trust is taking active leadership in ensuring healthcare information is more accessible, improving patient confidence, and ultimately driving better health outcomes for its population.

At the heart of this initiative is the establishment of the trust’s Health Literacy Team, tasked with ensuring that all communication across the trust is clear, accessible, and supportive of patient understanding (STSFT, 2023b). This spans a wide range of written materials, from clinical leaflets to staff policies, alongside a focus on verbal communications. By embedding health literacy principles into everyday interactions, the trust is working to reduce patient anxiety, improve self-management of health conditions, and ultimately enhance health outcomes.

A key aspect of the programme is the creation of a health literacy approval process, which applies a rigorous review to patient information leaflets. This process includes using a health literacy checklist and a guide to writing leaflets, ensuring that health literacy considerations are factored into the earliest stages of content development. Materials that meet the required standards receive a stamp, providing assurance that they have been designed with patient comprehension in mind.

Recognising the importance of an organisational culture shift, the trust has secured board-level buy-in to ensure health literacy remains a strategic priority. This senior level commitment has facilitated the roll-out of specialist training for staff, equipping them with the knowledge and tools to support patients more effectively. Training focuses on practical strategies for simplifying complex information, using plain language, and engaging patients in ways that empower them to take control of their health.

Beyond the trust, STSFT benefits from the wider support of the North East and North Cumbria Integrated Care System (ICS), which has developed a system-wide healthliteracy workplan (North East and North Cumbria ICS, 2025). This collaborative approach enables the trust to align its efforts with regional initiatives, ensuring a cohesive and impactful response to health literacy challenges across the region. The trust has, however, maintained a leading role in the development of collaborative regional work on health literacy and the system workplan is built on the existing work of the trust (North East and North Cumbria ICS, 2025).

Evaluation and impact

STSFT has taken a systematic and evidence-based approach to evaluating the impact of its health literacy programme. This has included a comprehensive review of existing literature, comparisons with international best practice, and the assessment of interventions in patient and community settings.

One of the key measures of success has been the qualitative feedback received from both staff and patients. Trust staff have reported increased confidence in their understanding of health literacy principles, as well as an improved ability to write and communicate in a more accessible manner. One staff member said, “by using simpler language and avoiding jargon, it feels like we’re really speaking to the patients, not over them. They can feel more involved and like they’re part of the conversation about their health”.

From a patient perspective, themes emerging from feedback groups include a greater sense of empowerment, enhanced shared decision-making, and an overall improved healthcare experience. Patients have provided positive feedback such as, “the way they explained everything and the leaflet they gave me, it was really clear. I felt like I could follow it on my own and manage things without needing to come back all the time”. These insights suggest that the programme is effectively addressing communication barriers and fostering a more inclusive healthcare environment.

The trust has also made significant strides in embedding health literacy principles across its wider strategy. It is on track to have trained over 1,000 staff members, ensuring that health literacy is a fundamental part of professional development.

The team has assessed and revised over 800 written documents to align with best-practice principles, making patient information clearer and easier to understand. Before, only 7% of trust leaflets matched the local reading age, now 70% of leaflets do. This percentage is growing as more leaflets are agreed by clinical governance groups. The approach has been externally evaluated, with results demonstrating patient preference for updated materials, with participants in the study feeling more empowered to manage their health and address concerns with their healthcare provider (Dunnett et al, 2004).

Beyond internal improvements, the trust has maintained a strong focus on community engagement. More than 500 conversations have taken place as part of ongoing outreach efforts, ensuring that health literacy improvements extend beyond clinical settings and into the communities served by the trust. The trust aims to deliver engagement exercises at least once per month, and is exploring working with local colleges, to ensure new leaflets are still meeting the needs of local people.

The success of the programme has also been recognised externally, with the health literacy team receiving multiple award nominations, including the NHS Parliamentary Award and Royal Society for Public Health’s Healthier Lives Award.