The month in COVID on nhs.uk: May 2022

My team and I look after the website’s COVID hub. We provide users with the information they need and we signpost them to COVID-19 services when they need them. Here’s what happened on nhs.uk in response to COVID-19 in May 2022.

The month in numbers

On average, there were about 326,000 visits a day to the COVID hub. The most frequently viewed pages were booking a vaccination appointment, getting a digital COVID Pass, finding a walk-in vaccination site and getting a COVID Pass letter.

Overall, there were 5.3 million journeys into 1 of the 18 services that users of the COVID hub are signposted to. That’s slightly lower than the number of journeys in April.

Knock-on impact of change to COVID symptoms

Last month I wrote about how the list of COVID symptoms was expanded to 12 from just the 3 main symptoms that required you to get a test.

The new UKHSA guidance on which this change was based talked about “symptoms of respiratory infections, including COVID-19” — not just COVID-19. And the guidance for people with symptoms was:

If you have symptoms of a respiratory infection, such as COVID-19, and you have a high temperature or you do not feel well enough to go to work or carry out normal activities, you are advised to try to stay at home and avoid contact with other people.

We had to consider how far across nhs.uk this change should spread — should this advice to stay at home also appear on the pages for flu, common cold, lost or changed sense of smell, headaches and so on?

On pages like this we had previously had used a yellow warning callout box to ask visitors “Could it be coronavirus?” and signposting them to the COVID symptoms page.

Yellow warning callout signposting to COVID symptoms pages

We decided this was no longer the best approach — especially with the extended list of symptoms — so we removed the yellow boxes and merged the new guidance into the general advice for that condition.

For example, on the fever in children page, the list of things to do now includes “try to keep your child at home and avoid contact with other people until they do not have a high temperature”.

Vaccinations for children aged 5–11

Users highlighted a problem with our information about vaccinations for 5–11 year olds — the Pfizer vaccine patient information leaflet we were linking to contained this line which seemed to contradict what we were saying about the vaccine being safe for 5–11 year olds:

Comirnaty 30 micrograms/dose concentrate for dispersion for injection is not recommended for children aged under 12 years.

5–11 year olds get a smaller dose of the vaccine (10 micrograms/dose instead of 30) and there is a separate patient information leaflet for this ‘paediatric’ dose of the vaccine.

We quickly fixed the issue by adding a link to the other patient information leaflet. We hope that we didn’t confuse too many users, and we are grateful to the people who brought it to our attention.

(This tweet was posted about a week after we fixed the issue on nhs.uk but it shows how easy it is for conscientious parents who are trying to make an important decision about their child’s health to get confused by clinical details and the way that teams like ours publish information.)

In our team we talked about why we missed the other patient information leaflet in the first place. In a nutshell:

• Before it also covered 5–11 year olds, this page was just for 12–15 year olds. We converted an existing thing into a new thing but it retained some of the characteristics of the existing thing.
• The concept of different dose sizes was not something we had come across before. We have a lot of experience communicating eligibility for vaccines and doses and how to get vaccinated, but dose size had never been a thing to consider because until 5–11 year olds became eligible for vaccination everyone was getting the same dose size.
• The patient information leaflet was on GOV.UK so we didn’t scrutinise its contents too closely. Our priority was to make sure the link worked and was pointing at the right thing.

COVID information on non-COVID pages

We planned what will be a big piece of work for our team — reviewing and either removing or updating hundreds of messages about COVID across the whole of the NHS websites. Most of these were added in a furious burst of activity towards the beginning of the pandemic, and thankfully my colleagues who did this recorded where they had put them.

For example:

• On liver disease there is a link to the British Liver Trust’s page about coronavirus and liver disease.
• On snoring we remind people that they if they need to get in touch with their GP they should do so (people not coming forward with non-COVID conditions was a big problem during the pandemic).
• On ibuprofen for adults we recommend people try paracetamol first to relieve COVID symptoms. There are similar messages about medicines on 19 pages.

We organised the pages into 14 groups, including links to charities (119 pages), how to access NHS services (212 pages), NSAID medicines (4 pages) and — inevitably — Other (5 pages).

We used the RICE scoring method to help us decide which group to tackle first. RICE produces a relative priority score by using 4 input values:

• Reach — the more people affected by a change the higher the score.
• Impact — the greater the positive impact the higher the score.
• Confidence — the more research you need to do the lower the score.
• Effort — the longer it will take the lower the score.

We will now review each page in each group to decide if the content should a) stay as is, b) be updated or merged into the rest of the page, or c) removed.

This is not glamorous work. It’s going to be a thankless slog. But work like this is vital if we want to keep a website the size of nhs.uk accurate, trusted and useful.

Other changes to nhs.uk COVID content

• We removed references to the NHS Volunteer Responder Service when that service closed.
• We added Valneva to the list of vaccines approved for use in the UK
• We removed a link to 111.nhs.uk on How to find an NHS dentist because it was creating a circular journey between nhs.uk and 111 Online.
• We linked to the new Paxlovid medicines pages when they went live.
• We updated Who is at high risk from coronavirus to make it clearer and more accurate.
• We updated opening times for the 119 phone line across multiple pages.
• We linked from the NHS vaccinations schedule to COVID vaccinations information.
• We updated Long COVID to take into account the fact that fewer people are now testing, so more people who have COVID will not have had a positive test.

What we’re doing next month

I can’t share everything that we’re currently working on because some of it is sensitive, but here’s what I can tell you. We will:

• review (with the intention of removing) COVID messages on hundreds of non-COVID pages
• update our content on pregnancy and coronavirus
• hold a retro looking back at how the NHS.UK team responded to COVID, from the start of the pandemic to now
• keep the nhs.uk page about monkeypox up to date (yes, my team now looks after monkeypox as well as COVID-19).