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A to Z of house style

This A to Z gives detailed guidance on NHS Digital’s written style. All writing under the NHS Digital identity, whether online or offline, should be consistent with this style.

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abbreviations and acronyms

The first time you use an abbreviation or acronym, spell out the full version in words followed by the abbreviation in brackets (for example: ‘Office of National Statistics (ONS)’). You can then just use the abbreviation.

If readers might not see your first use, introduce the full version again. A new web page or a new chapter in a document, for example, should explain what the acronym or abbreviation means.

Do not use an acronym if you are not going to use it again later in the text.

Some acronyms are more often used than their full forms. These exceptions do not have to be spelled out on first use. Only use an unexplained acronym if you believe 80% of the UK population will understand and commonly use it. No NHS Digital programmes are in this category, but the following are: NHS, GP, BBC, UK, and US.

If you find yourself inventing an acronym, you should probably stop. Acronyms like the ‘NHS’ work because everybody understands them. Many acronyms are not generally understood and get in the way of communication.

Do not use full stops in abbreviations or acronyms: ‘BBC’, not ‘B.B.C.’

Do not capitalise words just because they are being used in an acronym. This use is correct: ‘The global digital exemplars (GDEs) will receive more funding.’ See also capitals.

active, passive

Use the active voice. This will help us write concise, clear content. 

The subject of the sentence performs the action in a sentence using the active voice, for example, ‘The study shows a trend.’

The subject receives the action in a sentence in the passive voice, for example, ‘A trend is shown by the study.’

The passive voice is sometimes useful. However, more often than not, you can find an active form that has the same meaning and is more direct and concise.

See first person.


Punctuate addresses when you write them horizontally:

NHS Digital, 7 and 8 Wellington Place, Leeds, West Yorkshire, LS1 4AP.

Do not punctuate when you write them vertically:

NHS Digital
7 and 8 Wellington Place
West Yorkshire


An ampersand is the ‘&’ symbol.

Use ‘and’ instead of ‘&’ because not everybody understands what it is. We only use it as part of an organisation’s name, for example, ‘Marks & Spencer’ or in commonly accepted abbreviations such as ‘A&E’.


Used for:

  • possessives, for example, ‘NHS Digital’s services’ - see possessives
  • missing letters, for example, ‘we're
  • avoiding confusion for the reader

You can also use apostrophes to:

  • mark omissions, for example, ‘the ’90s’
  • make single letters into plurals, for example, ‘mind your p’s and q’s’
  • avoid confusion when not using an apostrophe would create an unrelated word, for example, ‘the no’s have it’
  • substitute for a missing vowel when words are run together, for example, ‘it’s’, ‘there’s’, ‘we're’

We do not put apostrophes into ordinary plurals, for example, ‘peas’, ‘CDs’ or ‘the 1990s’ and we do not use an apostrophe for the possessive ‘its’.


An application for a mobile phone.

arm’s length body

Use an apostrophe but no hyphen.


blog post

Use two words when talking about an article published on a blog. A blog is the site on which a blog post is published.


Lower case unless it’s part of a proper title or you are referring to NHS Digital’s Board, 'the Board'. For example, ‘board minutes and papers are published after the Board meets'.

See also capitals.



Avoid using bold text apart from in headings and subheadings.


Punctuate inside brackets where a full sentence falls inside the brackets. (This is the way to do it.)

Punctuate outside brackets where only part of the sentence falls in brackets (this is the way to do it).

Only use square brackets to indicate comments added by an editor or editorial interventions like ellipses (see full stops). Avoid putting brackets within brackets.

Britain, British

bullet points

Bullet points break text into short, digestible sections and help to highlight important points.

Always use a lead-in line that ends with a colon and make sure that:

  • each bullet point makes sense when read after the lead-in line
  • you use lower case at the start of the bullet
  • you do not put ‘or’ or ‘and’ after each bullet
  • you do not put a semicolon, comma or full stop at the end of any bullet in the list, including the last one
  • you do not use more than one sentence per bullet point - use commas or dashes to expand on an item

Bulleted lists should be aligned left.

See numbered lists.

byte, kilobyte, megabyte, gigabyte, terabyte

Abbreviate ‘byte’ to B (for example: ‘a 180GB hard drive’).

Use MB for anything over 1MB: 4MB not 4096KB.

Use KB for anything under 1MB: 569KB not 0.55MB.




Always use lower case, even in page titles. The exceptions to this are:

  • proper nouns
  • the titles of organisations
  • the names of directorates or programmes (for example: ‘Clinical Triage Platform’)
  • trade names
  • the first letter of a page or section title in a document (but not the following words unless they take a capital for other reasons)
  • religious holidays (‘Christmas’ or ‘Easter’) but use lower case for seasons (‘summer’ and ‘autumn’)
  • the titles of publications (for example, books, films and papers)

Capitalise all of the words in the first part of the title (for example: ‘Statistics on NHS Stop Smoking Services in England’). Supplementary parts of a title should use lower case (‘Quarterly Improving Access to Psychological Therapies Data Set Reports – Summary statistics and related information’). Prepositions (for example, ‘on’), articles (‘the’) and conjunctions (‘and’) of fewer than four letters should not be put in capitals.

See also quotation marks on the use of single quotes rather than italics when referring to a publication.

  • job titles (but not descriptions of job roles)

Capitalise when using a specific job title (for example: ‘Melanie White, Director of Finance at Company XYZ’ or ‘Stanley Black, Non-Executive Director, NHS Digital’).

Use lower case when talking about a role rather than a job title (for example: ‘the finance director of company XYZ’ or ‘NHS Digital’s non-executive directors’).

  • the names of political parties

Use lower case when referring to government (for example: ‘the government policy on trees’ or ‘the government has passed legislation on public benches’). Only capitalise if using the full title of a government (for example: ‘Her Majesty’s Government of the United Kingdom of Great Britain and Northern Ireland’).

Capitalise ‘House of Lords’, ‘House of Commons’, ‘Parliament’ and ‘Civil Service’, but use lower case when talking about civil servants or parliamentary procedure.

Use lower case for white papers, the opposition, the minister, the cabinet or the secretary of state. However, capitalise when talking about to a specific department (‘The Department of Health and Social Care’), a specific body’s name (‘The Public Administration Select Committee’) or a specific job title (‘The Secretary of State for Health and Social Care’).


Clichés bore people and get in the way of communication.

A survey by the Plain English Campaign found the most annoying cliché in the English language was ‘at the end of the day’, followed closely by phrases like ‘ballpark figure’, ‘blue sky thinking’, ‘bottom line’, and ‘value-added’.

As William Safire said: “Last, but not least, avoid clichés like the plague”.


Lower case.




A colon is used:

  • at the end of a lead-in line before a list or bullet points
  • directly before a direct quote (do not use a comma)
  • after a complete sentence to connect to a second clause or sentence that explains or follows from it (for example: ‘She got what she deserved: a promotion’)

Only capitalise the first word after a colon if it is a proper noun, the start of a complete sentence or the start of a quote.

Do not use a colon when introducing a quote within a quote, use a comma and single quotes.


Commas help guide readers through the meaning of a sentence.

They can be used to mark out clauses or phrases that are not integral to the meaning of the rest of the sentence. Note the difference between the meanings of ‘NHS Digital staff who do not read our stylebook should not be communicating in public’ and ‘NHS Digital staff, who do not read our stylebook, should not be communicating in public’.

They can also separate adjectives qualifying a noun (for example: ‘a small, profitable company’). Don’t use a comma if the last adjective before a noun is an integral part of an established noun phrase: ‘a cheap personal computer’.

Finally, commas are often used to separate elements in a series: ‘Our systems are fast, resilient and secure’. It is not always necessary to put commas before the final ‘and’ in a list, but you should do this if it makes your meaning clearer (for example, ‘Whitby is famous for vampires, Captain Cook, fish and chips, and jet’).

Don’t use too many commas. If a sentence is getting weighed down, consider using dashes.

See dashes and hyphens


A contraction is a short form of a word or combination of words.

We use contractions such as ‘you’re’, ‘we’ll’ and ‘we’re’.


  • negative contractions like can't and don't - many users find them harder to read, or misread them as the opposite of what they say
  • should’ve, could’ve, would’ve, they’ve - these can be hard to read

coronavirus (COVID-19)

Write 'coronavirus' in lower case.

We use the full term 'coronavirus' (COVID-19)' when we first mention the illness. After that, we use 'coronavirus' as that is what most people call it and search for.

In some contexts, you may need to use language more precisely: ‘COVID-19’ is the infectious disease caused by ‘SARS-CoV-2’, which is a type of ‘coronavirus’.


Lower case.



Dashes (‘–’) and hyphens (‘-’) are not interchangeable. In Microsoft Word, a dash can be achieved by typing a space, two hyphens and a space (‘ – ‘).

Use dashes in place of pairs of commas or brackets when you want to draw the reader’s attention to something interesting or unusual.

They can also be used in place of commas or colons to provide a change of thought, continuity and pace: ‘Our job is supporting better health, better care and a more effective system – not computerising or going paperless for their own sake.’

Spaces should be inserted before and after each dash. We use the en dash (‘–’) but not the longer em dash (‘—‘).

See hyphens.


We treat ‘data’ as a singular noun (for example, ‘the data is stored on a secure server’) rather than a plural noun (‘The data are stored on a secure server’) when talking to the public and to non-specialist audiences.

Understanding Patient Data researched the public’s comprehension of these terms and recommended using the singular. This is consistent with the Government Digital Service’s advice.

But take a flexible and practical approach. The Oxford Dictionaries website says both usages are acceptable in standard English and notes that some technical audiences still prefer the plural. If you are talking to a group of specialists and feel that using the singular will get in the way of communication, use the plural.

data set

Should always be two words.


Dates are written ‘day month year’ with no punctuation: ‘22 April 2018’.

Avoid using ‘nd’ ‘st’ ‘th’ and ‘rd’ except when referring to centuries, anniversaries or positions.

In general, use ‘to’ for date ranges, not hyphens or dashes (for example: ‘10 November to 21 December’). However, to refer to a financial year, use a hyphen (for example: ‘2017-18’).

See times.


Insert a nought when expressing a value below one (‘0.6’).

Write decimal numbers (‘6.33’ rather than ‘6 1/3 per cent’).

See fractions, numbers and money.


double quotes

Use double quotes in body text for direct quotations.

Where the speaker’s name comes before the quote, use a colon: ‘Melanie White said: “More people are using our services.”’

Where the speaker’s name follows the quote, insert a comma before the closing quotation marks: ‘“More people are using our services,” said Mrs White.’

Use open quotation marks at the start of each paragraph of a quote. Only use closing quotation marks at the end of the quote, not at the end of every paragraph within it.

See single quotes.



Try to avoid synthetic words that use ‘e’ in place of ‘electronic’. Their meaning is often vague.

When you do need to refer to them, use hyphens (‘e-commerce’, ‘e-bulletin’) apart from in ‘email’. At the beginning of a sentence, capitalise the first letter of the word that follows the ‘e’, rather than the ‘e’ itself (for example: ‘e-Business’).

e.g., etc and i.e.

‘E.g.’ can sometimes be read aloud as “egg” by screen reading software. Instead, use ‘for example’, ‘such as’, ‘like’ or ‘including’.

‘Etc.’ can usually be avoided. Try using ‘for example’, ‘such as’, ‘like’ or ‘including’.

‘I.e.’ isn’t always well understood. Try writing sentences to avoid the need to use it. If that isn’t possible, use an alternative such as ‘meaning’ or ‘that is’.


Not ‘e-mail’.

email addresses

Write email addresses in full, in lower case and as active links.


exclamation marks

Take Howard Mittelmark’s advice: “In almost all situations that do not involve immediate physical danger or great surprise, you should think twice before using an exclamation mark. If you have thought twice and the exclamation mark is still there, think about it three times, or however many times it takes until you delete it.”

Never use multiple exclamation marks.



Upper case. Facebook is a trademarked name.


first person

Our success relies on the strength of our staff and our relationships. When we introduce ourselves, we use ‘NHS Digital’ in the first instance: “NHS Digital is launching a new website”.

Although not appropriate in all contexts, we prefer to talk in the first person when describing what we do and to address our readers directly: ‘we’, ‘us’ and ‘you’.

See active, passive.


Spell out and use hyphens for common fractions: ‘one-half’.

Do not compare fractions with decimals (‘one-third of men and two-thirds of women’ rather than ‘one-third of men and 66 per cent of women’).

See decimals, numbers and money.

full stops

A full stop:

  • ends a sentence
  • does not appear in headings
  • does not appear in formal abbreviations such as BBC

Three dots with no spaces between them (‘…’) are sometimes used to indicate the intentional omission of a word, sentence, or whole section from text. For example, a writer may choose to shorten a quote in this way. This is called an ellipsis. Spaces should be placed either side of the dots (for example: ‘David Vine said: “I am speaking from a deserted … Crucible Theatre.”’)

There is no need to insert an extra full stop if the omission is at the end of a sentence. Square brackets either side of the ellipsis can be used if it is important to highlight that material has been omitted.


general practitioner, GP and general practice

‘GP’ can be used interchangeably with ‘general practitioner’. Don’t capitalise the spelled-out version. It is not necessary to spell out the abbreviation on first use if the meaning is clear.

None of these words should be capitalised: ’ Our general practitioners practise medicine in general practices and general practice is a cornerstone of our healthcare system.’


Great Britain


headlines, titles and headings

For headlines, page or section titles, we use a capital for the first word only, except where words would ordinarily take a capital letter (for example: ‘Trust leaders visit NHS Digital’).

Note, however, that all of the words in publication titles are capitalised except prepositions (‘on’), articles (‘the’) and conjunctions (‘and’) of fewer than four letters (for example: ‘NHS Digital Annual Report and Accounts’).

It is sometimes acceptable to use an acronym in a headline without first spelling it out. The full version with the acronym should be spelled out as soon as possible in the following text. This should never be done if a significant proportion of the audience will not immediately understand the acronym.


Use flexibly to support clear and respectful communication.

In general, use the full name without an honorific on first mention: ‘Theresa May’. Use an honorific with the surname on later mentions in the same text: ‘Mrs May’.

Some honorifics warrant use on first mention, including ‘Baroness’, ‘Lord’, ‘Sir’ and ‘Professor’.

But use will vary according to context. In a press release about a visit from a minister, the style outlined above would be appropriate. In a case study about a patient’s positive experience of a service, you might prefer to refer to the subject by their first name on second mention.

Do not abbreviate ‘Professor’ to ‘Prof’.

Do not use full stops in honorifics: write “Mr” not “Mr.”.



  • where two or more words are taken together and read as one (‘day-to-day’)
  • to join two words that act together like one adjective (for example: ‘five-minute presentations’)
  • when expressing fractions or numbers in text (‘two-thirds’ or ‘thirty-four’)
  • to avoid ambiguity (for example, ‘re-cover’ not ‘recover’)

It is usually best to avoid synthetic words that use ‘e’ in place of ‘electronic’. Their meaning is often vague. Where you do have to use them, the prefix ‘e’ should always be lower case with a hyphen. For example:

  • e-business
  • e-government
  • e-learning
  • e-procurement

The only exception to this is email.

At the beginning of a sentence, capitalise the first letter of the word that follows the ‘e’, rather than the ‘e’ itself. For example:

  • e-Procurement

Again, there is only one exception: ‘Email’ at the start of a sentence should have a capital ‘E’.


  • re- words starting with e (for example: “re-evaluate”)
  • co-ordinate
  • co-operate

Do not hyphenate:

  • reuse
  • reinvent
  • reorder
  • reopen
  • online

In general, use ‘to’ for time and date ranges, not hyphens. However, use a hyphen when talking about a financial year (for example: ‘2017-18’). Don’t use a forward slash. ‘2017/18’ is incorrect.

See dashes.




Lower case.


jargon and technical language

Jargon is a type of language that is used in a particular group and is difficult for others to comprehend. Try to explain things so the layperson can clearly understand what you are saying.

Technical terms are not necessarily jargon, but you should explain what they mean when you use them.

Experts sometimes say that they don’t need to use plain English because they’re writing technical or complex content for a specialist audience. This is wrong.

Research shows that people with higher literacy levels prefer plain English because it allows them to understand the information more quickly. A study of the use of specialist legal language in legal documents, for example, found that 80% of people preferred sentences written in clear English. The more educated the person and the more specialised their knowledge, the greater their preference for plain English. The more complex the issue, the more insistent this demand became.

Your readers, even the experts, don’t have time to pick their way through dry and complicated writing.

job titles

See capitals.


less, fewer

Less refers to quantities that cannot be counted (‘there is less milk in this container than there was yesterday’). Fewer refers to quantities that can be counted (‘there are fewer trees in this garden’).


Lists should be bulleted to make them easier to read.

See bullet points and numbered lists



Use numerals and spell out measurements the first time you use them. Abbreviating kilograms to kg is fine.

Don’t use a space between the numeral and abbreviated measurement: ‘3,500kg’ not ‘3,500 kg’.

Use Celsius for temperature: ‘37°C’.

Don’t use full stops after units: ‘10kg’ and ‘15cm’ are correct.

See temperature.



Use the £ symbol: ‘£75’.

Do not use decimals unless pence are included: ‘£75.50’ but not ‘£75.00’.

Do not use ‘£0.xx million’ for amounts less than £1 million.

Write out ‘pence’ in full: ‘Calls will cost 4 pence per minute from a landline’.

See also decimalspercentagesunits, numbers, dates and times.

myself, yourself, ourselves, himself, herself

Avoid using these terms and instead write ‘me’, ‘you’, ‘us’, ‘him’ or ‘her’.


NHS Digital

Refer to NHS Digital in the singular: ‘NHS Digital is launching a new website’.

When you refer to the organisation, use ‘NHS Digital’ in the first instance. You can then refer to ‘the organisation’, ‘NHS Digital’, ‘us’ or ‘we’ to add variety.


Do not use a space between ‘NHS’ and ‘mail’ and, in general, avoid using ‘NHSmail2’. The current platform is ‘NHSmail’.

numbered lists

Use numbered lists to help guide a user through a process.

  1. You do not need a lead-in line.
  2. Each numbered point should be a full sentence and end in a full stop.
  3. Steps are better than bullets if you want to explain a process.

See bullet points

numbers (1,2,3)

We use numerals (‘1’, ’2’, ‘3’ and so on) instead of spelling out numbers (‘one’, ‘two, ‘three’) because people find it easier to scan pages for numerals.

It is OK to use numerals at the start of sentences, for example, ‘8 trusts have signed up.’. If it looks confusing, think about rewording your sentence. 

It is also OK to use numerals in headings.

We do spell out numbers when:

  • we are using ‘one’ to mean ‘a’ or in phrases like ‘one or the other’, ‘one of the most common’, ‘one at a time’ or ‘the only one left’
  • talking to some specialist audiences - NHS Digital press releases spell out 'one' to 'nine' and use numerals from ‘10’ onwards because that is the journalistic convention - this makes it easier for reporters to use our announcements

See numbers and order (1st, 2nd, 3rd), numbers large and smalldecimals, fractions and money.

numbers and order (1st, 2nd, 3rd)

We use numerals with letter suffixes (‘1st', ’2nd', ‘3rd' and so on) instead of spelling ordinal numbers out (first, second, third and so on).

However, we do not use numerals in phrases like ‘first aid’, ‘first time’ or ‘second opinion’. We also do not use letter suffixes for dates.

Using superscript can make it difficult for people using screen readers, so we use full-sized letters after the number (‘1st’, '2nd').

See numbers (1,2,3) and numbers large and small

numbers large and small

For numbers over 999, use a comma for clarity, for example, ‘1,962’ not ‘1962’.

For numbers less than 1, use 0 before the decimal point, for example, 0.25.

In general, write out ‘million’ or ‘billion’, for example: ‘£14 million’. If it is necessary to abbreviate, put ‘m’ or ‘bn’ immediately after the value, for example: ‘£14m’.

See numbers (1,2,3)decimalsfractions and money.



Always use ‘%’ with a number.

When spelling out the word, use ‘per cent’ not ‘percent’. ‘Percentage’ is one word.

A percentage increase is not the same as ‘percentage point’ increase: an increase from 10% to 15% would be a 50% rise but a rise of five percentage points.

See decimals.


Refer to companies and organisations in the singular.

Some nouns are always plural, such as ‘police’ and ‘people’.


Singular words not ending in ‘s’ use an apostrophe before a final ‘s’, for example, ‘Peter’s pen’.

Singular words ending in ‘s’ use an apostrophe after that ‘s’, for example, ‘James’ pen’ not ‘James’s pen’.

Plural words ending in ‘s’ use an apostrophe after the final ‘s’, for example, ‘the Smiths’ house’.

Acronyms use apostrophes as they would in their spelled-out form, for example, ‘the NHS’s budget’ is correct.

See apostrophes.


Lower case: ‘Citizen Identity programme’.

public health

Lower case.

public sector

Lower case.


quotation marks


references to documents

References to documents should be easy to understand by anyone, not just specialists. They should follow the style guide.

When writing a reference:

  • do not use italics
  • use single quotation marks around titles
  • write out abbreviations in full: ‘page’ not ‘p’, ‘Nutrition Journal’ not ‘Nutr J’
  • use plain English. For example, use ‘and others’ not ‘et al’
  • do not use full stops after initials or at the end of the reference

If the reference is available online, make the title a link and include the date you accessed the online version.

For example: ‘Corallo AN and others. ‘A Systematic Review of Medical Practice Variation in OECD Countries’ Health Policy 2014: volume 114, pages 5-14 (viewed on 18 November 2014)’



Semicolons are often misread and so should be used sparingly. The Government Digital Service’s guidelines say they should not be used on web pages and suggests breaking up text into separate sentences instead.

However, semicolons can sometimes be useful in lists when each item is already comprised of words separated by commas. For example: ‘The events will be held in Guangzhou, China; Kolkata, India; and Berlin, Germany.’

single quotes

Use single quotes:

  • in headlines
  • for unusual terms
  • to highlight a term, word or phrase that is being discussed or defined
  • when referring to publications (for example: ‘Download the publication ‘Understanding Our Statistics’)
  • to put a quote within a direct quote

See double quotes.


Use a single space after a full stop rather than two.


The name of this NHS Digital programme is Spine. The infrastructure can also be referred to as ‘the Spine’ or ‘the NHS Spine’.


technical terms

telephone numbers

Use ‘telephone: 011 111 111’ or ‘mobile: 011 111 111’.

Use spaces between the city and local exchange. For example: ‘01273 800 900’, ‘07771 900 900’ or ‘+44 (0)20 7450 4000’.

When a number is memorable, group the numbers into easily remembered units: 0800 80 70 60.


Use Celsius: ‘37°C’.

See measurements.




  • ‘5:30pm’ (not ‘1730hrs’)
  • ‘midnight’ (not ‘00:00’)
  • ‘midday’ (not ‘12 noon’, ‘noon’ or ‘12pm’)
  • ‘6 hours 30 minutes’
  • ‘to’ in time ranges, not hyphens or dashes: ‘10am to 11am’ (not ‘10-11am’)

Midnight is the first minute of the day, not the last. You should consider using ‘11:59pm’ to avoid confusion.

For example, ‘You must register by 11:59pm on Tuesday 14 June’ can only be read one way. ‘You must register by midnight on Tuesday 14 June’ can be read in two ways (the end of Monday 13 or end of Tuesday 14).

See dates.


See headlines, titles and headings.

See honorifics for personal titles and forms of address.


Lower case unless you are referring to the full name of a foundation trust (‘NHS trusts’, ‘Bolton NHS Foundation Trust’, 'the trust').

See also capitals.

Twitter account

Upper case. Twitter is a trademarked name. However, we tweet tweets (both in lower case).


UK government

Not ‘HM government’.

United Kingdom

The United Kingdom (UK) consists of four countries: England, Scotland, Wales and Northern Ireland.

Britain is the official short form of United Kingdom.

Great Britain is the largest island of the British Isles, which also include the island of Ireland and numerous surrounding islands.

Much of NHS Digital’s work is focused on the NHS in England. Take care not to refer to Britain when you mean England.




Lower case.


One word and lower case.


One word and lower case.


No hyphen.