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Creating content that saves lives

Rich Kelly from the NHS website’s multimedia team explains how they provide video that is accessible, relatable and sometimes life-saving for their audiences.

The NHS is available to all so it's really crucial that the content on the NHS website must be available to all.

It is the UK’s biggest health website with more than 50 million visits every month and the NHS videos on the website and You Tube Channel  attracted over 28 million views in 2020. This indicates just how vital the video content is to our audience who need to absorb important information quickly and easily.

A woman accesses the NHS website to look up information about screening tests in pregnancy on her mobile phone.

A user-centred design approach

Continuously looking at how our users with different needs interact with our products and services is at the heart of our user-centred design approach.

Our users are a large section of the population. In the UK, almost 1 in 5 people have a disability of some kind.

What drives us is creating valuable content that could literally save lives.

Many more have temporary or situational disabilities, caused by an illness or injury, and 11 million people are deaf or hard of hearing.

What drives us is creating valuable content that could literally save lives. Our role requires us to distil complex clinical and policy information and provide that in an easy-to-follow narrative with visuals.

We believe this helps people who have barriers accessing written content alone. We test the content with a diverse pool of our users with varying abilities, which in turn helps us continuously improve our content.

As a team we looked to improve our video player, making it fully accessible. To do this we needed to co-design it with users who have challenges accessing our content. We decided to recruit research participants both externally and internally. We included people who use assistive technology such as screen readers, as well as people who are deaf or hard of hearing and blind or hard of sight.

We had originally outlined 1 to 1 research sessions in our new Accessibility lab in Leeds. However, due to COVID-19 restrictions, we switched the research sessions to 1 to 1 remote interviews.

Having listened to our users we empathised still further with their experiences by:

  • closing our eyes and listening to a video to get a greater sense of what the barriers are for those who are blind or hard of sight
  • playing the video with no sound so we check its robustness as a communication piece
  • using a screen-reader to view our content

This, married with the user research from our audience, makes us better content creators. It makes the content better for everyone – more thought-out and detailed in every sense, and most importantly, more useful to everybody.

A tech solution that improves our users' experiences

We embarked on research to identify all the available routes and solutions. During the research, we found an accessible standard video player plugin that would integrate with our video hosting platform. It was clear during the research phase (January 2019) that video accessibility was still in its infancy.

There was only one external solution that met all our needs. There was a balance of working out how much building something in-house would cost versus having the continued support and accessible updates from procuring an out-of-the-box solution.

We worked with EqualPlay, a team already supplying accessible plugin solutions to many public organisations in their native Sweden. 

However, we still needed to improve it to meet our and our users’ needs – leveraging our user research and data to further improve the offering.

We worked with them to create a proof of concept of the player with all new accessible features available, including captions, ability to toggle between 2 audio tracks (second being the audio description) an in-line transcript and a toggle button that activates a BSL interpreter over the video itself.

Proof of concept

As part of our internal Accessibility Working Group, we detailed feedback from across the organisation on the proof of concept, including feedback from our developers, accessibility leads, our Ability Network and various deaf and hard of hearing charities. This provided useful feedback to build and iterate upon.

Improvements came from internal testing, consultation with the World Wide Web Consortium (W3C) and testing with users. We tested the plugin with people with access needs and fed this back into improving the plugin.

Feedback from users of BSL said some videos are too fast, and we need to avoid this, as it's hard to keep up. If signing is extremely fast, it loses all meaning.

Some feedback from people using assistive technology concluded that it is best to add the word 'video' or 'watch our video on' in the titles that appear above the video, so the type of content is obvious as the user tabs through the page. It was also recommended that our videos shouldn’t auto-play. This is because the video could drown out the voice of a screen-reader and this also makes it harder to find the stop/pause buttons.

Feedback from users of BSL said some videos are too fast, and we need to avoid this, as it’s hard to keep up. If signing is extremely fast, it loses all meaning.

Ensuring the journey is accessible from start to finish

The feedback highlighted the importance of embedding accessibility at the start of all projects, so factors like this are accounted for. Be conscious of accessibility at script, pre-production and production stages. There are regional variations in BSL languages, but the translator's aim is to try and standardise the variations to cater for a nationwide deaf audience – same as you get with varying accents in the UK. 

Likewise, when supplying an audio description – make sure there is enough space in the edit to accommodate this. You want it to be audible and spoken at a good pace, not crammed in on top of other video narration.

Girl with hearing aid looks up something on the NHS website

The plugin provider worked hard to action all the feedback and we learnt a lot as a team on how best to deliver accessible assets like audio description and transcripts.  

Once the research phase was over, we then built a business case for this procurement along with the new improved proof of concept. This included the key benefits and why this solution would add value to our audience.

As of 23 September 2020, the accessible plugin was incorporated into our live video player and content management system. This included a big effort to update all video titles and descriptions on the NHS website and placing those titles above all videos, in-line with the journey our users expect.

You can see an example of an AA rated video with captions, an audio description and a transcript on this website about What is a colonoscopy?

Final thoughts

Our video player now has the functionality to deliver BSL content to our users. The NHS website user researchers are still in a phase of discovery of working out how best to deliver this, working with close-related charities, clinicians and other tech companies delivering this service.

The player's functionality will only do so much. Accessibility needs to be championed at the pre-production stage of the project.  Any new videos need to be designed with all abilities in mind. For example:

  • think about video speed, slow the video down or leave space in the edit for an audio description
  • make sure there is enough contrast between any words and background colours
  • are there graphics on screen that aren’t referenced in any audible dialogue – if so, add an audio description

We’ve written and shared our best practice regarding making video and other multimedia accessible on the NHS Digital service manual. As a team we’re sharing this with production agencies and NHS colleagues to drive awareness of how to create accessible multimedia content.

If you would like to know more about how we conduct user research with people with access needs watch our video about our accessibility lab.

And do watch this space as we seek to become an examplar for AAA accessibility.

Related subjects

Adriano Gazza, Multimedia team lead for the NHS website, explains how the principles of user-centred design can help create engaging video, animation and infographic content for the public that is clinically accurate.


Last edited: 2 November 2021 10:15 am