About the style guide
A style guide will help improve the quality and consistency of writing across all of our websites.
Why do we need this guide?
- to strengthen and differentiate our brand through consistent use of a considered voice
- to promote uniformity in content across different teams, channels and formats
- to help freelancers, partners, or anyone else writing content to maintain consistency
- to speed up decision-making on style, as those decisions are made already
- to ensure we create content that's sensitive to our audience
English offers many options in terms of tone and grammar, punctuation and spelling. Setting ourselves a standard by which we use the language is as essential to our identity as the design of our logo, the look and feel of the pages, or the choice of our typeface.
If we talk of an x-ray in one place, an X-Ray in another and an X-ray in a third, readers will lose confidence in our competence. Such inconsistency sends out a message of sloppiness that raises questions about the quality of what we're saying as well as how we’re saying it.
This guide can’t cover every eventuality, although it's dynamic and can be added to. While it does set out some rules, its main purpose is to offer broad tenets on which to base our decisions about the use of language on NHS inform.
How to use the guide
The style guide is set out into sections which you can navigate between using the tabs at the top of the page. Within each tab items are listed alphabetically, and in the longer pages, you can jump to the particular section you wish to read by clicking on the letter your term starts with at the top of the page.
Voice and tone
The voice of NHS inform content should be consistent across all NHS inform products and services. It should be straightforward, active where possible, and accessible. The tone will differ across the site as follows:
- Self-management (regarding illnesses, conditions and symptomatic queries) – Reassuring, supportive and authoritative (Characteristics – nurse / teacher)
- Prevention (regarding healthy living, lifestyle advice and preventative measures) – Friendly, motivational and upbeat (Characteristics - personal trainer / motivational speaker)
- Anticipation (regarding identification of common characteristics, health risks and benefits and life stages) – Encouraging, reassuring and supportive (Characteristics - peer to peer)
NHS inform is for everyone in Scotland. Plain English makes our content as accessible to as many people as possible. We've a public service remit to reach as many people as we can. All audiences should understand our content. It’s not about ‘dumbing down’ – it’s about making public services in Scotland easily accessible by all.
Words have to be appropriate and not too vague or they can lead to misrepresentation. Avoid using jargon, whether in the form of specific words or in an overly complex sentence structure.
Even as adults, we find a core of 2,500 to 5,000 common words easy to recognise and understand. If you write in plain English, thinking of the reading age of a child of 9 years old, your English will be accessible to most of your users. When you use a longer word (8 or 9 letters), users are more likely to skip shorter words that follow it (words of 3, 4 or 5 letters). Use longer, more complicated words, and readers will skip more.
'The recently implemented categorical standardisation procedure on waste oil should not be applied before 1 January 2014.'
You can imagine people missing that ‘not’, which would be a big deal. Instead, write:
'Don't use the new waste oil standards before 1 January 2014.'
Don’t use formal or long words if easier or short ones will do and avoid metaphors. We can generally get rid of any long words or metaphors by breaking the term down into what you’re actually doing. This makes our content easier to understand and avoids confusion.
Writing for the web
When writing content for the web stick to these simple rules for clear, effective writing.
7 golden rules
- make it brief and to the point, with one idea per paragraph
- break up text into subheaded sections to answer users’ questions
- use bullet lists to break up flat text
- ‘front-load’ titles, headers, subheaders, and bullet points with the most important information
- include links to external sites and relevant pages
- use words that are easy to understand
- use active, not passive, tense
Keep your body copy as focused as possible. Include search keywords where possible – without shoehorning them in - to satisfy SEO. You can add other terms via a meta keywords function for search purposes.
If you want their attention, don’t waste users' time. Users don’t necessarily read top to bottom or even from word to word. They want clearly defined headed sections which answer their questions concisely.
By writing in clear, simple English that informs the user in a direct and coherent manner, and by structuring your content in a logical flow with clear signposts (headers, subheaders, calls to action, and so on), you will satisfy both the human reader and the robot.
Headers and subheaders
- keep all titles to 65 characters (including spaces)
- use sentence case
- be as concise yet descriptive as possible
- avoid using questions too much
- think about how the title will look in a search on site and on search engine results
- front-load keywords and use colons to break up long titles, as it helps users to scan – see ‘F’ shape pattern
- explain any unusual terms and keep a friendly, informative tone
- use 'Further information', not 'More information', as we aim to link to more detailed content, as we want to link to more detailed content, not just 'more'
- never use a sub-header (h2) directly following a header (h1) – always use a lead in sentence or paragraph
Length of page
A study showed users only read 20 to 28% of text on a web page, so the quicker we can get to the point, the faster a user will consume the information, understand, and either leave or engage.
Front-load link text with the relevant terms and make them active, descriptive and specific.
- write anchor text like ‘page’, ‘article’, or ‘click here’
- use text that is off-topic or has no relation to the content of the page linked to
- make them long
- use the page's URL as the anchor text in most cases (although there are legitimate uses of this, such as promoting or referencing a new website's address)
- set links to open in a new window unless it's to a document
- use any links to external sites which are not government, NHS, or are already on the QA master list quality assured
- use a full-stop at the end of a linked call to action – for example, Read more about bowel cancer
In links to organisations where you give an abbreviation or acronym in brackets, include the material in the brackets as part of the link phrase, for example 'The British Psychological Society (BPS)' not 'The British Psychological Society(BPS)'.
Anchoring a link
Related links and stand alone links (links that aren't anchored to words within the body text) should be setup with the following syntax:
British Lung Foundation: Lung cancer
This only applies to external links, internal links should be anchored to words in the body text.
More about lung cancer
Most users start looking for information by using a search engine. There’s a good chance your audience won’t even find your page if you don’t use the vocabulary they use for their search in your page title. Adding metadata can improve both Google and on-site search success.
Meta fields to be completed include:
Page title – descriptive, keyword/ phrase rich, less than 69 characters and separated with hyphens (-). All page titles will carry site branding using a trailing pipe ( | ) and NHS inform - for example, Cancer – Illnesses and conditions | NHS inform.
Description – descriptive, keyword/phrase rich, less than 155 characters. Use it to sell a benefit or provide a solution. Use action-orientated words. Templates will be set up to populate descriptions automatically from the first line of content. This will be the default, and custom descriptions can be added as required. Meta descriptions should end with a full stop.
Remember that the meta description – along with the title – is often what users will see in search results. So let them see quickly whether this page will have the information they want.
Search engine optimisation (SEO)
When designing content, it’s important to create content in a way which will help SEO. Identify words and terms (and synonyms) that people are entering into search engines, by using tools like Google Trends and Google AdWords Keyword Planner, and user testing and feedback.
Once you know the most popular keywords, prioritise them in the:
- title (brief but descriptive)
- chapter/part titles
- body copy
- metadata descriptions
You can find further information about SEO in Google’s SEO Starter Guide PDF (1.9 MB)
Style and punctuation
Search for guidance on style and punctuation using the alphabet below to jump to the relevant letter.
Abbreviations and acronyms
Mr, Mrs, Dr etc don't take a full stop at the end.
You can use an acronym to replace a name or term that appears frequently in a single content item. Don’t include an acronym unless you'll use it several times later on in the same text.
Spell out the acronym in full the first time it's used, putting the acronym in brackets immediately afterwards - for example Abdominal Aortic Aneurysm (AAA). Don’t use full stops in acronyms – AAA, not A.A.A. From then on, use only the acronym in that specific content item.
There’s no need to spell out acronyms in common usage - for example DVLA, EU, HMRC, MSP, UK, USA, VAT. This includes government departments and schemes.
Ages are given between commas – for example John Smith, 32, a doctor (not 'aged 32').
Fertilised egg = from conception to 14 days
Embryo = from 2 to 9 weeks
Unborn baby = from week 10 to birth
Baby = 0 to 12 months
Infant = less than 2 years
Toddler = 1 to 3 years
Child = 1 to 12 years
Teenager, young person = 13 to 19 years – don’t use pubescent or adolescent
Older people = 60 to 70 years – don’t use old age pensioner, pensioner, OAP or the elderly
Elderly people = over 70 years, although if possible avoid using elderly
Hyphens for age ranges, rather than en dashes or use 'to'.
Ampersand (&) symbol should only appear in the logo image of an organisation or department, or in a page title. Always use ‘and’ in headers, subheaders and body copy.
Use for plurals - for example 'Choices' style guide' and not 'Choices's style guide'.
Use only sparingly.
Make sure that:
- you always use a lead-in line ending with a colon
- all of the bullets make sense following on from the lead-in line
- you use lower case at the start of the bullet
- you don’t use full stops within bullet points – where possible start another bullet point, or use commas or dashes to expand on an item
- you don’t put ‘and’/‘or’ after any bullet, although there may occasionally be a need
- if you add links, they appear within the text and not as the whole bullet
- there's no full stop after the last bullet point
- make sure your bullet points are all in the same tense and verb form, with any common information in the lead-in
- if you need to use complete sentences, start with a cap and end with a full stop for each line, and make sure each are complete sentences (but use this type sparingly)
- lists are consistently phrases or sentences – don't combine style in one list
You can use numbered steps instead of bullet points to guide a user through a sequential process. Each step ends with a full stop because each step should be a complete sentence.
Words should be capitalised as follows:
- initial caps for organisations/projects/initiatives – for example Getting It Right for Young Carers strategy, National Care Standards, the British Museum, the National Gallery, the Royal Albert Hall, the Tate Modern (except for the...a, an, and, at, for, from, in, of, the, to.) The exception to caps for organisations is where they use the lower case themselves - for example npower.
- initial caps for acts – for example Integration (from Public Bodies (Joint Working) (Scotland) Act 2014), but lower case for 'act' on its own, and legal concepts – for example power of attorney
- publications – The Phantom of the Opera, but newspapers drop the initial cap for 'the' -for example the Guardian and the Times
- titles of websites – use the capitalisation as the website does, even if this is contrary to our capitalisation rules
Use a colon to introduce a list of bullet points. Never use semicolons. For use of dashes see below.
'I like chocolate, cakes and puddings.' Use the Oxford comma only for complex sentences or to prevent confusion.
Examples of complex sentences
Find out information about holiday entitlement or sickness absence, calculating leave, and disputes.
I like cheese and ham, cheese and tomato, and cheese and pickle sandwiches.
Use to separate clauses – 'If you're in Scotland, prescriptions are free of charge.' And 'He had chicken pox, but his sister didn't contract it.'
Use for subordinate clauses – 'Tremor, which normally begins in one hand or arm, is a symptom of Parkinson’s disease.'
Be consistent in offering contact info in links (phone number, for example). It should be in this style: Phone 0300 000 0040, Monday to Friday, 9am to 5pm.
Try to use contractions consistently when writing. There are instances where contractions aren't suitable - use your common sense when deciding on appropriate use.
Who are to who're isn't an appropriate contraction.
En dashes, not hyphens, can be used for subordinate clauses, in place of parentheses or commas. Always put a space before and after. A dash should be used in place of a colon if introducing a call to action or a list but not if this would be better realised with a bulleted list. A dash is less formal and can help the content flow better.
You can fill in the form – paper or online version – to tell us about a change.
It’s important to tell us about any changes immediately – so act now.
When writing dates, use the format - 14 June 2015.
Don't include 'the' definitive, or a 'th' after the day.
Always use positive language about disability. Don't use outdated terms that stereotype, stigmatise, label or depersonalise. See GOV.UK’s words to use and avoid when writing about disability. You could also visit the Scottish Commission for Learning Disability website.
- afflicted by
- suffering from
- victim of
- struck down by
- people living with
- people with
- person with
- disabled person
- person with a mental health problem
- person with a mental health condition
- person with a learning difficulty
There’s an exception to the person-first language rule when writing about autism. Most autistic people prefer to be referred to using identity-first language – for example:
- autistic people
- autistic person
- someone who is autistic
Use the above language when writing about autism.
Disease, sickness and illness
Disease, sickness, illness are OK, but prefer condition.
- sick person
- the sick
- the ill
- disease carrier
- special needs (as in 'a special needs person') but bear in mind that some people do have defined 'special needs', for example someone with a statement of Special Educational Needs
- specific need(s)
- individual need(s) but note caveat above.
Exclamation marks - are almost always unnecessary! If you absolutely have to, never use more than one!!
Fractions and percentages
Spell out common fractions like two-thirds. For percentages, use the % symbol - for example, 50%. However, it's often better not to use a percentage. Instead of 50%, for example, you could say "1 in 2" or "half".
Gender neutral language
Use gender neutral and inclusive language such as 'they' and 'them' throughout all content.
Use hyphens for phrasal adjectives that come before the object - for example 'quality-assured website', but 'this website is quality assured'. Adjectives after the noun should not be hyphenated – 'The boy was 14 years old', 'the gap was five miles wide'. Nor should there be hyphens between adverb and participle – poorly written prose, highly charged drama, badly performed surgery (but well-chosen words).
As English evolves, compound adjectives often become single words – bloodstained, overblown, underdone, redheaded, half-hearted. This is also true of compound nouns – steam ship became steam-ship then became steamship; machine gun became machine-gun, and now is machinegun. In general, favour the hyphenless form. It's neater and punchier.
Avoid clashes of letter (redeye, but blue-eyed). Don't hyphenate words with the prefix re, except to avoid a clashing e (re-elect) or a visual snare (re-ignite), or to distinguish two meanings (reform, re-form; re-creation, recreation).
Don't use them.
Conditions are spelled in lower case, except for use of proper names - for example Alzheimer's disease.
Conditions described in abbreviated/acronym form, like AIDS and HIV, don't take full stops after the letters.
Avoid medical jargon and technical terms as far as possible. If you must use them, explain them. Put the common terms first, for example 'flu (influenza)' rather than 'influenza (flu)'.
The reference work for all medicines spellings is the British National Formulary. You have to register online, but it's free and is updated monthly. Generally, use the generic (scientific name) first followed by the brand name with an initial cap and in brackets - for example atorvastatin (Lipitor). Lower case for generic and upper case for brand name.
Once medicines have lost their patent protection, there may be rival branded generics that have a brand name and ordinary generics that use just the generic name. So in some cases, there may be several brand names.
Example, the asthma drug salbutamol has Airomir, Asmasal. Salamol Easi-Breathe, Salbulin Novolizer and Ventolin brand names as well as the generic name. In cases such as this give the best-known brand name, but indicate there are several – salbutamol (brand names include Ventolin). Some medicines have no brand names in use – examples include warfarin and hydrocortisone.
A handful of medicines are so well known by their brand names that it would be perverse to refer to them first by their generic name. The best known example of this is probably Viagra. In such cases give the generic term in brackets – Viagra (sildenafil).
- mental handicap
- mentally ill
- victim of
- suffering from
- afflicted by
- slow and other outdated terms.
- a person with mental health problems
- people with learning difficulties
- mental illness
- mental health condition
Other common mistakes
- 'schizophrenic’ or 'bipolar' shouldn't be used to mean ‘two minds’ or a ‘split personality’
- somebody who's angry is not ‘psychotic’
- a person who's down or unhappy isn't the same as someone experiencing clinical depression
‘a schizophrenic’ or ‘a depressive’
someone who ‘has a diagnosis of’ is ‘currently experiencing' or ‘is being treated for…‘
‘the mentally ill’, ‘a person suffering from’ ‘a sufferer’, a ‘victim’ or ‘the afflicted’
‘mental health patients’ or ‘people with mental health problems’
'prisoners’ or ‘inmates’ (in a psychiatric hospital)
‘patients’, ‘service users’ or clients
‘released’ (from a hospital)
Write all numbers in numerals (including 1 to 9), except where it’s part of a common expression and it would look strange - for example ‘one or two of them’. Use common sense.
- 1,000, 2,000
- 500 to 600 (ie not a dash)
- ordinal numbers – spell out first to ninth. After that use 10th.
- in tables, use numerals throughout
Avoid beginning a sentence with a number that is not written out unless that number is a date.
Use the singular form of a verb – 'CIS is a service...' and not 'CIS are a service...'
Text should contain plenty of paragraph breaks. Keep paragraphs short and aim for no more than 3 sentences. New paragraphs don’t have to be for new subject matter, and it’s OK to have a one-line, one-sentence paragraph. You should aim to communicate just one idea per paragraph.
Use sparingly. Dashes are better for web content, but only use for one aspect of a sentence. When they contain a whole sentence, final punctuation falls within the brackets, otherwise it's outside.
PDFs and other documents
Include (PDF 358.7 KB), (DOC 1.7 MB) or (ZIP, 40 MB). Only quote up to 1 decimal place and always open documents in a new window.
File sizes should have a space between the number and the measure. Measures should always be expressed in capitals, for example KB instead of kB.
Refer to 'people' (ie not 'men' or 'women') unless you have to medically, to prevent discrimination against transgender people. Use gender-neutral words whenever possible – use ‘them’, ‘their’, ‘they’ if not using ‘you’.
Use the word phone (not call or telephone), as both verb and noun, and quote the number in one of these formats (but follow how the organisation would style its number if not as below):
- 01273 800 900
- 020 7450 4000
- 0800 890 567
- 07771 900 900
- 077718 300 300
- +44 (0)20 7450 4000
- +39 1 33 45 70 90
Replace a negative form with a positive one wherever possible.
not able / unable
not available / unavailable
not forget / remember
not omit / include
not pay attention to / ignore
not possible unfeasible/impossible
not sure / unsure
Use single quotes for unusual terms that require explanation but use sparingly. Don't for titles of publications or documents.
Use single quotes for speech. Use doubles within singles if necessary.
Silent ‘h’ words
Use ‘a’ with words pronounced with a hard ‘h’ - for example ‘a hotel’, 'a hospital'. Use 'an' with words pronounced with a soft/silent ‘h’ - for example ‘an honour’.
Use a single space only following a full stop (never a double space). Add spaces around an en dash, but not around an oblique – for example and/or.
Only use for data values and never to contain large amounts of text. Bulleted lists or Heading / Sub-heading groups are a much better way to represent this information.
Use 1.00am, 6.30pm, rather than the 24-hour clock. Note no space between the time and 'am' and 'pm', and no points. Use a full stop rather than a colon to separate hours and minutes.
Don’t do it (apart from underlining for links).
Use the second person as much as possible and be consistent.
A-Z of spellings
Search for guidance on spelling by using the alphabet below to jump to the relevant letter section.
Use British English spellings throughout. Where words can end in 'ise' or 'ize' (or 'isation' or 'ization') use the 's' version. Note, however, that some words, for example capsize, are spelt only with the 'z'. Exceptions are proper names using the US spelling - for example the World Health Organization.
act (parliamentary) – lower case except when citing the full, correct name. The Health and Social Care Act 2012, but the NHS reform act.
advisor – not adviser, but note, advisors act in an advisory capacity
ageing – not aging
AIDS – the condition
all right – not alright
among – use rather than amongst
antenatal – not ante-natal
barbecue not barbeque - the former is used more widely
bill (parliamentary) – see act
call – no, always use phone (and not telephone) for both verb and noun
Care Information Scotland
care needs assessment – or care assessment or assessment of your care needs
caesarean – note lower case and 'ean' (also 'oe' in oedema)
ChildLine – note capital L
Citizens Advice Bureau – note no apostrophe
Citizens Advice Scotland
continual – means frequently recurring throughout
continuous – means without intermission. A speech is a continuous flow of words that may be subject to continual interruption.
co-operate – but uncooperative
co-ordinate – but uncoordinated
coronavirus - use coronavirus (COVID-19) for page titles and the first reference on a page then refer to coronavirus only thereafter. Coronavirus is only capitalised at the start of a sentence.
coronavirus pandemic - used in an international context, for example most countries have been in lockdown during the coronavirus pandemic.
coronavirus outbreak - used in a national context, for example the Scottish Government have published guidance to help households during the coronavirus outbreak.
counsellors (medical professional) not councillors (elected member)
data – not datum, but use the singular form of verb - for example 'Your data is safe with us.'
degrees (temperature) – centigrade/Celsius, as 16C, -4C. If appropriate, give Fahrenheit equivalent in brackets, 54F.
dietitian – not dietician
differ from, different from (never different to or different than)
disc – as in a slipped one disc (disk is in a computer)
doctor – but use GP if the person is a GP
drugs – see medicines. When you talk about drugs, ensure the context makes clear whether you mean legal or illegal ones.
email – not e-mail
eardrops, eardrum, earlobe, earwax
Eat Better Feel Better
eg – don't use. Instead, use 'for example' (with no comma after)
ensure = against risk; insure = life; assure = to make certain
etc – avoid. Say 'and so on' or be more specific
every (year, eg), instead of each (year)
feedback if a noun, but feed back if using as a verb
Fit for Work Scotland
for example – has a comma before but not after, and don't use eg or for instance
fractions – spell out phrases like two-and-a-half, three-quarters
GP practice – not GP surgery or doctor's surgery
health board but NHS Board
health professionals – rather than medical staff
health service – but National Health Service, NHS
healthcare – not health care
heartbeat – noun, but one's heart beats (verb)
helpline – not phoneline
homosexual – OK, but prefer 'gay men' or 'lesbians'. In this context, 'straight' is OK for heterosexuals.
hospitals – a, not an, hospital. Use 'taken to hospital', never 'rushed into hospital'. Only cap the H in the full name of a hospital.
however – it's not a conjunction. "However much you try, you can't..." or "He didn't like pizza. However, he did like lasagne."
ie – don't use. Use 'for instance' (without a comma after) but avoid altogether if possible.
immediately - not straightaway or right away
incapacity – not an incapacity
in order to – use 'to' instead
instal – not install
leukaemia – not leukemia (same with other words containing ae)
lifelike, lifelong, lifespan
like – not such as
Living it Up
local council – not local authority
major – don't use as a synonym for big or important. It's best reserved as a comparator to minor.
majority of – reads better as 'most'
medical staff – use health professionals instead
mental health – see notes on writing about disability.
morning-after pill – OK, and can be 'emergency contraception'
mucous – is an adjective; mucus is a noun. Mucous membranes secrete mucus, not mucous (and not mucose).
Muslim – not Moslem
National Health Service – u/c, but health service (l/c) thereafter, and can be NHS at first mention.
nobody – use rather than no-one, no one or noone
north, south, east, west, south-west, northern Europe, the west, etc.
OK – not Okay, okay, O.K., ok or Ok
ongoing – but prefer continuing
on to, onto – both are correct depending on context, for example: 'He travelled from Glasgow on to Edinburgh'; 'She jumped onto the roof'.
over-the-counter medicine – not over the counter medicine
paediatric – not pediatric
per cent – 98.5%, 2%, 0.5%. Note '%', not written in words. Also note, if something rises from 10% to 12%, it does not rise 2% but 2 percentage points, or 2 points.
pharmacy – not chemist
phone – not call or telephone (for both verb and noun)
prognosis – prefer outlook
race – don't mention a person's colour, country of birth, ethnicity, religion and so forth unless it is vital to the story (for example when a condition is more prevalent in a particular ethnic group). Avoid offensive and stereotyping words such as coloured, half-caste and so on.
radiographer, radiologist – radiographers take X-rays, radiologists read them
safe/safer – beware of referring to 'safe drinking', 'safe sex' and so on. It’s hard to know what really is 'safe'. It has become accepted practice to refer to 'safer sex', 'safer drinking' to imply that the suggested behaviours will lower, but not necessarily eliminate, risk. If you use words such as 'safer', you should be telling people what is safer than what. Despite this, we should follow this 'safer' convention where we can’t, for whatever reason, avoid such phrasing altogether.
said – use rather than explained, discussed, told, exclaimed, claimed, added
Scheduled Care Services
Scottish Centre for Telehealth and Telecare
(the) Scottish Government – never government alone, as it has to be clear which
self care – but a self-care system
sexual health clinic
small- and medium-sized businesses
social care (sometimes health and social care) departments at councils – not social work any more
STD – don't use.. Call them STIs or name the specific sexually transmitted infection.
STI – 'a' sexually transmitted infection, but 'an' STI. Don’t use sexually transmitted disease or STD.
telecare – generally but also telehealth and telehealthcare
telephone – use phone instead for both verb and noun
that – is almost always better than 'which' in a defining clause. 'The train that I take stops at Slough.' Use 'which' for clauses between commas. 'The train that I take, which leaves at 5.30pm, stops at Slough.'
the state – although State Pension as GOV.UK link capitalises
try to – not 'try and'
UK Government – not ever government alone, as it has to be clear which
ultrasound scan – not just an ultrasound
under way – 2 words
unplanned – use rather than 'unwanted' in relation to pregnancy
uterus – prefer 'womb'
very – don't use, as it almost always adds nothing
wellbeing – not well-being
which – see 'that'
while – not whilst
whom – avoid. Use who, even if it, strictly speaking, should be whom.
World Health Organization (WHO) – only proper names take non-UK spellings - for example the US Centers for Disease Control.
X-ray – not x-ray
yoghurt – not yogurt