The Accessible Information Standard (DAPB1605), applied to surgical patient information

NHS England describes successful implementation as complying with six essential steps. They are a sequence, and most services fail at one of the ends rather than in the middle.

1. Identify.A consistent approach to identifying people’s information and communication needs. The duty is to have a method for asking, not to wait to be told.
2. Record.Consistently and routinely recording those needs in the person’s records, and in clinical management and administration systems.
3. Flag. Using electronic flags or alerts, or paper-based equivalents, to indicate that an individual has a recorded information or communication need, and to prompt staff to act.
4. Share. Including those records as part of data sharing, and of treatment and referral processes.
5. Meet.Taking steps to ensure people’s information and communication needs are met.
6. Review. Regularly reviewing needs, and ensuring records are kept up to date.

Two things follow from the shape of that list. A service that identifies, records, flags and shares diligently, and then sends the same PDF to everyone, has not met the standard — step 5 is the operative one and the first four exist to serve it. And a service that met a need correctly three years ago has not thereby discharged step 6: a recorded need can change, and a record that is never revisited degrades into a wrong answer held confidently.

The standard applies to information and communication support needs relating to a disability, impairment or sensory loss, for patients and service users, and for their families and carers — including parents and carers who themselves have such a need.

Identifier. The current identifier is DAPB1605. The standard was formerly identified as DCB1605, and that identifier still appears in older documents and local policies; DAPB1605 is the one to cite now.

Since 1 August 2016, all organisations that provide NHS care and/or publicly funded adult social care are, in NHS England’s own wording, legally required to have regard to the standard. That includes providers from the voluntary, community, social enterprise and private sectors where the adult social care they provide is publicly funded.

The mechanism is section 250 of the Health and Social Care Act 2012. As amended, it provides that an information standard must specify to whom it applies; it may apply to public bodies exercising functions in connection with the provision of health care or adult social care in England, and to other persons including providers required to be registered under the Health and Social Care Act 2008; and a person to whom a published information standard applies must comply with it, except so far as the requirement is waived.

Where that leaves wholly private surgical practice. A private consultant seeing self-funding and insured patients, outside NHS care and publicly funded adult social care, is outside the population the standard itself reaches. That is the accurate statement, and it should not be dressed up as something stronger.

What still applies is the Equality Act 2010. A private clinic is a service provider, and the duty to make reasonable adjustments for disabled people is anticipatory: a service provider must think in advance, and on an ongoing basis, about what disabled people with a range of impairments need, rather than waiting until a particular disabled person wants to use the service. The Act deals with information directly — where the reasonable-adjustment requirement relates to the provision of information, the steps it is reasonable to have to take include steps for ensuring that, in the circumstances concerned, the information is provided in an accessible format.

So: DAPB1605 is not binding on wholly private practice, and the underlying obligation to provide information in an accessible format does not depend on DAPB1605 being binding. Many private providers use the standard’s six steps as a working framework because it is the recognised way of organising that obligation in a healthcare setting, not because they are compelled to.

The standard was reviewed, updated and re-published in 2025, and the 2025 version introduces a self-assessment framework as the means by which organisations demonstrate compliance. NHS England’s position on timing is specific, and worth stating precisely rather than as a deadline:

• Organisations should be in a position to annually publish their compliance with the 2025 version by March 2027.
• The first self-assessment responses should be completed by the end of March 2027.
• Implementation will be tested with a number of integrated care boards and systems following publication of those first responses.

The framework is designed to use readily available data and follows the six steps. It exists to let an organisation measure itself against a set of performance measures and develop a local action plan for the gaps it finds.

Two cautions. This is an expectation on organisations within the standard’s scope — it is not a deadline for private practice, and it is not a certification scheme. And a self-assessment is exactly what its name says: it produces an organisation’s own account of its compliance, published annually, not a third-party verdict.

These are recognisable failure patterns, described as patterns rather than as measured findings. None of them reflect carelessness; they are what happens when a document is written by an expert, for a colleague’s eye, and then handed to a patient on the day they were told they need an operation.

One format for everyone. A single PDF designed for printing is a common default. It may not reflow when enlarged, may be poorly structured for a screen reader, and offers nothing to a patient who cannot use dense prose.

No place to record a need. In private practice particularly, there is often no field in which a communication need could be recorded even if it were asked about — which makes steps 2, 3 and 4 impossible by construction.

A need captured once and never carried forward. A patient who asked for large print at referral may receive standard print at pre-assessment, at discharge and at follow-up. This is a step 3 and step 4 failure, and it is invisible to the person who took the original request.

Accessible versions that are abridged rather than adapted. An “easy-read leaflet” that omits the material risks is not an accessible version of the information; it is different, and worse, information. This is the most serious failure in the list, because it looks like compliance.

No review loop. An accessible version produced against a guideline since reissued is now an accessible version of superseded content. Step 6 is the one most often absent from local policy altogether.

It is worth being exact about what carries authority here, because this is where guidance, good practice and house style get blurred together.

What the standard requires. DAPB1605 requires that an identified information or communication need is met. It requires the step, not a particular typographic recipe. Easy read is one accessible format among several — others include large print, braille, audio, translated material, and the provision of communication support such as a British Sign Language interpreter or an advocate.

What NHS England’s editorial guidance says about readability. The NHS digital service manual — NHS England’s guidance for its own digital content — states that it aims for a reading age of 9 to 11, and acknowledges that with some medical information this is not easy to achieve, in which case it aims to make sure an 11 to 14 year old will understand. That is editorial guidance for NHS content. It is not a legal threshold, and no statute or information standard sets a reading-age figure. (Related: what reading age your patient information is written for.)

What is recognised editorial good practice. Across easy-read practice the recurring features are: one idea per sentence; short sentences; active voice with a named actor; no clinical term without an immediate plain-English gloss; no idiom or figurative language; numbered steps for sequential instruction; images that carry meaning rather than decorate; and generous type size, spacing and hierarchy. These are conventions of the format, not requirements imposed by DAPB1605, and this page does not attach a number to any of them, because no primary source sets one.

The two constraints that matter most.

Nothing material may be dropped. An accessible version must carry the same material risks, options and instructions as the standard version. Changing how something is expressed is the point; changing what is disclosed is not.

Frightening content still belongs in it. Anatomical detail and complications belong in the easy-read version. What good practice adds is warning and control — telling the reader what is coming and letting them open it when ready, rather than either forcing it or removing it.

The gap is easier to see than to describe. This is an illustrative post-operative instruction, written for this page. It is not taken from any leaflet and contains no complication figures, no drug names and no doses.

Standard version

Following your procedure it is advisable to avoid strenuous physical exertion, including heavy lifting and vigorous exercise, for a period of approximately two weeks, as this may predispose to wound dehiscence or haematoma formation. The dressing should remain in situ and be kept dry until reviewed. Should you experience increasing pain, erythema, discharge or systemic symptoms such as pyrexia, you should contact the department for advice.

Complete, accurate and professionally written — and carrying four instructions, three clinical terms, one conditional and a passive construction in three sentences.

Easy-read version

Nothing has been removed: the same four instructions, the same two reasons, the same four warning signs. The clinical terms have been replaced with what they describe rather than deleted. And the action is separated from the reasoning, so a reader who takes in only the numbered list still has the instruction.

The difficulty in practice is rarely writing one such passage. It is holding two versions of every step of every procedure in alignment with a clinical source that changes — which is a maintenance problem, and is why services more often hold a few accessible documents than a complete set.

Check the reading level of your own leaflet — free, in the browser, and nothing you paste is stored.

Three different instruments, three different questions. They are complementary and none substitutes for another.

WCAG 2.2 is not part of DAPB1605 and DAPB1605 does not impose it. A digital service can conform to WCAG 2.2 AA in full and still fail DAPB1605, because conformance says nothing about whether anyone asked this patient what they need. The reverse also holds: a service can meet a recorded need impeccably by post while running a website nobody using a screen reader can navigate.

Readability sits outside both. It is a property of the text, addressed by editorial guidance rather than by either instrument.

Every item is achievable with existing staff and no procurement. The list is ordered to follow the six steps.

1. Add the question to your booking or pre-assessment script (step 1). “Is there anything we should know about how you prefer to receive information — large print, easy read, a translation, or support with reading?” One sentence, asked consistently.
2. Create somewhere to record and flag the answer (steps 2 and 3). In a private practice this may be a single field in the practice-management system. It has to be consistent and visible to whoever opens the record next.
3. Decide what travels with a referral or discharge (step 4). Agree that the recorded need is included, and where in the letter it goes.
4. Inventory your patient-facing documents and find their owner (step 5). Most services cannot immediately say how many they issue or who last revised each one. That inventory is the precondition for everything after it.
5. Date-stamp each document against its clinical source (steps 5 and 6). Record which approved guideline or protocol version it reflects, and when it was last checked. Anything you cannot answer for is your review backlog, ranked.
6. Improve findability before format (step 5). Move the material risks and the “call us if” content above the anatomy and the logistics. This costs nothing.
7. Produce one complete accessible version, properly, for your commonest procedure (step 5). One unabridged, well-made version establishes the house standard for everything after it.
8. Put the review cycle in a calendar with a named owner (step 6). Step 6 is a standing obligation, and it is the one that silently lapses.

• It does not require a pre-made version in every format for every document. It requires that an identified need is met.
• It does not require you to guess. It requires a consistent approach to asking, and action on the answer.
• It does not require an app, a portal or any digital product. Large print, an easy-read version, an interpreter and a phone call are all ways of meeting a need.
• It does not permit abridgement. Meeting a need in an accessible format does not license removing material content from that format.
• It does not set a reading age, a sentence length or a typeface. Those come from editorial guidance and format convention, not from the standard. (Nor does it award external quality marks for patient information — those are separate schemes.)
• It does not end at the leaflet. Appointment letters, consent material, pre-operative instructions and discharge advice all fall within a recorded need.

Most of what is above is process: asking, recording, flagging, sharing and reviewing. No software performs those steps on a service’s behalf, and such a claim should be examined carefully.

What software can change is the maintenance economics of step 5 and step 6. A dual-format library has to be written twice and revised twice, indefinitely, each time a clinical source changes. A structured digital pathway addresses that: content can be held in a standard and an easy-read version as a matter of structure rather than of effort, and each item can record the approved source document and version it reflects, so that alignment is a tracked state rather than an act of memory.

The Patient Compass Suite is built on that model. Every pathway step holds a standard and an easy-read version, the patient is offered the choice and the choice persists in their browser. Content carries the source document type, the source version it reflects, the date last synced against it, and an explicit alignment state of in sync, flag for review or pending source update. Publication is gated on sign-off by a registered clinician, and the gate blocks release when mandatory structural, attribution or dual-format requirements are incomplete. It is built to a WCAG 2.2 AA baseline with an AAA target for text contrast. It is a clinical content governance and delivery platform for information a clinical team has already approved, not a clinical system, and it holds no patient accounts. (See our published governance position.)

It does not identify, record, flag or share a patient’s communication need — those remain the service’s own, in the service’s own systems. It does not assess or certify an organisation against DAPB1605, does not complete the self-assessment framework, and does not make or evidence compliance with the standard. Compliance is a property of what a service does with individual patients.

See how a dual-track pathway is built

What are the six steps of the Accessible Information Standard?

Identify, record, flag, share, meet and review. NHS England describes these as the six essential steps to meeting people’s information and communication needs: identifying needs consistently; recording them in records and in clinical and administrative systems; flagging them so staff are prompted to act; sharing them as part of data sharing, treatment and referral; taking steps to meet them; and regularly reviewing needs so records stay up to date.

Is the Accessible Information Standard mandatory?

Since 1 August 2016, all organisations that provide NHS care and/or publicly funded adult social care are legally required to have regard to it, in NHS England’s own wording. Its legal basis is section 250 of the Health and Social Care Act 2012, under which an information standard must specify to whom it applies, and the persons it applies to — including non-public-body providers registered under the Health and Social Care Act 2008 — must comply with it, subject to any waiver.

Is it DCB1605 or DAPB1605?

DAPB1605 is the current identifier. DCB1605 is the former identifier and still appears in older documents and local policies. Cite DAPB1605.

What happens by March 2027?

NHS England’s expectation is that organisations should be in a position to annually publish their compliance with the 2025 version of the standard by March 2027, and that the first self-assessment responses should be completed by the end of March 2027. Implementation will then be tested with a number of integrated care boards and systems. It is a self-assessment against a published framework, not a third-party certification.

Does the Accessible Information Standard apply to private practice?

Not where the care is wholly private. The standard reaches organisations providing NHS care or publicly funded adult social care. However, private providers are service providers under the Equality Act 2010, where the duty to make reasonable adjustments is anticipatory, and where the reasonable steps in relation to information include ensuring it is provided in an accessible format. Many private providers therefore use the six steps as a framework for an obligation they hold under different legislation.

What reading age should patient information be written for?

No statute or information standard sets one. NHS England’s digital service manual, which governs NHS digital content, states that it aims for a reading age of 9 to 11, and that where medical information makes this hard it aims to be understood by an 11 to 14 year old. That is editorial guidance, not a legal threshold.

Can an easy-read version leave out the complications?

No. An accessible version must carry the same material risks, options and instructions as the standard version. It changes how information is expressed, not what is disclosed.

Is WCAG 2.2 part of the Accessible Information Standard?

No. WCAG 2.2 is a W3C technical standard for web content accessibility, with conformance levels A, AA and AAA. The Accessible Information Standard is about identifying and meeting an individual’s information and communication needs. Conforming to WCAG 2.2 AA does not satisfy DAPB1605, and meeting DAPB1605 says nothing about a website’s technical accessibility.

What is step 6, and why does it matter?

Review: regularly reviewing people’s needs and ensuring records are up to date. It matters because a recorded need can change and because an accessible version produced against a superseded clinical document is no longer an accessible version of current information. It is the step most often missing from local policy.

Does software make us compliant with the Accessible Information Standard?

No. Compliance depends on what a service does with individual patients across all six steps, in its own systems. Software can reduce the cost of producing and maintaining accessible formats, which is the part services most often find unsustainable. It does not perform the identify, record, flag, share or review steps, and it does not evidence compliance.

• NHS England — Accessible Information Standard – requirements (DAPB1605)
• NHS England — Accessible Information Standard – implementation guidance
• NHS England — Accessible Information Standard – self-assessment framework
• NHS England — Assessing your level of compliance
• NHS England Digital — DAPB1605: Accessible Information
• NHS England — Digital accessibility standards
• NHS digital service manual — How we write
• legislation.gov.uk — Health and Social Care Act 2012, section 250
• legislation.gov.uk — Equality Act 2010, adjustments for disabled persons
• Equality and Human Rights Commission — What are reasonable adjustments?
• W3C — Web Content Accessibility Guidelines (WCAG) 2.2