5 minutes with... Matt Edgar

Headshot of Andrew Rickards

Data and Optimisation Consultant

3 minute read

Meet Matt, Head of Design for NHS Digital. Matt will join us at Camp Digital 2019 to talk about "The experience of care". We caught up with Matt about his talk.

Matt Edgar

At Camp Digital, your talk is entitled “the experience of care”. Why is this important and what can the audience expect?

In this talk, I want to explore the way people’s expectations of care are rising and what that means for the way we design and deliver our national health service.

The NHS Constitution commits us to provide “high-quality care that is safe, effective and focused on patient experience.” Increasingly the experience is impacted - for good and bad - by the way we design and deliver the digital bits of the service. That includes the systems used by our 1.3 million staff, as well as the ones used directly by patients and the public.

As a history graduate, it’s my immense privilege to work in a 70-year-old organisation that is still so true to its founding principles. As a technologist, I’m excited by what this service could become when we head into a world of genomics and personalised medicine.

Your career has been heavily focused on public sector service design. What are the biggest changes you’ve witnessed over the years?

I spent 12 years at the mobile operator Orange before becoming a consultant and training civil servants for the Government Digital Service, Department for Work & Pensions, and other departments. First, GDS made it possible for agile, user-centred design to exist in government at all. Then more recently, Lou Downe led the focus on end-to-end, front-to-back service design. It’s thanks to Lou and their team that the public sector is one of the most exciting places to work as a designer right now.

In parallel with my work at GDS, I was also part of a more grassroots service jamming movement, including hosting the Global GovJam in Leeds with my colleague Kathryn Grace. When we first ran the service jam in our city, it felt like an outsider initiative, with a handful of pioneers working in our local council and health services. Today, many of the people who were at those early jams are in influential positions in design and user research for local and national government, and big departments block book places at the jam. I hope we've retained our low-fi, fail fast spirit of “prototypes not presentations”.

How did you start out on your career path? And do you have advice for anyone thinking about getting into the field now?

After studying history at Manchester University, then journalism in Preston, I got my first job in local newspapers. I always preferred the smaller, human stories to frontpage splashes. I get the same feeling of fascination now when I observe user research with patients and staff.

In 1997, I moved into what was then called “new media,” and from editorial to product management and interaction design. The company I worked for was acquired by Orange, and I had the opportunity to lead Orange UK's design and usability team. That was when I discovered how rewarding it could be to coach others for success.

We recently selected an intake of 9 people for our first NHS Digital user-centred design graduate scheme. They’ll each get a chance to try a range of roles - user research, content, interaction design, service design, and graphic design. My advice to them will be to keep an open mind and take the time to find the work that gives them the greatest sense of accomplishment.

Can you share any exciting projects you’re working on at the moment?

Last year, we released a re-designed NHS website (NHS.UK) and a private beta of the new NHS App. There were tremendous efforts from both teams to get these launched. We’ve done a lot on responsiveness and accessibility, but we still have a lot to do to make the user experience of both website and app more intuitive, especially in the way different services work together. Priorities for the coming months include overall information architecture of the website, and a modernised service finder that guides people to the help they need, whatever their health problem and wherever they live in England. (Scotland, Wales and Northern Ireland have their own devolved health services.)

What are you most looking forward to at Camp Digital?

I’m a massive fan of both Jared Spool and Dana Chisnell, so I’m looking forward to their keynotes. Representing the NHS at any event is always a pleasure because everyone is so invested in our brand and our purpose. I’m looking forward to learning from other sectors and meeting anyone who has an interest in designing for health and care.

Matt Edgar - The experience of care (Camp Digital 2019)

In 1948 copies of leaflets like this were

dropping through letterboxes up

and down the country.

Announcing the creation of the

new National Health Service.

Something that would be free for everyone,

universally covering every person in this country.

Taking away money worries that people

used to have associated with getting

health care and getting ill.

This is the minister of health at the

services foundation, not far from here,

on the first day of the National Health Service,

5th July 1948.


He visited patients in a hospital not that far from here.

And since then, 97% of the babies born in England

have been born in National Health Service care.

And quite a lot has changed.

We are all living longer, healthier lives,

many of us are.

Medicine has been transformed in the

70 years since 1948.

The way treatment works,

the way hospitals are configured,

many things have changed.


We are on the cusp of a new revolution

with artificial intelligence, with personalised medicine.

We have a lot to do.

I work for an organisation called NHS Digital,

with a digital technology partner for

the health service in England,

those services are devolved in Scotland,

Wales and Northern Ireland,

so we serve around 350 million members

of the public across England.

1.3 million health and care worker,

we are not the world's largest employer,

the Chinese red army and Indian

National Railways outnumber us.


But we are the world's largest employer

of skilled professionals, doctors, nurses, 

health professionals and increasingly technologists

designers, all the many different professions

needed to keep the help service

moving of the we also work providing data

for vital medical research for the research community,

using data from this massive data set of

health and care across England to inform

the search for cures,

for understanding disease better,

for finding new cures and the wider community,

so the third sector, family careers,

all of the people who support patients and

the public when they are ill and when they need care.


And so it is a massive audience,

a massive group of different stake holders and

users that we serve.

And this is some of our team.

I took this picture when some of the team were

helping to recruit our next generation of

user centred design graduates who are

going to be starting at NHS Digital in September.

I am really excited we are able to bring

in a new generation of talent and

develop our own skills inside the organisation.


This is just some of the team,

we have about 23 interaction designers,

10 service designers, five graphic designers,

40 user researchers, content designers,

product managers, delivery managers, developers,

which feels quite a big team but also

when I think about the scale of the challenge also quite small.

So we need some help and I think

I am hoping that many of you in the room

either as working in agencies and suppliers

or working perhaps with many of the different

health organizations and care organizations in the country,

you might be part of the solution to

that gap that we have.


So I am going to do three things,

I am going to show some of the work

we have been doing.

I want to talk about what we are learning about

the experience of care,

what's it like for patients and the public and

for staff using digital services in the NHS today.

And how we are working to improve those things.

And then also share some challenges,

so I can talk about some of the things

I think we need to crack in the next two, five,

ten years as we look ahead to try and

make the National Health Service sustainable and

relevant for the next decade, the next 70 years.


A year ago if I had shown you the NHS website

you would be looking at something that

didn't work very well on mobile devices,

certainly had a large number of accessibility issues,

and was hosted mainly on Microsoft share point 2007.

Everyone laughs when I say that!

Today we are on an open source modern

content management system.

We have fundamentally a mobile first approach

to the design of the service.


We are working through a long backlog

of accessibility issues making things better and

more inclusive, by no means are we there yet but

we know what we need to do.

Critically, the role of the Web site is changing,

because historically the NHS website and

NHS choices was a kind of health Encyclopaedia,

vast amounts of content about symptoms,

conditions, and we are moving to a time

where people go online and they access information

not just for information because they want to do something,

ah so how do we link that information

with more actional things like finding the NHS service

that you want, booking an appointment,

accessing a GP, getting hold of your

prescription information, getting the things that are

actionable that allow people to do something for themselves.


We work in user centres,

agile multidisciplinary teams,

we believe strongly in the power of user research and

this won't be the first time I have linked back

to what Jared Spool would have said this morning,

but that two hours every six weeks of

getting your team and everyone in the team

exposed pro-primary user research is really important.

We believe user research is a team sport and

also that particularly given the stuff we are working on,

it is really important that we make services

that are accessible, that are inclusive and

we try to include people with access needs

in every round of user research,

we also will run rounds where we

are specifically only recruiting people with

access needs, because for some services

that's the reality of who our users are.


I want to share a comment from user research

participant a few months ago in Leeds,

where we did a study with people who

have Parkinson's disease.

Because it was important for us to understand

a range of different access needs and

the participant who I am quoting from now

had both a motor impairment and a visual impairment,

Parkinson's disease gave him eyesight problems

and made it harder for him to manipulate things

on a screen and he described in

painful detail the trade-off he had to make

on a daily basis when a website wasn't useable for him.


Where he could, to read better he might zoom in,

but then he zoomed in and so he's got fewer words on the screen so he has to pan and zoom around the screen

more so in order to be able to see the

words he is trying to access.

Then he said this, which really struck home:

When a link is too small, or a button is too fiddly,

it's doubly depressing because

it reminds me of my condition.

I thought, nobody goes to work at NHS Digital

every morning wanting to make someone with

Parkinson's disease feel worse.

But that's what we do when we inadvertently make

something that isn't fully accessible,

isn't inclusive, hasn't been tested with

people who have access needs.


In that quote I think is also a microcosm

the range of user needs we see across health and

care and I have Janet Hughes to thank who is in the room.

Janet is there, thank you Janet,

for distilling this down so brilliantly.

Janet did work with us and

framed this and said people have clinical needs,

so everything we do on the NHS website

has been clinically safe and accurate.

We have clinicians, doctors, nurses,

midwives imbedded with our teams,

often helping to create the content to make sure

everything is safe and accurate and effective,

there are certain types of treatment and

services that you won't see on the NHS website

because there isn't an evidence base behind them.

Everything we do will be clinically safe and effective.


But the safest service would be

one that nobody used and

unfortunately in the past the NHS might have

created some of those.

It also had to be practically useful.

If we know more than 70% of our users are

using our services or had mobile devices,

we need to design mobile first and then

it has to be emotionally engaging and

meet the emotional user need.

So if somebody goes to the NHS website trying

to understand what to them is a

very urgent health problem and

they read our clinically safe, accurate,

UpToDate information, accessed on their

mobile phone in a responsive way,

but if at the end of that they are still not sure what to do,

or they haven't been reassured,

they will probably still phone us up

on 111 or 999 or go to Accident & Emergency or

book a doctor's appointment because we

haven't met their user need.


If we don't also meet the emotional need.

In everything we do,

we see these patterns playing out and

I will give you some more examples of that as we go through.

First one is really simple, paracetamol,

one of the most common painkillers,

the old NHS website, NHS Choices had a page of

comprehensive information about paracetamol.

But when we researched the page with

members of  the public, there was one group in

particular who had a problem with it and

that was parents with small children,

because the old page mixed together

information about paracetamol for adults and children.


Parents were worried,

you can imagine the scenario

in the middle of the night,

not fully focussing they might read the wrong information.

The team worked on the problem,

they worked around and came to

the breath-taking conclusion the best thing to do

was create a new page about paracetamol for children,

because sometimes the simplest solution is the best.

So now it's still clinically safe and accurate,

hopefully safer.


It's meeting that practical need because we

are now going where the user is thinking

are they trying to find out about paracetamol

in general as an intellectual exercise or

are they trying to work out how much to

give to someone and it's meeting that

emotional need because now everything on

this page is the stuff that you need to know

as a parent or a career,

thinking about giving paracetamol to your child.

We are able to bring together those dimensions and

hopefully now empower someone to give

some simple medication that will make things

better for themselves or their child,

but also avoid the need to go and access a service

where they don't need to get up and

out in the middle of the night and access that service.


Some of the things we do might look

superficially simply, but then there's a deeper complexity.

So this is the 111 online service where you can

go on to the NHS website or on the NHS app,

you can answer a series of questions

about a condition, something that is worrying you,

and at the end it will tell you how serious

based on the questions you have answered

it might be, how urgently do you

need to get help and also where could

you get the right kind of help for

the problems that you have described.

It is a choose your own adventure of illness.

A set of questions and answers and

on the back of that, a disposition,

what to do next.

The thing this makes this complicated is that,

depending on your answers,

an ambulance might be despatched.


And so, it is that link from the information that

someone gives us online,

through to the services that are delivered

across the National Health Service in different localities,

commissioned in different ways,

it is the link to making sure that information about

the patient is in the hands of the ambulance crew,

when they go out on that call,

so they can give the best care.

And it is lining up all of those things,

so that we get it right first time and

don't ask patients to go through multiple access

points until they solve the problem that

they were trying to solve.


So, we have been doing some work,

particularly with future, around 111 and

emergency care as a wider thing to understand

what are the digital opportunities for

us across the whole of that space,

how can we make the health service digitally

more effective when people have an urgent

need or when it is an emergency.

I promised you more Jared Spool.

This is my "go-to" definition of design,

I was honoured to be standing on the stage

where Jared was a few hours ago.

I spend a lot of my time explaining

design it people hop aren't designers and

I always come back to this

"design is the rendering of intent".


Without rendering, intent is a great strategy,

we have lots of great strategies in the NHS,

but how do you make it real?

You need rendering side.

Without intent, rendering might be fine art,

it might be fun but it is not going to

get you where it needs to get you to.

So from the start of my time at NHS Digital,

I was challenged our designers and

user researchers to be able to talk about

the intent of what you are trying to do.

If we cannot start a show and tell presentation

explaining why we are doing this,

we probably shouldn't be spending any

more time and effort on it.


So start by understanding the intent but

then have the craft skills,

have the capability to Mick that real and

turn it into something that really solves the problem.


Quite often we think of needs,

user needs in this kind of linear way,

and again I'm feeling some of

the pictures you saw this morning,

they might also be echoed in this presentation.

It's not as straightforward as, you know,

I have a problem, I look on the internet,

I take a paracetamol, my headache goes away,

actually, when we do research,

it tends to be a bit like this,

there are ups and downs, emotional highs and lows,

moments when people need more support

than when they need others.


And unfortunately there are knots and

joins and bits where siloed services

don't quite work together and so

the experience of care can rapidly become

a little bit disjointed and it is either the

frontline workers who join the dots and

make things work for patients or it is the

patients and the public having to

puzzle it out for themselves, which isn't right.

Then we find a lot of experiences aren't linear at all.

They are cyclical.

So, when you get a repeat prescription,

or if you have maybe a condition that is seasonal,

that comes back at the same time

every year or just a general experience of

keeping well on a day-to-day basis,

there are things that you do over and over again.


You have an opportunity to learn about

your own health and well-being,

you have an opportunity to understand

how services can work, because you can

encounter them over and over again.

And so understanding where experiences

aren't just a linear beginning, middle and end

but actually are loops and cycles,

is one of the keys, I think,

to being able to deliver a much better

experience of health and care.

The other pattern that we see is

this kind of layers, the work on urgent and

emergency care is bringing this out.

It could be that the first time the

problem wasn't dealt of, it went back again,

and seeing the maps of layer after player.


Some of the things we do might look

superficially simple,

but then there's a deeper complexity.

So this is the 111 online service where

you can go on to the NHS website or

on the NHS app, you can answer

a series of questions about a condition,

something that is worrying you,

and at the end it will tell you

how serious based on the questions

you have answered it might be,

how urgently do you need to get help and

also where could you get the right kind of

help for the problems that you have described.

It is a choose your own adventure of illness.

 And that to me looks like waste,

it looks like something whereas designers

we ought to be challenging it and

say couldn't we have answered that

patient's problem the first time.

So Tero our lead service designer has

been audaciously making a map of the

whole experience of health and care,

trying to look at which bits of that

health and care environment and landscape

are cyclical and which are more transactional services.

So you will see the cycle of mapping my wellbeing,

we want to spend as much of our life

as possible in that circle, staying well,

not having to worry too much about things.


But then something might happen

that tips you into one of these more

linear experiences, of finding out what the problem is,

getting a diagnosis, managing, getting an,

having some episode that needs

urgent care and acute episode and

then recovery and then for some people,

for a growing number of people,

there's a cycle of managing a longterm condition,

an increasingly because people are

living longer with these conditions,

multiple longterm conditions,

and the interaction between them,

at that point the learning really kicks in

because it's the patient often who is the

expert in their unique combination of

medical conditions, so while the

health service is here to help and

there to support them, over time we speak to

some patients who are undoubtedly the

world expert in being them self.


Both in the health condition but also in

the way they live their life and

the way they have adapted life to fit

around the conditions they are living with.

And then there is a bubble at the end

will take us into end of life care as well.

Ultimately all of us will die,

we would like to think that will be a long time away,

and people will be well looked after in end of life.

There is a whole cycle there that people might also fall into.

So stretching those things out help

us to understand what is the overall experience,

user experience map that lasts literally a lifetime

from the cradle to grave,

from birth all the way through to end of life.


Here is a mapping example from our team

who work to on type one diabetes,

so they worked with both patients,

people with diabetes but also with clinicians,

so the pink sticky notes are incites from

user research with patients and

the green ones are incites for user research

with professionals, clinicians who look

after people with type one diabetes.

The team mapped the whole experience

from not even knowing that you've got a problem,

to some sort of trigger which starts people thinking,

well, maybe there's something wrong,

I need to get help for this,

through getting a diagnosis of

a potentially lifechanging condition.


And then starting to become more confident

in managing that condition and then

getting into potentially we would hope

many years of managing the condition

successfully through things you have to do,

appointments you have to go to but

you could live a very long and

relatively healthy life with type one diabetes,

if it's caught early enough and

you get the right treatments.

So they looked at the whole end to end journey,

they looked to the emotional highs and

lows through that and where people

needed most help and they came to the

conclusion that there was one point in

that journey where we as the digital bit

of the NHS, the NHS website could

help with most and that was the bit

just after someone had got a diagnosis.


Again, the old NHS website had some

great comprehensive information about

diabetes and it was structured the

way doctors think about diabetes,

the different types of diabetes,

these are the symptoms,

these are some of the treatments,

this is how diabetes works, medically.

But now we have moved from thinking

about diabetes the way that

clinicians think about it,

to presenting it on our website the

way patients experience it.

Which is in stages.


Going through that journey.

We gathered together just a few pieces of

information that people told us that they

really wished they had known in the

first few weeks and months after

getting a diagnosis of type one diabetes,

it uses video, because some people prefer

that to reading vast amounts of text.

It discloses the stuff that you need to know as you go along.

We think that structuring information

this way is really a key part of

giving power back to people who

have been disempowered.

It is easy in health and

care for people to be disempowered.

People at the top of their life,

being ill is just disempowering,

disability can be disempowering,

worrying about being ill can be disempowering,

stress is a cognitive impairment.

But because people are worried about being ill,

but they are worried about it,

it becomes an impairment.


So a whole lot of reasons why illness and

health problems can be disempowering,

but also one, sometimes, as the NHS,

we have designed things in way that

takes power away from people, accidentally.

We didn't mean to but the way we set up services,

when we make them difficult to navigate,

and make them impenetrable and

require special knowledge or jargon to

get their way around the service,

we have disempowered people,

we have to stop that by

making things simple and more

understandable and structuring in the

way people think about them rather than

the way professionals think.


We need to design them for the

positive role people have in managing

their health and well-being,

for what people can do for their assets,

rather than thinking about a deficit model,

fixing the problem.

We need to involve family and

carers and make sure we are addressing

people and involving them in the co-design

of services, because, again,

the people are the experts in their

own health and their own lives,

even though we have this amazing skilled

workforce of medical professionals

who can help serve them.


This is Hastings at dusk where some of

our team on the widening participation

went to work with people who are

homeless to help them understand

how digital services can help them when they are homeless.

Many of those participants had smartphones.

Their issues were around connectivity and

skills and awareness of what they could do.

So, by working with third sector organisations

that are supporting homeless people,

we are starting to try and make sure that

no-one is excluded from access to

these new digital services.


And we need to move up a ladder of participation.

As UX professionals, as user researches and

user-centred designers,

we are good at involving users as users

doing the usability test to make sure

it works for a user, one individual on a phone,

all looking at a screen,

that is really only step 1.

Quite often the beneficiary of the service isn't the direct user.

So there are services that are used by

pharmacist services used by clinicians,

but they still have a patient who is the end user

of that service, the beneficiary of the service,

we need to involve them even when

we are not designing something that is

going to be used directly by them.


Families play a key role. 

It's very rare, in my user research,

when we bring people into the lab,

it is very rare not to hear someone bring in

a story of a time they helped a family member or

a family member helped them when they were ill.

So, thinking about user research beyond

the individual is really important.

Thinking about the role of communities and

thinking about the role in decision-making,

not just passive consumers of health services,

but also making decisions about people's own

health and care, making decisions about

their family, making decisions and

sharing in the decision-making about how

the health service works in communities.


There is a ladder of research that

starts there but by no means ends there.

People see the blue NHS logo and think

we are one thing and in fact we are

many different organisations and

even within those organisations,

many different teams working on different services.

So, it was really important that we gathered

together a set of good practice,

some shared design patterns and

standards but before we could converge,

we had to diverge a bit.

When I first joined NHS Digital,

I was worried that we were in danger of

prematurely optimising on a set of

design patterns that hadn't been tested in

enough different services.


We had some things that had come from

good work on content pages and

one or two forms but nothing that

really fully explored all the different kinds of

services we worked on.

I made myself unpopular as a Head of Design by

asking designers to go away and

working on their own problems for longer.

By doing that we were then able to identify

where were people most at need,

what were the common patterns,

and then bring it altogether,

so a big synthesis day here where we

printed out different work from different

designers and started to identify what

were the things that were working and

could come together into a shared library.


We have Open Source code a

front-end library for the National Health Service website,

being picked up and adopted by

teams outside of our organisations,

in localities, in other national organisations.

We have got content-style.

We have got UI styles, components,

we have design principles.

We had to combine the best of the

gov.uk designs which are brilliant,

which I recommend but also brings something

of the NHS values to play as well.


You will see at the top of our

design principles "put people at the heart of everything you do"

a principle that comes from our

constitution but you will also see some of

the DDS, gov.uk principles coming into play as well.

It has been a delight to see some of

those appear on walls, in photos, in social media,

in teams we have never talked to directly.

But they came it the service manual,

they found them, felt they were useful to them.

They have not been mandated to use them but

they have picked them up and started running with them.


It feels like we have got a groundswell of interest and

adoption of our front-end code,

of our design principles,

of our patterns and styles that will take

this out across the National Health Service

beyond the small number of national teams that

are working on things like the national NHS website.

I have a short video of the NHS app.

I want to show you how some of that

work merges together where multiple teams

works on things and we bring it together into an app.


At an exhibition in Manchester

Matt Hancock stood up and

presented some of the work we had done on

the NHS app and he said,

which is good because you want your

minister to like the things you have made,

he said I like it and then he said

something which had our researchers punching

the air at the back of the room,

he said "I like it, but more important than that,

the design has been led by user testing and user research,

and that was for us the starting gun on

a new technology vision and

strategy that you will see rippling

through the NHS today.


We have a bunch of principles,

but for everything we do across health and

social care now, we expect them to be

based on user needs, on privacy, security,

openness and interoperability of systems and

inclusion has gone in as our fourth major

principle because the NHS is for everyone and

we recognise that if we don't meet those

needs we are not meeting the needs that

the service was set up to meet we have a

longterm plan by has a whole list of things,

I went through the NHS longterm plan and

pulled out the verbbased good services and

there are dozens of them,

the patient facing ones but also the

kinds of services that we are going to offer to

clinicians and people who serve those patients.


And by the way, genomics,

every line in the longterm plan has something that

looks like a massive piece of service design and

a set of principles that we want to be more

proactive in providing services,

we want to be more personalised because

that's not something that the NHS has

been wellknown for, we are very known for

being universal and providing great coverage to

all our population, less so for providing a

personal service to people.

Critically we want to be more joined up.


This is the big challenge for us right now,

if you think about all those different services,

different bits, commissioned in different places.

19% of adults in the UK have experienced

what's called a care coordination problem

in a two year period.

That's like a missed test result,

an appointment that wasn't booked properly,

some information not being present when

the clinician needed it to deliver care.


All those care coordination problems.

And actually, we are not that bad in

the international rankings,

19% is a pretty good score out of the

11 countries in that Commonwealthrun survey.

But this is less good  37% of low-income

adults experienced a care coordination problem.

So here we are, here for everyone,

this universal service that we are really proud of,

but we aren't yet getting it right for

the whole of our population.

And the people with the least capacity are

often the ones who are experiencing it most.


So, it's a clinical safety issue sometimes,

it is definitely an equalities issues and

technology that doesn't work right is also

now a workforce issues,

so you may have heard that the NHS needs more doctors.

I have heard stories of GPs timing their

early retirement to coincide with the introduction of a

new computer system in their surgery.

So just at a point when we need every doctor

we can get, we need technology which is

a joy to work with that makes people feel

that it is supporting them in doing their job,

not something that makes their lives harder.


In the United States there is a whole

profession grown up called the medical scribe,

people whose sole job it is to sit next to

the doctor and look after the computer so

the doctor can look after the patient.

Now that doesn't sound like a very efficient way of

using technology to promote better care.

So I think we've got this paradox,

it's not a contradiction to say the service

needs more money, but that also there's still

quite a lot of failure waste,

we could do better with what we've got,

if we had a better approach to the way we

use technology in the service and the way we design.


We need innovation, Genomic,

personalised medicine are coming our

way and we want to take advantage of

those amazing break through that science is

bringing us, but at the same time we

need to get the basics right, because

if we don't have information in the

right places at the right times when people are

delivering care, none of that other stuff will help.

We need everyone to be a designer but

also this is no job for amateurs.

I think if you want to come and join us,

I am sure many of you are already,

working in health and care,

the first thing I want to say is just be

careful because a sense of mission is not enough,

we do get, every time I do an interview,

I have done, I have interviewed a lot of

designers applying for jobs in the

HHS over the last two years,

I can think of one in that time who

didn't tell me how excited they were to

come and work for the NHS.


It's great that people have that

sense of mission, but I worry sometimes that

if that is the only thing bringing you in,

you are going to burn out pretty quickly,

because these are tough problems,

it takes a long time to make a change sometimes,

and just a sense of mission is not going to be enough.

We need people who are also able to

tangle with that complexity.

Secondly, a mindset is not enough,

so I see a lot of really good application of

design thinking, cocreation, idea generation,

and then it's such a shame because

the ideas are let down by poor execution.


So, we need to have the design craft skills to

be able to come up with good things

using that service, that design thinking mind set but

then have the service design craft skills to

be able to turn it into a reality.

So, I mean things like communicating complexity,

how do you show the vastness of

the problem but make it understandable to people.

How do you rapidly prototype different

solutions and experiment with them?

How do you do that when you are

working across multiple channels, some online, some offline.


How do you design with data because

doctors don't trust anything unless it's

got evidence behind it, right?

We should as digital practitioners be

there with all the evidence ready to hand.

You need to think about the pacing,

are you working on a service that needs to

work instantly because it is an urgent

situation that needs to be resolved in the

next five minutes, or are you working on

something that's a condition that is going to

unfold over a lifetime where someone is

going on a journey and needs a little bit

every few months to be able to get to grips with something.


Service designers, I think,

are really well placed to bring those

skills that have been missing in parts of the health service.

So this is the E service,

the journey of getting a referral from a

GP when your family doctor refers you to

get help from a specialist or hospital appointment,

people get a referral and they map this

journey and the designer there, Pete,

talked me through this massive service map,

hundreds of sticky notes on the wall and

he stopped at one PostIt note and said,

that, that is where we could use AI to

help a clinician be confident they are

making the right recommendation.


I really liked that because it struck me that,

yes, we want to use this technology but

we can only do it if we fully understand the

whole experience that we are introducing it

into and when we've got designers and

user researchers who understand that

whole picture, they are really well placed to

direct the technology in the right ways.

I have been hearing a lot recently about

voice interfaces and chat bots and

how they can be used in health and

care and there are really exciting things

being done, interesting experiments,

but I kind of think that those fashions for

interface technologies speak of something deeper.


They are telling us that people want to

have a conversation with their service.

It's not necessarily because they want to

use natural language processing,

it's because they want a service that is responsive.

That's the hard work of service design that

we've got to take on.

Not knowing how to slap an interface on

an existing service but how to make the

service configured to be more responsive and

personalised so it can deliver the untapped

behind the chat bot,

not just render the basic reality of it.

We have had to create the space for

design to work in the NHS.

Because this is not a green field site.

It's a place where there are already

lots of opinionated professionals who

have ways of solving problems.


And they are great and we want to work with

them all but when you are introducing a

new methodology or service design,

you have to create the space for the

service designers to do their work and

hold the space open when people are

getting impatient and saying what are

these people doing with post it notes,

why aren't we seeing any evidence of success yet.

Because it is going to take time.

A design leader's job is hold the space and

defend that space for the team to

do its work before it comes through.


Finally I have been thinking about a

bit about what would a user experience

strategy look like at the scale of health and

care and that is not which font to use,

which colours, how we do the front end design,

it is big questions like this,

it's how do we move authority for

design decision making to the places that are

best placed to make it.

So who knows where is the best place to

make these decisions, is it local,

is it national, is it somewhere in between,

how do we get the right design skills and

capabilities in the places where decisions are being made.


How do we treat technology as an enabler of

good experience rather than something that

is driving its own agenda and then

experience has to be layered on top.

How do we align the incentives when

systems are being bought and sold,

how do we align the incentives of

buyers and suppliers with the needs of

end users because quite often the

end user isn't the one that is making

the technology buying choice.

But their experience is dependent on

the choices that are made.


Somehow do we integrate it for the quality and improvement.

Every day there are people managing hospitals,

and doctors’ surgeries want to make it better.

If we believe user design can help them,

how can we make sure these methods will

help them to improve the

health service day by day, week by week.

I want to end on a quote from Nye Bevan again.

Because Bevan, I think, as a politician,

had this wonderful capacity to see into the

future and see human progress in a dynamic way.

So right back, even before the service started,

he was making a speech to the

College of Nurses, I believe.

They were challenging him saying - minister,

you have not given us enough

resources to make this a reality?

Does that sound familiar?

The NHS never has enough money.

And Nye Bevan said "We shall never have all we need.

Expectations will always exceed capacity.

The service must always be changing,

growing, and improving.


It must always appear inadequate."

So, now, today, 70 years later,

I have these yellowing dogged pieces of

paper from 1948 but the intent is still the

same and we are still here,

70 years later with a service that is always growing, changing and improving.

And I hope that you will be inspired to play some role in helping us to that.

Thank you.