Its been a while. Being honest, I’ve just not prioritised public weeknotes for a while. I finish on Thursdays and then do all the jobs on Friday.

Anyway, what’s been going on?

I’m still working with NHS England Digital Prevention services, splitting my time between improving delivery conditions across the portfolio, and Managing My Health team.

Disco -> Alpha

Managing My Health are still a new(ish) team, moving from discovery into Alpha, with a focus on how to improve results presentation for prevention services in the NHS app. I dropped in to the first day of their Alpha planning sessions on Thursday, and their recent discovery playback too. A few things are obvious:

• When you’re working across all of prevention, a lot of contextual knowledge is needed. That takes time, but the team has shown it in spades. The research hasn’t only been with the public, but across teams. Understanding their plans and goals, as much as building on the research they’ve already done.
• There’s huge opportunities to improve how people see results in the NHS App. Each service is handling results differently, and there’s still some ongoing issues with ‘unexpected results‘ where the process of results becoming visible in the app isn’t working as intended.
• Lots of challenges with results for prevention services (e.g. screening) come down to the fact that the infrastructure is built on the historic assumption of a Healthcare Professional receiving the result and then communicating the result in an appointment or via a letter/phone call. This is being repurposed to meet the ambition of the NHS App acting as a heath companion, but the language and formatting is intended for clinicians, not the public.

What’s less obvious is:

• How short or long term should the team be thinking right now. My gut is telling me that very little is certain about what the political or technical landscape we will be operating in will be in 6 months time, so we shouldn’t assume we can plan based on that. We don’t lack ambition, but we also haven’t yet proven that anything we want to do is possible. So I think we start there.
• What to do with all the other potential opportunities, the team is full of talented people with great ideas, with more flowing in form leadership, advisors and other teams. Justifying *not* working on something is almost as hard as justifying the thing you are working on.

Shout out to the team for a great Alpha kick off and welcoming me along for it.

Clearing the path?

Designing and delivering services in the NHS is different than the rest of central government. Assurance processes keep people safe, but they’re also one of the main challenges in maintaining a rapid pace of delivery.

The ambition for digital in the NHS is huge, you only have to read the 10 year plan. Digital teams are responding, but its causing the classic friction where governance and assurance aren’t growing at the same rate.

Multi disciplinary teams tends to mean design/engineering/product/delivery/analysis/research etc. But in reality what you need, especially in the NHS, is clinical and Information governance in teams too. That’s particularly challenging in an org that’s restructuring whilst it merges with another. Or maybe that’s the opportunity, when there’s an operating model up for grabs. Continued support for the work is essential, but that means very little without the rest of the organisation having the capacity to enable it.

We’re still working at the lower levels of leverage, trying to reduce failure demand, helping people only spend time on the really difficult bits, improving first drafts, introducing concepts during onboarding etc. Its a bit frustrating, its really hard to collaborate with a team that’s already struggling a lot with capacity. Its tempting to roll out the criticism of being too busy to change, but every meeting us time that they’re not supporting teams with delivery. And we’re meant to be helping!

We press on, very little *feels* like service design, but a combined ground up and top down approach can have an impact, so we’re trying to make that happen.

What else?

• Wrote about service mapping in the water sector
• Finally rode the Trans Cambrian Way. It was good. Hard, but good.
• Took my son to Bike Park Wales for the first time
• Got my certificate for the Prof Doc in the post
• Helped demolish a friends garage base
• PD’s summer gathering
• Birmingham Design festival for the first time