NHS notes

Week 91: Writing like we’re running out of time

2026-04-12T00:00:00Z

My win of the week was getting a blog post approved for publication on the NHS Digital Design Matters blog.

Getting an official blog post out is a lengthy process with several steps and sign-off needed from multiple teams. The post was initially rejected, but approved after I appealed for more feedback. I’m not entirely sure why, I wasn’t in the room where it happened.

I’ll say more about the post and why we think it’s important when it’s actually live and I can link to it – it still needs adding to the CMS and then a grid slot agreed for publication.

There’s a part of me that understands why there’s a high bar for publishing. The work is what counts. But we do also need to talk about it. Not as vapid fluff, but openly and honestly showing the things as we build them, discussing what we’ve learnt, and inviting others to contribute.

Agile comms are a critical part of the method.

These weeknotes and the weeknotes and blog posts of my colleagues help to tell our story.

Our mission is important, and we’re not throwing away our shot.

Week 90: Hail Mary

2026-03-28T00:00:00Z

I went to see Hail Mary on Monday at the cinema. It’s a space film about an against-the-odds quest to save humanity, based on a book by the same author as The Martian. I enjoyed it. You should go see it if you like that sort of thing.

Sometimes working in digital for the NHS feels like a Hail Mary activity. Trying to fix an organisation saddled with decades of technical debt and unfathomable complexity. Against a backdrop of continual organisational restructuring, some big dominant suppliers and shifting political priorities.

We even share some of the same language as space flight, with our mission patches and go/no-go calls.

But unlike the movies, our tale is not one of solo heroic acts. Instead it’s a story of collaboration and smart, multi-discipline teams doing the steady work of building and shipping software, designed around our user. Not enterprise architecture or generic data platforms but specific digital services for specific needs.

This is radical in its own way. We’re working in the open, releasing the source code, and sharing our learning as we go.

For the NHS, by the NHS.

It’s a Hail Mary endeavour but it might just work.

Week 89: Signs of Spring

2026-03-22T00:00:00Z

This week the sun finally returned, and I could stash away the winter coat. Even managed an after-work drink stood outside watching the sun go down.

Prototyping with real data

I spent much of the week preparing for some user research that took place on Thursday. We’ve been looking again at how pharmacies sign up to Record a vaccination. The design we launched in August last year has been successful, but it only lets pharmacies sign up one at a time. So now we’re looking at making it easier for pharmacy chains to sign up multiple locations at once.

It’s a tough problem as the chains vary massively in size. There are hundreds of small companies which own a handful of sites, lots of mid sized companies owning dozens, and then there are few big national brands which have hundreds of shops.

We wanted the user research to be as realistic as possible. My initial idea was to set the prototype up with the information about the companies that the users who’d signed up for research were from. But this was a fair amount of tedious work, copying names and addresses into a data file. So I pivoted and decided to just set the prototype up to query the live API of NHS organisations (which includes pharmacies) instead. The data is open and public so I didn’t have to ask permission or worry about privacy.

It worked a charm, and instantly transformed the prototype from being a basic demo to something that feels far more real. It’ll also tell us a lot about the quirks and limitations of the ODS data source too.

The actual interface I’ve designed doesn’t really scale for the very biggest pharmacy chains yet. They basically get a very very long page of checkboxes. But I decided to test with this anyway, as these companies are the exception, and we need to learn more about how they operate before designing anything more complicated.

Vaccination history redux

There was news this week of a meningitis outbreak in Kent, in which 2 students have sadly died. Colleagues from UKHSA and NHS England have mobilised a response, distributing antibiotics and vaccinations.

It’s promoted some further discussion about the difficulty that patients currently have in being able to easily and reliably access their vaccination history. As I’ve mentioned before, the NHS App does offer this, but only if you’ve set it up and have asked your GP to enable full record access, and even then the information may be partial or hard to interpret. For those in Kent, the best advice right now is probably to check with their GP.

One of our teams has launched a check children’s vaccination history alpha which will explore the data problem, with an initial focus on MMR vaccinations.

In Cardiff this weekend there was an NHS Hack Day. I used to love going to hack days (fond memories of a massive one in Ally Pally sponsored by Yahoo!) as they were a great place to learn and experiment. I couldn’t make it to Cardiff, but I did watch the final presentations online, and one team explored the topic of vaccination histories, presenting a prototype called ‘Find my jabs’.

Their prototype aimed to help patients understand that they may have to consult multiple sources to get their complete vaccination record, including any given privately, through occupational health, or by the health service of another country. Well done to the team for giving up their weekend to explore this tricky topic!

I’m hoping we can collectively make some inroads into improving this.

NHS frontend and prototype kit updates

We’ve released a couple of small updates to NHS frontend and the NHS prototype kit.

Version 10.4 of NHS frontend contains a new ‘inline’ option for the header. This is useful in contexts where the header contains only a couple of elements, as it’ll now take up less space on mobile.

It also contains updates to the Nunjucks macros which aim to make them easier to use. Instead of having to remember (or look up) a bunch of special hyphenated class names like nhsuk-input--width-10 and nhsuk-button--secondary, you can now use width: 10 or variant: 'secondary' instead.

For the prototype kit, version 8.1 contains a new date formatting filter. This makes it easy to take a date entered as numbers by the user and display it as the more readable ‘22 March 2026’ format on the check answers page.

Both of these last 2 changes came directly in response to our prototyping training course, where we’ve learnt which things participants find it hard to do. A nice example of user-centred-design for design systems.

Week 88: Seasons ahead

2026-03-15T00:00:00Z

A short week for me, as I returned on Wednesday from my skiing weekend (which was great), so I’ll keep these brief too.

Spring

We’ve been getting ready for the start of the Spring 2026 Covid vaccination campaign. As with the winter campaign, this is for those over 75 years old, resident in a care home or immunosuppressed (see JVCI guidance).

For the staff using Record a vaccination (RAVS), we’ll be sending them out an email reminding them to do the usual preparatory things such as making sure the right staff have access to the service, and adding the new vaccine products and batches for the locations where they’ll be giving the vaccinations.

As the service is being continually improved, we’re also taking the opportunity to tell them about some recent updates. We know that some staff like to know about every change, whereas others don’t have time for this and prefer to just discover changes as they use the interface. For those who do want to know, we’ve now added a What’s new page which details the last few months of changes.

My colleague Anna has written a design history post giving more context on this: Telling users what’s new.

We’ll keep an eye on the new page to see what kind of engagement it gets.

Winter

We’re also already planning ahead for next winter. Our roadmap for this is ambitious, with several new features and an expansion for more users in different settings.

One crucial but tricky question is how we can best integrate with the Manage your appointments service, to make recording vaccinations for patients who’ve booked far easier.

Week 87: How the sausage is made

2026-03-05T00:00:00Z

Over the past week I’ve been involved in a workshop and some conversations about the design process.

Whilst most of our teams within NHS England are now using the NHS prototype kit, some teams are also using Figma to document every variant of every screen. I can see how it can be useful to be able to visualise the flow of a service, but I fear that expecting designers to maintain both a coded prototype and a Figma version could slow things down and be unnecessary duplication.

Teams also vary in how much detail about designs they add to Jira cards, and whether they use Confluence or Mural or Word or other platforms to document stuff.

I don’t think we need this to be consistent across teams. The design process can and should vary according to the context, dynamics and preferences of each team.

Design artefacts are just that: artefacts. The only thing that really counts is the actual thing that gets built and used by real people.

I try to avoid thinking of any designs or prototypes as being the ‘single source of truth’. It’s all too easy to end up with designs that are months and months ahead of a live service, and even if all the build work is on your roadmap, plans can change.

The relationship between design and development is something that needs constant work to develop and improve, especially as people come and go in a team. In my experience, the closer the 2 disciplines are to each other, the less you have to formally document. Regular conversations and demos beat reams of written acceptance criteria.

We’ve also had discussions about whether and how to version designs. I don’t think there’s a single answer here either. Some teams in an early stage might have distinct iterations of a design, whereas other teams with a live service may be continually tweaking and updating, or be working on several things concurrently.

For coded prototypes, I tend to recommend that designers avoid maintaining several versions within a single prototype unless there are good reasons to, as it can soon get unwieldy and hard to keep all the versions working independently. An alternative strategy is to make use of some of the Git features that developers use. You can use branches to try out different ideas in parallel. Or make use of the commit history to view a design as it was several months ago, if needed. It’s incredibly powerful but there is a learning curve - so this is something we could offer more support and guidance on.

I also advocated again for writing design histories. These can go beyond documenting just what the designs are, but instead describe the intent. The why to go with the what. They’re also a place where you can describe any discarded ideas that didn’t work, or things you’d like to have done but couldn’t yet for pragmatic or technical reasons.

I’d love to hear from other teams about how they document their designs. Other disciplines too - I’m sure there are some interesting debates within the user research community on how best to write up their research and in what level of detail.

Ultimately there are many ways to make the sausage.

A short week for me this week and next week, as I’m currently on a TGV en route to thr Alps for a ski weekend!

Week 86: Red books

2026-03-01T00:00:00Z

This week I got a stark reminder of the importance of vaccinations, in the form of a text message from my kids’ school about increasing measles cases in North London.

The message linked to a PDF of a letter from our local Integrated Care Board (ICB) which tell us to:

Learn about the signs and symptoms of measles
Check if our children (and us) have had the MMR vaccination
Arrange MMR vaccination if needed, either through the GP or at one of the local catch up clinics
Notify the school if you think your child may have measles, and call your GP or NHS 111

It is alarming stuff.

Checking whether your children have had both doses of the MMR vaccine isn’t currently easy. I was pretty confident ours had, but thought I’d see how easy it was to verify (let’s face it, those first few years of parenting are a bit of a sleep-deprived blur).

Your first port of call is the red book. These were given to us by midwives shortly after our kids were born, and were dutifully taken to all the early health appointments for check ups, weighing and vaccinations. But I’ve not looked at them for many years now, so I had to dig them out from a pile of old paperwork at the top of a wardrobe.

Within the book, the MMR vaccinations are on page 19s and 20 (for us at least), with the hand written notes giving the date, venue and details of the vaccination (product, batch number, and ‘LA’ indicating left arm). I also discovered the folded information leaflet from the vaccine, tucked into the sleeve of the book.

If you’ve set up proxy access for your children (which itself is a bit of a faff), you can instead check their vaccination history within the NHS app. To do this you have to select ‘Manage health services for others’, select a child, then go to the GP health record section and look under ‘Immunisations’.

In our case, the immunisations section lists 34 items for our eldest child (age 10). Some of these are actual vaccinations, but others seem to be vaccination-related notes, like ‘Full consent for vaccination’, ‘Recommendation to have child immunised against poliomyelitis’ or in one case just the single word ‘Immunisations’.

My kids’ MMR vaccinations are listed as ‘Measles/mumps/rubella vaccn.’ in one case, ‘First MMR (measles mumps and rubella) vaccination’ in another, and ‘Measles mumps and rubella booster vaccination’ in a third. This inconsistency is confusing and makes the history hard to scan.

If your don’t have proxy access set up, and can’t find the red book, the other option is to phone your GP and ask them to check. Hopefully they have good records for your children, but for adults they may not have - my GP seems to have no vaccination records for me except for the COVID-19 ones.

There is much to do to improve this. The NHS app needs to make it far easier and quicker to check your children are up-to-date with their vaccinations. Ideally you wouldn’t even have to remember to check, but could be notified when the vaccinations are due.

Thankfully, our teams are already on the case, with plans to improve the view of vaccinations in the app, make it easier to get proxy access set up, get better historic data on MMR vaccinations, and building services which let teams run some of the catch up vaccination clinics we’re seeing in response to outbreaks.

I’m proud to be playing a small role in supporting the design of this important work.

Week 85: 3 ways

2026-02-21T00:00:00Z

If you’re a designer working on a service for the NHS, it’s unlikely that your service operates in complete isolation from everything else.

Instead, it’s likely hooked up to a bunch of other services to exchange data or deliver core functionality.

As a designer it’s tempting to treat the intricate details of how all this works as a purely engineering concern. But design is how it works, as Steve Jobs once said. And even if we can’t influence the design of all these integrations (and we should try to), it falls to design to make it clear to our users.

It’s in this context that I find myself reading and trying to understand the technical documentation for all the various systems and services within the NHS.

This is often made trickier by there being multiple different mechanisms to do the same thing, whether it’s reading and writing to GP records, searching for patients, getting information about organisations, single sign in systems, and more.

To give a quick generalisation, there might be 3 ways to do a thing:

the old way, which is still being used but considered legacy and will be retired at some point
the current way, which meant to be a replacement but has several known limitations
the future way, which will supposedly fix all the issues but is not live yet

This isn’t just an NHS problem. I was chatting to someone who works at a gigantic tech company who was describing exactly the same thing there. It’s probably true of all large organisations.

I don’t know what the answer is. There’s often lots of good reasons to build a new thing rather than improve the current thing, whether it be technical, political or purely pragmatic.

And turning off the old thing is hard. Long transition periods can be sensible in a field as highly dispersed and mission-critical as the NHS.

But we have to try and trend towards making things simpler rather than ever more complicated. Particularly where that complexity spills out into complexity for our users – although NHS staff are now well used to different systems giving them slightly different data.

In the meantime, as designers we can help by trying to understand and describe the different ways to do a thing, both internally and for our users.

Week 84: The ideological Turing test

2026-02-15T00:00:00Z

This week we had Professor Tom Stafford come and give our Thoughtful Thursday talk. Tom is a friend of mine, and I invited him in after a discussion we had about vaccinations when out walking in the Lake District last year.

Tom discussed 2 of the psychology research project he’s worked on which looked at vaccine hesitancy.

The first was Using dialogues to increase positive attitudes towards COVID-19 vaccines in a vaccine-hesitant UK population Open Access and aimed to replicate a French study which showed that a 5 minute interaction with a chatbot could lead to increases in positive attitudes towards vaccinations. As well using the chatbot style interface (which wasn’t AI based but more like a branching narrative interaction), they also had a control group presenting the same information in a static format. Both groups had the same positive effect.

Their conclusion was that it was engagement that counted, not the interface, and that people’s minds could be changed.

It’s also worth saying though that the study measured attitudes rather than action, so there could still be a motivation-volition gap.

The second study explored the ideological Turing test. This puts a spin on the original test proposed by Alan Turing to distinguish human and artificial intelligence.

The idea is to test whether people are able to summarise an argument which you don’t believe, in such a way that your opponent would agree with. In short: can you at least listen to and understand another point of view?

The project tested this by asking people to give opposing arguments on 3 topics: veganism, COVID-19 vaccines, and Brexit. Their arguments were then shown to the other side, who were asked to rate them.

The results were that, on all 3 topics, people were able express convincing opposing arguments to a reasonable degree. The one exception being veganism, where both pro and anti-vegans struggled to argue the case for eating meat.

You can explore the data, including keywords from the arguments people gave on each topic, in an interactive explorer tool.

Tom’s conclusions from both studies are that people are more rational and willing to engage in complex topics than the media might sometimes portray. Misinformation is not a virus.

In the questions after we also discussed trust. People’s trust in institutions may be reduced, and there’s less deference to doctors than there was. But trust needs to be earned, and perhaps having a more engaged patient population is a good thing, even if it takes more time to explain and reassure?

There’s also a question for us digital folks: should we focus on the ‘low-hanging fruit’ of reducing frictions and making for those who want it to actually get their vaccinations? Or do we have a role to play in decreasing vaccine hesitancy too? I think we can contribute to both, even if the latter is harder.

My thanks to Tom for giving the talk. He’s published the slides online. His Reasonable People substack is worth a follow too.

Links

What is user research? on YouTube is a fantastic video from my colleagues in the breast screening team, where Fred manages to show (not tell) the value of their ongoing user research.
Personalised Prevention Strategy – an update in 2 stickers from Irina and Naomi gives an update on the strategy from their team.
Children to be better protected from second-hand smoking and vaping from the Department for Health and Social care kicks off a 10 week consultation on the extension of the smoking ban to include outsides spaces like playgrounds and hospital grounds. I do wish that this included pub beer gardens too though.

I just had a jacket potato for the first time in ages. So good, and an antidote to this miserable weather.

Week 83: Searching patiently

2026-02-08T00:00:00Z

I was up in Leeds for 2 days this week as part of our monthly team get togethers.

We had some productive sessions and it was great to see the team. But I did feel guilty this time as my daughter became sick just as I was on the train leaving London. Bad timing! (She’s fine again now)

Patient Demographic Search

One of our team sessions was to look at how we can improve the experience of searching for a patient within NHS Record a vaccination.

Most of the time, staff are able to quickly look up a patient using their NHS number, either because the patient knows it by heart (more common than you’d imagine!) or because their number is associated with a vaccination booking or other record.

However in circumstances like a pharmacy walk-in, the staff have to find your record using your name, date of birth and optionally postcode. In our service this currently returns a match 70% of the time. We want to see if we can make this number go up.

There can be many reasons for a failed search, including mis-spellings of names, name changes, address changes, or someone not remembering their date of birth. Double-barrelled surnames are often mentioned by users as an issue too.

The API that we use for searching is called the Patient Demographics Service ( PDS). We spent some time looking at their public documentation for ways to improve searching, which include the possibility of wildcard searches, fuzzy matching and partial postcodes. All things to explore further.

Unbeknownst to us at the time, it turned out that the team managing PDS were sat not far away from us. We’ve since reached out to them and have gotten some further advice.

Being able to quickly and accurately search for patients across England must be a very common need across NHS staff facing services, so I’m hoping we can learn from other teams too. And maybe we could even collaboratively produce some design guidance around this.

Accessibility lab

Whilst in Leeds we also took the opportunity to use the accessibility lab. This doesn’t replace the need to get an expert external audit, or to test services directly with disabled users and those with access needs. But it gives the team some more awareness of the different assistive technologies and the chance to test our service in them for ourselves.

I’ve tested with VoiceOver a fair bit in the past, but I’ve not had much chance myself to use JAWS and NVDA. There’s a fair learning curve, but the volunteers who run the accessibility labs in the Leeds office have written some helpful getting started guides.

There’s also a Chromebook set up to demonstrate some personas. I tried the ones which simulated dyscalculia and dyslexia, both of which affect people close to me. You can try them for yourself at Accessibility Personas (thanks to the GDS team for making this open!)

Product support

Support for the Record a vaccination service is soon switching to using the NHS national IT customer support team. Planning for this has taken up a fair bit of our time.

Part of the change means switching from offering support via a phone number and email address to using a contact form. We’ve published a design history post to detail how we’ve approached designing this.

I’m hopeful that we’ll be able to work more closely with the new team, and gain some insights into what our users are asking questions about.

Co-incidentally the NHS Notify team have published a blog post about this very topic this week: More than a helpdesk: user support’s role in helping GOV.UK Notify send 12 billion messages. They say:

User support is more than just answering a question or helping users complete a task – it’s a shared responsibility, a source of insight, and a catalyst for improvement when delivering a service.

Yep, yep, yep!

Prototype kit major update

This week I finally released version 8 of the NHS prototype kit. It has a few new features but the biggest problem it aims to solve is upgrades. Previously, upgrading prototypes was a laboriously manual and error-prone task. This then meant that few people bothered to do the upgrade, which in turn limited the immediate value of making improvements to the kit.

Version 8 solves this by using the node package management (npm) system. This makes upgrades a largely 1-click process, and also means that designers will be notified by tools like “Dependabot” of any updates.

Switching from version 7 or below to version 8 is still quite a manual process though, so we’ve released a detailed upgrade guide, and will be helping anyone who gets stuck.

It’s taken me over a year to get version 8 ready. It borrows much from the GOVUK Prototype Kit, but aims to be simpler and more flexible, which will hopefully allow us to maintain it more easily.

I’m grateful to Colin for helping with the code, and to a whole group of NHS folk for testing early versions.

Despite all the testing and 10 pre-release versions, we still had to quickly release an 8.0.1 release with some bug fixes. Slightly embarrassing, but there we go.

Onwards!

Week 82: Beware the combine harvesters

2026-01-31T00:00:00Z

This week our CTO Duncan Brown gave an updated version of his Team dynamics after AI talk. I won’t bother trying to summarise the whole thing, as you can go read his published version for yourself.

However he introduced a new analogy which struck a chord.

It relates AI to climate change. No, not the impact of data centres on electricity and water usage (although that is an issue too). But how AI has the potential to take the communities of products, platforms, design systems, open source tools, shared knowledge and so on that we’ve built up, cut it all down and replace it with a monoculture of less diverse products. This perhaps gives us a immediate higher yield, but ends up destroying the ecosystem.

In this scenario it’s not hard to identify the big tech firms promoting the combine harvesters. But we’re the bats and bees.

If this sounds depressing, the upbeat note was that we can resist it by having diverse teams, telling stories about what we do, and getting on the front foot.

Beware the portals

Also this week, the government launched an AI Skills hub offering free (mostly) training from a bunch of big name partners.

It didn’t take long for people to realise that the hub doesn’t actually host the courses themselves, but instead links out to existing course elsewhere.

You can see where this strategy may have came from. If you take the premise that there’s a skills shortage around AI, you might then conclude that this gap exists partly because people don’t know where and how to acquire the skills. Hence a proposed solution of: a portal. You might even have some research where people suggest this or think it sounds like a good idea.

The thing this: this applies to just about any domain. The world is complicated and messy, and finding out about anything, whether it’s clubs you can join, places to eat, entertainment you can watch, or health services you can access, is hard work.

But a portal rarely solves this problem. More often that not, they just add another website to the existing cacophony of websites.

And sure, there are some successful examples. Deliveroo, Netflix, Happity, and so on. But they’ve survived through a combination of heavy marketing, initial discounting, adding extra value like payment processing, and a good deal of luck.

As for skills and training, well the government already has Skills for careers, National careers service, Free courses in England, T-Levels, Apprenticeships and probably several other portals I’ve missed.

For NHS prevention services, it’s tempting to think of the NHS App as our ultimate portal. And in some ways it is. But I still think we need to embrace multiple front doors, not put all our hope in having a single one.

Beware the public deadline

On Record a vaccination, this week we finally removed the old interface for recording vaccinations. We had been dual-running the old and new interfaces side by side for several months, allowing users to get used to the new one and to switch to it in their own time.

However we twice advertised a date for retiring the old interface, only to postpone it due to technical issues requiring a bit more work. In many ways this proves that the strategy of dual-running rather than switching everyone all at once was the right one. It reduced the risk and meant that the new interface is more robust than it might have otherwise been.

But we’ll definitely think twice in future about giving our users an exact date for changes to the service.

Week 81: Do interrupt me

2026-01-24T00:00:00Z

I sometimes need distraction-free time in order to focus on a tricky bit of design or prototype coding.

But most of the time I don’t actually mind being interrupted by a Slack message or an in-office tap on the shoulder. Being able to be responsive and to help a colleague or jump on a call to collaborate feels like part of the role. I’m generally working on several things at once.

However I appreciate that not everyone works best this way.

Interruption pages

This week we released a new Interruption page guidance in the NHS design system.

Interruption page guidance on the NHS Service manual

It’s based on a longstanding pattern used across government services, after being first introduced by GOV.UK Verify back in 2015. Since then Ministry of Justice have written some excellent guidance for it, which I’ve now adapted for the NHS.

For example:

if a user has entered a blood pressure value which is theoretically possible but very unlikely
if someone is about to cancel a hospital appointment which has a long waiting list
if a clinician is about to record an unusual medication dose

The pattern aims to slow the user down, so they can confirm their action is correct. This is one way we can help improve clinical safety.

However it should not be overused, as it can lose its impact if users become inured to it.

I’m hoping that some of our services using it will be able to collect some metrics, showing how often the page is shown, and the proportion of users continuing vs reconsidering.

We’ll continue to iterate the pattern and its guidance as we learn more.

I’ve also proposed that it is added to the GOV.UK Design System.

Newcastle training

I was up in Newcastle this week to deliver another session of our prototype kit training course, alongside Ananda and Jo.

The 10 participants were from both NHS England and NHS Business Services Authority, and so we assigned people into mixed pairs – a small way to encourage cross-organisational collaboration!

They day went really well, with each pair being super engaged and enthusiastic, and seemingly delighted that they were able to build a working prototype of an 8-10 page service.

The only sad note for me was that Vicky, who developed much of the initial concept for the course, wasn’t there to teach it with me in her home town.

Fix things, moving fast?

Government minister Darren Jones gave a speech this week titled Move fast. Fix things.

There was a good articulation of how technology can be used to increase rather than decrease human interactions:

modern technology to do the tedious admin that we spend so much time and energy processing right now, and then frees up our public servants to have the human interactions needed with a child, a parent or a patient.

This is something that especially applies within the NHS, where it’s not uncommon for patients to feel that staff are spending more time looking at their computers than talking to them.

The faster and simpler we can make services like Record a vaccination, the more time a nurse can spend reassuring a potentially needle-phobic or vaccine-hesitant patient.

As to both moving fast and fixing things, I did wonder whether you can truly do both at the same time. But perhaps it’s all relative, and even if it takes a year or two to develop a minimum-viable new digital service, and then another year or two of dual-running alongside a legacy service – that might still be considered fast compared to a massive design-everything-up-front waterfall IT programme?

Week 80: The bull in the room

2026-01-17T00:00:00Z

I’m writing these notes on the way back from UK Gov Camp in Birmingham. It was great to catch up with people at the event, meet some new folk, and take part in some thoughtful sessions.

One of the more NHS-relevant discussions was about digital identity and verification. This meandered into talking about ‘proxy access’ too, with someone from the Department for Education saying that they’d like GOVUK One Login to be able to support parent or carer relationships. This is something that the NHS already has, although it’s not yet as widely used or as easy to set up as it should be.

Patient-centred-design

The Secretary of State for Health and Social Care gave a speech this week, Modernising the NHS to meet changing demands.

There were several mentions of both prevention and digital in it. My favourite bit though was this:

If public services are designed around the convenience of the institution, the result is silos, handouts, delays and poor performance. When those services don’t co-ordinate, the public pays twice: in money and in misery. If public services are designed around the citizen, the result should be joined up support, better impact and better value for money.

I’d like to see us put more detail on what patient-centred-not-organisation-design means though.

My starter-for-10:

services available at a time and place that suits patients
patients own their own health data, and can see it, correct it, and take it with them if they move to another country
medical notes written in language understandable by patients, not just for other clinicians
organisational boundaries are visible (for transparency) but highly permeable

Surveys, surveys, surveys

By co-incidence I received 2 survey invitations by post this week.

The first was from my GP, asking me about their services. The letter included this line, which amused me:

You can help to save the NHS money by taking part as soon as possible. That way we won’t have to send you any reminders.

I can’t see us using this language in vaccination invitations, but I wonder if it makes a difference for survey response rates!

The survey was mostly standard questions about the GP’s services and ease of booking. I presume it’s some kind of standardised thing they’re obliged to do, but I’ve not yet tracked down where any results are published.

The second letter asked me to take part in a new Community and Engagement Survey from the Department for Culture, Media and Sport, which offered a £10 incentive.

There were a lot of questions, and they veered somewhat between the boring (‘how many children in your household?’) to the personal (‘in general, how much do you trust people?’) to the existential (‘to what extent do you feel that the things you do in your life are worthwhile?’).

There were also a ton of questions about distance from and engagement with local amenities and culture, which made me realise how much I genuinely love living in a London neighbourhood with so much on my doorstep.

I’ll be interested to see the analysis of this new survey. Whilst the topic was culture and community, I strong suspect that a lot of this correlates with the social determinants of health too.

Week 79: Vaccines that come to you

2026-01-11T00:00:00Z

Welcome back after the winter break. I enjoyed 4 days of heavy snow in the Netherlands with the kids, and then only just made our train home.

A short week for me with not much I can report, so let’s cover some recent health and prevention news instead.

Health visitor vaccinations

A pilot project to trial having health visitors offer childhood vaccinations has been announced, and will take place across 2026.

The pilots will focus on trying to reach families who face difficulties getting vaccinations at a GP, whether that be through travel costs, language barriers, or other circumstances, as well as those that might be hesitant.

As well as testing whether this approach will increase uptake (and I hope it will), it’ll also be a test of the logistics of having health visitors take vaccines to families, and administering and recording the vaccinations in people’s homes.

For NHS Record a vaccination, we may have to consider issues such as connectivity and making sure the service works well on the devices used by health visitors (mobile? tablet? laptops?). Our service is intended to be ‘setting-agnostic’, but there are sometimes differences in setting that are worth accommodating: the design should be user-centred rather than user-agnostic. But there are trade-offs here so it’s a delicate balance.

NHS online hospital

This concept became a little more concrete with the announcement that it will cover 9 common conditions as an online service. The conditions are:

cataracts
glaucoma
macular degeneration
menopause symptoms
menstrual problems
prostate enlargement
raised prostate specific antigen (PSA) levels
iron deficiency anaemia
inflammatory bowel disease

There’s a deadline too: the first patients are expected in 2027.

Of course, announcing it and delivering it are two very different things. There will no doubt be lots of interesting and tricky design problems to solve, which I hope we’ll all be able to learn from. There’s also the likely organisational and finance/accounting conundrums to work through, given this is an England-wide service which to some extent will replace locally-commissioned services.

I still think it’s a terrible name, but hopefully that’ll be an internal-only term.

Road death prevention

Away from the NHS, but still relevant to prevention, the Department for Transport announced a new Road Safety Strategy.

Outside of work, I’m an occasional active travel campaigner (I got 90m of new cycle lane built in my local area), and so I was pleased to see the strategy published.

The strategy contains a bunch of good stuff, such as lowering drink-driving limits, better driver training, and improving the design of both roads and vehicles. It also promises a Road Safety Investigation Branch who will investigate trends and use a test-and-learn approach to produce actionable recommendations.

Improving road safety doesn’t just help to prevent deaths and serious injuries from road collisions (which remain shockingly high), but encouraging more active travel through safer infrastructure helps prevent poor health from inactivity too. A double win.

Remembering Vicky

It’s been a year since we lost Vicky Teinaki. I’ve missed her greatly over the past year. Many of the projects I’ve worked on she would have been helping and cheerleading. I’m still stumbling across her blog posts and comments in GitHub issues and pull requests. Such a sad loss.

Week 78: Reflections on 2025

2025-12-31T00:00:00Z

Happy New Year’s Eve! Here are some reflections on 2025.

Vaccinations

Being part of the national vaccination programme remains extremely motivating. Vaccinations save lives, and unlike some other health prevention efforts, have an almost immediate benefit.

Our mission is enviably simple: to increase vaccination rates up to the World Health Organization (WHO) targets.

Working on the digital products to support this, it can be hard to draw a direct causation line between our work and the intended outcome. But I’ve seen how important usability and ease of onboarding is for busy pharmacists (where vaccinations is only a small part of their business). It’s not hard to imagine that this can affect how many appointment slots they open up, or whether or not they even offer the vaccine in the first place. And we know that ease and availability of vaccinations is a key factor in uptake.

I had several chats with older folk over the Christmas period about their recent vaccination experience. Some complained to me about no longer being eligible for the COVID-19 jab (the age criteria has changed from 65+ to 75+). One told me about their initial appointment being cancelled as the pharmacy had run out of stock. But generally they were happy to have been able to boost their immune systems for the winter, against a backdrop of nervy news stories about busy hospitals. This is the real world impact of our work.

Product strategy

One of the enduring challenges we have at the NHS is that we have a lot of digital products, with more being launched each year, but they’re often not very joined up.

For staff working on vaccinations, there a separate services for getting training, managing appointments, advertising walk-in times, recording vaccinations, ordering stock, getting paid, reporting on uptake, and so on.

For the public there are different services for booking different vaccinations, or another service for finding pharmacies offering walk-in slots.

Over the next year I plan to spend some time with others thinking about and sketching ways to improve this. It might be that some services ought to be merged, or that other services remain separate but become more porous, with interface and data links to connect them. We might also look to align logins and account settings a bit more.

All of this is the realm of service design or product strategy, which in my view is a team sport born of pragmatism rather than something you can architect in isolation from reality.

Leadership

As a long time (12+ years) freelancer, I’ve never had to do ‘line management’, and words like ‘appraisal’ remain a bureaucratic mystery to me. The closest I’ve come has been doing some unofficial coaching.

At the NHS I now have a kinda split role. I’m both an interaction designer working on a single digital product (Record a vaccination) and a lead across the wider collection of vaccination digital services. At times this balance has been tricky, but on the whole I think it works ok.

In the past year I’ve been helping to build the design community within our bit of the NHS, organising things like design crits, community of practice get-togethers, prototype kit training. Alongside this is the less visible work of gently encouraging, supporting and sometimes cajoling others in private chats.

I’m grateful to be working alongside other more experienced leaders like Caroline, Micol, Mike and Ralph, whose thoughtful leadership styles I can seek to emulate.

Possibly I’ll at some point I’ll hit a career fork of having to choose between being a practitioner or a manager, but for the time being I’m enjoying being mostly in the first camp whilst learning more about the second.

Office spirit

I work from the office more than most. I tell people that this is because my flat is small and uncomfortable to work in, which is true.

However it’s also in a large part because I enjoy being around other human folk, which feels almost counter-cultural to say in a WFH dominated era.

Our little crew of regular office-goers has grown over the past year, and I’m grateful to them all for the corridor chats and lunchtime story-telling.

In numbers

In 2025:

NHS Frontend had 8 significant releases, a huge leap forward
46 people attended prototype kit training, across 5 sessions
I woke up early for 8 trains to Leeds
I wrote 47 weeknotes (including this one)
I visited 11 pharmacies and 2 hospital trusts for user research
I attended 6 events (5 internal, 1 external)
131 posts were published on the DPSP design history site, an incredible advert for working in the open
I’m in 103 Slack channels - deffo need to archive some of those

From others

More 2025 notes from our team:

I’m about to head off to the Netherlands for a few magical days in Efteling, where the forecast is currently predicting snow. See you in 2026!

Week 77: Design History Day

2025-12-20T00:00:00Z

Writing design histories are a core part of our practice in NHS digital prevention services.

In our regular welcome calls for new starters, I have a slot to introduce what they are and how to contribute.

I’ve honed my spiel down to offering 3 motivations for them, in order of importance:

for your future self, your team and anyone who succeeds you: to remember what you did, the design intent, what you learnt, and anything you’d like to have done but which got deprioritised.
so that other related teams within NHS prevention services can understand what you’re doing, learn from you and spot opportunities for connection.
to communicate more widely with stakeholders across the healthcare system, and for public transparency.

However, it can be hard to get around to actually doing them. So I had a last minute idea last week to declare the last Friday before the Christmas break as Design History Day, when we could support each other to publish as many as possible.

It was a success! We did 13. A huge well done to everyone who took part.

I have now read them all, and I’d invite you to at least read some of them too. To whet your appetite, here’s brief bit about them each.

Vaccinations

What we learnt from visiting London pharmacies – this was the one that I wrote, although it was mostly a summary from a research playback that our researcher Mark Harnett presented. Whilst we had lots of positive feedback, we learnt about plenty of issues too.

Our first customer experience survey – in this, Anna documents the satisfaction survey we sent for the first time to all 16,500 users of Record a vaccination. Read the post to find out our scores and what we plan to do next with the results.

What we learnt from our first seasonal vaccination campaign – the new Manage your appointments service offer reflections from their first winter campaign. Stand-out quote for me is: ‘for staff working in the NHS, double entry is a fact of life, so much so users do not often bring it up unless prompted.’

Reaching our under-represented users – this post from the Book a vaccination service reports on findings from pop-up user research sessions in libraries. This led directly to a changes in the service, including swapping the terms ‘AM’ and ‘PM’ for ‘morning’ and ‘afternoon’.

Responding to insights – another one from the Book a vaccination team, this time showing how they’ve responded to analytics data and user feedback. One bit that stood out to me was helping users who try to use the service but can’t because they are registered to a GP in Scotland or Wales.

Screening

Understanding how participants are selected for breast screening – this is an amazingly accessible summary of what is currently an incredibly complicated process. Read it to learn about the difference in approach between 2 subtly different ‘batching’ processes.

Using design sprints to help us learn quickly – how a design sprint helped the Breast screening reporting to rapidly research, design and iterate a prototype dashboard to replace an existing report that is ‘not used regularly’.

Running a film reading design sprint – hot on the heels of the previous design sprint, this post sets out how they plan to run their next one, this time focused on a report which supports the assurance process of radiologists who read mammograms.

When logins become dead ends, and how to avoid them – an honest look at the problems of staff authentication (‘If they have to log in, we’ve lost them’), and some diagrams showing future improvements.

Checking information collected during an appointment – the Manage breast screening team show how they’ve iterated on the classic ‘Check your answers’ pattern to give staff a more succinct summary of the patient information they’ve entered.

Recording what images have been taken – another from the Manage breast screening team, this one showing a screenshot from the current Visual Basic application, and how they’re planning to reduce the amount of information that needs to be manually entered in the new service. Also contains a design for a new ‘stepper’ component which may helpful elsewhere.

User research findings from digital-first breast screening invitations – this team’s work has now been paused, and so this post summarises what the team have learnt, as a helpful guide to whichever team picks up this work again in future.

Personalised prevention

Improving uptake – the NHS Health Check Online team show how they’re updating the service to try and reduce drop-off rates. One example: ‘the tone of the final reminder initially felt too threatening and was softened based on feedback’.

This weekend I’m taking the kids to see the legend that is Michael Rosen, telling stories and poems at the Old Vic. And then we’re off to North Wales for Christmas.

Week 76: Sweet spot

2025-12-13T00:00:00Z

A busy week! Let’s jump right to it.

DPSP winter event

We had our now-traditional NHS digital prevention services (DPSP) winter event this week. After being heavily involved in organising our vaccinations event in November, I was able to relax and enjoy this one as a participant.

The event had a good mix of both external and internal speakers.

The morning keynote was from Sam Burrows, Chief Executive of NHS Frimley (an integrated care board or ICB). He spoke about their impressive partnership working across an incredibly complex panopoly of organisations, including councils, foundation trusts, ambulance services, care partnerships and voluntary organisations. Getting all those people together meant building trust, and sharing data between them meant overcoming technical and legal challenges.

My ears really pricked up though when he spoke about the tension between national services and their local needs. He mentioned their frustration when the centre takes a paternalistic we-know-best approach, and tries to impose a cookie-cutter service on them which doesn’t work when they take it out locally. Instead of ‘unthinking compliance’, they have sometimes said no, but always when demonstrating why, and showing a different way.

Sam also acknowledged that we can’t allow infinite variation between areas, and that there is also a huge challenge with geographic disparities in access to health services. Instead we have to find the sweet spot in having national services which have the right level of flexibility in the right areas. I’d agree with all this - but of course the devil is in the detail.

In the afternoon there was a festival format, with different presentations in different rooms. I opted to attend these talks from other internal teams:

an update from the HomeTest team, who are building a platform for the ordering and sending of home test kits
a demo (with great roleplaying acting) from the Manage vaccinations in schools service, showing how parental consent is requested but also how children can be assessed for Gillick competence and consent for themselves
a hands-on mobile demo of an alpha prototype from the Lung cancer risk check team

I also helped to run a session showing NHS Record a vaccination, where we asked for volunteers to play both patients and the clinician, demonstrating how the digital service can be successfully used even with no prior training or guidance.

The day ended with the traditional quiz (my team did not win), and an evening social.

Card sorting user feedback

We recently sent out a survey to all users of Record a vaccination, and got over 1,000 responses. Mostly it contained closed questions, but around half also left a free text response.

To analyse these, Anna and I decided to print them all out (92 pages of A4!) and slice them up into individual comments. We then reviewed them as a team, grouping them into piles like giant game of snap. It was chaotic but fun.

For colleagues who couldn’t make to the office I also created a digital whiteboard version on Mural. This didn’t get the same level of engagement. Some things really are more easily done in-person.

Reading the comments was like being exposed to a firehose of user feedback. Between those offering praise (yay!) and those filled with grumbling complaints (boo) were hundreds of detailed, thoughtful suggestions for improvement. We’ll review and prioritise these over the coming weeks and months.

The organisation-location continuum

One philosophical-design question I’ve been slowly grappling with this year is the difference between “organisations” and “locations”.

You’d think there would be a distinction between these two concepts, but in the NHS it’s more like the space-time continuum with a big blurry space in the middle.

Our data sources routinely contain a blend of the two, and whilst at first this seems like a complete mess, it’s also understandable. A maternity or oncology department in a hospital might well be a physical floor or wing, but it also represents a team of people, and sometimes that team might be working in other locations.

Pharmacies are similar, being both physical stores (except when they’re mail order) and independent organisations (except when they’re part of a bigger group).

In some contexts the blurriness is fine, but in others it can lead to all kinds of confusion. I’m not yet sure how best we can resolve this.

Imposter syndrome

Liz Glidewell led our last DPSP user-centred design community call of this year, with a very thoughtful and insightful session on imposter syndrome. It left space for people to share their own experiences, whilst also offering expert analysis of the phenomenon and some practical tips for dealing with it.

I left the session with a renewed sense of how important and delicate it is for us all to build a supportive community of practice. We’ve come a long way on this in the past year, but there’s plenty more still to do.

Week 75: Zoning in

2025-12-07T00:00:00Z

The Christmas season is upon us! ‘Change freezes’ are being referenced, and some issues are now being punted into next year.

I’m happy with how the week has gone, but I’ve developed a bit of habit of working late into the evening. I’m not complaining. It can be quite a peaceful time. Everyone else at home is in bed, there’s no Slack messages to distract, and I can zone in on some design and coding work. But I should probably avoid doing it too often.

Prototype kit training

On Monday we ran our final prototype kit training course of the year, up in Leeds. That brings the total up to 46 people who’ve completed the course now.

We’ve tweaked and improved some things along the way, but the course is pretty stable now, and we can turn up and run it with minimal prep.

I think we’ve also landed on a good balance between telling participants what to do versus giving them scope to make changes and add their own flair. This keeps people engaged and also makes the demos at the end more varied.

I hope people come away being impressed with themselves for having being able to build a 7 or 8 page prototype, including branching questions, from scratch within a day.

Once you know how, using the prototype kit can be a lot quicker than futzing about in Figma, as well as giving you a more realistic and interactive prototype that can be usability tested.

Next year we’ll continue running the course, with one session already scheduled in Newcastle in January.

Scaling for pharmacies

On Record a vaccination I’ve just finished a design iteration to try and make an incremental improvement for those managing pharmacies.

It’s an interesting design challenge, as pharmacies can vary from a single store, to a small independent chain of a few nearby pharmacies, to a mid-size regional chain, to the big national ones (including supermarkets).

Our service currently assumes each physical pharmacy is a separate organisation. The iteration I’ve designed would allow users to view and generate reports across all their pharmacies in one go, rather than having to do them individually and combine them.

It’s still not perfect, and the interface probably doesn’t scale to the very biggest pharmacy chains (they’ll end up with a very long page of checkboxes). But to fix that we’ll need to understand how the big chains group and organise their pharmacies for management and operational purposes - so that’ll be a question we take into user research.

Design systems for staff-facing services

Someone from another bit of NHS England asked for a chat this week about design in staff-facing services. The view from their teams was that the NHS design system was for services for the public, and there might need to be a new design system for services for staff.

This comes up a fair bit, and it’s an understandable assumption to make. The NHS design system was originally developed for the NHS website and public services, so it’s true that lots of the examples and patterns are geared to that.

But I don’t think we need a separate thing. Not all staff-facing services are the same. Some might genuinely need more complex interfaces optimised for speed and mastery rather than initial ease of use and error prevention. However others are used much more occasionally, by less experienced staff, alongside dozens of other services – and those might be more similar in style to public facing services. There’s a spectrum.

Instead of having multiple design systems, our strategy is to have a single one, containing different components and patterns for different contexts.

In the past year we’ve added a lot of new things to support staff-facing services, including a logged in header, smaller radios, smaller checkboxes, smaller buttons, numbered pagination, and more.

We’ve perhaps not done enough to shout about this though. Perhaps we need post about this on the official NHS blog?

Links

In-year benefits and the 10 Year Plan for the NHS from Dan Bower, explains how organisations incentives can lead frustrate long-term outcomes.
Goodbye, November from Veronika Jermolina has some great reflections on the work the digital breast screening team has been doing, getting out of the building and talking to users.
ADHD Taskforce Part 2: A strong foundation, but who will deliver it? contains the team’s response to the report of NHS’s independent ADHS taskforce.
Health and social care statistical outputs consultation: follow-up is an update on how the NHS/ONS/DHSC/UKHSA might publish health statistics in future. I’m all for a future of dashboards instead of PDFs, but let’s make sure that they are well-designed ones and not just a cacophony of PowerBI widgets.

Next week is the big DPSP winter event. I’ve not been involved in organising this one, so apart from one small slot when I’m helping to demo a service, I’ll be able to relax and enjoy it as an attendee.

Week 74: Satisfaction

2025-11-30T00:00:00Z

I was off ill on Monday, so the rest of this week felt like I was playing catch up, whilst still not feeling 100%.

Notes in brief:

We sent out a survey to all the users of NHS Record a vaccination and within a couple of days had over 1,000 responses. This is something we’d be talking about doing for yonks, so it was great to finally press send. We’ve not analysed the responses yet, but the headline figure is a satisfaction score of about 90%. This is a great vanity metric, but mainly it serves as a baseline so that we can see if the score improves or drops in future surveys.
The NHS declares this week the Big Week of Vaccinations in London for the flu jab, with outreach events at football stadiums, shopping centres, soft plays and more. These campaigns and digital communications are run by a different bit of NHS England from vaccination digital services (VDS), with the 5 different integrated care boards (ICBs) involved too, which is why you’ll see the location lists scattered across multiple different websites. But if the aim is to reach people not actively searching for a vaccine, then perhaps it’s more about foot traffic than online traffic.
Mike wrote last week about user-centred design and patient safety, and by coincidence we had a good discussion this week about clinical risks when recording vaccinations. One interesting aspect is there can often be a risk in not doing something as well as doing it. Clinicians face real-life trolley problems all the time, and have to make these calls. With vaccinations, it’s often not possible to show a patient’s full vaccination history, for a variety of reasons, and the patient may not remember either. Our clinical safety person pointed out though that with vaccinations the risk of additional side effects from being vaccinated twice is often much lower than the risks from not being vaccinated at all.
I’ve now updated to iOS 26 and it’s taking me a while to get used to the ‘liquid glass’ – is that a water droplet on my screen or is it a button? The GOVUK design system team are currently discussing making their buttons rounded, and we’ve had a half-joking debate about whether the NHS should respond by going even more rounded? It’s a bit of a cliché for interaction designers to endlessly tweak buttons, but they can end up being a signature visual element in a brand, as well as needing to be as usable and accessible as possible. My only real contribution is to suggest that sharp edges on physical things can be painful, which perhaps explains why we associate rounded corners with child-friendliness?

Links

Why use React? from Jeremy Keith explains the downsides of using React in the browser. This is still often the default for many NHS services despite guidance to the contrary, but things are changing (I hope).
The Digital prevention services website now has a page about our vaccinations digital services. We’ll continue updating this to tell our stakeholders what we’re working on, working in the open as much as possible.
A consultation on draft prostate cancer screening recommendation opened this week, following a recommendation to not recommend population screening. This got a lot of news, as some public figures like Chris Hoy have been advocating for more widespread screening. It’s a tricky, controversial topic, as screening carries risks of over-diagnosis.
I’ve been doing some more small experiments using AI for boring coding tasks, by assigning some tasks to Copilot in GitHub. The thing I like about this is that it’s far more transparent, and I’m not invisibly passing off AI code as my own.
Getting ready for the Autumn-winter 2025-26 campaign is a design history entry from the Book a vaccination team detailing some of the changes they’ve made for this winter.

Weekend plans include seeing Zootopia 2 and going to a Christmas market. The season has begun.

Week 73: Prevention for we, not me

2025-11-24T00:00:00Z

This week I took part in some research with pharmacies and enjoyed a talk from Dr Jess Morley.

Research in the snow

I spent a freezing cold Wednesday trekking around pharmacies in North London with our researcher Mark and content designer Anna. Despite the weather (we had both rain and sleet) it was invaluable to hear from some of our newest cohort of pharmacies using NHS Record a vaccination.

In general, they were very happy with the service, seeing it as a major improvement on other systems. They all started using it in October, and have been able to get on and use it with very minimal training and guidance.

That’s not to say it’s all perfect though. The most humbling thing to happen on these visits are when the pharmacists welcome you as tech support, and ask you a ‘how do I…’ question. We’re happy to help, but these encounters help reveal aspects of the service that aren’t as obvious as they should be.

We have been dual-running a new interface alongside the old one for a transitional period, in order to help de-risk the change. Despite communicating this to users both through emails and in-service content, several of the pharmacies weren’t aware of the change. A reminder of just how task-focused they are. We have some ideas on how to improve this, but product update comms remain a challenge.

Once warmed up after the visits, I wrote up my notes. Within these pages are plenty of detailed findings that will help us improve the service over the coming months.

The research reminded me again how valuable it is to get out and talk to your users where they are. Pharmacies are fascinating, varied environments, and seeing how many different digital service pharmacists have to use really puts everything in context.

AI for we not me

We had an amazing talk from Dr Jess Morley of the Yale Digital Ethics Center this week. It started out with a great primer on the different forms of AI, going beyond the buzzword. But the big pivot in the talk was a call to stop thinking about just using AI to just treat the individual, but instead to look at the bigger picture of population health.

As Jess put it, we cannot make our bodies work like computers. You don’t get a health population by improving the health of individuals. Health is connected, and so we have to target populations. There’s no point in predicting that somebody is about to develop a specific disease and telling them that what they need to do is to exercise and eat better if they live in a food desert and don’t have time to work out.

You can’t empower people just by telling them what to do if you don’t make the environment more conducive to it.

Jess argued that one of the strengths of AI models is being able to find connections that human cognition is unable to find, and this could be applied to health at a population level. It could model different types of intervention and predict the likely outcome.

There was lots of other great stuff too, but the focus on social epidemiology and the social determinants of health was fascinating. Not least because so many of our existing products and projects are individual level.

Week 72: Act like a tech company

2025-11-14T00:00:00Z

Notes in brief from me this week:

I enjoyed an internal talk from James Plunkett about digital-era healthcare systems. The most interest bit for me was the middle section about ‘market-shaping’, which urged the state to ‘act like a tech company’ and do things like strategic acquisition of companies and open sourcing of key products.
Ed and I ran another session of our training course teaching people how to use the NHS Prototype kit. It was our biggest one yet, with 15 attendees (and no drop-outs!), and ran pretty smoothly. As ever, it’s very satisfying seeing people thrilled at being able to make things.
Our monthly community of practice meeting for people in user-centred-design focused on the topic of contributing back to the NHS digital service manual. This is something that’s strongly encouraged by the NHS service standard, but often doesn’t happen. So we ran through the different ways teams can contribute (big and small), and talked about how we can try and overcome some of the barriers to doing so.
I’ve been continuing some design work looking at how we could enable large pharmacy chains to more easily get reports on how many vaccinations they’ve given across all their pharmacies. Currently this is a bit of a painful one-site-at-a-time process. We’ve got an idea for a short-term improvement, but longer-term we’ll likely need to change our organisation data model.
Some of our research has indicated that changing the order of our questions could benefit some users, for reasons we hadn’t previously anticipated. It’s not conclusive yet as the research hasn’t wrapped up, but I’ve started some early prototyping of how things could be re-jigged around.
I enjoyed getting a demo from Mike of some early prototypes for a new NHS App using native iOS code. The difference is night and day.
I dipped a small toe in the AI waters, using the NHS’s GitHub copilot trial to write tests for some existing JavaScript. This feels like kind of tedious work that I don’t mind outsourcing. It worked, and I did learn a couple of things in the process. The over-confident chatty tone is annoying though.