https://digitalhealth.blog.gov.uk/2016/10/14/healthy-start-learned/

Healthy Start discovery - what we learned

In August we introduced you to the Healthy Start digital programme. The discovery phase of the programme has now concluded and we’re keen to share with you some of the things we’ve learned.

The purpose of the discovery was to:

  • build empathy with our service users
  • understand what works and doesn’t work in the current system
  • understand how Healthy Start fits into our users’ lives

Following discovery, we’re starting to explore possible solutions which might make the service better for users in the future.

We’ve been working in partnership with Department of Health policy and digital colleagues, NHS Business Services Authority colleagues, and two discovery specialists from Pilot Works.

It’s been a fascinating discovery for the team. Not only have we gained an in-depth understanding of our users and done some of the groundwork for alpha, but we’ve also learned a huge amount about using agile project management and development techniques (like story mapping) in practice, and we’ve got to grips with the agile roles, like the product owner role I discussed in the previous post.

Key themes from our user research

We interviewed 19 mothers across different demographics, including a range of digital skill levels, English levels, urban and semi-rural locations, and different levels of parenting experience. We also interviewed 11 health professionals including midwives and health visitors. We triangulated the large amount of insight we gained from the new discovery research with findings from the extensive body of existing academic research into Healthy Start and data from the Healthy Start Issuing Unit. The following key insights emerged:

  1. Users really value the Healthy Start scheme

The scheme has a positive impact on users’ and their families’ diet. Many users rely on the financial support the scheme gives.

  1. The scheme is not reaching all those who are eligible, particularly during pregnancy

The percentage of eligible people who are actually receiving the benefit has dropped from 80% in 2009 to the current 72.4%. In addition, the Healthy Start Issuing Unit data suggests that eligible pregnant women are disproportionately missing out on the benefit.

  1. Awareness of Healthy Start relies too heavily on busy health professionals and word of mouth

Most users report being made aware of the scheme by midwives and health visitors. However, it’s easy to see how Healthy Start could be overlooked in conversations between health professionals and their clients. Contact time is tight and women report being overwhelmed with information during visits. Furthermore, a lack of consistency in approach across areas means some women are being missed out, often in more affluent areas where receiving benefits is less common overall and assumptions may be being made about users’ eligibility.

  1. The requirement for a health professional to sign the form adds unnecessary delay to the application process

The need for a health professional signature has been widely cited by users and health professionals as a barrier to applying, and a key reason why users are delayed in receiving the benefit. Users and health professionals agree there is no clear health value in the interaction necessary for completing the form.

  1. The complexity of the benefit arrangements, and the transition arrangements within the scheme for when the child is born, are easily misunderstood by both users and health professionals, sometimes leading to delays in receiving benefit or unexpected stoppages

When applying for Healthy Start, users must first be in receipt of certain other benefits or their claim will be rejected. When a Healthy Start recipient’s child is born they need to phone the Healthy Start Issuing Unit to register the child to avoid a break in benefits while the system ‘catches up’.

  1. Users want control over how they use their Healthy Start benefit

Users often lose part of the value of their voucher because no change can be given. The voucher expiry date can also lead to users losing part of their benefit value.

  1. Users want a reliable and stress-free interaction with retailers

Users naturally want to avoid hassle and embarrassment in-store. They want all staff in all branches of supermarkets to understand the scheme, but this isn’t always the case currently. A wider range of retailers, including online, would be helpful.

  1. Users experience issues with the paper vouchers and most are ready for some kind of digital solution

Paper vouchers have a number of drawbacks for users, such as children damaging them and the inability to spend smaller amounts, which could be solved by digital technology.

  1. Although the users interviewed during discovery all had smartphones there is evidence of degrees of digital exclusion within the Healthy Start demographic. We must make sure solutions work for everyone

All users we met during discovery had a smartphone, but they often had limited or no credit. Users sometimes felt uncomfortable installing apps or using the phone for transactional purposes. Within our demographic there are people with disabilities, low literacy levels, English as an additional language and people leading chaotic lifestyles; these factors can often be barriers to internet access and use.

What next?

The discovery research offers many opportunities to redesign the current scheme so it is more efficient and works better for users. We identified a breadth of existing technology which might help us realise some of those opportunities. There are also some policy and wider business transformation changes that we can explore. We’re being bold in our ambition and don’t want to limit ourselves to only replacing existing parts of the system with digital technology. We’ll describe some of the solutions we plan to test at alpha in our next post.

As part of the discovery phase we’ve also started to firm up some of the measures we’ll use to judge the programme’s success. The benefit take-up rate has always been a key focus, but we’re also now thinking about cost per application, cost per voucher issued, and cost per voucher redemption. We’ll hone these transactional cost indicators further as we move through alpha.

We’ve also fine-tuned our service vision statement to better capture what the investment in digitisation and business transformation should deliver:

A digitally-enabled Healthy Start Scheme, which helps more disadvantaged families eat healthily by providing support that’s simpler to access, easier and more flexible to use, and more cost effective to deliver.

In our next post we’ll tell you about our plans for the alpha phase.

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