https://digitalhealth.blog.gov.uk/2020/01/07/nhs-continuing-health-care-model-website/

NHS Continuing Health Care Model Website

Text saying "Service Assessment" with DHSC approved brand colours

From: NHSX

Assessment date: 3rd December 2019

Stage: Beta

Result: Not Met

Service provider: NHS England

Service description

NHS Continuing Health Care (CHC) is an ongoing package of health and social care that is arranged and funded solely by the NHS where an individual is found to have a ‘primary health need’. Such care is provided to an individual aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness.

Service users 

Any health or social care worker who works with any part of the CHC pathway – i.e. Clinical Commissioning Groups (CCG), CHC Teams, Commissioners, Finance Teams, Social Workers, hospital discharge teams, NHSE Regional Team, Directors of Nursing etc.

1. Understand user needs

Decision

The team has not met point 1 of the Standard.

What the team has done well

  • The team have done an impressive amount of engagement with stakeholders and potential users via large scale workshops and webex calls, Basecamp comments and informal chats.

What the team needs to explore

  • The panel didn’t see enough evidence for the design decisions taken or evidence of where designs had been iterated based on observation of users attempting to complete tasks on their own. 
  • We’d also like to see outcomes of testing with users with accessibility needs (especially when it comes to non-standard navigation patterns and the interactive maps) and any changes based on them.

2. Do ongoing user research

Decision

The team has not met point 2 of the Standard.

What the team has done well

  • There are plans to engage with user groups when producing content.

What the team needs to explore

  • There was currently no plan for ongoing website design user research after going into public beta. 

3. Have a multidisciplinary team

Decision

The team has not met point 3 of the Standard.

What the team has done well

  • The team is clearly passionate about delivering a service that will improve their users’ day to day lives.
  • The team works closely with specialists within and outside of the department to ensure the content and documents they publish is clear and understandable. They are continuously working to add content, currently around finance. They have also fed back findings on CHC guidance shortcomings to DHSC who are the owners of the document, so it can be improved. 

What the team needs to explore

  • Lack of user researcher and/or designer familiar with NHS good practice on the team - this is likely to have negative impact on users’ ability to successfully complete their journeys. Other parts of this report make recommendations in those areas.
  • It would be good to hear in more detail how exactly the site and the documents will be iterated once ownership of the site moves to the BAU team.

4. Use agile methods

Decision

The team has not met point 4 of the Standard.

What the team has done well

  • The team works with the supplier on a sprint basis, prioritisation and decision making take place regularly, making change of direction possible. 

What the team needs to explore

  • How they can iterate the design of the website based on an observed user need and describe the process in which it is taken from research to development, and how they improved this process through team-wide retrospectives and planning.

5. Iterate and improve frequently

Decision

The team has not met point 5 of the Standard.

What the team has done well

  • The team worked with large groups of stakeholders to create the current version of the website and carried out some improvements. 
  • The team works closely together with user groups and subject matter experts to iterate and improve the content of the website.  

What the team needs to explore

  • How to make improvements to the website based on individual user research, data, and observed needs. 

6. Evaluate tools and systems

Decision

The team met point 6 of the Standard.

What the team has done well

  • No proprietary technologies are used in the service, it is built using tools typical for this kind of website HTML, PHP and Javascript for analytics. 

What the team needs to explore

  • The website is not responsive and so elements such as the interactive map on the front page are lost when viewing on a mobile device. 

7. Understand security and privacy issues

Decision

The team met point 7 of the Standard.

What the team has done well

  • The team has put in place appropriate security for managing user credentials for this service.  

What the team needs to explore

  • Whether a login is necessary for the service. 

8. Make all new source code open

Decision

The team has not met point 8 of the Standard.

What the team has done well

  • The team has made plans to open source the code once live.

What the team needs to explore

  • The team can take steps to open source the code prior to going live.

9. Use open standards and common platforms

Decision

The team has not met point 9 of the Standard.

What the team has done well

  • The service makes good use of non proprietary technology. 

What the team needs to explore

  • The documents on the website are currently a mix of docx and pdf, static content where possible should be provided as HTML or PDF-A, documents which will be edited by the user should be provided in odf format. Where there is a user need for alternative formats, provide them in addition to those. 

10. Test the end-to-end service

Decision

The team has not met point 10 of the Standard.

What the team has done well

  • Development, Test and Live environments are available to the developer team.

What the team needs to explore

  • Testing the service end to end in person with users from a range of different demographics. 

11. Make a plan for being offline

Decision

The team met point 11 of the Standard.

What the team has done well

  • The service has an appropriate disaster recovery plan in place.

12. Make sure users succeed first time

Decision

The team has not met point 12 of the Standard.

What the team has done well

  • Survey results indicated users generally managed to accomplish what they set out to do. 

What the team needs to explore

  • Observe users not familiar with the site try to accomplish what the team think are the common user journeys. 

13. Make the user experience consistent with NHS design patterns

Decision

The team has not met point 13 of the Standard.

What the team has done well

  • The team worked with users to create a first version of the design. 

What the team needs to explore

  • How a version of design that uses existing design patterns and elements would look like and how users would interact with it in a realistic setting. 
  • Contribute any new or modified patterns to the NHS / Government design libraries so other teams can benefit from their research. 

14. Encourage everyone to use the digital service

Decision

The team has met point 14 of the Standard.

What the team has done well

  • The team conducts extensive continuous engagement with their users via workshops and Webex, as well as a network of regional leads who spread awareness of the resource and can assist users with any issues. 

15. Collect performance data

Decision

The team has not met point 15 of the Standard.

What the team did well

  • The team conducts a frequent survey among users of the site and has a process to respond to any issues and make changes to the site based on comments.

What the team needs to explore:

  • Provide more quantitative information about the surveys and the number of respondents and how the respondents correspond to different user groups, and if any group is underrepresented how this will be addressed in further research and surveys
  • Implementing metrics on the site and using them for insight and making decisions on ongoing user research and iteration.

16. Identify performance indicators

Decision

The team has not met point 16 of the Standard.

What the team has done well

  • The objectives for the overall programme are well thought through and the metrics for the website correspond them. 

What the team needs to explore

  • It is permissible to gain a greater level of insight making use of Google analytics as long as appropriate cookie notifications and option to consent to do so are provided. This could be helpful in understanding how your users are using features such as the interactive map in order to make improvements.  
  • The service team have established their KPIs - the panel suggests reviewing these to ensure that the information gathered provided actionable insights beyond acting on individual comments.

17. Report performance data on the Performance Platform

Decision

Point 17 of the Standard does not apply to this service. 

18. Test with the minister

Decision

The team met point 18 of the Standard.

What the team has done well

  • The team is embedded in a wider programme and provided evidence of frequent engagement with senior stakeholders within the organisation. 

What the team needs to explore

  • The team should provide evidence of testing with the minister, or an appropriately senior member of their organisation at the Live assessment. 

Recommendations

To pass the reassessment, the service team must:

  • Work with a user researcher and designer who is familiar with the GDS standard and NHS or GDS design system.
  • Carry out at least 3 rounds of usability testing with users who aren't already familiar with the site (12-18 users in total).
  • Make sure at least some of these users have access needs
  • Make sure the usability testing includes non-leading tasks that can be completed by using the navigations and the scrolling journey map.
  • To keep things as objective as possible, the UR should lead the sessions, and the team should observe and make notes only. 
  • After each round of research, analyse findings and iterate design and content as needed (the content writer(s) should be involved with this).
  • Provide a copy of a penetration test results. 
  • Undergo an accessibility audit - https://www.gov.uk/service-manual/helping-people-to-use-your-service/understanding-wcag.
  • Make the code available to the public 
  • The CHC team must be able to update the website content themselves without relying on a third party supplier. 

The service team should also:

  • We recommend making contact with the NHS and/or GDS design and user research communities to support with using their design patterns. You can sign up to the NHS service manual Slack channel and ask the community for advice. 
  • Add a feedback survey to the site that asks whether visitors found what they were looking for, like the one if the footer here https://www.gov.uk/universal-credit (you should be able to find the code for this from the gov design community). Or you can link to a short survey. 
  • Have a process in place for analysing the feedback survey responses and making iterations based on themes, including further testing with users.
  • Add analytics to the site and monitor the use of multiple navigations. If one navigation isn’t being used we’d recommended moving it to make the site simpler to use and give the user fewer options.
  • Test different ways of presenting the maps (i.e. vertical rather than horizontal) with users and present feedback and findings at the next assessments.

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