Skip to main content

https://digitalhealth.blog.gov.uk/2020/12/07/nhse-i-learning-disability-mortality-review-leder-alpha-assessment/

NHSE/I Learning Disability Mortality Review (LeDeR) Alpha Assessment

Posted by: , Posted on: - Categories: Alpha, Assurance, Service assessments

Text saying "Service Assessment" with DHSC approved brand colours

From: NHSX
Assessment date: 23rd November 2020
Stage: Alpha
Result: Met
Service provider: NHS England and Improvement

Service description

The Learning Disability Mortality Review Programme (LeDeR) was established to deliver improvements in the quality of health and social care for people with a learning disability in England, by supporting local areas to carry out reviews of deaths of people with learning disabilities (aged 4 years and over) using a standardised review process. The programme needs to be supported by a new web-based management system to replace the old one, which is outdated and soon to be out of contract.

Service users

  • Notifiers
    • Family members, carers or health professionals responsible for notifying the death to the LeDeR programme via the notification form on public facing website
  • Reviewers
    • Conduct and complete reviews on the web based platform. Role includes seeking information from family members and healthcare professionals about the person's life and care leading up to death
  • Local Area Contact
    • Responsible for allocating reviews to reviewers,  supervising/quality checking completing of reviews and signing off reviews for completion 
  • Regional Coordinators
    • Overseeing review process and performance across their region. Escalating point for unresolved issues
  • National LeDeR Team
    • Monitor overall performance across the country, manage providers of web-based platform, use findings from reviews to embed national service improvement

Report contents

  1. Understand users and their needs
  2. Solve a whole problem for users
  3. Provide a joined-up experience across all channels
  4. Make the service simple to use
  5. Make sure everyone can use the service
  6. Have a multidisciplinary team
  7. Use agile ways of working
  8. Iterate and improve frequently
  9. Create a secure service which protects users’ privacy
  10. Define what success looks like and publish performance data
  11. Choose the right tools and technology
  12. Make new source code open
  13. Use and contribute to open standards, common components and patterns
  14. Operate a reliable service

1. Understand users and their needs

Decision

The service met point 1 of the Standard.

What the team has done well

The panel was impressed that:

  • The team have an excellent understanding of the policy context which the service fits within, and are seeking to build a service which complements the policy needs.
  • Have continually engaged with stakeholders throughout the Alpha phase.

What the team needs to explore

Before their next assessment, the team needs to:

  • The service comprises of both a front-end public facing web form and internal case management system. While the team have engaged expert users as part of the design process, they have not yet tested the form. The team must test the public facing web form with a range of users, including those with accessibility needs, before the next assessment and iterate based on that testing. The team must demonstrate evidence of this testing before booking the next service assessment.    
  • Carry out further exploratory research with platform and output users (beyond those that will form part of the user testing group) to explore how the service integrates with the offline elements of the reviewing process.

2. Solve a whole problem for users

Decision

The service met point 2 of the Standard.

What the team has done well

The panel was impressed that:

  • The team have a good understanding of the pain points in the current service provision (run by University of Bristol), and are seeking to improve the service in the design and build of the new case-management system.

What the team needs to explore

Before their next assessment, the team needs to:

  • Test that the service improves the user experience and pain points that occur in the current service provision. 

3. Provide a joined-up experience across all channels

Decision

The service met point 3 of the Standard.

What the team has done well

The panel was impressed that:  

  • The team have engaged well with stakeholder groups spanning across most user types to ensure the service meets all needs.

What the team needs to explore

Before their next assessment, the team needs to:

  • Conduct end-to-end usability testing with all users, to ensure the case management system complements the offline elements of each service users journey.  

4. Make the service simple to use

Decision

The service met point 4 of the Standard.

What the team has done well

The panel was impressed that:

  • The team has created wire-frames and are continually iterating the design based on feedback from stakeholders.    

What the team needs to explore

Before their next assessment, the team needs to:

  • Ensure the multiple user journeys within the service are built in line with the design styles, components and patterns in the NHS digital service manual.
  • Ensure the service is tested end-to-end with potential users of the service (beyond those who will form part of the user testing group). This testing should be representative of the user demographic, and include all users within the Platform and Output user groups.
  • The content of the service should be reviewed by a content designer and tested in usability testing sessions.

5. Make sure everyone can use the service

Decision

The service met point 5 of the Standard.

What the team has done well

The panel was impressed that:

  • The team has considered the needs of each user group that the service will be used by. 

What the team needs to explore

Before their next assessment, the team needs to:

  • Conduct research with users with accessibility needs to ensure they are able to use the service.  
  • Ensure the service meets accessibility requirements.

6. Have a multidisciplinary team

Decision

The service met point 6 of the Standard.

What the team has done well

The panel was impressed that:

  •  There is a blend of teams with different disciplines.
  •  The team has access to the specialist advice it needs.
  •  The SRO is engaged and champions the project.

What the team needs to explore

Before their next assessment, the team needs to:

  • Recruit and embed a user researcher as part of the beta phase - particularly when testing the service with users.

7. Use agile ways of working

Decision

The service met point 7 of the Standard.

What the team has done well

The panel was impressed that:

  • The delivery team works in an agile way - working in sprints with the relevant ceremonies.
  • The delivery team carries our retros at the end of each sprint and looks at lessons learnt.

What the team needs to explore

Before their next assessment, the team needs to:

  • Continue working in an agile way.
  • Make sure the SRO and other senior stakeholders test the service.

8. Iterate and improve frequently

Decision

The service met point 8 of the Standard.

What the team has done well

The panel was impressed that:

  • Both the front end web form and case management system have been co-designed with user groups, healthcare professionals and “experts by experience”.
  • The tech teams work in an agile way, reviewing what they’ve done and improving on it.

What the team needs to explore

Before their next assessment, the team needs to:

  • Embed regular rounds of user testing with all areas of the system to learn from and iterate the service.
  • Make sure user feedback and user testing is planned for once the service goes live.

9. Create a secure service which protects users’ privacy

Decision

The service met point 9 of the Standard.

What the team has done well

The panel was impressed that:

  • All data will be encrypted at rest in SQL Server by default.
  • Annual Penetration testing is planned.
  • Public end points will be linked to NCSC Active Defence hub services. 
  • Authentication will use existing nhs.net Azure active directory. 

What the team needs to explore

Before their next assessment, the team needs to:

  • Continue to explore the possibility of using two factor authentication.    

10. Define what success looks like and publish performance data

Decision

The service met point 10 of the Standard.

What the team has done well

The panel was impressed that:

  • The team have looked at feedback from the existing web platform, including availability and down time and have identified specific benefits.
  • The team have defined KPIs and have analytics in place to measure these.

What the team needs to explore

Before their next assessment, the team needs to:

  • Make sure they are measuring user satisfaction as part of their metrics.
  • Continue to look at identified benefits and review whether the service is delivering these as expected.

11. Choose the right tools and technology

Decision

The service met point 11 of the Standard.

What the team has done well

The panel was impressed that:

  • The team considered a range of potential tools considering their functionality, available expertise and existing infrastructure.  
  • The team is making good use of open source technologies. 
  • The team has plans to continually evaluate the tools selected.      

What the team needs to explore

Before their next assessment, the team needs to:

  • Continue to regularly evaluate the services technology stack to ensure it is fit for purpose.     

12. Make new source code open

Decision

The service met  point 12 of the Standard.

What the team has done well

The panel was impressed that:

  • The team site will include a developers page which will include detailed information on the service.    

13. Use and contribute to open standards, common components and patterns

Decision

The service met  point 13 of the Standard.

What the team has done well

The panel was impressed that:

  • The service makes use of the FHIR standard to enable interoperability. 
  • The service makes use of the NHS design system.     
  • The service will leverage national data sources.    

What the team needs to explore

Before their next assessment, the team needs to:

  • Consider how the team can contribute to the open source community.     

14. Operate a reliable service

Decision

The service met point 14 of the Standard.

What the team has done well

The panel was impressed that:

  • The proposed solution uses non global resources. The team has agreed to a 48 recover time, with 24 hour recover point. The solution will be provisioned in such a way that an automatic redeploy to a secondary region can be manually triggered in the event of a regional failure, DNS entries could then be updated to complete the transition of regions.    

What the team needs to explore

Before their next assessment, the team needs to:

  • Consider how users will be managed in the event the service is unavailable.   

Sharing and comments

Share this page