From: DHSC
Assessment date: 19/06/2025
Amber review date: 03/09/2026
Stage: Alpha reassessment
Result: Green at reassessment
Service provider: DHSC
Service description
Under the terms of the Abortion Act 1967 and the Abortion Regulations 1991, medical practitioners have a statutory obligation to notify the Chief Medical Officer (CMO) of every abortion, within 14 days of the procedure, using an HSA4 form. DHSC are responsible for monitoring the Abortion Act and producing statistics on abortions in England and Wales.
The Abortion Notification System (ANS) is the digital service provided by DHSC for medical practitioners to enable them to submit their HSA4 forms. Currently it is possible to submit them using 3 channels – paper, API or webform.
Service users
This service is for:
● Abortion providers
- Registered Doctors
- Nurses and midwives
- Telehealth call handlers
- Medical secretaries and administrators
- IT Systems Administrators
● DHSC staff
- Public Health Intelligence Analyst
- Social Researcher
- Data Entry Team
- Medical Advisor
● Data Consumers
- Healthcare services and research
- Policy and politics
- Education and academia
- Media
- Police
Report contents
- Understand users and their needs
- Solve a whole problem for users
- Provide a joined-up experience across all channels
- Make the service simple to use
- Make sure everyone can use the service
- Have a multidisciplinary team
- Use agile ways of working
- Iterate and improve frequently
- Create a secure service which protects users’ privacy
- Define what success looks like and publish performance data
- Choose the right tools and technology
- Make new source code open
- Use and contribute to open standards, common components and patterns
- Operate a reliable service
1. Understand users and their needs
Decision
The service was rated green for point 1 of the Standard.
Optional advice to help the service team continually improve the service:
● continue to research and increase the numbers of participants you have spoken to, although it is acknowledged that you have received consistent feedback with your existing participant numbers.
● continue to strive to recruit users, or proxy users, with additional access needs and low digital confidence using methods already identified and investigated during alpha.
2. Solve a whole problem for users
Decision
The service was rated green for point 2 of the Standard.
Optional advice to help the service team continually improve the service:
● continue efforts to research with users on mobile or tablet devices
● consider user testing the proposed new service name and researching the discoverability of the new name through internet search engines
● keep on tracking recommendations for potential legislative changes that have potential to improve user experience and processes in future
3. Provide a joined-up experience across all channels
Decision
The service was rated green for point 3 of the Standard.
Optional advice to help the service team continually improve the service:
● carefully consider your roadmap for beta to ensure that you are solving the harder problems first across all elements of the service, to de-risk complexity of delivery in later stages
4. Make the service simple to use
Decision
The service was rated green for point 4 of the Standard.
Optional advice to help the service team continually improve the service:
● ensure that you follow through in a thorough manner with your tracking metrics, as the panel felt that you had a well-considered set of KPIs
● ensure that your service support includes clearly documented guidance and consistent recommendations for staff who are expected to utilise any new or modified user roles, such as the ‘super-user’ functionality, that are introduced in beta
5. Make sure everyone can use the service
Decision
The service was rated green for point 5 of the Standard.
Optional advice to help the service team continually improve the service:
● continue to involve users with access needs and use your new recruitment incentives that you have indicated for beta phase to focus on increasing the number of people from this user group who are involved in testing
● continue prioritising accessibility including carrying out the plan to commission an external accessibility audit during beta
6. Have a multidisciplinary team
Decision
The service was rated green for point 6 of the Standard.
Optional advice to help the service team continually improve the service:
● continue to involve policy colleagues closely with the development of the service and if possible, encourage them to observe user research directly
7. Use agile ways of working
Decision
The service was rated green for point 7 of the Standard.
Optional advice to help the service team continually improve the service:
● ensure the team has a robust plan to respond or adapt to potential future changes to abortion policy arising from parliament
8. Iterate and improve frequently
Decision
The service was rated green for point 8 of the Standard.
9. Create a secure service which protects users’ privacy
Decision
The service was rated green for point 9 of the Standard.
Optional advice to help the service team continually improve the service:
● continue working closely with DHSC Cyber team
● as this is a first within DHSC, record feedback on experiences for future projects.
● look at other authentication approaches used within health and government. Contact NHSE to find out what’s used there and any standards or approaches in place
● the legacy service has outdated components leading to vulnerabilities. The new service must have a plan to avoid falling back to this post launch
● continue to work closely with DHSC Cyber on the Secure By Design self-assessment and other relevant tasks. The panel note that it is important to include this thinking early and continue throughout beta
● the alpha includes a strong set of security recommendations, make sure these carry over into beta and are implemented. The timescales for beta are tight with a hard deadline for ending the existing system, be careful that tactical urgency does not cause lapses in best practice approaches.
10. Define what success looks like and publish performance data
Decision
The service was rated green for point 10 of the Standard.
Optional advice to help the service team continually improve the service:
● the team should consider any potential governance gaps carefully and reach out to partner organisations who have a greater digital deliver capability where appropriate
● the methodology for choosing additional KPIs was well reasoned, based on current pain points and NHS priorities such as time spent completing a form by staff. The team should review these throughout beta to ensure they still reflect what success looks like for the service
11. Choose the right tools and technology
Decision The service was rated amber for point 11 of the Standard.
During the assessment, we didn’t see evidence of:
● clear decisions or decision trees for next steps. While a lot has been done to identify pain points and problems within the current service, the decision routes for next steps is not clear. It is good to be flexible in line with findings, but the team is going into beta with a lot of outstanding questions including known DHSC standard approaches
● The team have worked with DHSC IT and Cyber from an early stage to get feedback and guidance, but it was not clear if they are following DHSC standards – largely because this approach is a first within DHSC. Although this may be outside the control of the project team, this does make them trail blazers and presents additional risk
● alignment with NHSE who will be part of DHSC within the next 1-2 years will be. Make sure that any decisions align with NHSE standards and practices as they will be part of the same organisation post launch
● a cloud-first approach. The alpha findings on the existing system outline replacing non-scalable hosting, which has led to poor performance at busy times, with scalable cloud-first hosting
● During the assessment, the team said they were looking into on-prem hosting at the DHSC data centre – The DAC. DAC is not currently approved for PII. Changing from cloud to on-prem is out of step with The Technology Code of Practice point 5 - use cloud first and would need strong justification for this approach to gain spend approval.
Optional advice to help the service team continually improve the service:
● given the team will be asking the beta supplier to procure infrastructure as a stopgap, anything that they build must be easily portable. Make sure that this lines up with DHSC and NHSE standards and if a tactical, stopgap platform is needed for launch that a migration plan is included in this activity with a path to a strategic solution
● make sure the stopgap approach does not risk exposing the service to poor performance, see related comments under point 14
Reassessment:
The service was rated green after reassessment for point 11 of the Standard.
12. Make new source code open
Decision
The service was rated green for point 12 of the Standard.
GitHub: https://github.com/DataS-DHSC/Abortion-Notification
Optional advice to help the service team continually improve the service:
● the team have planned an approach of build over buy as the requirements would lead to heavy customisation of any CoTS product with dependencies on the supplier for compatibility
● the team have shown a strong commitment to making things open in alpha. This must continue in beta and suppliers for the current or future phases must agree to this open approach
13. Use and contribute to open standards, common components and patterns
Decision
The service was rated green for point 13 of the Standard.
Optional advice to help the service team continually improve the service:
● give feedback on findings on admin and professional patterns which are outside the core public facing design system and have a different, professional, user base
● the team have identified what appear to be common pain points such as having to map legacy APIs onto new version. Scanning paper forms may also fall into this category as health and wider government are still using paper forms with need to scan. Although this may be wholly handed over to a 3rd party though directly rather than via another supplier. Make sure these learnings are shared
● use the design system in a way that supports easy updates so the service can stay in line with ongoing changes to the design system
14. Operate a reliable service
Decision
The service was rated green for point 14 of the Standard.
Optional advice to help the service team continually improve the service:
● the team have thought about hosting options, but a short-term stopgap infrastructure is being considered as a tactical approach to meet launch timescales. Depending on the interim approach, this could lead to launching with a service that doesn’t perform well leading to a negative perception from users that could carry forward in how they see the service. The team have identified slow response times as a pain point and want to avoid fall-back to paper. It is critical that private and early public beta don’t create a negative association around performance and reliability
● make sure the team carefully consider costings relating to service options in beta and live and consider learnings from Alpha and the legacy service
● the team should agree an SLA and associated service wrapper at the appropriate time. This should be shared with relevant stakeholders and published in a sensible place
Next Steps
[Amber - alpha] This service can now move into a private beta phase, subject to addressing the amber points within three months' time and DHSC assurance/GDS spend approval if applicable.
To get the service ready to launch on GOV.UK the team needs to:
● get a GOV.UK service domain name
● work with the GOV.UK content team on any changes required to GOV.UK content
The service must pass a live assessment before:
● turning off a legacy service
● reducing the team’s resources to a ‘business as usual’ level, or
● removing the ‘beta’ banner from the service
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