A million little pieces

I’m working on plans for a new round of work that will explore our general approach to designing the NHS App, our design system, and how we make use of native technology. If I’m lucky, this is going to be a major part of what I spend my time on for the rest of the year. Writing about this in public sets off a certain amount of trepidation because I don’t want to jinx anything. I’m not a superstitious person, but getting to the point where we might take this on for real has been such a long road that I don’t want to take any chances of something going wrong, be they material or cosmic.

We’re getting on the design histories train. There isn’t much there yet, but we’ve set out our intention of creating a public record of why we've made design decisions, and much like this very website, the mere presence of the design history site is motivation to add to it.

We’re also trialing new a set of design principles that aim to clarify our definition of what good looks like. They’re an amalgamation of various sets of design heuristics, tailored to our domain and values. They still need a bit of work, but we’ve now got a few teams putting them into action and the early signs are positive.

A discovery looking into a niche component of appointment booking concluded this week and the main thing I walked away thinking was that we can’t solve any of the challenges that have been identified whilst in our current shape. As a team dedicated to working on the NHS App, we aren’t set up to solve problems that require changes to how services work outside of the app – not by ourselves, anyway. This is one of the big, persistent issues with having a team that works on an app when said app is only ever a window into a much wider and deeper system.

When the problems that make the app less than it could be exist well outside of our area of control, whose job is it to fix them? Marianne Brierley and Jane Maber cover aspects of this issue very well in their article The space around the thing: why products alone won’t transform healthcare. They say:

The NHS environment is especially complex. It’s governed by opaque, interwoven factors – structures, behaviours, legacy systems, safety protocols, policies, culture, and people. And when those forces aren’t understood, or accounted for, even the best designed product will struggle to survive rollout.

Yes, exactly. In my team we can add an extra dimension to the challenge: we can’t even responsibly design the thing without first sorting out all of the spaces that might surround its hypothetical future area. It is a very chicken vs. egg type of problem.

Cathy Dutton published an article this week called It’s time to get serious about design that absolutely nails a lot of what I’ve been struggling with lately. The basic pitch is that now – in 2025, following on from the Blueprint for Modern Digital Government – is the time to reset what we expect from design, moving away from digitising paper processes and formulaic approaches toward something messier and more imaginative. Further, this change is the only way we (collectively) will ever be able to deliver on the ambitions set out in the blueprint.

Dutton pulls out a quote from the blueprint:

We need to holistically improve policies, business processes, data, and systems rather than on a piecemeal basis.

That sounds about right for addressing the 10 Year Plan, no? The reset being asked for mirrors some of what Kuba Bartwicki describes in What’s a good design team anyway?, specifically the note that a good design team “can ship, but can also dream”.

There are stickers proclaiming “be bold” all over the place in the office. Mostly this is the doing of the prevention services gang. Is this the responsible, considered version of YOLO? Perhaps something is in the air.

I find this declaration easy to internalise but tricky to operationalise in my current role. Most of the big bold things I want to do sit outside the team’s remit (see above). Pursuing bold ideas means coalition building to assemble and coordinate all of the many little pieces required to make significant change happen. The good news is that cross-team plans across the entirety of the NHS are beginning to come into focus, however the amount of zoom in / zoom out telescoping required to keep track of everything is rather a lot for one’s neck muscles.

Speaking of the 10 Year Plan, now that we have a collective north star, I’ve been getting involved with an ever growing number of conversations in which people ask some version of “ok so how do we fix this big systemic problem that affects all care settings?” It is too early to tell whether any of the conversations and diagrams and workshops and project plans are going to solve any of the challenges they are aimed at, but there is a palpable sense of energy in the air.

None of the topics being discussed are novel, none of the ideas being proposed have never been had before. The issues affecting the health system are well known and thoroughly catalogued (and have been for quite some time), but the level of ambition set out by recent policy documents has had a galvanising effect across the organisation that is really nice to witness. What a time to be alive, eh?