Taken
We’ve been trying to build toward something. This week we stopped and questioned whether we were building toward the right thing. It felt like a false start. I’ve felt torn between applying pressure to move forwards and the need to make sure we’re creating solid foundations.
We tried to move fast – find somewhere we could add value quickly, learn what it takes to make changes in the NHS app. Maybe unsurprisingly, there’s not much we can do that has value, progresses the strategies of Digital prevention services and the NHS app, and isn’t incredibly complex.
Part of the need to reassess came from a set of stakeholders who wanted us to support something so far outside our assumed scope we hadn't even considered it. If we're going broad, we need to go really broad. What are the most important things we can do?
Scrimshaw
With new people joining a couple of weeks ago, it felt like a good time to reassess. What’s our purpose? What foundational work do we need to do to reduce the risk of going in the wrong direction?
Even with a relatively small team – the effort to make sure we’re communicating clearly and transparent about our purpose is important. We’re now five people and suddenly we’ve grown beyond the point where I can safely assume everyone is on the same page.
R‑Type
For me, there’s one riskiest assumption. ‘Prevention’ or ‘reduce your risk of getting ill’, or whatever we end up calling it – makes sense to users as a single concept. We need an informed view of this to shape almost everything else. The last thing I want is to ship our org structure if it doesn’t match how users think.
We started by exploring whether to put screening and vaccines on a single page. But they’re just two things that reduce risk. There are others – taking medicine, for example. A chronological view feels like an inside‑out view, organised by when things happen rather than what they mean to someone. An overview might be useful for someone managing their own health. This probably changes for someone managing another person's health – parents might think differently about their child’s record. Most people will only care about the most critical thing – what have they missed? What needs action now? This matters most for people who are least likely to chase up, who move frequently, have lower health literacy, or have had poor continuity of care. The people we need to reach.
Dowager
When we look across the ideas we’re exploring, they fall into two groups. Transactional services – one‑off things like screenings and vaccinations – where the app can help people know what they’re due and act on it. And ongoing support – behaviour change, managing long‑term risk – where the relationship between the user and their health is sustained over time. Different problems. The transactional stuff is hard, really hard, but people are working on it. Ongoing health management may well be something else.
Shill
The stakeholder challenge is still sitting with me. If the scope is genuinely open, the question of what we prioritise becomes more important and harder to get right.
Blackfriars
The prototype I built is useful to talk around, to explore what data needs to be available and what will be hard about this. It might be the wrong approach. I'll be more comfortable starting with basic user needs and mental models. How do people think about reducing their risk of illness? What do they need to know, and when?
None of these ideas are small. Making any of them real will need commitment from across the NHS. I keep reminding myself we’re not going backwards – we’re strengthening our foundations.