NHS 111 - service assessment
NHS 111 is a service that gives patients the ability to triage themselves as an alternative to the NHS 111 telephone number. The service uses a 'symptom checker' system using clinical content approved by the British Medical Association and the Royal College of GPs.
Department / Agency:
DH / NHS
Date of Assessment:
Result of Assessment:
Outcome of service assessment
After consideration, the assessment panel have concluded that the NHS 111 service is on track to meet the Digital Service Standard at this early stage of development.
The team demonstrated a thorough understanding of the clinical and technical complexities of what is essentially a self-diagnosis service with substantial associated risks. The team is fully aware of the potentially life-threatening impact of an error or fault.
The delivery team is complete in terms of skills and experience and appropriately funded to take the service into beta development.
The methods of working evidenced by the team are in line with agile best practice set out in the Government Service Design Manual.
Reasons and Recommendations
Given the purpose of the NHS 111 telephone service is well understood by the majority of its users, giving the digital service the same name may confuse users. The purpose of a digital service should be obvious from its name. Although it’s anticipated that the digital service will operate alongside the current telephone service, the team should consider how it will differentiate the two and create a specific identity for users unaware of the phoneline.
The assessment panel felt that ‘waiting times in A&E’ and ‘parking at the hospital’ would not be at the forefront of users’ minds. The headline need from the panel’s personal experiences of NHS 111 seemed to be “I’m not well, do I need medical attention? If so, what type and where/when can I get it?”
The service team understood that an online service would likely appeal to users with mental health issues, and users wishing for extra privacy. The service team should also address the possible extra challenges an online service will present to these users.
A thorough research plan, focussed entirely on users rather than potential savings and channel shift, is essential to further development of the service. The team needs to give this careful consideration and should not underestimate the scope of the research required.
In addition to independent users, considerable work is required to identify and evidence the needs of users who will need support to use the on-screen service (aka assisted digital users). The presence of the existing telephone service is not appropriate support for users trying to use the digital service. Helping those who’d otherwise be unable to use the service needs to be considered in some detail. Support must be specifically designed for the users of this service.
The service team must ensure that the process of finding the service, and then seeking and receiving help to complete it, does not cause excessive delay in the receipt of potentially critical clinical advice.
The service should also be clear about the difference between training NHS staff to help users develop their digital skills (‘digital inclusion’), and providing the immediate support that some users will need to complete the service (‘assisted digital’).
The service needs to be designed to consider the journey from the point of need for medical help to the fulfilment of that need. The team has been doing good work testing with real users in medical centres but this needs to be widened to consider the steps outside of using a computer to access the service.
Several content designers and a content lead are part of the team and they are responsible for the content being in plain english. The content lead has a clinical background so is empowered to challenge that aspect of the language. The team also has a creative director who is responsible for the end-to-end design and three of their developers specialise in front-end development.
The service is not on GOV.UK so does not need to meet the GOV.UK design consistency requirements set out in the Digital Service Standard.
Iteration and improvement
Although all of the necessary skills and components are in place for iteration and improvement - and a ‘pass’ has been awarded - the complexity of the clinical rules will impact the ability to actually do this. The team needs to formulate a test and release approach that ensures that the public facing service remains accurate and comprehensive at all times within the context of rapid iteration.
Test the end-to-end service
In terms of the accuracy and usefulness of the service, objective research is unlikely to be possible without ‘the whole thing’ being in place, including support for users who can’t use the on-screen service independently. There is no simple, deliverable Minimum Viable Product. This presents a substantial challenge given the massive complexity of the underlying clinical rule base.
Abstracting users with specific conditions that match the portion of the service available at any given time will not reproduce the stressful and emotional context in which this service would be used.
The assessment panel recognised that the team is working with hugely complex clinical rules and a service that can actually mean life or death for its users. The team is well resourced and has the right skills and experience to produce and iterate a valuable, useful and usable service. The panel looks forward to seeing how the team addresses the recommendations made as a result of this assessment.
Digital Service Standard criteria