Get healthcare cover for travelling abroad
This is the alpha assessment report for the NHS Business Services Authority's Get healthcare cover for travelling abroad service.
Service Standard assessment report
Get healthcare cover for travelling abroad
| From: | GDS |
| Assessment date: | 22/09/2020 |
| Stage: | Alpha |
| Result: | Met |
| Service provider: | NHS BSA |
Service description
Overseas Healthcare Services (OHS) manages reciprocal healthcare on behalf of the Department for Health and Social Care (DHSC).
Overseas Healthcare Services enables access to reciprocal healthcare for entitled citizens or UK ordinarily residences within the European Economic Area (EEA) or Switzerland.
We administer:
- application for healthcare cover for customers:
- traveling or studying overseas (EHIC - European Health Insurance Card)
-
working or residing overseas (S1 – healthcare certificate)
- registration of healthcare cover entitlements honoured by Member States
- claims and recovering costs of medical treatments
Service users
- EU Nationals legally residing in UK (living in UK with settled / pre-settled status or indefinite leave to remain)
- Students whose course starts before 31st December 2020 and continues after this in EU
- S1 Pensioners*
- S1 Posted Workers*
- UK Nationals (Subject to Future Relationship Negotiations)
*The S1 is a certificate that entitles an individual access to state healthcare on the same basis as all citizens in the Member-State countries S1 holders moved to. Users can be entitled to an S1 if they are in receipt of a UK State Pension or certain other (exportable) benefits.
Our users:
- travel overseas
- reside overseas
- work overseas
- study overseas
- get medical treatment overseas
Their main need is to know that their healthcare is covered in place after 31st of December 2020.
High level user needs this service aims to meet
- As a user I need to know what healthcare I’m entitled to when travelling abroad so that I can make sure I have the correct cover and access to healthcare.
- As a user I need to know if my current EHIC will still cover my healthcare after EU Exit so that I have travel insurance for treatment if I need it.
- As a user I need clear information about what an EHIC covers me for so that I can make sure I am appropriately covered for healthcare when travelling abroad.
- As an applicant I need to how long it will take for me to receive my EHIC so that I can plan and be sure I have it in time for my holiday.
- As a user I need to be able to show evidence of my cover so that I feel reassured that I will get the treatment I need when I need it.
- As a user I need to have a convenient way of applying for an EHIC so that I can do this by myself at a time that suits me.
- As a user I need to know how long my EHIC will be valid for so that I know I am covered for healthcare or whether I need to sort out an alternative or re-apply.
- As an applicant I need clarity on what evidence I need to provide with my application so that I can make sure I correctly apply and do not delay receiving my EHIC.
- As an applicant I need an update on the progress of my application so that I do not unnecessarily call the contact centre to chase this up.
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 has a good understanding of their users’ needs, despite many aspects of the policy being undecided
- the team has documented explicit, implicit and created user needs separately, demonstrating a robust and nuanced understanding
- the team has undertaken research with a wide range of current and potential users and made sensible decisions about which groups to prioritise
- the team has a good understanding of the behaviours, motivations and pain points of people who’ve used the existing service
- the team has identified their riskiest assumptions and have established a process for monitoring their progress in dealing with them
What the team needs to explore
Before their next assessment, the team needs to:
- ensure their user needs are still accurate as more policy decisions are taken. For example, the team has assumed the offering for UK citizens going on holiday will be broadly the same as it is now. If this isn’t correct, more research will be required to ensure the right design decisions are taken
-
undertake more research with accessibility and assisted digital users. The panel acknowledges the difficulties of working with these users during COVID-19, but more detailed plans are required to ensure this is overcome. These articles/blogs may help:
- https://www.slideshare.net/btopps91/planning-and-conducting-remote-usability-studies-for-accessibility-rosenfeld-event-238482016
- https://userresearch.blog.gov.uk/2020/05/20/conducting-remote-research-with-people-with-access-needs/
- ensure they fully understand the needs of those who are currently unaware of or excluded from the service. The panel understands the pressures the team is under to deliver the replacement service in tight timescales. But it’s important these users are not forgotten about
- prioritise the user needs not met by the private beta service. For example, introducing options other than a physical card and steering people away from unscrupulous third parties. This is what will transform the service and improve its inclusivity
- ensure the needs and behaviours of internal users are fully understood and documented
- have a realistic and detailed user research plan for the private beta phase. The plan presented is ambitious and it is unclear how the activities will be managed and prioritised. This should also include how the research issues experienced in alpha (for example working with accessibility users) will be overcome
- ensure that they are not solely relying on feedback from call centre calls and feedback forms to identify issues with the service. These data sources are skewed and won’t be representative of all users
- ensure they focus their priorities on designing for explicit and implicit user needs, and minimise the impact of created user needs
2. Solve a whole problem for users
Decision
The service did not meet point 2 of the Standard.
What the team has done well
The panel was impressed that:
- the team has a good understanding of what it means to solve a whole problem. They have developed a good understanding of the wider user needs and user journeys. They are making connections across government to other services and teams who meet the same user needs
- the team has researched and mapped user journeys, questions and pain points
What the team needs to explore
Before their next assessment, the team needs to:
- be given the autonomy, time and protection needed to research and design a service which solves a whole problem and meets the needs of all users. The team has been under a lot of pressure to deliver a replacement service in time for a tight and firm EU exit deadline, which has prevented them from prioritising work and creating the service the way they know it should be done. The team has been directed to focus support on existing users and to build a service based on the needs of existing users. However, it’s the more vulnerable, more confused and more peripheral users who are the more important ones to design for first - these are the people who need and rely on public services the most
- be allowed to research and design the wider user journey, the broader user needs and the related services around their service
- be given the space to design unhappy paths (including error paths and failure paths) as well as the happy paths. The unhappy paths are usually the more difficult ones and the ones that are harder to get right. The design of unhappy paths often impacts the happy paths, and has to be considered simultaneously
- develop an understanding of who is excluded by the existing service (and therefore the new service), why they are excluded and what their needs are. This includes understanding users who are confused, unfamiliar with the service or policy, and who don’t understand the terminology, language or acronyms used
- not assume that high completion rates necessarily indicate the service is good, if they have not designed for all users and all journeys
- explore the impact of EU exit and COVID-19 on users behaviour and needs
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:
- digital teams are working closely with call centre operations
- digital tools have enabled operational staff in call centres to switch to home working since the introduction of COVID-19 restrictions
What the team needs to explore
Before their next assessment, the team needs to:
- consider how parts of the live service currently unavailable through digital channels (for example the service for non-EEA nationals) can be made available online
- provide suitable hand offs to the telephone service and information about telephone service availability
- have a plan for retiring the legacy digital service while minimising any impact on call centre staff or back office operations
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 used NHS and GOV.UK design patterns well
- the team has conducted research into getting the language and interactions right in the service, making changes based on research insights
What the team needs to explore
Before their next assessment, the team needs to:
- ensure that the use of abbreviations throughout the service is appropriate for a wider user base, including users who don’t understand the existing service or the policy and haven’t used it before
- consider the harm that can be caused to users by asking for gender, including excluding some users from using the service. The team must be allowed to act on their concerns in this area, mitigate the damage and find other ways of identifying users if needed
- review the content on the start page as there seems to be a lot there
- consider the placement of help text on question pages - it might be more appropriate above the answers
- be given the time to get the questions right, make sure all users understand the service, what it covers and how to interact with it. For example, consider whether all users understand how to answer the question “where do you live?”
- re-consider the user of a select field for addresses input. Work with the GOV.UK design system and NHS design system to develop a better input method for addresses
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 made a commitment to building for accessibility first, and ensuring that the service can be used by people with a variety of access needs
- the team is committed to coding the service to meet standards and conducting research with users with access needs
- the team had developed a good understanding of the variety of users and their needs
What the team needs to explore
Before their next assessment, the team needs to:
- ensure that they design for all users who are more vulnerable, less familiar with the service and more peripheral. These are the users whom we need to design for first.
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:
- the service is being built by a multidisciplinary team with a good mix of roles that is appropriate to what they need to achieve during alpha
- the team has a close working relationship with the parts of the organisation delivering the telephone service
- the team has access to the relevant expertise within DHSC (including legal, policy and communications colleagues)
- the team contributes to ministerial submissions and are able to shape policy development through its good relationships with DHSC
- the team has a good mix of employees and contractors
What the team needs to explore
Before their next assessment, the team needs to:
- build on their strong relationships within DHSC to gain support for further transformation of the service (especially as described in ‘2. Solve a whole problem for users’) and testing of the organisation’s assumptions about the EHIC
- develop relationships with other government departments which could provide valuable insights for example the Foreign, Commonwealth & Development Office
- ensure they continue to have service design knowledge and skills informing and working with the team
- continue to have user researchers, interaction and content designers as full members of the team
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 team uses appropriate agile techniques (scrum), including sprint planning and show and tells (which it has extended out to DHSC colleagues)
- agile tools and practices have enabled the team to seamlessly transition from being fully co-located team to completely remote
- there is a good line of communication between product owner and service owner, and decision making appears to be appropriately delegated
- the service owner attends sprint reviews regularly
What the team needs to explore
Before their next assessment, the team needs to:
- build on its good work so far and gain continued senior buy-in for agile ways of working and governance practices
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:
- the team has iterated the service based on user research and documented its progress in the prototype
- the team has started to work on the journey for users who will be able to pre-register for the EHIC, in the absence of clarity around what can be offered to a wider range of users
What the team needs to explore
Before their next assessment, the team needs to:
- address the uncertainties around the service currently arising from ongoing negotiations in the implementation period
- prioritise addressing shortcomings they have identified, such as the fact the service requires users to know about things the product does not tell them
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:
- the service is unauthenticated and as such does not require holding user account data
- the service secures communications between the user, itself, and upstream services
What the team needs to explore
Before their next assessment, the team needs to:
- describe the tools and processes with which they would detect an intrusion and then action a response
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 will use Google Analytics from day one of the service
- the team are considering the best way to measure performance against the previous service
- the team has raised a request for entry onto the Performance Platform
- the team has identified additional KPIs beyond the four mandatory ones, and appropriate ways to monitor them
What the team needs to explore
Before their next assessment, the team needs to:
- consider what other measures of success might exist outside of technical service performance metrics such as completion rate, for example reduced calls for consular assistance
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 chose to use a language common within BSA
- the team opted to use an unauthenticated journey for alpha where a full login was deemed not necessary
- the team were able to justify their reasons for choosing public cloud rather than internal platforms or private clouds
What the team needs to explore
Before their next assessment, the team needs to:
- explore whether or not logins are necessary to improve inclusivity, and if they are whether to port logins from the existing system
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:
- there is a plan to open up code in the private beta phase
What the team needs to explore
Before their next assessment, the team needs to:
- move their private GitLab repositories over to public repositories as soon as possible
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 team used the NHS prototype kit rather than creating their own
- the team used existing services provided by the NHS for data lookup rather than creating their own integration
What the team needs to explore
Before their next assessment, the team needs to:
- explore the best solution for shared interface components such as address lookup, and if possible borrow from existing solutions
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 team will have alerting and monitoring in place for private beta
- AWS DDoS protection will be in place
- regular penetration testing is anticipated to to check how secure the system is
What the team needs to explore
Before their next assessment, the team needs to:
- confirm what their reliability goals are for the service
- consider how the service can help users who require out of hours support for a Provisional Replacement Certificate (PRC)
Next Steps
This service can now move into a private beta phase, subject to implementing the recommendations outlined in the report and getting approval from the GDS spend control team. The service must pass their public beta assessment before launching their public beta.
The panel recommends this service sits a beta assessment in around two months time. Speak to your Digital Engagement Manager to arrange it as soon as possible.
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