Healthy Living for people with type 2 diabetes beta assessment
This is the beta assessment report for the Healthy Living for people with type 2 diabetes service, on 3rd September 2020
Digital Service Standard assessment report
Healthy Living for people with type 2 diabetes
| From: | GDS |
| Assessment date: | 03/09/20 |
| Stage: | Beta |
| Result: | Not met |
| Service provider: | NHS England/ NHS Improvement |
Previous assessment reports
Service description
Healthy Living is an online programme for adults with type 2 diabetes. It provides information and tools for users to self-manage their condition. The content incorporated in the programme has been evidenced to achieve improved health outcomes through a randomised control trial.
The programme is designed to improve the user’s knowledge and skills, as well as helping to motivate them to take control of their condition and self-manage it effectively, tailoring content to user needs.
Service users
- Primary users: Adults diagnosed with type 2 diabetes
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Secondary users:
- Carers/relatives of people living with type 2 diabetes
- Health care professionals
1. Understand user needs
Decision
The service met point 1 of the Standard.
What the team has done well
The panel was impressed that:
- the team has continued to research with a diverse range of users
- a full accessibility audit has taken place as previously recommended
- the team emphasised that due to covid this hasn’t been possible but are aware of the need to test more with BAME users and users that fall in the lower end of the digital inclusion scale
What the team needs to explore
Before their next assessment, the team needs to:
- evidence that they are reaching out to BAME and users that fall in the Assisted Digital spectrum
- continue to understand user needs from the perspective of communities that are helping users, GPs, practice nurses and other health care professionals
- show that the service also works for non expert users (users that have no awareness of this service, first time use)
- ensure through ongoing research we capture in depth needs of users of assistive tech
2. Do ongoing user research
Decision
The service met point 2 of the Standard.
What the team has done well
The panel was impressed that:
- the team has a plan in place to ensure research continues and iterations are made to the design based on user needs
What the team needs to explore
Before their next assessment, the team needs to:
- test the end to end service journey with users of assistive tech (this can be non expert users too)
- continue to research with BAME communities to further understand their needs, where do they currently go for support and level of support needed to access the this service
- current user testing was heavily weighted towards people who had had diabetes for more than 10 years. It is recommended that for ongoing testing they include people who have been newly diagnosed
- when a decision has been made on priority languages it is imperative that testing on the end to end user journey takes place with specific language users
3. Have a multidisciplinary team
Decision
The service did not meet point 3 of the Standard.
What the team has done well
The panel was impressed that:
- the team is very knowledgeable about the long term changes that they want to create for people with type 2 diabetes
- the team is made up of a core team of full time people from Changing Health and NHS, with access to specialist roles
- the team has reacted to recommendations from their alpha assessment by engaging a service designer and an assisted digital lead, and that they recognise the need for more analysis skills as they move forwards
What the team needs to explore
Before their next assessment, the team needs to:
- take steps towards employing a full time content designer. It is accepted that some of the content is from providers, and that good work has been done to ensure this is useable. However, this is a content heavy piece of work, and clear, consistent, easily digestible copy throughout the service is vital. All the more so as the team will need to make sure that all video and imagery is fully accessible post-September 2020 and will be exploring changing the content to reflect different languages and cultures post go live. It is recommended that the content designer joins and interacts with the wider government content community to ensure best practice can be shared
4. Use agile methods
Decision
The service met point 4 of the Standard.
What the team has done well
The panel was impressed that:
- the team is working in an agile way using epics and sprints
- the team is reflecting on the work they produce and are keen to improve
What the team needs to explore
Before their next assessment, the team needs to:
- consider introducing formal regular retrospectives on ways of working
- ensure data and analytics is discussed as a team and used to inform data driven hypotheses for improvements
- ensure prototypes (or a replica environment) are used to test changes to the service, rather than making the changes in the live service
5. Iterate and improve frequently
Decision
The service met point 5 of the Standard.
What the team has done well
The panel was impressed that:
- the team regularly reports to NHSE and there are multiple feedback loops in place
- the team has a regular release cadence
What the team needs to explore
Before their next assessment, the team needs to:
- ensure data and analytics is discussed as a team and used to inform data driven hypotheses for improvements
- ensure prototypes (or a replica environment) are used to test changes to the service, rather than making the changes in the live service
- keep doing user research, alongside its plans for quantitative analysis, particularly as the content will keep changing
- ensure that research is conducted with more BAME users and assistive tech users
6. Evaluate tools and systems
Decision
The service met point 6 of the Standard.
What the team has done well
The panel was impressed that:
-
the team has considered multiple existing solutions for their use cases
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the team opted to retrieve client data from the Personal Demographics Service (PDS) in batches rather than with a real-time API call because it suited their use-case better
7. Understand security and privacy issues
Decision
The service met point 7 of the Standard.
What the team has done well
The panel was impressed that:
- no single user has the ability to create and push code
- all changes are created as Merge Requests in GitLab, which require another developer to review the code
- the trunk brunch (master) is protected from direct pushes
8. Make all new source code open
Decision
The service did not meet point 8 of the Standard.
What the team has done well
The panel was impressed that:
- the team has worked on some tooling and infrastructure-related code in the open https://github.com/owlsdepartment/maildev, forked from maildev/maildev
- the team has published their landing page on BitBucket
What the team needs to explore
Before their next assessment, the team needs to:
- identify which parts of the service are able to be opened in their own right. The beta NHS digital, data and technology standards framework and GDS Technology Code of Practice highlight that all new code should be open unless there is a compelling reason for it not to be, such as security or unreleased policy. The underlying platform may be private on account of being proprietary, but services running on that platform do not need to be.
9. Use open standards and common platforms
Decision
The service met point 9 of the Standard.
What the team has done well
The panel was impressed that:
- the service was deployed using open platform providers such as Kubernetes and Docker
- the public API accepts requests and returns responses formatted in JSON
- the service uses existing digital NHS services rather than implementing their own
What the team needs to explore
Before their next assessment, the team needs to:
- identify whether there are services that could be deployed onto existing government common platforms such as GOV.UK PaaS
10. Test the end-to-end service
Decision
The service met point 10 of the Standard.
What the team has done well
The panel was impressed that:
- the team tests for compliance against Web Content Accessibility Guideline (WCAG) version 2.1
- the team tests for accessibility with screen readers
- the team matches up its manual testing cycle with each release, and monitors in production for missed regressions
What the team needs to explore
Before their next assessment, the team needs to:
- have accessible content in place for when a user attempts to use the service without JavaScript enabled in their browser
11. Make a plan for being offline
Decision
The service met point 11 of the Standard.
What the team has done well
The panel was impressed that:
- while there is no specific replacement offline process, there are existing resources outside of the service to help users that can be directed to in the case of a severe outage
- the plan for being offline was thorough, including management of communications with users - for example, expected time of resolution
- the recovery process was detailed and the team demonstrated that they iterate upon learnings from disaster recovery drills
12: Make sure users succeed first time
Decision
The service did not meet point 12 of the Standard.
What the team has done well
The panel was impressed that:
- the team is committed to collecting a minimum of data in order to tailor the service to users and to provide NHSE with data to track clinical effectiveness
- the team is monitoring short term measures of engagement as well as longer term measures of behaviour change, as reflected in clinical measures like HbA1c
- the team worked hard to align content from 4 different licence holders and have pushed back in the interests of meeting user needs
- the team plan to use the platform’s ability to offer content in alternative languages for BAME users and are aware of the complexities involved in offering culturally appropriate content
What the team needs to explore
Before their next assessment, the team needs to:
- provide an accessibility audit report to indicate the service is AA compliant before launching publicly
- show how they have taken specific transaction (for example successful registration and return rates) and engagement metrics, iterated the service and improved the metrics before launching publicly (recognising that behaviour change takes longer to evidence)
- test the new dashboard and overarching navigation to make sure that users can find what they need from the start and try different approaches if need be
- consider which data is mandatory and which optional (data to tailor information could presumably be optional)
- not rely on users reading the legal documents and instead make clear to users, as they register, which data is being collected for what purposes, testing different approaches to making it more transparent (for example, using hint text as in the GOV.UK email address pattern or the NHS details component with a heading “Why we are asking this” as some NHS services do)
- make the terms and conditions and privacy policy easier to find, read and understand (removing ALL CAPS, for example)
- keep content under regular review to make sure that it is meeting user needs and iron out typos and inconsistencies (for example, “type” or “Type” 2 diabetes) as content is added or iterated
13. Make the user experience consistent with GOV.UK
Decision
The service did not meet point 13 of the Standard.
What the team has done well
The panel was impressed that:
- the team has reviewed content against the GDS and NHS content style guides
- the team has contracted an experienced GDS content designer to review their content
- the team is interested in sharing their experience of developing behavioural change patterns with the NHS design system team
What the team needs to explore
Before their next assessment, the team needs to:
- present a plan for how they will make sure they deliver a similar level of usability and accessibility to GOV or NHS.UK
- consider applying the NHS.UK frontend to the platform (it may still be their cheapest long-term solution to meeting usability and accessibility) and, if that is not possible, set out in the plan how they will make their existing designs follow specific NHS components more closely in the next phase (GOV.UK ones if NHS ones aren’t available), including formatting, alignment and other details
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For example:
- for date input, follow the recommended box size and do not include leading zeros (see the NHS date input component), and follow GOV.UK advice (in the dates pattern) on the use of calendar controls for the profile section
- replace dropdowns (Select) with more accessible radios
- use the NHS review date component so that users know when the content (particularly clinical content) was last reviewed and will be reviewed again
- arrange a further accessibility audit for all new designs and functionality if it isn’t possible to use NHS.UK frontend code
- engage with the NHS design system team for advice, to share learnings and potentially contribute to the design system
14. Encourage everyone to use the digital service
Decision
The service met point 14 of the Standard.
What the team has done well
The panel was impressed that:
- the team has explained the rationale for a digital service
- there is a support phone line open during office hours
- users can be referred to or self refer to the service
- there is a plan to include mobile as well as email referrals
What the team needs to explore
Before their next assessment, the team needs to:
- use analytics to consider whether the support phone lines opening hours need to be extended
- complete actions identified in the accessibility audit
- how to better support those lower on the digital inclusion scale. The driver behind the online service is to provide better access to provision. Whilst it is accepted that there is alternative provision, it might lead to better outcomes for service users if more work was done to allow them to access this one
15. Collect performance data
Decision
The service did not meet point 15 of the Standard.
What the team has done well
The panel was impressed that:
- the team has a full time performance analyst
- the team is collecting performance data and storing it to allow for analysis
What the team needs to explore
Before their next assessment, the team needs to:
- ensure that they are collecting data by consent. There is no consent mechanism on the service at the moment. This means that all data is being collected without [a]consent. NHS consent mechanism can be seen on https://www.nhs.uk/
16. Identify performance indicators
Decision
The service did not meet point 16 of the Standard.
What the team has done well
The panel was impressed that:
- the team has clear outcomes that they want to improve for patients in the long term
- the team has identified some performance indicators on the service itself that imply improvements to the patient outcomes
What the team needs to explore
Before their next assessment, the team needs to:
- show how the service level KPIs meet the patient outcomes and overall service objective with something like a measurement framework [b]
- show how iterations to the service have changed the KPIs
- show how change hypotheses are linked to making improvements to the KPIs and how these drive priorities.
- use data to ensure the changes they have made to the service have had the impact they expected, particularly as it’s taking time to go back to UR after a release
17. Report performance data on the Performance Platform
Decision
The service met point 17 of the Standard.
What the team has done well
The panel was impressed that:
- the team is storing and sharing the data in a clear way that can be accessed by stakeholders
- regular data sharing is automatic and doesn’t cause excess work for the team
18. Test with the minister
Decision
The service met point 18 of the Standard.
What the team has done well
The panel was impressed that:
- the team has kept senior leaders informed throughout the alpha and beta phases, and has walked through the content with the Director for Diabetes