Medical Examiners Examining a Cause of Death alpha reassessment
The service will enable and record the scrutiny of the cause of non-coronial deaths in the NHS by an independent Medical Examiner. In other words the ability for a Medical Examiner to scrutinise a death and agree or disagree with the attending doctor’s verdict as to causality. The Medical Examiner is able to refer cases to the Coroner where appropriate to do so.
| Stage: | Alpha Re-assessment |
| Service provider: | Department for Health and Social Care (DHSC) |
Previous assessment reports
Service description
The service will enable and record the scrutiny of the cause of non-coronial deaths in the NHS by an independent Medical Examiner. In other words the ability for a Medical Examiner to scrutinise a death and agree or disagree with the attending doctor’s verdict as to causality. The Medical Examiner is able to refer cases to the Coroner where appropriate to do so.
Service users
- Medical Examiners (inc. the National Medical Examiner and regional lead Medical Examiners)
- Medical Examiner Officers (inc. regional lead Medical Examiner Officers)
4. Use agile methods
Decision
The team met point 4 of the Standard.
What the team has done well
The panel was impressed that:
- the service team has a mature approach to agile, whilst also balancing the need to meet important policy commitments and legal considerations
- The team has iterated the service a number of times, and demonstrated how each iteration has significantly improved the design, policy and technical architecture of the service
What the team needs to explore
Before their next assessment, the team needs to:
- engage closely with and have a shared roadmap for the service with NHS Improvements (NHSi) who will be the long-term owner of the service
- consider how to scale their agile ways of working to involve more closely in the design their users beyond the 2 pilot sites and wider stakeholders - for example, consider doing wider engagement through roadshows, regular newsletters, open community show and tells. This will also help with encouraging greater digital take-up
5. Iterate and improve frequently
Decision
The team met point 5 of the Standard.
What the team has done well
The panel was impressed that:
- the service team has done significant de-risking and continuously iterated the scope for Alpha to get to a minimum viable service (MVS) that meets user needs and the Service Standards
- the service had undergone significant change from the original Discovery/ early Alpha prototypes, and the whole team really understands their users and has designed with them in mind
What the team needs to explore
Before their next assessment, the team needs to:
- define better the different user and stakeholder groups, and come up with a prioritisation methodology that encompases all groups - there was some confusion between the 2 different types of pilot users (medical examiners and medical examiner officers), the various stakeholders that need to be engaged in the service, and the 4 permission levels they are offering in the service
- have a clear view of how to sequence, scope and size iterations and features for different users in private and public Beta
7. Understand security and privacy issues
Decision
The team met point 7 of the Standard.
What the team has done well
The panel was impressed that:
- the team has engaged with policy teams and data guardians in DHSC and NHSi and Wales DA to determine the appropriate restrictions are put in place to meet data privacy concerns
- the team has adopted best practices for data security and worked with NHSi to align their work with their recommendations
What the team needs to explore
Before their next assessment, the team needs to:
- consider security hardening of the data captured by Medical Examiners (MEs) using immutable records and more restrictive security permissions on CosmoDB
- ensure they are using Azure templates provided by National Cyber Security Centre (NCSC), or adapted by NHSi from this baseline
- agree with NHSi additional tools such as static file analysers that will improve the security of code handling sensitive aspects of the service
- incorporate all the findings from the data protection impact assessment being conducted by DHSC and ensure prior to their Beta assessment to review their progress
- capture and make available their policy around access to Azure environments by team members and support staff, ensuring they are following best security practices in this area
8. Make all new source code open
Decision
The team met point 8 of the Standard.
What the team has done well
The panel was impressed that:
- the team already provides their prototype on a public source repository and intends to open source development throughout the Beta
What the team needs to explore
Before their next assessment, the team needs to:
- consider providing suitable documentation to make contributions from outside parties possible to the long-term benefit of the service
10. Test the end-to-end service
Decision
The team met point 10 of the Standard.
What the team has done well
The panel was impressed that:
- the team have built an interactive prototype that includes capture of the full lifecycle of service usage as suitable for an Alpha
What the team needs to explore
Before their next assessment, the team needs to:
- resolve outstanding questions around the tech stack they have adopted working with stakeholders in NHSi especially around data partitioning, DevOps and the build pipeline tool chain
- demonstrate they have full end to end testing in place and supported by NHSi for their Beta assessment. It is important they use an appropriate toolset and methodology to align the deployment of their service with the DevOp / TechOps at NHSi prior to the public Beta
11. Make a plan for being offline
Decision
The team met point 11 of the Standard.
What the team has done well
The panel was impressed that:
- the team has suitable offline paper based data capture processed and reasonable expectations about business continuity in the event of downtime
What the team needs to explore
Before their next assessment, the team needs to:
- establish firm expectations with NHSi around the service availability and contingency measures, including for assisted digital, during the Beta development period
12: Make sure users succeed first time
Decision
The team met point 12 of the Standard.
What the team has done well
The panel was impressed that:
- the service has been through considerable design iterations since their first Alpha assessment with a clear focus on designing for user needs
- the team is working closely with the providers of the training that users will need to go through before using the tool
What the team needs to explore
Before their next assessment, the team needs to:
- gain confidence that the training medical examiners will get will be sufficient to induct new users to the tool
- have a clear idea of what ‘succeed first time’ means in this context and show how the service helps users do that
- design and implement a support model for users struggling to use the service which includes inclusivity issues (assisted digital support) and technical issues
- make sure the service is inclusive to those users with access needs
13. Make the user experience consistent with GOV.UK
Note: This service will be on NHS.UK and so this point is adapted to be “…consistent with NHS.UK”
Decision
The team met point 13 of the Standard.
What the team has done well
The panel was impressed that:
- the team is working to the new NHS patterns and are working with the NHS Digital team, including sharing designs on the cross-NHS Slack
- the service was initially designed agnostic to NHS/GOV.UK styles whilst the team waited for a decision about which website it would be on
What the team needs to explore
Before their next assessment, the team needs to:
- continue working with the rest of the NHS, contributing patterns and research findings so that the new NHS design system can continue to grow
- continue using, and feeding back to, the GOV.UK Design System where appropriate
- consider what the scope of the search bar in the NHS header will be and test expectations with users
14. Encourage everyone to use the digital service
Decision
The team met point 14 of the Standard.
What the team has done well
The panel was impressed that:
- the team has engaged closely with the 2 pilot sites, who have almost co-designed the service, so digital take-up should not be a problem
What the team needs to explore
Before their next assessment, the team needs to:
- see point 4 for more details
15. Collect performance data
Decision
The team met point 15 of the Standard.
What the team has done well
The panel was impressed that:
- the service team has considered how to collect and measure performance data that is actually useful for the service
- the team has done technical analysis to understand constraints in how to measure the data
16. Identify performance indicators
Decision
The team met point 16 of the Standard.
What the team has done well
The panel was impressed that:
- the team has considered the indicators that would be useful and valuable for them to measure, and are realistic on what is possible in private Beta
What the team needs to explore
Before their next assessment, the team needs to:
- do benchmarking and more analysis on volumes to support take-up and planning for public Beta and live - it was not clear whether analysis had been done to identify the volumes the service might generate
- align the performance indicators more closely to the user needs to help with the prioritisation of future improvements in Beta and beyond
- work more closely with NHSi to validate the suggested performance measures and how they will be benchmarked, captured and measured. There should also be a way to feed back the outcomes to NHSi, so that they know how the service is performing
17. Report performance data on the Performance Platform
Decision
The team met point 17 of the Standard.
What the team has done well
The panel was impressed that:
- the team has contacted the Performance team and has it on their roadmap to feed data on the Performance Platform
What the team needs to explore
Before their next assessment, the team needs to:
- speak to the GOV.UK Performance team and agree a plan and next steps to get on the Performance platform