Digital and data strategy - Section 6 – Build to make a difference

We need to make what people need.

To achieve our principle of people first, the user will be at the heart of what we do and we will embrace user centred design to create solutions and services that are designed with the actual people using them. By incorporating user research at the start of every project, the focus will shift from us as an organisation to all the users wherever they are. Our teams are users too and they also need the opportunity to help create the services they run.

When we develop an existing service, we can measure its efficiency by assessing the value it gives to its users. Our new user centred design team will be able to help services align to the service standards as they begin a new cycle of continuous improvement based on user need.

We’ll keep increasing our groups of users in different areas so that we can have a good mix of people without putting too much pressure on a small group of people. We’ll develop our user research abilities so that over time we can do more discoveries ourselves, without needing help from external partners.

Diabetic Eye Screening

Diabetic Eye Screening Wales (DESW) is transforming its digital service together with the people who use it.
Following a successful Discovery, which found some clear issues:

• • Lots of people do not attend appointments because they can’t change to a date that suits them.

• • Referrals, bookings, and reporting are almost all done by hand which takes up a lot of time.

Now we have done an Alpha where we developed:

• • A prototype for an app that people could use to receive and manage their booking.

• • Automation options for referrals into the screening program

• • Future options for improvements

We have recently completed a discovery around our web estate. It highlighted that we have a very spread out set of websites that aren’t really linked by design or by address. People said that it was not easy to understand which sites were part of Public Health Wales or what they were for.

We will modernise our web presence in stages, rationalising our estate and making sure that it is easy to see we are a part of the NHS, a brand that people can recognise and trust. We will write for the web and publish with the accessibility standards in mind. That means we can use .pdfs if something is going to print, but the official version should be in HTML5, so that it can be accessed on any screen and by screen readers.

We will build our web presence around the journeys that users need to take, rather than around the part of the organisation that creates the content. We’ll monitor the impact of our advice and publications and use what we learn to make our future writing even more useful.

We’ll keep up with the changes in social media, understanding where people like to go to get their information and their entertainment. We’ll monitor sources of misinformation and work with people and providers to be a clear beacon of honest advice and support.

Agile Development

Agile development typically goes through several stages:

Discovery – find out from users what they need from a service. See what is hard to do and what could be improved or created to meet the biggest needs. What is the smallest service that can meet the needs of users?

Alpha – test the bits that will be the hardest to make. This bit often has failures in it but learning from those failures often shows the best way to build something.

Beta – take what was learnt in the alpha to build the smallest working service, called the minimum viable product. Test it with lots of people and make sure it works well.

Continuous deployment – even while going live with the minimum viable product, testing is already going on to add or improve things. With a live service we can keep on developing until we meet all our user needs

In order to make meaningful changes that focus on what people need, we will develop our capability in modern delivery approaches like Agile, Lean Six Sigma and User-Centred Design. Rapid cycles of development and delivering things that were “good enough” that could be improved once they were already live worked well for us during COVID. This approach was designed for software development but can be used more widely and is about getting working products on the ground rather than waiting for perfection.

We will promote and champion Agile ways of working throughout the organisation, using our professional families and connecting with the portfolio management group and Improvement group to share and develop skills. Pragmatic delivery is useful in data analysis too, where finding the most useful data and sharing it when it is most useful can be more effective than waiting until the data are perfect but the usefulness has been reduced.

We will review the outcomes of the three discovery projects, two alphas and a review that we delivered in early 2023 across Public Health Wales. We’ll work to support the organisation prioritise what’s next. Depending on what is decided, we’ll work on and support any further discoveries, alphas, betas and deployments.

By being open and collaborative while we iterate, we hope to encourage engagement from all kinds of users, and get honest feedback from people who haven’t worked like this before. We can then make changes and work through any issues from an early stage. We believe the result will be a better user experience and provide us with better knowledge for future projects.

Our development teams will focus on the work that has been prioritised with service managers, service owners and the user-centred design team. That means that our backlog/programme of work will always be aligned to the biggest priorities of our users. We’ll keep testing new changes, and clearly document our work so that others can help if we need more resource.

Regardless of its shape, a Lego brick can connect to other Lego bricks because they all have a standard connection. We want our services to be able to connect with other services so that users can have a seamless journey. There are plenty of ways to connect components with computer code, but that can be a bit like glue, so it’s hard to separate the pieces when one gets old or broken.

Application Programming Interfaces (APIs) are small components that we can use to connect systems together more like Lego. They define how components talk to each other and set the terms for data to move between systems. That means when we want to swap out one piece for another, we should be able to do it faster and more effectively. We’ll try to ensure that we have clean, public APIs when we create systems, and that when we buy services they have APIs that we can use so that we aren’t locked in with glue.

Where appropriate our APIs will follow the FHIR (Fast Healthcare Interoperability Resources) standard, which is a global standard for exchanging health care data. These standards will be key for the likes of electronic health records, ensuring the right people have access the right information at the right time, whilst keeping the information safe.

There are so many new opportunities for Public Health Wales to engage with. We will work with health boards to understand what better services could look like and link more of our data to improve people’s experiences.

We will be bringing our pathogen genomics group into a new site alongside the human genomics programme. There are opportunities to study diseases for markers that might show if some people would be more susceptible or need different treatment from the usual.

We need to understand the opportunities for keeping people healthy at home. There is wearable technology, which leads to the possibility for remote monitoring and a true hybrid or digital ward. For instance, people who are at higher risk but otherwise fit could be living at home, but with ward monitoring and be admitted if the readings indicated danger.

As mobile technology gets more efficient there may be opportunities such as using mobile phones to take eye screening pictures from our own homes. Electronic prescriptions could offer to set reminders if it is hard to remember which medicine to take and when. That sort of reminder could be integrated into the NHS App, which might also hold the prescription itself. Health and wellbeing information that can be shared on a trusted application is more likely to be trustworthy and less likely to be a scam than information found on the internet.

It is likely that AI will become more and more important to public health. It could drive real changes in diagnosis and treatment, health promotion and prevention, and in operational efficiency. It could help to look after people in their homes, and help people live healthier lifestyles that keep them out of hospital. We need to make sure that we are making the most of the opportunity AI brings.

But there are also risks. However AI is used, whether it is to help identify risks, or through developing personal assistants to help with health care, or to support diagnosis, it must be safe, and it must be fair. We will work with our colleagues across the NHS, in Welsh Government, and more widely, to make sure any AI adopted meets agreed standards of fairness and safety and benefits the people of Wales.

AI technology is a long way off being able to replace humans. It still, legally, ethically, and technically, requires human oversight. Even so, it has an important role to play in health and care, alongside human skills and expertise. We have recently applied to develop an AI Commission with a view to supporting activity in this area in Wales.

It isn’t enough to provide the right information at the right time, we need to explain it clearly, and help to take action based on the insights we get from analysing information. The story told by clear information should guide us to making the right next steps.

Through excellent data and analysis, we will inform timely decision-making, influence Government priorities, and enable the people of Wales to take positive action on their own health and well-being.

By building on our solid foundations, we will be able to harness innovative, data-driven technology for better public health such as wearables, remote monitoring, mobile screening, and technology that can support healthy behaviour changes.

To measure this influence we will track our impact, examining how our data is being used by us and others to make a difference to people health and wellbeing. We will also measure the efficiency of our data and systems by assessing the value it gives to its users.