Blues and greens

We’ve spent time together as a blended team over the last couple of weeks, shaping what good looks like for where we’re landing in August, and therefore what outputs and outcomes we need to get us there. It’s key with work as complex as this — where we could easily get lost in the detail — to keep a strategic outlook towards the type of questions we want to answer for and with the digital urgent and emergency care system, and how that affects what we do as we discover, design and prioritise our roadmap going forward that delivers on the long term plan.

In Matt Edgar’s recent blog, he most excellently reflects on the relationship between the vision of the long term plan and the role of design. This absolutely chimes with how we believe this strategic service design programme adds value to the NHS Long Term Plan’s vision for digital-first urgent and emergency care.

“Chapter 1 of the NHS Long Term Plan… began: ‘Compared with many other countries, our health service is already well designed.’ The truth is that most of this service was never consciously designed at all. It emerged through countless policy decisions and reorganisations… Every time we make another tweak, we risk making matters worse — unless we step back and consider the system as a whole. The aspirations of the Long Term Plan are sound: more joined-up and coordinated care, more proactive services, and more differentiated support to individuals. And they’re crying out for service design approaches.”

The image below summarises the outputs and answers we’re working towards on this programme to both help us understand the current state, and to design the future state in line with the ambitions of the Long Term Plan

The questions our as-is outputs will answer
The questions our future-facing outputs will answer

Prioritising emerging opportunities with the steering group

We had a very productive extended session with our steering group this week, to explore and prioritise emerging opportunities across multiple perspectives. The opportunities are informed by (East London and some of Somerset for now) evidence gathered from patients, staff, commissioners, leaders and suppliers about their needs, pain points, and success stories in receiving or delivering urgent and emergency care. Our first step for prioritisation was grouping opportunities into:

  • What we need to continue doing: we know this already and are doing something about it at pace and scale and it’s working well so let’s continue with BAU
  • What we need to work harder on: we know this but may not be doing enough at pace and scale to address the issue
  • What we need to start doing: we need to start seriously thinking about this and assessing the potential/risk of doing something/nothing
Emerging opportunities steering group notes
Emerging opportunities steering group diagram

Our second step was to prioritise opportunities according to the level of complexity vs. where digital can deliver the most impact. So we spent some time talking about what we mean by ‘impact’ and what we mean by ‘digital’ so we are clear on what we’re anchoring decision-making against. Below is our first stab at defining these terms however there is some work to be done to get the order of priority in our ‘impact’ strawman right.

Defining impact
Defining digital

Wrapping up fieldwork!

It’s been a crazy nine weeks of fieldwork. We wrapped up Somerset last week, and aim to round off South Yorkshire and Bassetlaw this week — although we’ll be back for co-design and testing in June and July. In Somerset we did some more reflective interviews with patients, spoke to the psychiatric liaison team in Musgrove hospital in Taunton and their mental health support, and visited Millbrook surgery which is pioneering a fascinating approach to appointments and scheduling giving patients and GPs more autonomy over the care they receive and give. In South Yorkshire and Bassetlaw, we interviewed commissioners and visited the Inclusion Health Centre, pharmacies, the Emergency Department at Doncaster Royal Infirmary and Yorkshire Ambulance Service (YAS). Rebecca shares below stories from our YAS visits.

Doncaster Market

Yorkshire Ambulance Service Headquarters (YAS HQ) in Wakefield

  • We were given a very useful overview of how the service works and was able to meet some of the staff that work behind the scenes in 111. This included (but was not limited to) health advisers, clinicians and governance. We split off into teams to cover a lot of bases, we were very fortunate that we had exposure to a great number of 111 staff.
  • In the afternoon, we were offered the chance to observe call takers and listen to 999 calls in the emergency operations centre. This shadowing highlighted the huge volume of calls and requests that proves a challenge for the service.
  • One of the leaders we spoke to that day aptly said that “YAS is the glue that sticks everything together”. This was clear from our visit and we’d like to say a huge thank you to all of the staff that organised this and accommodated us at YAS that day.

Doncaster Ambulance Station

  • We also visited Doncaster Ambulance Station later in the week to speak to some paramedics before and after their shifts. They were very engaged with us, and it was valuable to discuss their roles in more detail. We were able to understand their frustrations as vital front-line members of staff and found that access to certain information would make a difference to their service delivery. We also spoke to their area manager, who informed us that the key thing for them is ensuring that their paramedics remain happy in their roles.

What we’re doing next week

Next week is all about analysis and synthesis! We’re spending four days as a team together locked in a room going through all the data we’ve generated over the last few weeks, and what it means to understand current challenges and opportunities for people in urgent and emergency care, and where digital can have the most impact!

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