We recently invited Rachel Murphy, CEO at Difrent to join us for Transitions 2.0.

Thank you very much. I’m Rachel Murphy, CEO at Difrent and we’re a sister company to FutureGov. I'm going to talk today about a programme of work that I lead for the NHS around engaging leaders and citizens for better health outcomes.

Transforming how people consume healthcare

When I landed at the NHS, the gig was really about reducing footfall into accidents and emergencies (A&E). We needed to look at introducing omnichannel in a way of driving those services a different way, and for obvious reasons. We needed to reduce the spending on people physically walking into an A&E. But we also needed to increase the speed that we can actually service that demand.

It's not easy trying to get a handle on baseline data within the NHS. But we really needed to understand how many people have actually shown up for those meetings, whether they should have come into A&E or should they have engaged the system earlier and differently via a pharmacy, GP or 111 etc.

The NHS is one of the largest employers in the world, there's over a million staff who are employed in the UK. I made the mistake when I first landed at the NHS of assuming it was one large organisation, and the reality is, it's thousands of little organisations. And whilst the challenges are unique in the NHS, they're not unmanageable. It's just about understanding that the scale is mind-blowing in the NHS.

My remit was about empowering users and actually transforming how people consume healthcare services. But it was also about making patient’s accountable and responsible. When I first came in, there were 10 different programme boards that were running this big portfolio of work and there was no clear vision and there was not necessarily buy-in across the system.

So the first thing we did was actually create a visual proposition. And that's tricky when you're building digital services. Because if you show something, people assume five minutes later, the new service is going to look like that. So we had to do a balancing act of talking about the value proposition and the visual proposition. But reinforcing the fact it wasn't going to appear on screen like that in five minutes. So we did a huge piece around engagement.

Building live transactional services

But I'm getting ahead of myself a little here. NHS choices was the big health repository. And there were 25 million visits per month of patients and citizens looking at this data. And from a technology standpoint, it was very cumbersome. It was held on legacy technology, there were 22 suppliers in the mix holding this service together. And there was a further 120 staff supporting the service. And I don't know about the audience, but the majority of people that we spoke to at that stage, if they had young kids, they chose NHS choices. But that was predominantly it.

So the surface was built 10 years before it wasn't user-centred. It was just a massive content repository. So a lot of the content was written at a degree level from a reading age, which made it particularly difficult to consume. And information architecture was more of a bolt-on. So when we started unpicking this we had a massive piece of work to do to overhaul the content, but also build out the front door to the NHS. So that's what we were really creating with nhs.uk.

We wanted to not just transform the content but wanted to build live transactional services. Services like the ability to not just search on a website for the closest GP, but to actually go a step further and register with that GP, and be able to access your medical record and to enable the ability to book appointments.


We had a health minister at that time, who was very keen on wanting to build out an app, but we knew that this was much more of a platform. We knew that web services would be a much smarter move. So we opted for an open-source content management system (CMS), and one that we knew could handle live transactional services with a very heavy load of users. So we selected Wagtail, which has now been selected as an open-source CMS for lots of organisations, most recently for Instagram.

Creating real value for citizens

Over an 18 month period, we really transformed the content and we did it bit by bit. We did extensive user research and then we moved through the alpha and beta stages. We took feedback and we iterated the service. And the reality is that NHS choices was a national asset. So we had to be really careful about maintaining the traffic. So as we were switching off services and turning on NHS.uk, we had to be very careful about that.

Within four weeks of nhs.uk launching, we had 50 million people accessing that service within a month. That's when we really started to develop out the services, like accessing records. And these services became the precursor to the NHS app. These are huge services in their own right. And in way of the team, 600 people were working on this programme of work with daily code releases, and a huge marketing effort to make sure that we transferred from one brand to another.

As more and more services were launched, we really started to take the heat out of the system. So by reducing footfall into A&E, which is super expensive, and driving people through digital services, we were saving 10s of pounds per interaction. And I'm very proud to see how their service has continued to evolve. And in the last 12 months, has developed additional services like the NHS login, the NHS apps library, but also a platform that allows third parties to build services for the NHS. It's very much been the foundation for how the NHS has responded to the pandemic in the last 12 months.

In summary, I've talked a lot about how we engage stakeholders and the system of the NHS. Whilst this was relatively straightforward because we had a strong buy-in and this was a cost-saving exercise within the system. You can't underestimate the one receptionist at a GP surgery who is very wedded to her NHS choices leaflet.

From a citizen perspective, once you start creating value for users, you’re halfway there. When we could demonstrate for users that by using these services, they could access their medical record, book appointments and get repeat prescriptions that value creation came with heavy buy-in. Thank you very much.

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