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I write science fiction, and science fiction isn’t about the future. I don’t know any more about the future than you do, and very likely less. — Ursula K. Le Guin, introduction to The Left Hand of Darkness , 1976 A few weeks ago, somewhere in the midst of explaining why a thing annoyed me so much, I started to understand a gap in how we work, and by “we” I mean NHS England or possibly just “The…
It surprises me sometimes that few teams propose big, radical ideas that would completely reshape the NHS App. For the most part, people ask if they can add their thing to ours. A simple addition; one more appendage. That leads to the most common debate around here: “Where should we place a link to this new thing?” The framing of the question is a problem. Maybe the problem. The question sounds…
The size of it all carries us along More equals better, it’s what we want — “A New Kind of Water”, This Heat, 1981 Amazing how heat distends both matter and time. The whole week has been a fever dream. Apparently we had quarterly planning. That feels wrong. I had to re-look at my calendar to make sure I wasn’t hallucinating. Alas, yes, it was four days ago. I discovered that carbon steel – what…
We’ve been working on ways to improve the interface of the NHS App. Most of this has involved realigning design fundamentals to better match platform conventions. I’ve written about this before , so I won’t repeat myself here. But there is one other idea that we’ve been exploring that sits outside of that category: should we ditch the “ tab bar ” (or “ navigation bar ” on Android), and simply…
For most of this calendar year, I’ve been focussing my energy on the native re-platforming work. There is still quite a lot to do in that space, but this past week felt like a return to a mode of operating that I haven’t engaged in quite as much lately. Specifically: trying to steer a variety of projects that exist on the fringes of the App, work that will end up there but which is not happening…
We’ve spent a long time working toward a situation in which all of the designers in the NHS App team prototype in code. Today, when it comes to interaction designers, we’re there – and we rejoice. Working this way means our prototypes perform better in research and are more accessible. Designers get a clearer sense of how the features and services they’re designing really behave. We build a…
This is the second of two notes on the particular way of knowing things that design represents. The first part is here. When you are working at the scale of an object or an interface, design methods feel clear. Constraints, requirements, tools, and materials are easy enough to understand and work with because they can all be laid out in front of you. For the most part, you can manipulate them…
In grad school, we used to talk about “thinking through making”, by which we meant that design ideas couldn’t be fully developed before you started making something. The act of designing was itself a way to think, a way to create knowledge, which would be embodied by the thing you had made. Ideas were discussed as seeds of an investigation to come, but weren’t treated with any degree of…
My friend Mo is big on theory. Design theory, product management theory, organisational theory – you name it. He loves a framework that helps explain a working situation. He introduced me to Lean UX sometime around 2015, then to the theory of constraints , and onward to a handful of others I’ve half-forgotten. One concept he told me about – probably over a mixed grill somewhere on the Kingsland…
We’ve just had quarterly planning again. It is a big event that involves bringing all of the App teams together for two days. Lots of presentations, lots of discussions, a fair amount of negotiation. During these events, my normal role has always been to float around between teams as a roving advisor. For the last two editions, my energy has been focused on working with our native transformation…
Work on our native re-platforming continues. The work is still moderately experimental but we’re inching closer to a plan for what the first release will be. It is likely that the first user-facing release will be quiet chunky, but I’ve been resisting calling this an “MVP”. In general, I dislike the term for its over-used vagueness. I have yet to find two groups of people who use the term in…
I’ve spent a lot of time over the past few weeks translating. Translating ideas between groups of stakeholders. Translating intentions and concerns between people who need to work together. Translating artefacts from one platform to another. I sometimes feel like an osmotic membrane or a post-processing engine, perpetually stuck in the middle. I don’t dislike it, mind you, but it does leave me…
One of the designers in the team has been on holiday for the past two weeks so I’ve stepped in to cover. This meant getting to grips with designing and prototyping for Android. This has been, shall we say, a learning experience. Figuring out how to use Android’s programming language and interface framework (Kotlin and Jetpack Compose, respectively) is one thing – they aren’t so different to their…
Out of all of the government design principles, “make things open: it makes things better” is probably tied for memorability with “do the hard work to make it simple” . It sounds bright and modern, almost the opposite of how most people perceive government behaviour. Today, an appeal to make things open is so common that it sometimes feels like a stock phrase that people tack on just because it is…
This week, I do not have the strength to elaborate on the various things that have gone on at work because my headspace has been completely overwhelmed by the murder of an ICU nurse by border patrol officers in Minneapolis (300 miles from the actual US border). I am worried about family members who live across the river in St Paul, Minnesota. The US, the country I grew up in and for which I still…
While the team are making plans for what to design or research or build next, I’ve been hitting the road like some sort of wandering bard, telling the story of the work thus far. This past week I presented an update about our native re-platforming work to a handful of different groups. Some of these groups need to be kept up to date and some are just curious because the project is strange. Telling…
We’re currently wrapping up our alpha looking at how to use native code to improve the design of the NHS App and this past week we put the the work through our internal design assurance process – imagine something like the mid-point between a standard design crit and an alpha service assessment , and we always include a clinician as part of the conversation. (There is more to say about this…
When asked what my job is, I usually say something like, “My job is to make it possible for everyone else to do a good job.” That breaks down into spending a lot of time out ahead of teams, lining up new work and then acting as a sounding board, coach, and critic for designers once the work has started. This maps nicely onto the Venn diagram of “solve the right problem / solve the problem right,”…
We’re getting toward the end of our alpha looking into how we might approach redesigning the NHS App in native code. We’ve tested lots of ideas, discarded plenty, and are now trying to tidy things up ahead of planning for the next phase of work. It is an odd piece of work because we’re trying to set out a vision for how to improve the design of the App but we still have to deal with most of the…
Last week, the Health Services Journal (HSJ) podcast featured an episode about how patients were receiving cancer diagnoses via the NHS App before a doctor had a chance to have a conversation with them: Cancer Research UK told me their helpline nurses are increasingly getting calls from people who are seeing something in their App, don’t understand what it means, and calling them up to interpret…
Most designers don’t spend much time thinking about how their app might kill someone. The vast majority of designers out there work on projects that aim to attract more users or generate revenue. If they’re lucky, they might get a chance to make people’s lives a little better, too. My daily life at my job is very different. Working on the NHS App, we are constantly confronted with all of the ways…
Public sector digital services in the UK have a specific set of design patterns that were originally developed by GDS for gov.uk . When gov.uk was initially being created, there wasn’t a standard way that government digital services worked across the world. To a large degree, GDS had to define how public sector digital services should be designed from scratch. Over the last 14 years, teams across…
Defining what “good” means when it comes to user experience design is difficult. In NHS England, all our work is measured against the NHS service standard and we use the NHS design principles to help make decisions about how to align our work with our values. While both documents are useful, I’ve observed teams struggling with a lack of clarity about how to put them into practice. It doesn’t help…
We’re now fully into the “let’s make some stuff” phase of our exploration of how to make better use of native code . Before the work started, my ambition was to spend about half my time on this with the team for the last quarter of 2025. So far, so good, but retaining enough brain space to keep on top of everything else I’m meant to be doing is a challenge. Much to my chagrin, the rest of the…
Being a manager or leader or whatever – being a person who works across multiple teams and attempts to help them all do something good together – I occasionally get asked to participate in forums outside of my own team. This is quite fun. It is also entirely logical: if this place is going to function, information needs to flow across a vast set of semi-independent fiefdoms. The bridges necessary…
In Japan, you encounter a lot of restaurants and shops that do just one thing. Often they do that thing really well. Tonkatsu , onigiri , shaved ice , you name it. I sought out quite a few of these places while travelling around Tokyo recently and two weeks ago I ate this bowl of soba noodles: Everyone I could see in the restaurant was eating the same thing because it is the thing the restaurant…
Right now, the NHS App is mostly a website. For what feels like forever, I’ve been advocating for us to take a hard look at our approach to technology because of how much of an effect it has on our approach to design. This autumn, we’re going to make some prototypes to probe the various options for how far we can push our use of native code, which exist on a spectrum ranging from do nothing to…
When people in the NHS discuss strategy, tactics, and how hard it is to change the current direction of travel, you often here phrases such as “its like trying to turn an oil tanker”, but that analogy has never sat particularly well with me. Earlier this week, Steve Messer wrote a thing that gets so much closer to what reality feels like. It is hard to reference his post without quoting nearly the…
I’m working on plans for a new round of work that will explore our general approach to designing the NHS App, our design system, and how we make use of native technology. If I’m lucky, this is going to be a major part of what I spend my time on for the rest of the year. Writing about this in public sets off a certain amount of trepidation because I don’t want to jinx anything. I’m not a…
A small but important piece of discovery work that is investigating how new approaches to technology might affect the way we design is wrapping up and I’m trying to get ahead of whatever comes next. This week I was able to spend time with Sarah and Ben writing a few versions of a project brief for the next phase of work, each of which describes what we might do and how we might do it in slightly…
Earlier this week Frankie and I published a post on the NHS’ Design Matters blog about prototyping in code and the work we’re doing to improve the NHS prototype kit . The post is part of an initiative across NHS England to re-centre our working practices on common foundations using open, accessible technologies. It is an approach that has been popular across the public sector in the UK for a long…
I was on holiday when the NHS 10 Year Plan came out, which meant that I got to avoid the initial frenzy of activity that was inevitably going to surround a big new government plan. After getting back I had set aside a few blocks of time to read and re-read the document in an attempt to start working out my own understanding of what it entails. The thing about the NHS 10 Year Plan is that, as…
This past week we had the latest instalment of quarterly planning for NHS England’s Products and Platforms (the sub-directorate that the App team live in). These kind of cross-portfolio events can be tough – there is so much material to get through and so many details to try to keep in your head – but I found this particular instance of the event to be interesting, productive, and even kind of…
I know that a lot of people hate personal development plans. The process can feel artificial, forced, like a distraction. When there is always so much “real” work to do, having to periodically review some arbitrary goals you set nine months ago is no one’s priority. When modern admin systems (e.g. Jira) already involve so much pro forma data entry, filling out yet another document that no one is…
Suffice to say that things in the US have been chaotic over the last six months. One result of said chaos was the dissolution of 18F and the takeover of the US digital service , both at the hands of DOGE. (Technically the US digital service was renamed the US DOGE service, but that is just too moronic to lend any credibility to.) As an american, this act of national self-harm has made me…
I’ve been covering for one of our design managers [1] who has been out of work for a little while. It adds to my workload, but it also lets me get closer to the day-to-day activity happening within several teams. Suddenly I find myself digging into project planning and research analysis and (heaven forfend!) actually designing stuff. This is extra work and thus it puts a strain on the operations…
In a system as complicated as the NHS, pretty much all work is collaborative. Getting seemingly simple things done usually means that at least three or four teams are required. In a way, this is really nice: to move forward, we all need to rely on each other. A shared sense of purpose develops. It’s also really frustrating: to move forward, we need to agree on a unified approach, but the system is…
I’ve just finished The Spirit Catches You and You Fall Down by Anne Fadiman (see: last week ). I’d definitely recommend it if you’re interested in how culture frames our understanding of health or the relationship between migration and identity. Perhaps not coincidentally, it also touches on many ideas that are relevant to my work and design in general. (A little context: the book is about a Hmong…
I’ve just started listening to the audiobook of The Spirit Catches You and You Fall Down by Anne Fadiman. The book is about epilepsy and different cultural understandings of sickness, but there is a passage in the preface that pulled me up short because of how well it weaves together a few concepts I think about all the time. I stopped walking down the street to transcribe the following: I’ve…
When I was hired by NHS Digital in 2022, my title was “lead designer”. During the merger of NHS Digital into NHS England my official title changed to “lead service designer”. So far as I can tell, this was a simple administrative matter. “Lead designer” doesn’t exist in the list of possible jobs and someone (I have no idea who) chose between the available options, which were “lead interaction…
My first day back from a long holiday was spent in a full-day workshop. This was for a big project that is bringing several teams together to test a set of hypotheses that I had formulated. In this instance, I’ve acted as the commissioning agent who developed both the problem statement and a proposal for how to solve it. This isn’t the normal way we work. We talk a lot about giving teams problems…
This was a whirlwind of a week, I’m about to be on holiday for a while, and I am definitely running low on energy. So instead of trying to think new thoughts right now, here is an annotated list of some recent readings. Books Empire of pain: The secret history of the Sackler dynasty , by Patrick Radden Keefe. A devastating study of incentives (read: money) and how they can blind people to the…
It finally feels like spring. The weather is changing and the NHS is in a transitional phase (to put it mildly). Somewhere, the 10 Year Plan is being developed with the goal of setting the direction for the organisation for the next decade. There are a number of possible futures that could come out of this, each shaping what I will or will not be able to do. Ahead of any bold new plans being…
This week felt like a return to normal service. People are still talking about the impending merger of NHS England into the Department for Health and Social Care, but there were no major events and teams were largely just getting on with their work. Outside of my workplace, plenty of articles are still being published about the merger, with various pundits chipping in with their take on what the…
This was a week of two halves. Monday and Tuesday were spent in an office with 60 or so people doing quarterly planning for the NHS App. It is a strange activity because while the nominal goal is to plan what the 12 NHS App teams are going to try to accomplish over the next three months, the NHS App is not a self-contained entity. For better or worse, it is the nexus of organisation’s wider plans.…
I’m currently reading Secondhand Time: The Last of the Soviets by Svetlana Alexievich. The book is an oral history that creates a tableau of what happened when the Soviet Union collapsed and what that felt like. The theme of the book that I’m most interested in is the tension between a grand idea and the reality of its implementation. How do you square your ideals, which you still think are the…
When asked what my job is, I typically say that my main responsibility is making it possible for the team to do good work. Management, coaching, operations, and funding are all obvious elements of that. Strategic design work that sets up future projects is essential. Working with other teams to develop relationships and keep track of where the organisation is going is another big part. One thing…
This week started, or really last week ended, with a short trip to Paris to see Ingrid Caven (who is 87!) perform with Albert Serra’s band, Les Molforts . The show was literally (actually literally, not figuratively) jaw dropping and the crowd was nearly as fascinating. One week later and I’m still trying to process what we saw. In work land, the theme of the week was strategy and planning (NB:…
The likelihood of me doing this every week is effectively zero, but this was an interesting week so hey why not. This week was half term in the UK so it was very quiet at work, which in turn meant I got to a spend a lot of time thinking. In my current context, this is rare! Knowing that this is rare does not feel very good, but having time to get closer to a number of process and project things…
I’ve been thinking about re-doing this site for a long while. I have also not done anything about that for a long while. So, here’s an attempt to stop procrastinating. I’ve removed the entirety of the last incarnation of this site. I’ll probably add some of the content from the last version back here at some point. I could say that this site is a prototype that I’ve made so that I can learn by…