From: DHSCAssessment date: 27/09/2023 Reassessment date: 01/02/2024Stage: Beta reassessmentResult: Met at reassessment Service provider: NHSBSA
Service descriptionThe Request a Baby Loss Certificate service was born out of the Pregnancy Loss Review. Currently, there is no formal recognition of baby losses prior to 24 weeks gestation, leaving some bereaved parents struggling to find closure. DHSC commissioned NHSBSA to create the service to fill this gap. It is an online application form which, upon successful completion, results in a physical certificate of loss. The aim is to provide recognition of a life lost and to provide comfort to bereaved parents. It is an optional service, and it is not a legal document.
Service users Our users are:Anyone who has a parental relationship to a baby which was lost before 24 weeks of pregnancy who lives in England, their baby loss was in England, and the baby loss happened in the last 5 years.
High level user needs this service aims to meet.
As a user, I need a certificate to commemorate my baby's life after they have passed As a user, I need to do this using a service which is easy to find, access and complete As a user, I need to know where to find answers to my questions about my certificate As a user, I need the option of adding the details that are important to me on the certificate As a user, I need to know what to do if there are any problems or difficulties I experience when completing my application As a user, I need to be able to complete this form without causing myself or others additional distress Report contents Understand users and their needs Solve a whole problem for users Provide a joined-up experience across all channels Make the service simple to use Make sure everyone can use the service Have a multidisciplinary team Use agile ways of working Iterate and improve frequently Create a secure service which protects users’ privacy Define what success looks like and publish performance data Choose the right tools and technology Make new source code open Use and contribute to open standards, common components and patterns Operate a reliable service 1. Understand users and their needs DecisionThe service did not meet point 1 of the Standard.
What the team has done wellThe panel was impressed that:
despite constraints, the user researcher has worked impressively and creatively to understand users and their needs, including working with charities, and engaging in training in this domain there has been an understanding of where the gaps are in research there has been a consideration of accessibility and assisted digital there has been an acknowledgement of lack of engagement with fathers and plans are in flight to remedy this What the team needs to exploreBefore their next assessment, the team needs to:
conduct more research with more users - especially those with accessibility needs, neurodiversity, assisted digital needs and English as an additional language refine the proto personas and ensure they are ‘living’ artefacts that the team knows how to access and can use in their work, now that they have started learning more about their users look at more varied and inclusive means to recruit users to participate in user research. There seems to be a reliance on digital surveys for recruitment, this can itself introduce bias especially when looking to recruit users with assisted digital needs or low digital literacy continue to learn from feedback surveys as volume of users increases and use what is reported as a basis for hypotheses to test in further research be given time to further explore the experience of healthcare professionals and other relevant user groups that have not been fully researched yet further research into the experience of multiple certificates and multiple losses further research into the second parent experience and validation Reassessment: DecisionThe service met point 1 of the Standard.
What the team has done wellThe panel was impressed that:
resource has been made available to support better understanding of users and their needs including recruiting a research operations executive and additional user research resource. The panel felt it was particularly impressive to see continuity of principal user research on this project more research has been conducted with users with accessibility needs, neurodiversity, assisted digital needs and English as an additional language research has been conducted to understand the second parent experience and the second parent journey the proto personas are ‘living’ artefacts that the team knows how to access and use in their work methods of participant recruitment have become more varied there has been work done towards understanding the experience of healthcare professionals, internal users and second parents and other relevant user groups that had not been researched with previously work has begun on understanding the complexity of multiple losses and its impact on user needs What the team needs to exploreBefore their next assessment, the team needs to:
work with the performance analyst to establish all the touchpoints you can measure and learn from. Collaborate to triangulate qualitative and quantitative findings that can guide the programme of user research and iterative improvement of the service continue to collaborate with the content designer and design team on the flow for a second parent to ensure it is as supportive as it can be and conduct user research to validate this continue to collaborate with the content designer on the design and ordering of charities or support for users at the end of service or kick out pages and conduct user research to validate this look at unintended consequences of this service and ways to empower users. For example, giving second parents autonomy to block repeated requests conduct user research into multiple losses including vocabulary around this, and how to handle the variety of different ways people experience multiple losses continue to investigate via user research how to make the service as frictionless and intuitive as possible for example:-how the importance of accurate GP records for this service to work might be made clearer -restarting the whole service if you would like a second copy of a certificate -the second parent flow between ‘these details are not correct’ on the check answers page to you ‘are you sure you would like us to cancel this certificate’ 2. Solve a whole problem for users DecisionThe service did not meet point 2 of the Standard.
What the team has done wellThe panel was impressed that:
there has been a consideration of offline and assisted digital routes the ‘kick out’ screens have been tested and designed to be as sensitive and helpful as possible the team has conducted user research with customer call centre staff the service allows flexibility and to provide information in the context of how users think. For example, the location can be an address, a hospital or a city. It allows people to have information based upon their personal circumstances, for example, baby name the service does not prevent the parent from resubmitting the form if they find that they want to change the certificate or if they made an error What the team needs to exploreBefore their next assessment, the team needs to:
test unhappy paths with users to ensure the best experience for them consider how they might address the issues with running a digital service through a human dialogue for the call centre or offline help and look at potential alternatives to improve this, for example a script for CC staff consider whether the need for an NHS number for the first parent is proportionate to the tick on behalf of the second parent and if it potentially puts the second parent at risk ensure that the journey for the second parent is both secure and fair for the second parent but also does not prevent the submitting parent from completing the task Reassessment: DecisionThe service met point 2 of the Standard.
What the team has done wellThe panel was impressed that:
there has been research into the unhappy paths and recovery from errors research with call handlers and operators and other internal users has been carried out to understand how best to support them. This includes an option for operators to not handle baby loss calls if this affects them, and how best to manage assisted digital users and others who need additional support via this service the contact centre staff have been highly motivated in workshopping and co-creating the call scripts with the service team, the work includes a framework, and ensures users understand that questions will be read out as though they were reading them, and finally the staff have received sensitivity training more research and iteration hasbeen carried out into the second parent journey to ensure a proportional use of verification of both parents. In doing so, the team have addressed previous concerns about use of NHS number and have offered another means of determining eligibility the team has taken an already well-signposted service and solid collaboration with adjacent services, such as register a stillbirth, and have continued to improve signposting to other services and charities to support parents who have experienced loss What the team needs to exploreBefore their next assessment, the team needs to:
conduct more research into the whole journey with a second parent with the second parent in a different space. From what was shared it has mostly been co-located user research continue to learn about the second parent journey, including how best to support second parents who do not have email or access to digital. There is currently not an option for the first parent to move they journey offline consider changes to content and consents that will allow the second parent to request a copy of the same certificate without restarting the journey and thus obtaining consents for the first parent consider changes to content and consents that will allow the first parent to automatically receive a certificate with just their name on it in the event the second parent does not respond and a certificate with both parents' names cannot be issued consider bringing user research collaboration into the design log to more closely integrate insights about users with design changes consider offering a preview of the certificate to parents. Even if not a customised preview, allowing them to see what the template looks like will inform their decision on leaving fields blank address any remaining recommendations from the content audit 3. Provide a joined-up experience across all channels DecisionThe service met point 3 of the Standard.
What the team has done wellThe panel was impressed that:
there is a solid end-to-end understanding of the journey and experience across all channels which the team has tested user research was carried out with call centre staff, and they have allowed staff who would feel uncomfortable with this service to opt of receiving calls the team has fed in improvements to the physical certificate and were planning to test and introduce further iterations to it if necessary there has been considerations and engagement with charities that support parents in the process to ensure a joined-up experience and better signposting the team has worked with other government departments and adjacent services to ensure signposting on gov.uk What the team needs to exploreBefore their next assessment, the team needs to:
continue to research signposting and entry points to the service particularly in regards to health care providers doing so do more research to understand what people might search for to find the service iterate the service so the assisted digital journey and the call centre staff user interface (UI) are more customised to this user group’s needs 4. Make the service simple to use DecisionThe service met point 4 of the Standard.
What the team has done wellThe panel was impressed that:
the team has a content designer, and they have also ensured they undertook a content audit the team has tested the service across multiple devices there has been a clear feedback loop from research to updates of the service the team has a clear roadmap of who they should be researching with and is working hard to close gaps there is both an up-to-date accessibility and privacy statement What the team needs to exploreBefore their next assessment, the team needs to:
continue to explore how the users perceive the empty boxes and if any further content guidance is needed to understand what the certificate will look like 5. Make sure everyone can use the service DecisionThe service did not meet point 5 of the Standard.
What the team has done wellThe panel was impressed that:
the team has attempted to test with users with accessibility and assisted digital access needs and have conducted an accessibility audit the offline and assisted digital provision for the service is in place and has been tested the NHS Business Service Authority (BSA) provides a suite of automated and manual devices which the team has utilised What the team needs to exploreBefore their next assessment, the team needs to:
ensure the recommendations from the accessibility audit are actioned prioritise research with users with accessibility needs and consider engaging a specialist recruitment agency if needed to ensure adequate recruitment continue to research how parents of multiples wish to use the service in the context not of separate certificates but separate journeys to enter the information Reassessment: DecisionThe service met point 5 of the Standard.
What the team has done wellThe panel was impressed that:
research with users with accessibility needs was prioritised and a specialist recruitment agency brought in to support this the team has completed and actioned three accessibility audits the team has recognised that research was primarily done with the female parent and have endeavoured to include more male parents and non-birthing parents to research What the team needs to exploreBefore their next assessment, the team needs to:
continue to research what parents of multiple losses need from the service consider how best to make clear the half-hour timeout period for the service to users, who are currently not informed, to prevent unexpected timeouts. Conduct research into whether this time is reflective of the time users need to complete this, especially considering the sensitive nature of the service and possible emotional impact consider research into ‘save and come back’ functionality to support users not having to re-enter information consider use of universal barriers framework to surface any barriers to accessing this service and how you might mitigate this consider using an ethics framework to surface any unintended consequences of the service so you can mitigate them 6. Have a multidisciplinary team DecisionThe service met point 6 of the Standard.
What the team has done wellThe panel was impressed that:
there is a well set up multidisciplinary team in place which are all very proud of the work they’ve done the team has remained focused and worked collaboratively despite all the challenging timeframes and changes to stakeholder requirements the team is made up of permanent staff and contractors but have made significant efforts to work as one unit and align to a common vision and ways of working there are solid plans for how the team will evolve in public beta and beyond the team collaborates with professional tech leads and the NHS BSA design authority to improve their technical and design choices What the team needs to exploreBefore their next assessment, the team needs to:
consider how to optimise the flow of work and potentially split into two teams - currently they’re operating as one very big team with individual disciplines having some separate rituals. This big team could result in some bottlenecks, lack of focus and alignment, and sticking to a more traditional ‘two-pizza team’ model could address these problems ensure that the transfer process of the service between the third party supplier and NHS BSA includes a sufficient period of knowledge sharing and preparation of detailed documentation, including on the code, to ensure the product can be supported in the future. All technical roles are currently provided by a third party supplier, which is a significant risk for the service as it gets transferred to the internal NHS BSA team. work in a more sustainable manner. The panel got the impression that the team is delivering against extremely tight timescales and has grown to such size to try and meet these demands. Whilst it is incredible how much the team has delivered in such a short period of time, it’s also unsustainable and could result in problems for both the team health and the quality of the product delivery explore creative ways to be more empowered to define its own scope and roadmap, evidencing even more to senior stakeholders because certain ideas are not practical or in line with user needs 7. Use agile ways of working DecisionThe service met point 7 of the Standard.
What the team has done wellThe panel was impressed that:
the team is well versed in Agile and have an experienced Lead Delivery Manager who supports their working practices the team has solid hybrid working practices, reflect on their work and improve where possible, building these retro actions into their main Jira backlog there is a strong commitment to iterative development and releasing value to users and the business as early as possible the team uses agile ways of working even when there are significant senior stakeholder requirements to deliver milestones that are not necessarily in line with this way of working What the team needs to exploreBefore their next assessment, the team needs to:
address the significant pressures from stakeholders to deliver in a fairly ‘big bang’ manner by a certain deadline, which goes against the principles of sustainable agile delivery ensure that the team that takes over once the service is stable, currently planned for March 2024 will continue to work in agile 8. Iterate and improve frequently DecisionThe service met point 8 of the Standard.
What the team has done wellThe panel was impressed that:
user research and content design collaborated on the language for this sensitive service and that this was tested and iteratively improved the team releases features and improvements at pace, although it didn’t seem they’ve had a chance to retest some of the work they’ve released What the team needs to exploreBefore their next assessment, the team needs to:
ensure that they continue to conduct user research and improve the service in line with recommendations from this report ensure that once the service is in public beta it continues to be iterated on. There is a risk that senior stakeholders perceive the service as ‘done’ once the second parent identity verification solution is delivered, and there is little resourcing available to continuously improve the product ensure that the pace of iteration is more sustainable as listed in point 6, and make sure there is more opportunity to retest end-to-end journeys, unhappy paths, different user groups consider if the technology and design choices they’ve made to get to an MVP as quickly as possible are appropriate for the future - such as looking at the NHS Login or the OneLogin solution instead of the basic identity proofing solution they have now, which might be easier to defraud derive a cost per transaction and monitor how their service improves on that and is value for money. The team hadn’t had a chance to consider this point much, but it will be essential to monitor this to decide if the service is successful and how much it should be iterated on 9. Create a secure service which protects users’ privacy DecisionThe service met point 9 of the Standard.
What the team has done wellThe panel was impressed that:
the team has engaged well with a range of colleagues responsible for different facets of privacy and security, including those considering clinical risks to users, and have completed relevant documentation such as a Data Protection Impact Assessment there is a clear understanding of what analytics data and logs can be gathered, how this can be used and who should have access to what data. This is reflected in a cookie policy and privacy policy the team has carefully considered approaches to balance the risk of multiple spam or nuisance submissions against the needs of genuine users who have faced multiple losses, and plan to implement appropriate controls soon the design of the service has included consideration of what limited data can be exposed to an end user and when, using a two-factor authentication approach through a reliably sourced mobile phone number. Similarly, the risk of certificates being sent maliciously to a user is further mitigated by only sending them to the address held on their NHS patient record a range of different threats have been considered and appropriate mitigations have been put in place, and an internal “IT Health Check” process followed to ensure compliance with internal policies What the team needs to exploreBefore their next assessment, the team needs to:
identify a suitable approach to “2nd parent identity verification”, to protect the potential risks to individuals based upon users fraudulently claiming their consent to being included on the certificate ensure that the risks introduced by future enhancements, such as “save and return” style functionality, are properly explored and mitigated prior to implementation, and the efficacy of any mitigations is tested through a further external penetration test. This is especially significant considering the current approach to authentication determine the usefulness of the data currently being stored in Aurora Postgres. Whilst there is a reason to store this data, which is only held for a fixed time, the risk of holding this data needs to be carefully considered relative to the benefits, as it is currently only used in very limited circumstances understand how potential changes to the authentication approach may risk excluding users who find it difficult to use username and password logins, and the demand this may place on other channels, such as telephony 10. Define what success looks like and publish performance data DecisionThe service did not meet point 10 of the Standard.
What the team has done wellThe panel was impressed that:
data on service availability and operational MI is being collected the team has a view of the volumes of service users through forecasting work undertaken the team has a dedicated Insight Analyst resource the team has taken some steps to identify the goals of the service and related metrics needed to measure their success. This includes the 4 mandatory KPIs the team has plans in place to create dashboards to share performance data across the team and more widely to stakeholders What the team needs to exploreBefore their next assessment, the team needs to:
make better use of tagging to collect the data from user interactions with the service in Google Analytics. This will give the team more valuable insights into user behaviour which can be translated into improvements to the service. For example, capturing data on the occurrences of validation errors will enable the team to identify areas where users are having difficulties with inputs have a clear understanding of how the team intends to measure and report user satisfaction. Consider conducting user research with the feedback mechanisms and survey designs as the 10-point scales used may cause cognitive overload for users and be difficult to use as a measure have an up-to-date comprehensive Performance Framework developed which clearly outlines the goals for both the service team and for users and the KPIs associated with them provide evidence that data is being used to drive improvements to the service and to analyse the effects of new features and changes made to the service on user behaviour consider whether other tools, such as A/B testing tools, can be used to better understand user behaviour and the effect on user behaviour of changes made to the service Reassessment: DecisionThe service met point 10 of the Standard.
What the team has done wellThe panel was impressed that:
the team has a performance framework, where goals have been outlined for both the service team and users, with measures associated with them the team is tracking the 4x mandatory Key Performance Indicators, with cost per transaction being a work in progress the team iscollecting data on service availability and operational Management information the team has visibility of service volumes through forecasting work undertaken the team has allocated analytics resource from a few analysts within the department the team plans to monitor Google Analytics daily upon going live the team has dashboards to share performance data across the team the team provided an example of using user research to make an iteration to the service the team is using various tools to better understand user behaviour and changes made to the service. The team has also identified tools that could be used in the future such as Hotjar and Pendo. Tools currently used include Google Analytics, Power BI, Snap Surveys and Data Dog What the team needs to exploreBefore their next assessment, the team needs to:
tag the service using Google Tag Manager and ideally before going live to avoid missing important insights. This will enable the tracking of insights such as validation errors and link clicks, which will assist with identifying pain points within the user journey. Although the team is using Google Analytics, tagging the service enables the tracking of custom events such as link clicks, that are not available with the standard Google Analytics reporting continue to monitor traffic coming through via Google Analytics, as this is important due to the spikes in traffic that may be expected from the comms campaign monitor the carriage letter feedback survey and consider alternate ways of sharing this with users if response rates stay low focus on using data to do further iterations, particularly to be able to demonstrate at least 3 examples at the next assessment. Although some good examples of using user research were given, there does need to be further examples of data driven iterations from Google Analytics consider moving to a 5-point scale vs a 10-point scale to track user satisfaction. The 10-point scale is currently the standard across the department, but the panel are concerned that this may cause cognitive overload for the user and recommend this being picked up as part of user research 11. Choose the right tools and technology DecisionThe service met point 11 of the Standard.
What the team has done wellThe panel was impressed that:
the team has identified that building a solution was appropriate and chose technology that is well-aligned with the requirements the technology choice was made whilst considering BSA’s architectural policies and standards, and align with these by choosing technology that is commonly used within BSA, the team has ensured it can be maintained properly even if handed over to another team in the future What the team needs to exploreBefore their next assessment, the team needs to:
consider whether there are other sources of data besides PDS that could be used as part of the “2nd parent verification” requirement, particularly considering data covering users outside of England and Wales (for example, identity information provided by One Login for Government) investigate other “2 party consent” journeys that exist across wider government, to determine potential technology options that could inform the design of “2nd parent verification” 12. Make new source code open DecisionThe service met point 12 of the Standard.
What the team has done wellThe panel was impressed that:
the source code for the frontend application has been made openly available under an appropriate open-source licence the code that has been made open source is automatically scanned to detect leaks of potentially sensitive information, such as passwords or API keys What the team needs to exploreBefore their next assessment, the team needs to:
consider whether other parts of the solution can be made available under an open-source licence, for example automated tests 13. Use and contribute to open standards, common components and patterns DecisionThe service met point 13 of the Standard.
What the team has done wellThe panel was impressed that:
the “PDS ID verification” pattern is being considered as a pattern for use in other services that have similar authentication requirements the team integrated with an existing service for printing of letters and certificates but have also built with a potential move to a different print solution in mind sending of text messages is implemented through an integration with GOV.UK Notify, removing the need to maintain a separate contract with an SMS provider the team has used existing components from the GOV.UK design system, so they are able to compose their service from well-researched, accessible components What the team needs to exploreBefore their next assessment, the team needs to:
investigate how the “PDS ID verification” pattern could be made more broadly available to other services, for example by exposing parts of it as a shared service that could be consumed by other services in BSA without having to integrate with the FHIR API or GOV.UK Notify 14. Operate a reliable service DecisionThe service met point 14 of the Standard.
What the team has done wellThe panel was impressed that:
a continuous integration pipeline has been designed to ensure tests are run automatically as changes are made, including acceptance, accessibility and cross-browser compatibility tests, and these are deployed through a number of testing environments the team is making use of monitoring and alerting tools that are common within NHS BSA, ensuring that the service can be run effectively without the need for specialist knowledge of uncommonly used tools automatic shuttering of the service has been put in place, in the case where certain dependent systems become unavailable for an extended period, to reduce the risk of users wasting their time the service has been built with scalability in mind and this has been tested using performance testing tools with sensible volumetric predictions the team has used queues and asynchronous processing to reduce the risk of downtime when certain dependencies might not be available an alternative telephony route has been built to cater for users who prefer or need to use a non-digital route to access the service, and this closely mirrors the approach used for the online part of the service seen at 18:39, 16 February in Digital health and social care.