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What we mean by service design and user experience
A service is something that helps someone do something. Services can be very small and simple, or very large and complex. We know services perform better when people with the relevant skills design and build them, involving end users of the service throughout.
- Service design addresses the whole user journey to create services that reflect the way users think about or use them.
- By doing this, we improve the user experience, which is the total experience of the user’s interactions with the service, including if necessary both online and offline steps.
User experience is impacted positively or negatively by factors including:
- the provider’s initial understanding of user needs
- the design and delivery of the system
- the reliable and secure performance of the service in life
- the way the provider uses data and insights to continuously improve the service.
The user must be the ultimate judge of the user experience.
Building on good practice
In many ways service design in health is no different from other big service sectors, such as government or financial services. We will adopt and reuse the best that those sectors have to offer. We will focus our own standards efforts on areas where there are specific health and care considerations, such as clinical safety, patient confidentiality, the NHS brand identity, and the special trust that people place in health and care institutions and workers.
The NHS Common User Interface will be fully deprecated
During the tenure of NHS Connecting for Health (2005-2013), a need was identified for consistency in the display of common items and their layout on screens, driven by a desire to reduce the likelihood of clinical errors through misinterpretation of information.
The Common User Interface (CUI) set out to define a common interface for healthcare IT systems. Nine standards were adopted for interface components including Address Input and Display, Date and Time Input, and NHS Number Input and Display. More detail on each of the nine standards can be seen under the alphabetical list of standards published for use in England.
The CUI standards are 'output standards' which provide reference wireframes instructing suppliers how to lay out their screens. They constrain output at the level of interface design but exercise little or no control over the other elements that combine to shape user experiences.
The CUI content has not been updated since the closure of NHS Connecting for Health and is now hosted in the National Archives. The CUI standards should not be relied on as interface design standards. Nevertheless, there is still residual value in several of the data elements identified within them.
Before fully deprecating the CUI, a formal review will be completed, in partnership with NHS England, and new guidance will be published which identifies those useful data elements in the current CUI standards which are still relevant to ensuring patient safety and continue to promote clinical take up of health and care IT.
The Digital Service Standard applies to services used by patients and the public
The Digital Service Standard, released by the Government Digital Service (GDS) in 2013 and still actively maintained, is a wide reaching standard that impacts all the main elements of the user experience. A new format and name change from the ‘Digital Service Standard’ to the ‘Government Service Standard’ is planned by the end of 2018.
The service standard is a 'process standard': it defines a user-centred way of working while still giving suitably skilled designers the freedom to innovate to meet identified user needs and deliver valuable outcomes. In other words - 'Make sure users succeed first time'
NHS digital systems must be designed in accordance with the principles of the Digital Service Standard and the Technology Code of Practice. In particular, they must:
- help users do the thing they want to do at the first attempt without having to understand government
- be designed based on user research and user needs
- be coded in the open and take full advantage of existing open source solutions
The Department of Health and Social Care and the Cabinet Office use these principles to check whether a service is suitable for public use.
The GDS standards are mandatory for nationally delivered services used by the public. They also remain sources of good practice for locally delivered services, and services used by heath and care workers.
Introducing the NHS digital service manual
Building on the good practice in the government service standard and manual, an NHS Digital Service Manual has been released in public beta.
The beta release covers things you need to make consistent, usable services for patients and the public. These include:
- design principles to guide all of our design
- look and feel - grid, colours and typography
- reusable components and design patterns that solve common problems
- content style guide - how to write for digital NHS services
- practices - how we approach accessibility, agile delivery and service design
For professional-facing services, further work is now required to define an approach that meets the clinical safety and usability requirements identified a decade ago in the CUI, in a way that is compatible with the modern digital service design good practice encapsulated in the GDS standard and NHS Digital Service Manual.
Requirements for digital accessibility
Digital accessibility means that websites, tools, and technologies are designed and developed so that people with a disability can use them as easily as people that don’t have a disability. To use digital services, people have to be able to perceive, understand, navigate, and interact with them. This can mean being able to contribute to services, as well as to consume them.
The Equalities Act 2010 requires that we make services accessible.
Digital services must meet government accessibility requirements:
- level AA of the Web Content Accessibility Guidelines (WCAG) 2.1 as a minimum
- work on the most commonly used assistive technologies - including screen magnifiers, screen readers and speech recognition tools
- include people with disabilities in user research.
The EU directive on making the websites and mobile apps of public sector bodies more accessible requires public sector websites and mobile apps to meet accessibility standards by the following dates:
New public-sector websites, created after 23 September 2018
|23 September 2019|
|Existing public-sector websites||23 September 2020|
|Mobile applications||23 June 2021|
Under the directive, organisations will be required to publish an accessibility statement detailing their compliance with the law, and listing the parts of their services that are not accessible under a limited range of permitted exceptions. GDS is leading the implementation of the EU directive in the UK.
Assessing services against the standards
The Government Digital Service Standard and Service Assessment model is directly applicable to healthcare.
Minor variations are necessary for services not delivered to the GOV.UK platform. For example, services may be required to use NHS.UK look and feel and components, instead of GOV.UK. GDS services assessors reviewing NHS services have pragmatically accepted such variations.
In line with other parts of the public sector, health and care should move to a model of continuous assessment at a level proportionate with the impact of each service, with assessments conducted by specialists and organisations that have the digital capability to make expert assessments.
Further guidance on specific topics
As well as the user centred and accessible approach described above there are standards (guiding principles) that would support patient facing data/information services. These are:
- Digital Assessment Questions for apps and wearables – to assess digital products for inclusion in the NHS Apps Library. The questions cover effectiveness, clinical safety, data protection, security, usability and accessibility, interoperability and technical stability
- Personal Health Record (PHR) Adoption Toolkit – standards to support health and care organisations in England to commission, develop or manage Personal Health Records (PHRs)
- DCB3051 Identity Verification and Authentication Standard for Digital Health and Care Services – the development of a single, easy to use system for verifying the identity of those requesting access to digital health records and services
- Digital inclusion guide – aimed at local health and care organisations to help them to take practical steps to support digital inclusion in their communities.
Service design standards and guidance available now
ISO 9241-210:2010 Human-centred design for interactive systems
An international standard published as ISO 9241-210:2010, including ‘six principles for human centred design’.
|Universal in the practice of user centred design. Included within the Apps and Wearables Digital Assessment Questions (DAQs).|
Accessibility (WCAG 2.1)
|Any service/product must comply with the Equality Act and meet at least level AA of the Web Content Accessibility Guidelines (WCAG 2.1), recently incremented from version 2.0).||Universal in inclusive organisations. Included within the Apps and Wearables Digital Assessment Questions (DAQs).|
UK government standards that apply to health and care
Government Service Standard
The Digital Service Standard is a set of 18 criteria to help government create and run good digital services.
|Mandatory for services subject to the Government Service Standard. Adopted informally elsewhere as a proven assurance model.|
Government Service Manual
|The Service Manual helps teams create and run great digital services that meet the Digital Service Standard. It covers accessibility and assisted digital, agile delivery, design, measuring success, technology, the team, and user research.||Mandatory for services subject to the Government Service Standard, and good practice for others designing and building services|
|The Technology Code of Practice||The Technology Code of Practice is a set of criteria to help government design, build and buy better technology. It is used as a cross-government agreed standard in the spend control process.||Mandatory for services subject to government spend controls, and good practice for others designing and building services|
Standards specific to health and care
|NHS Digital Service Manual: Design Principles (beta)||Design Principles to help guide the design of patient facing systems. Combining elements of the GOV.UK design principles and the NHS Constitution.||Released in open beta August 2018|
|NHS Digital Service Manual: Look and feel (beta)||Look and feel – the fundamentals of NHS design –the layout grid (based on GOV.UK) that allows for a mobile first design, our typography sizing and our colours, based on the NHS identity.||Released in open beta August 2018|
|NHS Digital Service Manual: Components and patterns (beta)||Components and patterns – specific to our health content in NHS.UK designed to guide the reader with consistent designs for ‘call out card’s’ and ‘do and don’t lists’. This is the first set of patterns which will grow by December 2018.||Released in open beta August 2018|
|NHS Digital Service Manual: Content style guide (beta)||Content style guide - NHS.UK’s working practice-level guidelines for making information which may be complex understandable for all; including guidance on writing for accessibility and inclusivity, and words to use and to avoid. (Compatible with the NHS Accessible Information Standard)||Released in open beta August 2018|
|NHS Digital Service Manual: Practices guides (first guide in beta)||Practices - Initially focused on making services accessible, this will grow to include guidance on how to work in a user-centred, agile and iterative way to design and build health and care services (including how we assess our services).||First guide, covering accessibility, released in open beta August 2018. For other practices, teams are currently relying extensively on the Government Service Manual, with which the new NHS manual practice guides will be consistent.|
|DCB1605 Accessible Information Standard (version 1.1)||The Accessible Information Standard directs and defines a specific, consistent approach to identifying, recording, flagging, sharing and meeting the information and communication support needs of patients, service users, carers and parents with a disability, impairment or sensory loss. Accessibility of health and social care websites is excluded from the scope of this Standard, but WCAG 2.0 is referenced.||Adopted and published by NHS England|
The NHS Digital Service Manual is hosted within the NHS Digital programme responsible for the public-facing NHS website, NHS.UK. The service manual roadmap to end of March 2019 includes:
- Guidance on ways of working, suitable for non-expert audiences, covering user-centred, agile and iterative methods
- Accessibility expert guidance, practice, tips and tools to produce accessible services and content
- Richer content style guide embedded in the practice of the NHS website - guidance about writing for the users of NHS services, words to use and avoid, health literacy and reading age
- Expanded looks and feel and interaction patterns and components to enable designers and developers to build NHS public-facing digital services more quickly and consistently
- Initial front-end toolkit and prototyping kit that enables teams to rapidly build prototypes and production-ready services using tried and (accessibility) tested patterns (fonts, colours, grid, page layouts, transactional elements).
Ambition for end March 2020:
- Deeper and more detailed guidance for audiences including commissioners, commercial providers, and in-house teams, to support digital service commissioning, design, delivery, and continuous improvement across regions and at a local level
- Engagement for greater uptake and adoption of standards, including wider understanding of user centred design, agile methods, continuous delivery, and devops practices in health and care
- Support for health and care organisations to meet their September 2020 obligations around accessibility of existing public-sector websites.
Ambition for end March 2021:
- Patterns, code, guidance, training materials scaled to meet a more diverse set of patient facing and workforce needs. This work will support more coherent user journeys across national services, and between primary, secondary and social care
- Support for health and care organisations to meet their June 2021 obligations around accessibility of public-sector mobile applications
- Cultivate a user-centred and agile community of practice across the whole health and care system, making the standards collaboratively owned, self-sustaining, and evolving.
This framework outlines the key standards for clinical safety, the use of data, interoperability and design interactions.