Our digital age provides many opportunities to improve public services but those opportunities are so often missed. GDS has made great strides in removing many of the obstacles with their "Digital by Default Service Standard" but this does not apply to the NHS. In this presentation we will share their experience developing SH:24, a digital service launched in 2014 to complement existing sexual health services in South London. We'll discuss the structure of the organisation (a Community Interest Company), the importance of close collaboration with existing healthcare providers, the benefits of user-centred design and how the appropriate application of lean and agile techniques can deliver a working service to real users at a pace unheard of in public health. You will learn: How to navigate NHS bureaucracy? What is a minimal viable healthcare service? How to identify the biggest risks and tackle them head on? How to engage with patients early on without disrupting their care? What difference this service will actually make?

2. SH:24
How new digital services can
effect real change in public
health
Service Design in Government
20 March 2015

3.
Introducing SH:24

5. 5

6. 6

8. 8Local authority income against expenditure 2010/11 to 2019/20

9. Concept
‣ New online sexual health service,
delivered in partnership with the NHS
‣ Free STI test kits, information and
advice - 24 hours a day
‣ Holistic, user centred service
integrated with specialist sexual health
services

10. Aims
‣ Improve local sexual health
‣ Improve access and experience
‣ Increase productivity/reduce costs

11. 11
2
Monday lunchtime
A straightforward online
assessment and my test
kit is ordered.
Monday morning
I had unprotected sex a
few weeks ago and still
haven't had an STI test.
What should I do?
1
From
SH:24
1
Tuesday morning
The kit arrives in the post.
Monday evening
I receive a text message
notification from SH:24
informing me that my test
kit has been dispatched.
3
Tuesday evening
I complete the
test kit at home.
5
9
At clinic reception
I show my text message
to the receptionist.
10
In the treatment room
I receive a course of antibiotics.
11
2 months later
Perhaps I should retest?
7
Friday morning
My results! I need
treatment for Chlamydia.
I need to visit a clinic.
5 minutes later
I text back SH:24 with a
question and they promptly
send me a reply.
LCOME
4
At the post box
I post the kit back to SH:24.
Should I go to the
clinic today?
Thank you for your
message. We advise
you to visit the
clinic as soon as
you can. From SH:24
6
User journey:
Step by step
18
8
FromSH:24
1

12. Guy’s and St
Thomas’ Charity
CIC
members
Provider commissioner
committee
Operating
board
Advisory
board
User
group
Key stakeholders:
A multidisciplinary team
Policy
Users
IGData
CCGs
Primary care
Academia
Pharmacies
Public health
Civil bodies
Innovation
Safeguarding
Core team
C.I.C
Clinicians
Public health professionals
Agile project managers
Designers
Developers
Advisory board
Public health policy
Sexual health charities
Innovation organisations
Partner health organisations
Academia
Providers
SH:24 NHS providers
Local authority commissioners
Voluntary sector

13.
Approach

14. Prototyping with real users Iterative development
Functions
Time
EHC
Oral
Contraception
Partner
Notification
Users are integral to the
development of the service.
By consulting and prototyping
with real users we gain a
rich understanding of their
attitudes, behaviours, needs
and wants. This allows us to
optimise existing functions
and inform new ones.
Early prototypes typically
start life as low fidelity
paper based mockups
before being digitalised.
The iterative nature of the service’s
development ensures that risks are
minimised and that the user experience
is never compromised – developing
functions (not features) that users
need, want and prefer to use.
The graph above illustrates how
prospective additional functions could
be layered to evolve the service –
driven by user need and demand.
6–8
weeks
1 Build
An iterative approach:
Agile prototyping
Chlamydia
Treatment
STI
Testing
2 Test
3 Learn

15. The Unboxed Way
Agile principles
Lean Startup
Design thinking

17. 17

20. VERY BUSY
https://www.flickr.com/photos/slworking/

26. LOGIN
There are 3 levels of staff permissions
to access the portal.
Security
Live orders and user messages are reviewed and logged.
Safeguarding and risk assessment responses are flagged.
Where appropriate, users are officially referred to their
local clinic or signposted to other services.
Order review
21 3
STAFF01
Clinic staff communicate with users
via text messages and if required
by telephone, email, letter or face
to face consultations (where required).
Communication
with user
Lab
Lab communicates test results
anonymously to SH:24 via a
secure connection.
A unique identifier (UID) is used
to avoid identifying users.
5487238
Results
User
Clinic
Secure login
Staff securely login on to the SH:24 with 2 factor
authentication portal which logs all orders, users,
messages and results.Updates are automatically
logged on the SH:24 portal.
Interfaces:
Lab and clinic relationship
Following review, new and repeat orders
are picked, packed and dispatched.
Users are informed about the status of
their order by text message.
Order dispatch
Automated text messages notify users of their
results. Where appropriate, users are officially
referred to their local clinic. Reminder text
messages are sent to offer helpful advice
to users and prompt the return of test kits.
Result notification

27. Local stakeholders

35. Managing orders and results

39. !
!
!

40.
Now and next

41. Launch (soft)

43. Continued learning
! !
Vs

44. Iteratively develop the service

45. Evaluation:
A continuous process
Economic
modelling
Prevalence
of STI
Whole system
change
Methodology
Impact on
vulnerable groups
Access to
services
Assess impact on local
sexual health economy
Activity rates and adoption
Local economic modelling
Efficiencies/
resources
Impact on existing services
Productivity, freeing up of clinical
expertise expectations
Conversion rates
Test kit return rates
In what circumstances and for
which users is SH:24 acceptable?
Developing a safeguarding
approach and policy
Establishing how to identify
those at risk and how they
can be supported
Measuring the likelihood of those
at risk of infection/unplanned
pregnancy to use SH:24 instead
of clinics
Explore formal and informal
routes into SH:24
How does sexual health service
provision change across the whole
system as a result of SH:24 activity?
Whole system economic modelling,
on activity and spend across the
whole system
Measuring changes in the rates
of diagnosed infection locally
Benchmarking against national data
User experience
How and why do users make the
decision to use SH:24 rather than
a traditional clinic?
Behavioural trends: Influences
and consequences
Adoption and conversion
Rates of STI testing and messaging
Return rates
Visibility
Desirability
Utility (take-up) of functions
Waiting times in clinics
Randomised controlled trials
Economic modelling
Qualitative and observational
user experience data
Live and analytical data on
SH:24 website usage