How I helped people get easy access to their health records and designed waste out of the system (2021)
posted 1st April 2024
Service Design Lead, Discovery, May to December 2021
THE CHALLENGE
The Council, working in partnership with the NHS, wanted to improve residents’ access to their health records, ideally through the NHS App. This wasn’t just a digital delivery challenge. For the service to be viable, it had to demonstrate measurable public health benefits while also delivering efficiency gains across a stretched NHS system. I asked two questions:
- How could easy access and clear signposting to services improve individual health outcomes?
- How could the same solution reduce systemic waste, by helping people navigate care more effectively?
THE SOLUTION
Collaborating with stakeholders across clinical, administrative, and policy teams, I led the design and validation of a new service proposition.
I designed and tested future-state journeys and service blueprints, grounded in real user needs and system constraints.
The journeys helped clarify how smarter access to health services could lead to earlier interventions, better patient self-management and reduced pressure on frontline services.
IMPACT
The proposed journeys and service models were:
- Desirable – welcomed by patients and carers
- Viable – supported by NHS teams and leadership
- Feasible – aligned with existing tools, including the NHS App
The Governance Board approved further funding for design and delivery, signalling both confidence in the solution and a wider shift in mindset toward patient empowerment.
Approach (Discovery)
I took a systemic, human-centred approach from the start.
It had to work for residents and it also had to make sense for the many moving parts inside the health system, from GPs to specialists to digital teams. That meant working across boundaries, balancing different pressures and always coming back to what would create the most value for all people with the least friction.
I worked closely with a delivery lead, clinical lead, technical architect, analyst and comms specialist to bridge perspectives.
I regularly ran workshops with frontline teams, spoke with patient representatives and tested early ideas with real users. I worked with the team and checked each insight against real-world constraints: clinical policy, existing tech, operational workflows.
The Health Landscape & Areas of Focus
I needed to understand the healthcare landscape in more detail. The health needs pyramid below helped with this objective. I used the health needs pyramid to inform priorities and focus.
Health needs vary widely across the population. Roughly 70% of residents are mostly healthy and use the system occasionally. The remaining 30% live with long-term conditions—and account for most NHS spending.
I developed two working hypotheses with the governance board:
- If we support the healthy majority early, we can prevent more complex issues later.
- If we give people with long-term conditions more control and better tools, they’ll manage their health better and avoid crisis care.
This lens helped us frame design decisions to serve the biggest number of people and free up resources where they’re needed most.
Personas & their Journeys
To ensure the future patient portal met the population needs as a whole, I developed a set of personas to represent the broadest spectrum of the population.
To keep the service grounded in reality, I developed a set of personas to represent the population and their health goals:
- Healthy and independent
- Living with ongoing conditions
- Going through cancer treatment
- Managing a high-risk pregnancy.
Each persona was mapped against real journeys: what they do now, what gets in their way, and what better might look like.
Across all types, the frustrations were familiar:
- Not knowing what services exist
- Feeling stuck chasing referrals
- No clear picture of what’s next
I uncovered a strong appetite for better access to meaningful and easy to understand personal records and better sign-positing to services, particularly if it helped people take more control and avoid unnecessary steps.
These insights helped me identify core journeys that could be improved, from the perspective of users and the system.
The primary personas considered:
- Biological, psychological and social health needs
- Levels of engagement and life-style choices
- Detailed as-is journeys across the healthcare system
- Digital literacy including access, skills and choice.
Below is an illustration of the primary personas developed and their key needs.
Health needs fall on a spectrum.
Some are simple and task-based. Others are emotional, long-term or tied to life circumstances.
I tested digital solutions across both ends of that spectrum.
For simpler, transactional needs, I tested features like:
• Easy access to records and care plans
• Clear referral timelines
• Self-service appointment booking
These were especially valued by digitally confident users and by GPs tired of handling chase calls.
For more complex needs, I explored hybrid solutions:
• Reminders and explanations tailored to the individual
• Access to community groups or step-by-step guidance
• Personalised tools to support behaviour change over time
Digital helped here, but it wasn’t the whole answer. What mattered was how these tools connected to existing care, rather than replacing it.
Digital exclusion is a health issue.
People at the base of the health pyramid are generally healthy and usually online. Those with more complex needs are often less digitally confident, or prefer face-to-face care. Around 20% of the population is digitally excluded and up to 35% prefer not to use digital channels, particularly older residents.
The new digital offer was designed as an addition to, not a replacement of, existing health services giving people more options, not fewer so that no one got left behind.
Proposed Solutions Tested & Benefits Validated
The future journeys we tested showed how the proposed service could let people:
• Book and manage their own appointments
• Understand care plans and referral steps
• Learn more about their condition and what to expect
Benefits for users:
• Independent and healthy poeple can self-manage and avoid unnecessary calls
• Those managing their long-term conditions well gain confidence to take more control
• Those dealing with cancer recover with better support and fewer surprises
• Those struggling to stick to his plan get the nudges and tools they needs to stay on track
Benefits for the system:
• Fewer missed appointments (a major cost)
• Fewer inappropriate GP visits (a major strain on primary care)
• Less pressure on admin staff
• Better use of existing tools, starting with the NHS App
Below is a high-level illustration of the new ways people and clinicians will engage with each other.
Design Challenges & How I Tacked Them
Finding shared opportunities in a fragmented system
Health journeys vary widely so I needed to understand patterns.
What worked: Mapping real journeys across diverse users helped me and the team find pivot points, where small changes could unlock bigger gains.
Balancing user needs with NHS capacity
Some patient expectations couldn’t be met, like guaranteed face-to-face access.
What worked: We shifted the conversation. Instead of “what people want,” we focused on why they wanted it. That helped us understand user bias and their blind spots and led to smarter, more realistic service designs.
The Outcome
The proposal gave leaders a clear path forward and was approved for further funding. It gave patients a stronger voice and illustrated that better access isn’t just about convenience, it’s about making the system work for everyone.