Case Study:

Healthy Start Alpha

How we translated findings from Discovery into prototypes that we could test with users and explore the riskier aspects of our intended solution.

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Context

Healthy Start is a UK-wide statutory passported benefit, funded by the Department of Health and Social Care (DOHSC). The scheme provides financial support to pregnant women and families with children under four by sending them paper vouchers which can be exchanged for healthy foods in shops.

In 2016 Pilot Works ran a Discovery phase, working as one team with DOHSC staff to:

  • Identify the users of the service, their needs and how well the scheme was meeting those needs
  • Understand how the service is currently delivered and the associated costs
  • Understand the business, legal, policy and technical constraints and drivers.
  • Identify opportunities to improve the service experience whilst delivering operational efficiencies
  • Generate ideas and how we would test these ideas in Alpha. 
  • Following discovery there was a pause in the programme whilst the Department of Health went through an organisational restructure. 

Pilot Works were then appointed to carry out the Alpha phase. 

Aims of the alpha phase

Research in discovery indicated that the two biggest opportunities were around: 

  1. Increasing take-up of HS by making it easier to apply for HS
  2. Reducing costs and improving the user experience by replacing paper vouchers. 

The discovery process had identified potential solutions for each, but they were underpinned by some important assumptions. 

Our goal in alpha was to test these assumptions - to ensure our new service would meet user needs and deliver the intended outcomes/benefits - in the most efficient way possible. 

We also needed to continue to help the DOHSC team to adopt agile working practices and create services in line with the GDS Digital Service Standards, particularly as the service would need to pass a GDS Service Assessment before progressing into Beta, and the team were under pressure to avoid any delays. 

Our approach

Members of the combined team were located in London, Bristol and Leeds, so we began by creating a shared Google Drive and setting up Slack and Trello as means of ad hoc communication. 

Then we brought the team together in London for an Inception Workshop to clarify goals, share what we knew and agree roles and ways of working for the alpha. 

The DOHSC team changed between discovery and alpha so we gave an introduction to user centred design and reviewed the insights from discovery to ensure everyone was aligned on user needs, opportunities and constraints. 

We split the alpha into two tracks, each focused on a different opportunity. 

Track 1 - Applying for Healthy Start online

Research in discovery provided the following insights

  • The majority of users wanted to apply for Healthy Start online and many were put off by the existing paper-based application process which requires a signature from a Health Professional.
  • Many users didn’t have access to a computer
  • Many users had low digital skills or spoke English as a second language
  • Users were often confused by the language on the current application form, creating pressure on HSIU in the form of unnecessary case work and calls. 
  • Our goal was to design an end to end application journey that people with low digital skills could complete quickly and easily using a mobile device.

Build, measure, learn.

Our content designers reviewed the paper application form and rationalised the questions, re-writing them to make them simpler and clearer for users.
We then created an HTML prototype of the application journey using the GOV.UK Prototyping Kit and tested it with users.

Feedback from testing was incorporated into the next iteration. After 6 rounds of testing, focused on different aspects of the journey, we were confident the end to end journey was easy and fast to complete, for even our most vulnerable users. 

  The content design on the 'Apply' journey went through six rounds of iteration.

The content design on the 'Apply' journey went through six rounds of iteration.

Track 2 - Spending Healthy Start credit using a prepaid card

During discovery we explored alternative ways to provide Healthy Start benefit to recipients. These included via digital vouchers, via a mobile app and via a prepaid debit card. 

Of these options prepaid debit cards was a clear winner in discovery, for a range of reasons - they are easy to carry, easy to replace, easy to freeze, they allow for more flexible spending than vouchers and they are not tied to an address. 

The cards also met the requirements of the HS scheme, such as the need to work with a wide range of retailers and reduce costs of printing and postage.

Piloting prepaid debit cards with users

To test our assumptions about how well prepaid cards would meet user needs, we ran a two week pilot with different types of users.

We needed to check that the cards would could be used easily in a range of shops, with  smaller and larger spends, that users would able to keep track of their balance and that they would prefer the cards to paper vouchers.

We recruited 12 users and tracked their usage of the cards, from receiving them in the post and activating them to using them repeatedly in shops. 

We used WhatsApp to get reports on the user experience and interviewed each user at the end of the pilot to discuss their experiences in more detail.

Results

Users liked the speed and convenience afforded by cards and the majority said they would prefer to keep the card rather than go back to paper vouchers.

“Using contactless was much faster and less awkward than waiting whilst the staff scan paper vouchers” - Participant in prepaid card pilot

Track 3 - Technology and delivery

In the final track we looked at the “backstage” elements of a Digital Healthy Start service, including:

  • How we would integrate online applications into the system
  • How the current HS management system could support prepaid cards
  • Changes to workflow of HSIU staff due to online applications
  • How we’d provide assisted digital support
  • How data from HMRC and DWP is used to establish eligibility
  • Whether a new online application process would be compatible with regulations of if the law would need to be modified.

This was done through a combination of desk research, interviews and workshops.

Preparing for service assessment

At the start of the Alpha we performed a gap analysis, comparing work completed in discovery with each of the points in the Digital Service Standard and the criteria for the Alpha service assessment. 

Throughout the Alpha we captured notes on work done against each of the Digital Service Standard points in a shared Google Doc. This helped us to check whether we were on track to meet the standard by the end of Alpha and fed into prioritisation during sprint planning sessions. 

At the end of the Alpha we helped the service manager prepare for the service assessment, ensuring they had the information they needed and felt confident answering any questions from the panel. And we attended the assessment with the service manager on the day. 

Passed first time!

The GDS panel were extremely thorough and we were delighted to hear a few days later that the service has passed the assessment. 

Comments from the assessment report include “The team was impressed with the level of research that has been conducted in such a short space of time, with limited resource.”

“It’s clear that the team cares deeply about doing the right thing for their users.”
“The team should be commended on their approach to performance measurement. They thoroughly explored key performance indicators that could be used to track the performance of the service, baselined these where possible and set targets for where they hoped to get to with the new service.”
 

Outcomes

At the end of the Alpha phase, the team had:

  • A validated online application process that meets user needs
  • A clear direction for their improved service and confidence to progress to private beta \Approval to continue from GDS
  • Buy in from senior stakeholders
  • Empathy with the users of their service and a clear understanding of their needs
  • A working understanding of agile methods, user-centred design and delivering services in line with the Digital Service Standard 

We are currently working with the service team to help them scope the delivery of the Beta and live service.

Please contact Suzanne How from the Department of Health and Social Care for further information about their experience of working with Pilot Works.

 
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