NHS X GSA Live

National Health Spaces

The Brief Looking at the design of Healthcare Services, through the lens of the future of Blended Healthcare, adopting a research led and collaborative approach.

The project aim was to create proposals for Future Healthcare Services that inspire the project partners and participants, and potentially support innovation in the sector.

Working in groups to examine Preventative and Holistic Care. Working with the health care professionals and other stakeholders to understand how it is responded to currently, and proposing what future services that relate to that theme might look like in ten years’ time.

My theme was Preventative and Holistic Care.

A live project working with NHS Ayrshire and Arran to reimagine Preventative and Holistic care in 2030

by Gabby Morris & team.

Initial Research For the initial research phase we worked as a larger group of 8 people and we broke down into smaller groups to research different parts of the topic. I worked with Greta Cozza and my topics were defining Holistic Care within the NHS and in wider context.

Lots of my initial research was desk based; looking at different definitions of Holistic care, running different searches through google, NHS.Scot, NHS.Inform, 111 Service and the NICE websites to see what information and articles were produced and to try and get a picture of what “Holistic� was defined as by the NHS themselves.

I also got in touch with the National Institute of Integrative Medicine (https:// ncim.org.uk/) an organisation based in Bristol who focus on Holistic medicine and

treatments to see if they could offer some information and to see if they could be interviewed as part of our project.

We started to run interviews with practitioners from NHS Ayrshire & Arran, NHS 24 and South Lanarkshire Social Work.

Alongside these interviews we met with Founder of CentreStage in Kilmarnock and a member of the NCIM. All our interviews were run with similar questions and asked people a range of different things; from their own involvement in the NHS to their thoughts on Preventative and Holistic Care.

“The National Illness Services” “Patients have to tell their story over and over again” “The NHS doesn’t do preventative or holistic care”

A flyer I found for Holistic Therapies - it was clear Holistic Care was very broad

Key Findings We had a lot of good interviews and between our two groups managed to come up with a range of different findings to feedback to the NHS practitioners.

My research led me to some key insights; • Current holistic care approach is lacking within the NHS but wanted by practitioners

• Systems are often not joined up even between GPs, Hospitals and external care providers including wider services such as social workers and carers.

• There is a lack of shared patient knowledge at touchpoints, patients are having to explain issues over and over • No connected system between the four HASCPs in Scotland

•There is very little focus on the whole patient or the whole system • There is little patient autonomy around their care or their medical data We also got some first hand quotes that summed up how people felt about Holistic and Preventative Care. It was clear at this stage that the NHS struggled with both Preventative and Holistic care; there were lots of opportunities that I identified that we could take forward, one of them was a more connected service.

From our feedback in this session the NHS practitioners asked us to “push the boundaries more” and “be more radical”.

We decided to go forward with one opportunity and focus on a more radical futures view of it.

A connected NHS (and wider service) system that enabled practitioners within the NHS and other care providers to see patients as a whole with shared information on patient data to provide a seamless service at every medical touchpoint and support with preventative care.

Our initial opportunity statement

Future World, Future Trends Still within our larger groups we decided to look more at the present and future to identify current issues and future trends that could affect health within Scotland in 2030.

that we felt were important or would have the most impact on health and Preventative and Holistic Care. We then used these trends to work out how they might affect 2030 and the NHS.

We started by researching as many future trends as we could find and focusing on their impact and likely outcomes. We also looked at key current topics like Brexit, the Coronavirus Pandemic and the possibility of a recession.

This eventually brought us to the conclusion that there were two group topics to focus on within our future world; Community and Space/Environments.

I developed Steeple cards for the team using all our trends, so that we could see at first glance their impact and how they could affect healthcare. Each Steeple card was triaged into Social, Technological, Economic, Environmental, Political, Legal, and Ethical, some had multiple factors.

Using these we then triaged all the factors

My team become Space and Environment and our focus was around physical, virtual and community spaces and their role in Preventative and Holistic care.

Some of the Steeple Cards I made for the group, these were made from articles that we found and key indicators/pieces of research.

Each one was given a time stamp.

The initial chosen “Steeple Topics” for our future world

Space and Environment One of the first tasks we set ourselves in the Space and Environment team was using our Futures Insights but also other pieces of research to think about Space & Holistic and Preventative Care.

Not just focusing on physical spaces, but thinking about the digital space we live within, community spaces and even other affects on Preventative and Holistic Care like Climate Change, Roads and Access to Greenspaces.

We then tried to look at where these fitted in terms of spaces i.e. “Digital”, “Physical”, “People’s Homes” and “Public Spaces”. As well as working on Miro and mindmapping we went out individually and looked at community spaces, greenspaces and disused spaces in our local areas within Glasgow.

“Village Concept” A really key idea for me that kept coming back into my mind was from the interview with the Founder of CentreStage in Kilmarnock, they talked about the “Village Concept”.

This was the idea of having multiple things under one roof, having different services that holistically “Wrapped around the user” and focused on the users needs, rather than what is currently a one size fits all.

I kept coming back to this in my research and thinking about how holistic might play a role in people’s health if everything was considered, not just physical health.

The Space & Environment teams first mind-map of ideas

Initial sketches of the “Village Idea”

Some of my initial ideas on our topic of Space and Environment

Sharing them on Zoom!

Thinking about replacing the GP in 2030

Scotland has endured a recession akin to the depression of the 1930s. Post pandemic spending has left the economy weak and people’s lives have been hard for many years.

Lack of jobs and poverty has led to a crisis of health and substance abuse. Through the hard times and the issues communities have come together, global movement has slowed and local economies have sprung up to survive.

There has been a backlash to online working, people are spending more time together.

People are more connected than ever. Due to changes put in place during COVID, the NHS has moved to a more online model, working with local communities and the third sector to provide most non-emergency services.

Due to Brexit, privatisation and a weak economy the NHS has been utilising community resources and working more locally with people to support other’s health and care. With healthcare being run more at community level, services have become more inclusive for everyone. This year is 2030 and the National Health Spaces initiative has been launched...

My future world statement

My initial user journey map

National Health Spaces From all of our insights, research, mindmapping and future world work we came up with the idea of the National Health Spaces as an initial concept to start developing. At the stage we had a brief idea of what the journey might look like and how it might look different, but we wanted to use the co-design sessions to get feedback from the practitioners and get them to define some of the parts and touchpoints.

The main concept at this stage was a “Care Cloud” that took data and enabled you to get help holistically rather than seeing a GP, you were assigned a care person/health citizen who would be able to assist you. Your Care Cloud would make decisions about your health and be able to put you in the right direction for holistic support and preventative help.

Personas

Designing our Co-design We wanted to test out this on our codesign participants but wanted them to have a lot of decision points about our future world, the type of Preventative and Holistic Care the “National Health Spaces� should offer and what types of roles people would play.

I developed a look and feel for the codesign sessions so that we could present it to the practitioners in a coherent and believable way, we branded all the cards and myself and Greta created illustrations that supported the look without persuading the answers.

We developed a range of Personas and then 4 Persona tribes that covered key aspects of people in our world. We developed the future world scenario and created value cards for our world.

In co-design session 1 participants were

presented with the future world, asked to talk about the personas and give their feedback on them and choose 3 value cards for the National Health Spaces within this world.

We then asked them to think about a care card and how someone might move through the National Health Spaces with one of these care problems.

This initial co-design session enabled us to get a foundation for our second stage session, which we would replay to all the participants.

For each co-design session we had 3 people attend.

Value Cards

Care Cards

Co-design stage one

We ran our initial co-design sessions with CentreStage, NHS Ayrshire and Arran and NCIM. Getting their feedback and thoughts on the world, values and personas.

We wanted them to build this initial world with us so that we could bring together a National Health Spaces user journey for them to then play with touchpoints, decision points and actions in the second co-design session.

We ran the co-design on Miro using boards we made for them to fill in

Developing our Co-design After co-design session 1 we had enough information to start thinking about the user journey and creating a hypothetical idea of what the National Health Spaces might look like and what someone with Diabetes might use in this new world.

but we wanted to capture all the different aspects that would be taken into account in terms of Preventative and Holistic Care.

We decided to start using the term National Health Spaces Initiative as we moved away from it being about physical space and more about community spaces and digital technologies. We wanted it to feel like a pilot scheme and we decided to run the co-design session 2 like we were creating a pilot scheme to be rolled out.

The NHSi at this point was focused on a diabetic person who would move through the system, we mapped everything from childhood prevention to death, knowing that this would need to be slimmed down

Our cradle to grave user journey for a diabetic person, looking at Preventative and Holistic Pathways

Co-design stage two

The co-design map for co-design 2

Decision point cards from Co-design 2

Running co-design 2 with NCIM

Provocations & Choices We created the skeleton of the user journey for the practitioners to work through in co-design 2 but they were given different choices at touchpoints to fully make this their choices (although some we didn’t keep).

We also prevented them with provocation cards, cards which made them make more difficult ethical decisions. We were realising as a team that actually blended healthcare could potentially have problems and we were inspired by the

Provocation Cards from Co-Design 2

Superflux studio work on not just showing a perfect utopian healthcare system. So we decided to use our co-design sessions to also push the boundaries of ethics and ask people how far Preventative and Holistic Care could go in the future.

Should you know you’re unwell or just be prescribed preventative medicine?

“I would only want to know if I was dying or it was something that couldn’t be prevented ” “How many people know what they are taking now, it would need to be safe though!”

“You’d need to explain it but it could be 98% automated, devices are now”

Responses from the co-design session 2 ethical question

Fully preventative?

One of the key cards in our codesign session was around being fully preventative; should people be prevented to the point of not knowing. We wanted to understand how people would react to being fully medicated and potentially fully prevented from ever using the NHS. This question was one of the most discussed parts of the co-design session and people found this the most interesting in our user journey. When we reflected back on the initial NHS meeting where we were asked to Push Boundaries and be Radical we realised that this was a really interesting focus point for our groups project.

We decided at this point to use the decision points that our co-designers had chosen and add in this idea of being fully prevented, coupling that with holistic

elements and community hubs.

We used our future trends of wearable devices, healthcare devices and also current used devices like the Diabetes Monitoring System and even Healthcare apps on people’s phones, to shape our outcome. We also discussed how people don’t really know, or choose to find out what medication they take in the NHS now.

Although our idea was future based and push the boundaries, it was also based on the trajectory that we are all potentially on, it didn’t feel too futuristic but was enough to hopefully make people think.

We wanted to keep some human elements as this was a blended healthcare project, so along with the codesigners we created an idea for local hubs that would supplement the tech.

Finalising the elements post co-designs

Final Outcome & Artefacts We developed two final personas; Robert and Jenny. Robert was our main case study, a person living within Ayrshire who was taking part in the trial.

We decided to make this feel real and believable that we would run this project back to the NHS in our final presentation as a role play, as though this was a pilot that had taken place.

Robert was used as the case study throughout the session and Jenny was his care coach who supported him with the holistic elements of his healthcare.

We developed a device that would be wearable, but futuristic looking and based on the co-design responses this would be compulsory for the pilot scheme.

We made other elements from advertising

campaigns to the mock-up of the box for the device, we wanted to show all the touchpoints as though they had been done and wanted to present them looking branded as the National Health Spaces Initiative. We used some of the initial colourings from the co-design session and created a brand logo and symbol to present to the NHS client.

Hypothetical adverts from NHSi’s rollout

Letters sent out to NHSi residents

The NHSi device and box that residents received

Provocative images showing people wearing the devices

The prevention pack mock-up showing residents receiving their weekly prescription

Social Activities

Care Core Local Care Cores - or Care Hubs were the human elements to the design. They were local hubs that understand the socio-economic impacts on peoples health and provided a wrap it around the person, village concept.

Community

Health Services

Access to Greenspaces

“Immensely clever narrative methods and NHSI. This was the first presentation where I inherently reacted to it, which is immensely useful” “‘Very thought provoking’ health revolution” “Don’t ever stop being provoking.

You’ve presented here in an absolutely spot on way - made us sit up and take notice. Challenging our assumptions and thoughts - rethinking our approaches” “Did create a visceral reaction when you presented the scheme. Upon reflection though, we’re already doing this we’re moving people into implant. Maybe we’re too close to this and that’s the provocative bit ”

Reflection It is hard to know where to start in terms of my reflection this project, I think this was the first time I felt comfortable in terms of the topics and design aspects but challenged in terms of it being a live project in my 3 years doing this course.

I felt this project was incredibly enriching; I learnt a lot about the scenarios, about medicine and about where the NHS long term plan is going. I also learnt a lot about co-design, my own passions and what design can do in terms of changing people’s perceptions, changing ideas and changing lives. This project for me has made me consider where I want to go as a designer and the path I would like to take post education.

This project was very time-demanding and difficult online and at times I felt I was treading water; this was the first group project we have done under the new coronavirus conditions and it was hard.

I felt a lot of the time I had to lead and make decisions in order to move us on and I would have liked more of a sounding board to work with as a team. However, I feel like the effort and collaboration from my team was great and our outcome reflected something I hope everyone is excited about and proud of.

The final outcome is something I feel was interesting, thought-provoking and did live up to the advice of the NHS Practitioners “Push Boundaries” “Be Radical”. I was happy that this was something that made people sit up and think and created a visceral reaction, using just enough of the future and the present to make something believable, yet not already in existence. As my first piece of speculative, future’s work I felt really happy with the response and feedback.

Left: Feedback from NHS Practitioners after our presentation

I would personally love to run this project twice over and think about how this could be changed or taken forward to make more people think about technology and healthcare.

The topic of Preventative and Holistic Care was a difficult one and I think if I could run this project again, I would look at different ways to create better holistic care pathways, I feel like the healthcare hubs were interesting but maybe an after thought due to time constraints, I would have liked an extra week or two to really get into the details of how they could be paired with the preventative devices.

I would have liked the experience, outwith the pandemic, to run this project within a location of NHS Ayrshire and Arran, it would be interesting to redo the project in a more localised area of the NHS rather than the whole NHS system. I think one of the things that my team struggled with on the project was the lack of overall NHS knowledge.

Gabby Morris