Posted on 18 August 2022

On establishing, scaling and nurturing design in NHS Scotland

Inside or Outside?

When I started working for NHS Scotland, I was one of only three service designers in the entire organisation. I joined the newly established National Digital Service in October 2019. Two years later, I moved to Healthcare Improvement Scotland, an NHS organisation with a range of responsibilities including quality improvement. No matter where I worked or what project I supported, the biggest challenge always turned out to be a lack of understanding, buy-in, and infrastructure to enable design work.

Working from inside the NHS with these roles was a conscious decision after a few years of working to bring design approaches and methods into NHS Scotland from the outside. Working externally - first as part of a team of design academics based at the Digital Health and Care Innovation Centre, then as part of a health software startup, then as freelancer and contractor -had brought its own set of complexities and issues that made any impact difficult to achieve or see.

In short, I tried to approach the challenge of designing for and with the NHS from all angles, and in the process experimented with countless methods, set-ups, and strategies. The reality is that an old, complex and changing system like this does not simply transform in a few years despite a handful of designers’ best efforts, and despite the increasing push to make use of digital technology in this context.

From designing services to building a practice

Good design simply doesn’t happen in isolation. It needs the enthusiasm and collaboration of a range of people to make it a success, and it needs a growing community, nurturing, leadership, and strategy. And I believe more than ever that design approaches hold huge potential for transforming health and social care for the better.

This is why my role moved further and further away from delivering individual design projects over time. No matter how great or well-funded or important they are, without a vibrant community and design practice to understand and support the work long term, they remain disconnected and cannot evolve or really make a difference.

So I increasingly focused on building awareness, knowledge, capabilities and confidence in implementing service design approaches and methods internally and externally across health and social care. Day to day this meant:

• Championing inclusive design approaches and methods by coaching and working alongside clinical teams tasked with designing or improving patient pathways.
• Mentoring junior designers new to health, NHS teams new to design, and explaining the benefits of a design approach to senior stakeholders in health, social care, and government.
• Leading service design in several long-term strategic programmes, supporting teams to develop and implement new models of care, and embedding the skills and methods needed for a more user-centred approach to system change.

What’s the legacy?

Now I’m leaving this challenge to a new generation of designers while I’m moving on to a new chapter. This new beginning has raised many questions for me, especially around the impact and legacy of my work over the last years.

My time with NHS Scotland has been challenging, and was not made any easier by a pandemic happening in a system and culture already in crisis. Yet I learnt so much here, especially from the many dedicated and passionate people working towards a kinder and more caring NHS. Any impact will only be seen long-term, and there are more setbacks and trial and error to learn from than highly successful projects to show off. All of us are still learning how to best use design and digital in the context of health and care and a large public institution.

This work has been really important to me, it helped me to grow and it has shaped who I am as a designer. That’s why it’s difficult to summarise my time here, its impact, or what I learnt. Some of my insights are small actions or simple tools, some larger strategic directions. Some might work elsewhere, some may be very specific to the situation and time I am reflecting on. Some might turn out to not make a difference in the long-term, and some might have helped to spark large-scale change.

Nevertheless, I’d like to share these insights and what I learnt in a series of blog posts over the next months. Watch this space!