The NHS: A taxonomy

For NHS, NES Digital Service

The taxonomy describes the NHS holistically and makes visible how technical platform components link to services, products, and patient experience. It connects patient experience and health outcomes to clinical workflows, services, products, interfaces, technical components, and data. This demonstrates that none of these exist in isolation, and that technical components need to be built based on patient and clinician needs, so they can effectively enable the whole health and care service to meet needs and provide public value.

The NHS taxonomy is a strategic design project. Creating the taxonomy was a multi-disciplinary collaboration and supports my team to understand and work with the wider context we are designing and building for. It helps to define and maximise the value of our offering and underpins our strategic direction and how we structure work as an organisation.

The NHS taxonomy shows that a meaningful reusable component includes several levels such as patient experience, NHS pathways, service components, and technical components. This helps my team to:

Build a common language within NDS to work better together as a multidisciplinary team.

Agreed definitions make sure we mean the same things when we talk about them. Our work at NDS consists of multiple layers, and the taxonomy will provide teams with the context on where the aspect they are working on fits in with the wider context.

Make it easier to consider repeating design patterns and technology components.

This saves time and effort and to organise the NDS portfolio of work more easily. The taxonomy provides a framework to help identify the reusable patterns NDS engineers and designers contribute to and helps avoid rework.

Start to design for public value, not just for a platform, a product, or a feature.

It provides a strategy for realising a national digital platform that fulfils its promise of using data and technology to enable whole services and transform patient care. As an NHS team, we need to have visibility of our impact in the service and patient care layers, so we can effectively design and build the parts we have agency and ownership of, and measure if we are really making a positive difference to the health and care services this is enabling.

Highlight ownership and maximise NDS efforts.

It raises the question of who owns the whole service and who can design it to deliver a health outcome through multiple providers. The taxonomy helps to discuss this context and where to focus our limited time and effort in order to maximise the impact of our work. It provides a vocabulary to approach work strategically and to deliver resilient solutions that can influence and transform the wider health and care context.

The taxonomy is made up of four parts: patient experience, NHS pathways, products and services, technical services. This framework connects data and technology to enable whole services and transform patient care.

Patient Experience

This part considers the high-level human context. Life Stage and Life Event are too big to design for but are key for understanding where services or products are needed in people’s life, and where they can have a positive impact. This includes researching and understanding people and the complex lives they lead outside their interactions with the NHS. And it includes looking at the NHS as a service from the patient's point of view through patient journeys which can be quite detailed, and highlight needs and current pain points.

NHS Pathways

This part considers the clinical workflow of an existing service. This means the series of steps performed by clinicians to assess, change, or maintain the health of a patient and using, changing, and producing data. It also includes the workforce and resources available in a current service and any policy and governance underpinning the current NHS pathways.

Products and Services

This part considers end-to-end health care services. A whole end-to-end service is everything a patient needs to do to achieve their goal, and also everything the health and care system needs to do to achieve a health. Products (e.g. home monitoring spirometry device), digital products (e.g. digital cancer summary, electronic referral process), and enabling services (e.g. text messaging, authentication) contribute to the successful delivery of a whole service, but do not deliver a health outcome by themselves. Some provide an entry point to a wider service, and are called channels. Most services can be delivered through several possible channels (e.g. physical appointment, phone, website) and interactions (e.g. fill in form, discuss options with health professional). One whole health and care service generally includes multiple local and national providers (e.g. GPs, healthboards) and several products.

The UI Design System developed at NDS is a reusable design language and library of components that can be used to build user interfaces. This promotes a consistent look-and-feel across products, and bakes in considerations for accessibility and integration. Service patterns are repeatable and reusable ways similar services work (breast cancer screening service, outpatient service), and verbs are repeatable and reusable actions and functions (book appointment, view data). When services use similar ways to achieve an outcome, the opportunity is to use repeatable components rather than building them using different technologies (more about this here). Considering and designing whole services and establishing tried and tested service patterns means maximising the impact and value for the public technical components and the platform can have.

Technical Services

This part considers the technical services that facilitate the development of software to support health and care services. They provide an on-ramp for internal and external teams to develop software that is integrated with the NDS National Digital Platform. Robust access control is a requirement for all digital health services – who has access to what information or services, and under what conditions. Having a common framework and reusable components to describe, implement, and audit access will make this much easier. A key outcome for the National Digital Platform is data availability at the point of care. This can be enabled directly by building digital components with a single source-of-truth, or indirectly by exposing a single view of multiple systems. Underpinning all technical components is a harness of foundational infrastructure that centralises bootstrapping and operational concerns such as automated deployment of new versions of software and monitoring of live services. Software Development Kits tie all of these technical components together for the convenience of delivery teams. Whilst all technical components will be based on open standards, platform SDKs can be created to capture best practices for integration in order to streamline and accelerate development.