Confronting a Pandemic: The Case of NHS Test and Trace
Author: Sechi Kailasa, Master of Public Administration, 2022
One of the panels at this year’s convening included colleagues from the UK’s NHS (National Health Service) Test and Trace team. They noted that it was only possible to stand up the organization because of the capability that had been put in place by the UK’s GDS and NHS Digital. This existing capability provided them with much-needed speed and reliable processes and ensured the quality of their own services and products. In this article we explore how the team was able to positively impact public health and confront a pandemic, in large part due to the investment in digital transformation capability that has been occurring throughout the past decade.
NHS Test and Trace is an emergency response organization that was set up in the UK to protect public health during the COVID-19 pandemic. The organization was responsible for the entire user journey from testing and contact tracing right through to providing self-isolation support. By the time of the convening in June 2021, the Test and Trace team had created over 100 different products, services, and guidance spanning both the GOV.UK and the NHS website. Their remit also included distributing and rolling out tests across the country; they undertake up to five million tests a week. Due to the organization’s emergency nature, they were essentially given the magic wand lever and were able to operate largely free of bureaucracy. This enabled them to remove traditional hurdles such as those found in procurement and hiring processes to speed up delivery and set up the organization.
The team was only able to have this impact because they were a beneficiary of the GDS and NHS Digital Capability. In the rest of this article, we consider the dimensions through which it benefited.
The Test and Trace Team had the mandate to set up a digitally native organization
The NHS Test and Test team had the authority to truly set up an internet-era organization. Authority here consists of the power to make decisions — they had the magic wand lever and were trusted to use it. This lever is defined as having the ability to redesign rules or processes that must be adhered to by others — essentially, the team were able to be rule setters. Being an internet-era organization meant the team were digitally native and everyone instinctively knew how to work digitally. The team didn’t have a separate digital unit tucked away somewhere in the corner that would tell others that users should be considered — everyone already knew this principle and applied it in practice. There was no cultural battle between those who were comfortable working digitally and those who weren’t. Additionally, the team knew they had to be omnichannel in its delivery of services and products. No one had to explain where digital fits in or include the service design function within the digital capability — the whole team was user needs focused. This isn’t the typical organization structure normally found in government departments.
The team was able to circumvent traditional processes in large part due to the capability put in place over the past decade
The team, as noted above, was able to remove traditional hiring hurdles and hire staff at speed because of the authority they were given. Importantly, they could draw on the readily available talent and communities of practice that had been developed since the creation of the UK’s GDS, and this talent wasn’t just located in the central government. Another reason the team was able to do this quickly was because they could draw on the hiring frameworks that had been created for digital roles.
New hires/existing civil servants already knew how to work digitally
The newly hired individuals were already familiar with GDS frameworks, protocols, assessments, and standards as they had worked with them and done their tours in government. This was an important element of standing up the NHS Test and Trace, and the central team’s job was reduced to just placing individuals into teams to build digital services, which they already knew how to do. It wasn’t enough to have the standards that demonstrated the right way of working; the team needed people who were actually experienced at using them. The team was also able to draw in private sector hires. While the hires might not have been completely familiar with the standards and protocols, they were so intuitive that they understood them in a matter of weeks and could offer a counter perspective.
The team didn’t have to reinvent tools and processes, this allowed them to set up fast and with quality in mind
Over the years, the UK’s GDS had put together a wide variety of tools: the Service Standard, a method to develop digital services in government, and the GDS Assessment to test whether a service met the Service Standard at each stage in the delivery strategy. They also enabled the creation of common design patterns that could be copied across services and communities of practice. In addition to the GDS tools, there is also the NHS Digital Service Standard and the NHS and GOV.UK Design Systems. Digital capability had become quite a mature capability, and the team could draw from this. They didn’t have to reinvent the wheel and could use what had become standard practice and influential beyond the public sector.
They used the tools to align and strategize
Due to the nature of the pandemic and the constantly changing circumstances, the team couldn’t always meet all of the requirements a service typically requires. The pandemic’s ambiguity usually meant that a new issue generally had to be prioritized over the continual improvement of a live service. However, the practices, standards, and guidance listed above guided the team’s strategy. They used the standards to ensure they were building something that was at least minimally acceptable and where possible met all of the standards. They used them to pivot and re-align work, and the magic wand lever was crucial in allowing them to make these decisions as the pandemic progressed.
The team had a challenging user base, so they adapted the standard methods of user research accordingly
The team ensured they tested with the most vulnerable groups and used trauma-informed user research techniques. Managing the customer experience in a complex changing situation is challenging as the impact isn’t linear, but they did use a variety of ways to ensure they got feedback ranging from market research surveys to classical metrics (e.g., customer satisfaction and tracking brand trust) to digital analytics, behavioral scientists, and social researchers being consulted.
The NHS Test and Trace team had a huge impact on public health and were able to meet the government’s needs on several fronts. This was only possible due the maturity of the digital capability that had come to be since the GDS and NHS Digital were created, and the investment into building this capacity played a significant role in enabling the team to confront a pandemic.
