Designing a health and work service to support
those with longterm health conditions
those with longterm health conditions
For: Policy Lab, Department for Work and Pensions, Department of Health
While at: Uscreates (Design Strategy)
With: Policy Lab (Policy Design), Mastadon C (Data Science), Keep Your Shoes Dirty (Ethnography)
Director: Joanna Choukeir
Service/Communication Designer: Laura Malan
Key words: User research, co-design, service design, data science, prototyping
Three-day design sprint with a multi-disciplinary team and stakeholders to jointly set the project aims and objectives.
Challenge
In the UK, there are around 2.5 million people on health-related benefits, with an annual cost to the UK taxpayer of around £15 billion; and the costs are not only to the taxpayer through benefit payments. The wider economic costs of sickness absence and worklessness associated with working age ill-health are estimated to be over £100bn. Evidence also shows us that the longer people are on these benefits, the less likely it is that they will return to work. Being out of work can have a significant long-term impact on people’s health and well-being. The solution may seem simple; getting people back into work has significant personal health and wellbeing benefits, as well as the boost to the economy of people earning rather than claiming. However this requires both a systemic and behaviour change at scale.
Ethnographic research was conducted with health and employment related service providers, employers of various sizes and with
people with term health conditions.
people with term health conditions.
It is often said that design can be used to tackle some of greater challenges facing Governments across the world. It is a big claim, but we are finding that more and more that methods from design – such as prototyping – combined with other methods such as ethnography and data science, can be used to form part of a rich evidence base that policymakers trust for the development and testing of new ideas to tackle complex problems. Our challenge was to use service design methods alongside methods from social science and data science to explore how to support people to manage their health conditions so that they can stay in or get back to work.
Data science techniques (Sankey Analysis and K-Means Clustering) were used to look at patterns of people surveyed through the government's Understanding Society survey. We then translated those into visual outputs to use in co-design sessions.
Approach
Across a 15-month project, the UK Government’s Policy Lab at the Cabinet Office and the Work & Health Unit (a joint unit sponsored by the Department of Health and Department for Work and Pensions) commissioned Uscreates – alongside an ethnography agency Keep Your Shoes Dirty and the data science organisation Mastodon C – as a multi-disciplinary team to work together to address this challenge.
We diagnosed the problem through a stakeholder workshop, and ethnographic work and data analysis to understand what qualitative and quantitative evidence told us about the system and its users. We then worked with service providers, policy makers, and users to co-design and prototype a potential service to bring about system-change.
Throughout the project ideas were co-developed with groups of policy makers, service providers, health care professionals, job advisors and those with longterm health conditions. Data and insight from the research was translated into visual formats that allowed groups to quickly get up to speed and ensure ideas were grounded in the research.
Key insights from our research included:
– Once people move onto long-term sickness benefits, they tend to stay on them. This means that preventing people getting to this point is vital
– People on health-related benefits also have non-health related needs such as housing or confidence building
– People on health-related benefits can be clustered into distinct groups with distinct needs meaning that we need to tailor and personalise responses
– People have to tell their story multiple different times to many different services, which do not share information, meaning no-one has a complete picture about someone’s needs
– Individual line managers and confidence are big factors in whether people stay in or get back to work.
– Individual line managers and confidence are big factors in whether people stay in or get back to work.
(1) Ethnographic research was translated into visual journey maps to more easily share findings and stories with the various policymakers and
stakeholders involved in the project
stakeholders involved in the project
(2) A blueprint of the proposed service: using the stories of three personas created from the ethnographic research, to show how various groups of people (those in work, on longterm sick leave, and out of work) might experience support from the service.
Outcome
A co-design process with service users and staff resulted in ideas forming around a dedicated Health & Work coach at Job Centres, who could signpost people to different health and non-health services, liaise with their employer to make adjustments and build their confidence to stay in or get back to work. A Health & Work Book captures the history, action plan and user journey in one place, and is accessible to all those offering support to ensure the user is receiving personalised and holistic support.
Creating materials and coaching local teams to 'experience prototype' aspects of the service in Job Centres and GP surgeries.
Our focus was on prototyping individual elements of a new service by building on existing services, rather than trying to design a whole complex system from scratch. Firstly, we mocked up elements, and shared them with around 50 users and service providers to get initial feedback. Secondly, local areas stepped up to ‘experience prototype’ elements of our service ideas in live situations to explore how it could fit in with existing services: a way for employers to refer their employees to the service (in Penzance), for GPs to refer their patients to it (in Southend), the role of the coach (in East London), and a Health & Work Book for users to keep their information all in one place (Bournemouth).
(1) Ongoing work with local teams to gather learning from prototyping the service to feed into new iterations
(2-3) Developing digital prototypes of a 'health and work book' to document complex health and work history.
This mixed methods approach, facilitated by the Cabinet Office has prompted
wider systems change and brought about significant investment:
wider systems change and brought about significant investment:
– It has played an important part in the creation of the Work & Health Unit set up to bring about collaboration between departments where the problem is multidimensional and affected by a number of different social issues simultaneously
– The establishment of a £40m Work & Health Innovation Fund which is taking similar innovative approaches to generating ideas
– The insight has fed into a new supporting tool for a more positive and holistic conversation for new applicants for Employment Support Allowance (ESA)
– There is ongoing work on a digital version for people who are still in work, preventing them from falling out of work
– Around 25 civil servants and 40 service providers have been involved in developing user-centred ways of working, embedding a service-design approach in national Government and local public services focusing on work and health.
