This is a time of digital innovation. Technology is continually changing the way people live, interact, learn, play and work, offering new opportunities to change the way Public Health England (PHE) connects and interacts with people. Digital tools offer new ways to gather and analyse data, engage within PHE and with our stakeholders, and improve public health. This rapidly-changing world offers many opportunities but also some challenges to public health. It requires new thinking about public health provision models, data, governance, partnership and engagement.
1.1 Context and reasons for change
PHE’s mission is “to protect and improve the nation’s health and to address inequalities.” PHE’s Knowledge Strategy (2014) committed us to developing a digital strategy to meet user and government expectations and make best use of technology to protect and promote health and reduce inequalities. From Evidence into Action: Opportunities to promote and protect the nation’s health (2014) notes that one of the 6 drivers of change for PHE is “using new behavioural change techniques combined with digital and mobile technology.”
PHE’s Strategic plan 2016 to 2020 coupled with our plans for an integrated public health science hub in Harlow highlights and provides a timeline for a cultural as well as a physical transformation of PHE.
Government Digital Service (GDS) has led the way in transformational change and has provided useful standards and ways of working, and the Department of Health (DH) has set out an ambition to lead a digital-first health and care system. Important guidance from across government is given in the Annex.
PHE has a national leadership role in developing new models of public health together with national and local government, the NHS, the voluntary and community sector, industry, the scientific and academic community and global public health partners, and presenting these directly to the public.
User needs, data and the latest technology are essential when developing approaches to prevention. The rapid increase in types and complexity of population health information requires an upgrade in PHE approaches to data generation, analysis and use, including new data science techniques. The challenge for PHE is to keep abreast of the opportunities created by digital technology, to implement the government’s digital by default strategy, and to ensure that the public health principles of equity and access are maintained and developed in this new digital world.
PHE aims to reduce health inequalities. At present PHE does not comply with many accessibility standards and requirements. Service standard requirements challenge us to think about people with different needs so that we do not increase the digital divide and perhaps, with assisted digital and well-designed services, help to close it. The government’s Digital Inclusion Strategy sets out how government and external partners will get people online. PHE should play a leading role in increasing health literacy and promoting digital inclusion.
1.2 Our ongoing digital work
Digital change is already underway within PHE with examples of digital work in many areas:
- GOV.UK is currently the main public facing platform for information-sharing and PHE is well on the way to completing a transition of legacy and new websites to this format and to NHS Choices
- tracking the epidemiology of outbreaks has new approaches which can include real time tracking via mobile phones
- the National Cancer Registration and Analysis service, run by PHE, is already a world leader using digital tools and techniques
- the award-winning Change4Life Sugar Smart mobile app, which uses the camera on a mobile phone to scan barcodes on food and visualise added sugar content, and One You, which addresses health risks in mid-life, have radically changed public health campaigns and health promotion
- Fingertips has gathered together many public health indicators and generates local health profiles
- agile development teams have been established in several parts of PHE
1.3 The change journey
The next challenge is to build new models of public health that include digital tools and incorporate data science techniques and new learning.
This strategy sets out some basic principles and foundations for accelerating digital change. As well as setting out the ambition for PHE, it describes the role and contribution for the digital team within PHE. It sets a common approach for digital work including principles, clear roles, responsibilities and standards for digital development across PHE. We will prioritise investment to ensure that the most strategically important pieces of work are addressed first. Multi-disciplinary working, recruitment and staff development will ensure we have the right skills in PHE and new kinds of partnerships will be required.
This change journey for PHE will involve clear communications and an organisational development plan to ensure PHE and its employees can build on the new skills and capabilities required and engage effectively with our partners and the public.
Change in a phased manner will ensure that PHE can continue to carry out its mandated responsibilities while bringing in new capabilities and working practices. A particular challenge we will address is managing risk and enabling transformation that is safe in the clinical context of our work. We aim to understand both the benefits and the harms that may arise from the change triggered by digital technology including how to mitigate digital exclusion.
The next steps will be to develop a framework and operating plan for how we will complete these changes across the organisation. This will include our approach to change management, recruitment and skills development, prioritisation and investment to help us decide where to allocate resources, decision-making about technology and tools, data architecture and governance and partnerships for success. This is a living strategy, one that will be updated regularly as the work progresses.
1.4 What we mean by digital and what it means for public health
We can be separated by a common language if the words we use are not consistently defined or understood. Some important terms and concepts are therefore described below.
Digital technology is the latest fundamental technology shift and it may be the greatest. Social, mobile, analytics and cloud (SMAC) technologies have been joined by advances in automation and sensors, 3D printing, robotics, wearables, and technology that may still be fringe today but won’t be tomorrow, including machine learning, augmented reality and artificial intelligence.
Customers and stakeholders are rapidly adopting digital approaches and mobile and smart devices are now commonly used. People no longer read maps in advance of travelling but now expect to look at a map on a smartphone and navigate towards their destination, banking is almost entirely done online and many solutions in daily life are crowd-sourced via digital channels.
Digital is best seen as a way of doing things rather than just a list of technologies and tools. Above all digital refers to working in a different way and putting users and people in the middle of what we do. Digital is about generating and using new kinds of data properly. It is about an open, faster culture and it is about learning by doing.
Digital change involves the end-to-end transformation of services founded strongly on user needs. For public health in a digital world we need to harness and create novel, non-traditional partnerships across government, academia, the technology industry and scientific bodies. Digital ways of working can bring together the many skills and resources to carry out this journey of transformation. Digital approaches can also help drive efficiency and deliver value for money across PHE.
Digital public health
Digital public health is therefore a re-imagining of public health using these new ways of working, blending established public health wisdom with new digital concepts and tools. It recognises the rapidly changing context of changing technology, exploring new models of public health using technology, and introducing flexibility and resilience that will allow us to adapt our public health practice, and improve outcomes. However, in all the digital work we do, we must always be careful not to exclude people who cannot easily access the Internet.
Within PHE, digital services and products include (but are not restricted to):
- maintaining or redeveloping existing websites and content
- the new PHE intranet
- digital ways of engaging
- mobile applications
- collaboration tools
- social media channels
- the databases that support and connect all of these
Some of these will be internal (for PHE staff) and others will be external, including other stakeholders, partners and the public.
2. Digital vision for PHE: what we are trying to achieve
PHE’s Strategic plan 2016 to 2020 provides a clear vision for the role of digital transformation in public health:
We will take advantage of new technologies and use digital techniques and ‘big data’ to protect and improve health, analysing and presenting our information in a way that people can readily engage with, from supporting the NHS on reducing antibiotic prescribing to informing the public about the sugar in their food and drink. We will provide local organisations with personalised data that allows them to tailor services to specific needs.
Our ability to access the latest technology is also vital to our work in keeping the nation safe from environmental hazards and infectious disease.
PHE’s digital strategy will guide this work and we will publish regular updates. The core elements will be shared with stakeholders and tested with them. PHE’s digital team will be responsible for ensuring the strategy is current and for publishing updates and related case studies.
PHE takes a ‘digital-first’ approach to protecting and improving the nation’s health and wellbeing, and reducing health inequalities.
By 2020 we expect that PHE will have:
- demonstrated public health leadership by developing and delivering new models of digital public health provision
- improved digital awareness and understanding across PHE
- embedded digital-first planning by integrating digital ways of working into the design of external and internal products, services and business processes
- built and continuously improved some important underpinning digital platforms for PHE
- increased digital skills across PHE, embedding learning and development for digital ways of working and designing new digital roles
For each of these 5 areas, the digital team and relevant business units within PHE will jointly develop a work plan as part of the annual business planning process.
2.3 Core principles
All of our digital public health work will be based on the following principles:
We will base our work on user needs, creating a dedicated digital user research team. We will blend research into digital user needs with more established public health user needs, so that we can be sure our work meets those needs, and learn and adapt quickly. This will allow more dynamic engagement with our stakeholders and with local partners.
Promote digital inclusion
Our work will promote and improve digital inclusion. The challenges of digital inclusion are well documented in the Government Digital Inclusion Strategy. We will rise to these challenges and ensure that all of our digital work is truly for everyone.
Having access to multiple, joined up streams of data, including those generated by the public and users, means we can tailor our work more effectively and generate new knowledge.
Connected to the public, government and partners
This means having two-way, rich conversations so that we can respond more flexibly, learn and work together, and can both lead and support public health change.
Open and transparent
We will be transparent in how we set priorities for digital work, telling people what we are doing and showing how we work.
Able to measure impact, learn and iterate change
Having better, real time metrics that are delivered in a joined up and accessible way across PHE will help us better determine investment and develop and promote new models of public health.
Efficient, with streamlined business processes
By automating some of our work processes we can reduce the time they take, simplify decision making and free up time to spend on higher level tasks
Provide value for money
We will use digital to reduce transaction costs and introduce new ways of working.
2.4 How PHE will decide which digital work to do
We will base our decisions around internal digital work on PHE business priorities. Digital work should be supported as part of the business planning process and should adhere to good practice for digital development. Integration with existing systems and taking a platform approach will be important. We will also need to ensure decisions are taken with an eye to future sustainability and relevance.
Before PHE decides to invest resources in an external digital project, we must be able to show that:
- the government has a clear and unambiguous mandate to do this work
- it will support the delivery of PHE’s corporate priorities
- it should add public health value (we will need to constantly learn how digital can add value to public health)
- our users are telling us that this is important and there is digital user needs evidence to support the proposition
- the work is sustainable in terms of human and financial resources; there is a clear owner and a plan for the product over its life cycle
- it will be carried out in line with GDS design principles and standards
- there is a clear way of measuring the impact of the work and engaging user feedback
2.5 How PHE should approach digital work
A range of approaches can be adopted by PHE, or by teams within the organisation. The options we will consider for external digital work are set out in Table 1 below, together with some decision points and illustrative examples:
Table 1: PHE’s approach to digital work
|Approach||When would we choose this approach||Example|
|1.||Advocate||To support another partner (for example NHS, other part of government, local authorities, voluntary sector) It is within our communications policy and plan.There is a clear plan for what methods of advocacy will be used and who will do it||Communication about a new public health project or tool through presentations, publications, papers, blogs, social media, conferences and other methods. Supporting a digital public health activity of one of our partners|
|2.||Strategic partnership||To explore new areas of work and contribute to learning and research; also to lead in digital public health new thinking||Build an alliance across government, industry, user groups, research bodies and other groups|
|3.||Explore and develop a new business area||We may be able to shape entirely new public health interventions that arise from new digital tools, trials, or research||Digital public health is a new area and, as we learn more, new opportunities will emerge|
|4.||Develop standards and create guidelines||When we need to adapt or adjust government standards to make them operational within PHE. To clarify the role of different part of PHE. It will raise the quality of something we do. It will make things easier for colleagues and partners by setting out clear ways of working||Promoting a platform approach to development rather than multiple standalone projects. Digital content strategy and guidelines. Digital procurement guidelines. Digital spend control process|
|5.||Endorse (apply PHE ‘brand’ or using our reputation on it)||Where our brand or reputation is the valuable asset. As a way to influence the commercial market||The mobile app endorsement programme|
|6.||Invest (we invest money to get a public health return)||Cross-cutting projects with other partners. When we understand the return in investment (such as measurable public health change, skills or training)||The diabetes prevention service programme by adapting tools already available elsewhere. Working across government where appropriate on cross-cutting projects or with NHS Digital|
|7.||Buy it in||It is a commodity and makes sense to buy it in rather than to build it||Software for data management, data visualisation, digital communications (SMS, email), hosting, licences|
|8.||Build it ourselves||When this is not something the market can do and is within our mandate. It is important that we learn from this process including how to generate and use data. It would be a strategic risk to outsource this to third parties||The core PHE platforms (external parties can then build services on top of them) such as the mobile platform|
|9.||Revenue generation||Enhancing the sales of products we develop. As part of a business development plan for PHE||Online sales tools for PHE products|
2.6 Role of the digital team within PHE
Digital change is a shared responsibility across all of PHE. A digital-first approach requires all sections of the business to understand, consider and apply digital ways of working. PHE digital team has a role to promote and aid this change across the organisation. Setting out standards and designing guidelines will help guide this change.
The digital team is part of the Chief Knowledge Officer’s directorate. It aims to:
- develop and maintain a digital strategy for PHE
- lead and manage some core digital projects and services for PHE
- work together within PHE and with a wide range of government, industry, academic and other partners to develop digital public health tools and ways of working
- help and advise on digital change across PHE
The team is also responsible for building a set of core foundational products that can be used across the organisation and as a basis for public health change and for new models of public health. These are explained in more detail below.
Digital ways of working will be embedded within the Harlow public health science hub conceptual model. Milestones will be aligned with the annual work plans and with the timelines set by Harlow.
GDS have set out clear standards and guidance for government digital products and services. The digital team has an important role in supporting PHE to use these development guidelines in a constructive way. The team also oversees the government digital spend controls process within PHE including implementation of standards for digital practice. To do this we will need to recruit a dedicated user research team within PHE.
The digital team has started to increase digital capacity across the organisation and has developed some digital tools. These have been built using a platform approach, by making sure each project adds to the one before. The next stage is to consolidate these platforms, develop them further and create exemplar models of change.
Each of these platforms will include:
- a common design pattern
- a common data standard and information architecture, with adherence to data governance and security
- shared infrastructure, such as hosting
- common code components that can be re-used and shared
- a centrally-developed product on top of which third parties can build and provide further services or local areas can adopt for their populations
We will also apply shared standards, share code where possible and reuse as much as we can with each product that is built. This platform approach will allow parts of this digital ‘jigsaw’ to be updated as needed, and this will be an efficient way to control development costs in the future.
3. What PHE will do in 2017 to 2018 and beyond
We intend to support digital change across PHE, using the digital team for consultancy and support and to build shared platforms. Digital change will happen across PHE. Examples of actions that will be taken in 2017 to 2018 are:
3.1 Public health leadership
PHE has a role across the public health system to support change by working in partnership, promoting case studies and examples, setting standards, influencing and creating new models of public health. This leadership role includes external communications and working with partners.
Actions for 2017 to 2018 include:
- maintain and develop the PHE digital strategy with regular updates
- develop new partnerships with innovators, industry, academia and others
- investigate an organisational model for PHE that will allow sustainable and rapid digital innovation
- build and test new models of public health behavioural change
- communicate learning on new public health models incorporating digital practice, including at PHE’s annual conference, via blogs and at PHE digital days
- identify scientific and research opportunities in public health generated by new digital ways of working
- support the development of data science opportunities arising from digital projects
- promote and support best practice for tackling the issue of digital inclusion, investigating partnership approaches to support the cross-government work on digital exclusion
3.2 Digital awareness and understanding across PHE
An essential part of developing digital transformation in public health is to build a common understanding of how to approach this work and also what is happening within PHE. Internal communication will be important to ensure there is a change in thinking and ways of working.
Actions for 2017 to 2018 include:
- communicate the digital strategy, standards, guidelines and examples of innovative work across PHE
- implement PHE’s agreed digital content strategy
- promote examples of what is already being done and is working within PHE, across government, in the health sector and in industry via digital days, blogs, case studies, reports published articles and at the PHE annual conference
3.3 Digital-first planning and delivery
Digital-first approaches will become mainstream across the organisation and embedded in the business planning process. The PHE digital team will publicise existing standards for digital products, develop guidelines tailored to PHE to guide decision making and product development across PHE, and help design ways of prioritising spend. They also maintain a list of planned and existing projects and will help create a system of prioritisation to better align with both corporate priorities and technical capacity within PHE. There is a need to further clarify roles and responsibilities between the digital team and ICT.
Actions for 2017 to 2018 include:
- refine the role and operational structure of the digital team within PHE and clarify expectations of support for other teams
- integrate digital work into the annual business planning cycle, learning from 2016 to 2017 and making recommendations for next year
- build on the current digital spend controls pipeline to create a model of priority-setting for digital investment in PHE and a clear governance structure for decision-making
- improve the digital spend control process to ensure it aligns with other spend controls within PHE and work with DH and GDS to have a more devolved model of approval
- design and develop an operational ‘product owner’ model for PHE which clearly sets out roles and responsibilities for each stage of the digital product cycle and ensures that the strategic roll out of digital products lies with the business leads within PHE
- create a multi-disciplinary ‘design authority’ within PHE which can guide and authorise the introduction of new technology and help find the balance between information governance and open data
- create a user research team within PHE to support major projects and provide consultancy and advice across PHE
- use the government’s digital inclusion scale and checklist when endorsing or building a product to allow us to track the impact on digital exclusion and better understand the support needs of our users
3.4 Foundational digital platforms
The digital team is working with partners to build or develop a platform approach. This new way of working will ensure that we are able to share and reuse the knowledge, skills and products or services that are created where they are most appropriate, rather than following a one-size-fits-all model. This work will lead to the development of a set of core products that can be used across the organisation and as a basis for public health change and for new models of public health, notably:
Consolidating content from pre-PHE websites
The need to support many legacy websites following PHE’s creation from over 100 different organisations adds unnecessary costs and additional complexity for PHE partners who depend on the content information they provide and who cannot find it while it is detached from PHE’s corporate presence on GOV.UK. This goes beyond merely moving sites over to GOV.UK and requires getting PHE to think differently, conduct user needs research, and redesign sites with partners.
Bringing this disparate information together helps the users and has in the majority of cases led to an increase in use. We also need to introduce user needs training and capabilities. Well over half the legacy sites have now been moved, leaving many of the complex, data rich sites for the new phase.
The existing PHE intranet is not fit for purpose. Our research points to high levels of user frustration due to poor user experience, limited functionality for some staff and poor access. It fails to provide an effective platform for internal communication, collaboration and knowledge exchange.
Our vision for the new intranet is simple: intranet as a collaboration hub, with fast access to the relevant information. We are currently in beta stage of the agile process and are conducting a technical appraisal of platforms that will supply our employee and organisational needs. This decision will form the basis of the beta stage proposal. The estimate for finishing the project is currently end of 2017, but some features will become operational sooner: as each stage is completed, the old service is turned off.
There are some tools available for collaboration across PHE (shared drives, email, Skype for business, SharePoint team sites). Collaboration platforms (such as Atlassian suite, Planio and Trello) are used by some teams and use of tools such as Yammer is increasing. Further work is needed on information sharing and collaboration across different work units; this is closely linked to the intranet redevelopment project.
A planned customer relationship management system will roll out in phases across PHE. This is an organisational change programme and a strategic enabler. It aims to create a single customer view across internal, public and partner audiences. Tools are also planned for engaging with public health partners and local actors (B2B). Finally, commercial tools that engage with customers are included within this range (B2C).
Mobile is an essential digital channel. PHE has relied to date on ad hoc app delivery using agencies. This has resulted in:
- a silo approach
- no economies of scale
- lack of use of best practice behaviour change insights
- poor or non-existent data capture
- failure to meet development guidelines and standards
- limited code libraries
In reality, apps and mobile services share many common components. We need to move away from building our own products in silos. This approach will establish a robust mobile platform made up of shared components and well-managed data, glued together by open standards and transparent information governance. It will allow PHE to move away from simply building internally, or relying on external agencies, to a more sophisticated approach, allowing for partnerships and adapting products that already exist.
Actions for 2017 to 2018 include:
- define the platform approach for PHE, identifying and developing a resource of common solutions and components that can be shared across the organisation
- continue the transition of legacy websites (end date expected 2018)
- complete the beta stage of the intranet project, deploying features as they become available
- develop and test technical customer relationship management (CRM) products for the marketing and knowledge and intelligence teams with an expectation that marketing campaigns will be running on the new CRM in 2017
- understand requirements and scope for information services for PHE Centres and other local units, designed around local partner and user needs
- scope out and test a new approach to combining health intelligence tools
- ensure an agreed mobile approach is in place; existing apps have a plan to bring them up to standard or retire them
- develop and test an evaluation process for public health digital tools and apps to allow PHE to endorse or partner with existing products
3.5 Digital skills
We need expanded skills and resources to manage the development, roll-out and ongoing support of new digital capabilities. We need to embed learning and development for digital ways of working across the organisation so that staff at all levels can become ‘digital natives’ and ensure that there are some core technological capabilities and skills in the workforce that will support the entire structure and vision of PHE. Agile project management is required for digital products and this sits uncomfortably at times with our ‘waterfall’ approach to project management.
Actions for 2017 to 2018 include:
- updated learning and development plan for PHE to include digital skills and Agile programme delivery skills
- an updated approach to workforce planning to include new roles and skills within PHE
- revised approach to recruitment including approval of job descriptions for new roles as needed and new approaches to recruitment
- a programme of online learning and webinars
3.6 How we will measure progress
Organisations can be ranked according to their digital maturity, ranging from beginner, to adopter, master and digital native. This benchmarking can be used to help PHE as a whole or individual business units benchmark their progress and to increase awareness of digital maturity. Table 2 below shows a model of a digital maturity index for PHE that supports our objectives.
Table 2: Digital maturity index for Public Health England
|Themes in digital maturity||Beginner||Adopter||Master||Digital native|
|1. Public health leadership||A few isolated models of digital public health. Absences of clear joined up tech and data strategy||Digital public health begins to cross PHE’s organisational boundaries, internally and externally. Tech and data strategies are merged||Research and innovation is widespread, with clear partnerships in place, and some clear proofs of concept for new models. Clear, linked tech and data strategies in place and working||Innovative models of public health embedded, co-designed and partnered across the public health system, disseminated and constantly being tested and evaluated. Strong tech leadership in PHE allied to public health practice|
|2. Digital awareness and understanding||Limited understanding among staff of impact of digital on PHE and public health landscape||Base level of digital awareness and some opportunities to use digital to support PHE objectives||Comprehensive awareness of digital opportunities to transform public health and strong partnerships in place||Clear ability and competence to identify and pursue new strategic opportunities for PHE using digital expertise and collaborative work with partners across PHE|
|3. Digital-first planning||Digital not considered or an after thought for employee, public and partner services||Digital options for services considered on a case by case basis and embedded in annual business planning. Prioritisation approach developed for investment||Digital designed as the default option for the majority of products and services within PHE and investment based on agreed priorities||All internal and external products and services designed, where appropriate, as digital and fully based on user needs|
|4. Use of strategic digital tools and platforms||Little or no availability of digital platforms and tools and limited connection with ICT and others strategies||Limited or patchy use of digital platforms and tools and limited use of data. Agreed approach to technology across PHE||Increased organisational efficiency and effectiveness from general use of digital platforms and tools generating joined up data||Digital platforms and tools enabling smarter ways of working, with joined up technology, tools and data across PHE|
|5. Digital skills||Low levels of digital skills||Important digital skills and roles defined and basic digital competency in some areas||Advanced digital skills, clear workforce and recruitment development plan||Digitally ‘native’ with an implemented recruitment and development plan|
Most parts of PHE currently rank as either a beginner or adopter in these areas, with some areas of higher achievement and excellence. The actions taken against the objectives will help build digital maturity across PHE, and we will also develop some self-administered guides for individuals, teams and projects to help measure progress.
4. Annex: government digital strategies
The UK is ranked top of the 2016 United Nations E-Government Development Index, which incorporates access characteristics, such as the technical infrastructure and educational levels, to reflect how a country is using information technologies to promote access and inclusion of its people.
Digital ways of working within government are accelerating and rapidly becoming the norm. Every government body now has a digital plan and approach, and is working to a core set of standards that means government products will be increasingly joined up.
Coding software using open source technology, applying Open Data Standards, and sharing our learning is increasingly expected. It is important that PHE’s approach work aligns with the objective of ‘government as a platform’ connecting with other government departments and approaches. These include:
4.1 Government Digital Service (GDS)
GDS, part of the Cabinet Office, plays an important role in providing platforms, expertise and support across government and states that “We help departments work together to transform government and meet user needs.”
The Government’s 2014 Digital Strategy sets out the Digital by Default Service Standards, criteria to meet for digital teams that are building government services that handle over 100,000 transactions per year. There are 18 (originally 26) criteria that should be adhered to for the full life of the service a government organisation is providing.
Crucially, the idea is not to replace services with digital-only options: instead it is meant to encourage those who can turn digital to do so. A new government digital strategy is expected in 2017.
4.2 Department of Health (DH)
DH is a digital-first organisation, leading a digital-first health and care system. It aims to “make digital both the channel for increasing departmental openness, and a guiding principle for the way we conduct our work” and “by taking a digital-first approach to our work we will strive to make time and cost savings across all of the department’s work, help our staff to work smarter routinely, and lead an increasingly digital health and care system with credibility and confidence.”
4.3 NHS Digital
By 2020, NHS Digital (formerly HSCIC) aim to have “revolutionised the way technology, data and information are used to transform the delivery of England’s health and social care service.”
4.4 NHS England
NHS England (NHSE) has a bold ambition to harness the information revolution to make the NHS paperless by 2020.
4.5 Local government
Local government is also implementing digital change. The Local Government Association (LGA) runs Digital Councils to support this change.