Apply for Healthy Start - alpha

The report from the alpha assessment for NHS's Apply for Healthy Start service on 7 February 2018.

From: Government Digital Service
Assessment date: 07/02/2018
Stage: Alpha
Result: Met
Service provider: NHS BSA

The service met the Standard because:

  • The team know a lot about their users and their needs
  • The team have designed a good prototype
  • They have excellent KPIs in place and a good plan for delivering on them

About the service


The service provides vouchers for pregnant women and parents of children under 4 receiving income-related benefits. The scheme is also available to pregnant women under 18 regardless of income. The vouchers can be spent on fresh fruit and vegetables, infant formula and cow’s milk.

Service users

The users of this service are pregnant mothers, or those with children under the age of 4 who are in receipt of other Government support.


It was a pleasure to lead this service assessment. The healthy start team are passionate about their users and knowledgeable about their service.

It must be noted that they are a very small team which has led to some noticeable gaps in their work and a long list of recommendations for the assessors. For future Alphas, NHS BSA should consider investing slightly more to allow a more thorough Discovery/Alpha to take place.

That being said, the panel believe that the team have done enough to demonstrate that they are ready to move into private beta. The team should be commended for their performance.

For the beta assessment, the team should focus on building the user facing application process and learning more about how users use the card. This should include consuming data feeds and building out the appropriate architecture and processes to handle sensitive data. Work on the backend of the card management and payment systems should initially be limited to technical investigation work to prove the integrations with card suppliers and messaging platforms (e.g. Notify) are possible. This will help keep the private beta at an appropriate size and cost whilst the team explores the potential for a policy change to make this proposed new service design possible, and will allow the team to come back in for their next assessment sooner.

User needs

The team was impressed with the level of research that has been conducted in such a short space of time, with limited resource.

The research for the service has been conducted in two stages so far; the first being the Discovery in August 2016, with the Alpha being conducted much later from December 2017 to January 2018 due to a restructure at the Department for Health.

Research in the Discovery phase identified the key users to be i, people apply/using the vouchers ii, Healthcare Professionals who need to approve a users eligibility for vouchers iii, Retailers that accept the vouchers.

Although the research conducted in the Discovery stage was relatively limited in its volume (20 end users and 10 Healthcare Professionals), it targeted key user groups in drops in centres, and concentrated on areas where there was a high level of deprivation. This included people in vulnerable situations, people for whom English is not their first language, and members of the travelling community.

Although the research was limited, the panel was impressed with the depth of insights the team had got from the interviews. This has enabled them to understand the following key barriers to using the service:

  • Delays in getting approval for the voucher scheme from Healthcare Professionals.
  • Lack of flexibility in the way vouchers can be spent, as many users reported that they had to spend vouchers all at once, when they would have preferred an option to use partial payments.
  • Stigma of using the vouchers in shops, particularly when shopkeepers weren’t familiar with them.
  • Vouchers not being robust and easily damaged.
  • Vouchers only being valid for a week at a time.
  • Users moving address frequently can mean vouchers aren’t received by the intended recipient.

And that a new service needs to:

  • Enable payments to be updated easily/remotely, and not rely on vouchers being sent in the post.
  • Provide users with something physical and robust that won’t get lost or damaged.
  • Be a method of payment that’s more compatible with conventional ways of paying - removing the stigma of paying with a voucher.

The panel did, however, feel that due to the lack of resource, there were some big gaps in the research that could have been conducted in the Discovery. This includes researching the suitability of Healthy Start as a name for the service, and interviewing more end users and Healthcare Professionals who are currently unaware of/using the service. Particularly those who live in more affluent areas where awareness of the service is lower, and are more likely to fall through the gaps. This should also include people in rural areas.

As the Discovery only involved interviewing one user who wasn’t aware/using the service, the panel felt that more must be done to understand this group to ensure that everyone who is eligible for help in getting it. The team must also focus some of their research activities with retailers that accept the vouchers - understanding more about their needs and pain points and how the experience can be improved for them and the end user. They should also think about ways in which retailer details can be monitored to ensure the are accurate and up to date.

Going into the Alpha the team focused on two journeys for the service - Apply for Vouchers, and Spend Vouchers (the Card journey). The team decided that the process that a retailer would go through to register to accept the vouchers is currently out of scope.

User research in the Alpha focused on testing the mobile journey with end users, with some also participating in a diary study, and feedback through WhatsApp. Although Mobile has been the main platform people have had access to in the research so far, future testing must also include people using laptops. They should also look at Ofcom data to understand the types of devices owned by the demographic of people using the service. Testing so far has also involved communicating with users via SMS, however the team also need to look at (and test) other ways of communicating with users such as email and letter.

Team has managed to produce 3 end user personas which have help them identify and understand the key users of the service. Moving forward they should look to build on these through continued user research, while also building similar personas for Retailers and Healthcare Professionals. The team must also conduct research with users with accessibility needs, particularly ensuring that people understand the language used, and that the voucher card can be easily distinguished from other cards by people who are visually impaired.

Although building awareness of the service is outside the remit of the team, they have worked with colleagues at the Digital Maternity Exemptions service so that questions to determine eligibility for Healthy Start vouchers are included.

The whole team is regularly involved in the research activities, including attending user interviews, and analysis and feedback session. The current team has limited people responsible for delivery, and user research is covered by one member of staff who is also responsible for design, and technology. Moving into Private Beta this need to be addressed, with at least one dedicated user researcher responsible for research activities. However, the team should review this and assess whether the research should be split across the Apply and Spend journey with a dedicated researcher for each.


This is the smallest service team I have assessed so far in my time at GDS, consisting of one FTE civil servant service manager and a small third party supplier. Whilst the team are not co-located, they have effectively taken advantage of communication tools such as slack and trello to work productively as a remote team. Senior managers regularly attend show & tells and have empowered the team to make appropriate decisions about the service.

The team will need to grow significantly to succeed at private beta. There should be dedicated team members in user research and design as well as a full stack team of developers. And the team should ensure there are representatives of all disciplines at service assessment.


For the Alpha the team developed a prototype frontend. This allowed them to iterate the design of the ‘Apply’ journey without unnecessary development costs. This source code is available publicly on Github and the team intend to continue to code in the open. However the small scope of the Alpha meant that the team did not investigate integration with external systems which the proposed beta will rely upon. The result of this is that the team were unable to gain a substantial understanding of the technical challenges involved in these integrations.

For the beta the team intends to consume data from an existing data feed that is currently managed by a 3rd party. The panel would have liked to see a more detailed description how the data feed will be made available including what data will be exposed to the ‘Apply’ application and detail around how the data will be secured both in flight and at rest along with associated threat models.

The panel would also have liked to have seen a comparison of payment card provider API functionality along with a high level analysis of the costs of adoption. Several pieces of functionality were proposed for the Beta however there was no evidence of technical investigation to support the feasibility of these proposals.

The panel were happy to hear that for the beta the team intend to use Notify for communicating with recipients and to host the apply journey application on PaaS.


It’s clear that the team cares deeply about doing the right thing for their users.

One of the biggest changes to the service that is being made is the shift from vouchers to a pre-paid card. The team has explored various options for what would be the most useful way for users to receive their entitlement whilst still meeting the policy intent, and it certainly seems like from the results of the team’s Alpha that the pre-paid card would make a big improvement to people’s lives.

The prototype for the application journey that was shown is consistent with the style and design patterns used on GOV.UK. The flow of the journey seems well considered and it’s good to see the team have tested it using the devices that users would use.

The team do however need to explore options for the name of the service. “Healthy Start” does not sufficiently explain what the service does and so the team need to explore options which more clearly explain what the service does.

In terms of the journey for the end users, the service seems generally well designed and tested. Where the team needs to do a lot more work is for the journey shop managers and checkout staff. The journey for registering a shop for the scheme, including motivation to do so, needs to be well designed and researched as well, as does the journey for checkout assistants who need to decide whether or not to accept the card for what the end user wants to spend it on. The team presented very little work on these areas of the service, and it is essential that they look at these aspects before they move on with the rest of the project.

The timescale of the Alpha was short (8 weeks) which probably contributed to the team not being able to look closely enough at these areas.


The team should be commended on their approach to performance measurement. They thoroughly explored key performance indicators that could be used to track the performance of the service, baselined these where possible and set targets for where they hoped to get to with the new service. They have also already been in contact with the performance platform team to set up a dashboard.


To pass the next assessment, the service team must:

  • Explore options for the service name which describe what the service does more clearly
  • Do user research and prototype the journeys for participating retailers: Both the applying to participate journey and the accepting the card journey
  • Do research with a wider variety of users, including with those using laptops, those who are not already aware of or using the service, and those in affluent / rural areas.
  • Do user research with users with accessibility needs, ensuring that people understand the language used, and that the voucher card can be easily distinguished from other cards by users who are visually impaired.
  • Provide a technical and financial evaluation of payment card providers
  • Have demonstrated how data feeds will be stored/processed and how identified threats will be mitigated
  • Have put in place appropriate monitoring in order to ensure technical issues can be responded to in a timely fashion
  • Have a full team represented at service assessment, with specialists in tech, user research and design

The service team should also:

  • Encourage the Academy to fast track the training application for the service managers. This will be critical to helping to ensure they have the skills to succeed in beta.
  • The team should also focus some of their research activities with retailers that accept the vouchers - understanding more about their needs and pain points and how the experience can be improved for them and the end user.

Digital Service Standard points

Point Description Result
1 Understanding user needs Met
2 Improving the service based on user research and usability testing Met
3 Having a sustainable, multidisciplinary team in place Not Met
4 Building using agile, iterative and user-centred methods Met
5 Iterating and improving the service on a frequent basis Met
6 Evaluating tools, systems, and ways of procuring them Not met
7 Managing data, security level, legal responsibilities, privacy issues and risks Not met
8 Making code available as open source Met
9 Using open standards and common government platforms Met
10 Testing the end-to-end service, and browser and device testing N/A
11 Planning for the service being taken temporarily offline Not met
12 Creating a simple and intuitive service Met
13 Ensuring consistency with the design and style of GOV.UK Met
14 Encouraging digital take-up Met
15 Using analytics tools to collect and act on performance data Met
16 Defining KPIs and establishing performance benchmarks Met
17 Reporting performance data on the Performance Platform Met
18 Testing the service with the minister responsible for it N/A
Published 6 August 2018