Why we’ve put sustainability into the NHS digital design principles

As the NHS embraces digital technology to improve the efficiency and effectiveness of its services, it is important to consider its environmental impact. The energy consumption of servers and devices, the amount of data transmitted and stored, and the disposal and recycling of electronic equipment are all factors that contribute to the carbon footprint of the NHS.

With millions of users, including NHS staff, accessing our digital services every day, we have a responsibility to make sure our digital offerings are not only effective and efficient, but also sustainable in the long run, and do not unduly contribute to the environmental impact of the health system.

About a year ago, a dedicated sustainability working group at NHS Digital (now NHS England) began to explore how our service design process can help the NHS and broader health and social care system meet our ‘net zero’ goals. We recognise the crucial role that sustainability plays in the design and delivery of our products and services and want sustainability to be prioritised alongside other considerations during the service design process.

The working group started by facilitating a workshop at the sustainability-themed design community away-day to understand what was important to the design community when considering sustainability, and what barriers they believed they would encounter in their day-to-day work.

We were careful to make sure that the sustainability requirements placed on the design community were fair and appropriate. While the importance of sustainability cannot be overstated and we all agree we must act now, we did not want to put an undue burden on the designers without providing them with the necessary tools to manage the added responsibility.

The working group identified 4 key problem areas for embedding sustainability into the design process:

• guidance
• process and tools
• measuring impact
• senior leadership support

Based on the feedback, we decided to use ‘guidance’ as the starting point. How might we help designers understand the importance of sustainability in their practice and incorporate core concepts into their thinking and into our design processes? Or simply, how might we help our designers to ask the right questions to initiate a meaningful conversation about sustainability?

The NHS digital design principles provide guidance for anyone designing products and services for the health and care system, including principles around inclusion, usability, and user needs. To encourage a focus on sustainability in design, we decided the creation of a new NHS digital design principle would be a good first step in encouraging all designers of health and care products and services to integrate sustainability into their work.

Starting with a design principle is starting small. From this, we can expand towards more detailed guidance and eventually work with the GOV.UK Service Standard team and the Department of Health & Social Care (DHSC) assurance team to embed sustainability into the NHS service standard.

In January, we sought responses from the wider community through social media on the 2 proposals we had developed for the new design principle. We received a wealth of feedback and suggestions, which helped us to refine and focus on specific aspects of the principle that were important to the community.

On the back of all the work done by the working group, we have now published the new design principle in the NHS service manual:

We wanted to focus on environmental sustainability as this was the aspect that resonated most with the design community. We felt the social and economic aspects of sustainability are covered in our other design principles, but the environmental aspect was missing.

We would like this principle to encourage designers and anyone who is designing digital products and services for the NHS to consider the environmental impacts of their designs. The community should strive for solutions that minimise negative impacts and maximise positive ones.

There are many ways that this principle could be applied in practice. For example, designers could reuse the common code and components already available in the NHS digital design system. They could consider the energy and resource use of digital services and aim to reduce the carbon footprint of these services wherever possible. They might focus on designing services that minimise data usage or the size of images or videos stored in servers, or work with our technical architects to optimise the server infrastructure of the service.

While some of these questions may be challenging to measure, they are still important to discuss. For example, how could designing more accessible and inclusive digital products and services reduce the travel needed by patients and staff and, in turn, reduce the environmental impact?

By adopting the new principle, the NHS design community can make sure that the digital products and services we deliver are not only effective and efficient, but also sustainable in the long run.