The first plan is the worst plan | Weeknotes S01 E02

11 Jan — 1 Feb 2019

5 min readFeb 26, 2019

As you get closer to the point of actual delivery, I find that a product manager’s role changes.

Early on in the product development cycle it’s about pulling together various strands in order to define and describe the product vision. At the mid-way point it’s about keeping the team focused on the goal — prioritising the steps that will get you there and pushing aside the distractions.

At the end of the cycle it’s about being a cheerleader for your product — reminding people what you’ve done and why you’ve done it and why you should be trusted to work on the next thing. And if the next thing does come your way there will be planning.

For me, the last few weeks have been dominated by 2 plans: the big, long-term one for the NHS and the smaller one for my team working on iterative improvements to the NHS website.

The NHS long-term plan and what it means for me

Plenty of people better qualified than me have published their responses to the NHS long-term plan. In particular, I recommend:

But none of these articles tackles the issue of what the NHS long-term plan means for James Higgott, a product manager working on the NHS website. To fill this vacuum, here are my top-5 take-aways:

1. Key goals for digital services are clinician efficiency and patient empowerment

Everyone has their favourite paragraph in the long-term plan, right? Mine is paragraph 5.6, which starts on page 91 and concludes on page 92. The first 2 sentences are forgettable but the last 2 are *Italian chef kiss*:

Technology will play a central role in realising the Long Term Plan, helping clinicians use the full range of their skills, reducing bureaucracy, stimulating research and enabling service transformation. People will have more control over the care they receive and more support to manage their health, to keep themselves well and better manage their conditions, while assisting carers in their vital work.

If you work in public-sector health tech right now this is the vision. This is what your work should be supporting.

2. There is a premium on evidence

One might expect health policy to be based on (or at least guided by) evidence in the same way that medicine is evidence-based. That’s not always been the case though.

Evidence plays a big part in the long-term plan though. There’s a desire to take what’s been learned from the vanguard experiments done as part of the five-year forward view (the new care models) and roll this out across the country. New Rapid Diagnostic Centres for cancer are based on a successful model piloted with Cancer Research UK.

The message seems clear to me: if you want funding and support for your big idea you’re going to need to start small and demonstrate evidence of effectiveness.

3. Policy-makers and national/regional delivery leads should embrace the power of the NHS website

There are hundreds of goals and objectives for individual services in the long-term plan. Many of these could be supported by activity on the NHS website, from a simple update to some existing content to the design and delivery of a new digital service.

If you want to publish top tips for young carers (page 43) where better to do this than the NHS website? If you are offering weight management services (page 37) you should think about the NHS apps library. And if you’re rolling out Rapid Diagnostic Centres for cancer (page 59) you might want to think about updating the diagnosis pages on nhs.uk.

So my plea to policy-makers is this: think about how the NHS website might be able to help you achieve your goals and get in touch. We can support behaviour change, information provision, signposting and finding, transactions and more. We get 40 million visits a month! Let us help you.

4. The award for creative use of language goes to…

It’s a tie! ‘STOMP-STAMP’ and ‘bundles’ are the joint winners.

The STOMP-STAMP (Stopping over medication of people with a learning disability autism or both and Supporting Treatment and Appropriate Medication in Paediatrics) programmes have possibly the most elaborate acronym in the whole of the NHS. And there’s a lot of competition in this field — there are 2 full pages of acronyms at the back of the long-term plan.

The new buzzword seems to be ‘bundle’. We have the SAFER patient flow bundle, the saving babies lives care bundle and the COPD discharge bundle. What is a bundle? It’s a collection of good practices that, when bundled together, deliver positive change. For example, the SAFER patient flow bundle has 5 elements that, when taken together, improve discharge from hospital.

5. Remember — it’s a marathon, not a sprint

The clue is in the title: it’s a long-term plan, not a plan for 2019–20. And the extra £20 billion for the NHS isn’t coming now, it’s coming by 2023–24. Between now and then the NHS budget will grow by about 3.4% a year, which is about what you need just to keep up with rising demand for health services and cost increases for things like medicines. So don’t expect there to be lots of extra cash sloshing around to pay for this.

The things in the plan need to be built and these things take time. And I hope that they are not set in stone — plans must be able to adapt to changing circumstances.

Planning — a quarter at a time

My team and I started work on a bunch of new features for the NHS website. Features are one way in which we iteratively improve the NHS website. They describe chunky problems — like ‘the way in which we signpost users to urgent care services needs rethinking to align with NHS policy’ or ‘our autism content isn’t meeting user needs’ — and we work out how to solve them.

We’re a fairly big team so we are working on between 3 and 5 of these at any time. We grabbed four high-priority problems off the backlog and started thinking about how to address them.

Do we understand the problem?
How much evidence do we already have? How much more research do we need to do?
What skills are we likely to need?
What are the potential risks?
And so on

Early planning sessions are messy affairs, which is OK — there are a lot of unknowns.

And the plan we created was out of date within a week. This is also OK, as long as you don’t try to stick to it.

The first plan is the worst plan (I’m TM’ing this phrase — as far as I can tell no one else has used it). But there has to be a first plan for there to be a second, third or fourth plan. And there has to be a worst plan for there to be a better plan.

This week’s cultural highlight

The Three Body Problem by Liu Cixin. As ever, I’m late to the party — this book was first published in English in 2014. It is very good sci-fi, full of big ideas on a massive scale. And I think it might be the first thing I’ve ever read by a Chinese author.