Everything we do on the NHS.UK alpha is based on user needs. But around us there is talk of something else – system needs. I hear things like ‘we can’t just think about user needs, we have to think about the system needs, too’.

I don’t believe system needs are a thing. I think they’re user needs in disguise. And this is why…

The people are the system

I have to admit that I had no idea what system needs were when I first heard the term. I was puzzled. Where was this system hiding? Where were those needs kept?

I didn’t understand how the system was different from the users. And I still don’t.

Two images:


Screen Shot 2016-03-03 at 09.43.45


Screen Shot 2016-03-03 at 09.44.06

Number 1 is a room with chairs, a window with blinds and a reception desk.

Number 2 is a GP waiting room.

It’s the people that make the second image a GP waiting room. They’re there with a need – a user need – that the doctor or nurse who’ll see them is going to answer.

To be able to do their job, the doctor or nurse also have their own specific user needs.

These are the people who make up the system. So why aren’t their needs the system’s needs?

User needs are about real world things

While I’m confused about system needs as a separate thing, I have a very clear idea what user needs are.

Here is one:

As someone with a child who has X, I want to treat my child at home where possible, so that I don’t have to go to my GP surgery and take up a slot.

I haven’t made this up. It’s what 3 young mothers told me when I interviewed them during our recent pop-up research day at the Mawbey Group Practice in South London.

They were only there because ‘the GP is the last resort’.

User needs are about real people moving through a real NHS. Most of these journeys have an online and an offline element.

Behind every system need is really a user need

Here are a couple of examples of system needs:

  • the NHS needs to save money
  • the NHS needs patients to become more activated

We know from our research that patients want autonomy and take charge of their illness where they can. But no one wakes up in the morning and thinks ‘I want to become a more activated patient’.

They think ‘where are those 3 letters with my test results that I need to take to my hospital appointment today?’.

One of the suggested solutions is to give everyone access to their health records. But to design useful solutions we have to make it real.

Behind the system need about activation are really 2 user needs:

  1. As someone with condition X, I need to tell my patient story when I have an appointment, so that the person treating me knows if the treatment is suitable.
  2. As a healthcare professional, I need to know a patient’s full history, so that I can give them the best possible treatment at the right time.

Well answered user needs benefit the system

When we researched the user needs for type 2 diabetes, people told us they have to repeat their story whenever they see a healthcare professional.

We saw patients at the Diabetes UK day carrying large paper folders of their history so they could keep track of things.

Easy to understand information and easy access to the right services can help answer these needs. Linked-up patient information can also help healthcare professionals treat their patients.

So ‘activation’ is really an outcome of a well answered user need.

As is saving cost. Patients who have easy access to the right information can use their appointments effectively. They’ll also have a much better experience.

Professionals with access to information that answers their needs will be able to do their jobs better.

The outcome from both sides is less time spent on things that aren’t necessary and cost the NHS money.

Thinking about user needs forces us to be real

‘The system’ isn’t some alien organism that’s living somewhere separate from the people who use it.

We, as people who work in the NHS, develop system solutions to answer user needs.

The system itself, however, doesn’t have needs.

Talking about system needs encourages us to work in isolation from the world out there. It puts us back into the bubble and back into silos.

We should burst that bubble, do the hard work and always ask ‘what’s the user need behind this thing we’re aiming for?’.

In the long run, a well answered user need will benefit the patient, the health professional and will therefore help the NHS to provide the care people need.


  1. Comment from George L

    Well, yes, but… any system does something useful is potentially quite complex, particularly if it’s been around a while. It can’t be changed overnight. So sometimes there are practical considerations – the user need in question might be as simple as “everything that currently works must carry on working” – but that is kinda taken as read.

    Effectively, the system does have needs – to deny that, is to refuse to consider the question “how to I get where I want to be, given where I am now”.

  2. […] There are no system needs, only user needs | NHS.UK Alpha blog ‘The system’ isn’t some alien organism that’s living somewhere separate from the people who use it. […]

  3. Comment from Dr Greenwood

    I am worry about the clinical safety of what you are doing, digital services are really important, but this post fundamentally demonstrates a lack of understanding about the healthcare ‘system’. No matter how much we can make it simple for users it is a supply and demand challenge.

    The part about “We saw patients at the Diabetes UK day carrying large paper folders of their history so they could keep track of things.” implies that this is not appropriate and the solutions you are building may meet a users need when everything works, but if they are centrally servered and technology fails the users through flat batteries, bad wifinets, network issues then we start to introduce a risk around clinical safety for patients, what are they going to do? Increase demand to me.

    I would like to know if you are going to carry this risk for my patients and how the increase in my demand to general practice is going to be addressed, if something goes wrong I am have to go to the coroner, that’s how the ‘system’ works and I wish to see a post on how this is going to be actually tackled and I don’t mean ‘we will work with local areas’ if you do not know what you are doing, you shouldn’t be doing it.

    Please can you respond with the name of the clinical accountable officer and their details please, I need assurances to how this affects my patients.


    • Comment from Hinrich von Haaren

      Derekk, thanks for your comment. User needs include both – needs from patients and healthcare professionals. We’re not suggesting at all that there shouldn’t be any clinical assurance. Quite the opposite. We have clinical assurance built into all processes on the project and fully recognise its importance. By a user needs-led approach we mean that the needs of patients and professionals should be assessed before anything is built.


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