Overhauling care identity management for NHS England

User research, journey mapping and careful examination of insight resulted in successful Alpha and Beta phases, and a 90% satisfaction rating from user testing


NHS England needed a modernised identity and access management (IdAM) capability to ensure secure and efficient access to health and care information systems for authorised end-users. The Care Identity Service (CIS) had been developed to meet this need, but further updates were needed to align it with GDS standards.

The outdated IdAM service was difficult and expensive to maintain, and failure to meet GDS standards had hindered efficiency and caused user dissatisfaction.

Modernising the IdAM capability, and implementing solutions that meet user needs, can improve service efficiencies and result in higher user satisfaction. A modernised IdAM capability can also lead to cost savings through reduced maintenance expenses and interoperability with other systems.

What we did

We carried out user research to uncover and define the problems our users faced. We used qualitative (interviews and observations of more than 40 people and surveyed more than 200 people) and quantitative data (web analytics and database analysis) to gain insights and a sense of priority over the issues.

From our user research, we uncovered a variety of pain points, and produced process/journey maps to express user needs and experiences. These were shared at stakeholder workshops and presentations to ideate and agree on areas for focus in design. 

We used discovery insights - which we uncovered working alongside NHSE's wider digital service design team – to define the design scope and areas for testing in Alpha. We followed a hypothesis-driven design process where we quickly designed a number of mock-ups or prototypes based on our understanding and validated them through user testing. Where successful, we carried those forward and where improvements were needed, we iterated our design and tested again until we got it right.

This included coded prototypes using the GOV.UK prototype toolkit for styles, components and patterns consistency, making the service look like GOV.UK. We tested with users to ensure we met needs and delivered at pace.

This approach has continued through Beta, with the validated designs being created into stories to fill the backlog and brought into sprints in priority order to support our users. In addition to this, within Beta, we have also carried on listening to our users through online and in-person feedback forums and through periodic feedback surveys.

We made sure to include users with low digital literacy and access needs across all research and testing to ensure solutions are inclusive and meet accessibility requirements.


A series of focused improvements were made to the existing service:

  • The service has passed all GDS phases and is compliant with WCAG 2.1 AA
  • During testing in Private Beta, 90% of users stated they were satisfied or extremely satisfied with the service; system usability was scored at 80.6%.
  • The service has 1.5k active Public Beta users (as of September 2023)
  • The service is scalable to meet the needs of the entire NHS registry community and its more than 1.8M end-users