 It's quite interesting to come after people who've been talking about projecting onto clouds and animating prehistoric animals because I'm really talking about something very today, very kind of normal and ordinary. I'm talking about how we can make better services that all of us use. The reason I'm here is that we've been taking a little bit of the culture of making and prototyping and making things quickly to try and solve bigger problems. We're just coming to the end of a project that I'm sort of going to talk about it, where we've been helping the NHS understand how to help older people have better deaths. I'm not really going to talk about all of our findings and learnings back to the NHS. I'm going to talk more about our approach and how we've worked and the things that we've understood. We thought everyone, we're really new, we were founded, to be honest, we didn't really start properly until probably January. Last year we found that Marflenn Mifox did the Dembuilby lecture on machine one, which some of you might have seen, which was talking about how we ought to be able to make technology before everyone. We ought to be using it as a force for good to drive equality as opposed to just money making. It's taken us a little while to work out how to do that and what it looks like. To be really honest, we probably don't really know yet, but I'm thinking right now is that there's the gap. There are people who have everything. The worlds that are opened up to you, the small maphoni in your pocket and the first internet connection aren't there before everyone. There are 12.5 million people in the country who don't have basic digital skills, and that means that their lives are harder. Can we start to create not only ways that that gap can be closed, but can we speed things up? We're a really small team, so it's not really possible for us to do enormous projects, which means that we need to do things quickly that have impact that people can understand. The areas that we're looking at are the skills. This isn't only the skills of people who may need to learn how to email. We're really interested in the skills of commissioners, how much to appease, really understand about the internet as they're legislating. To maybe try and turn some of those things that are a bit buzzwordy into proper things that people understand and can talk about and have opinions about. The team that I'm looking after is the services, and we'll talk about that in a moment. The other thing that we're really interested in is ethics, because it feels like there's lots of slightly hidden things and there's lots of things that people who understand them. People who understand the blockchain can have a very different conversation about the WP app that was recently launched that's attracting people's spending to people who've just heard it's cool and think it's new and interesting. There's lots there. I will be talking mostly about the work of this group. Actually, not everyone is there. There's a couple of others too. We've come together over about six months this year to do some prototyping. I have three bits. I'll be talking about our understanding of the prototype. I'll be talking about how that has helped us do the hardest thing first and then a little bit about our understanding and the value of that. The theme is can we make small things that help us to understand large problems? A thing that I'm really interested in, our ambition, is can we make the things that really weren't for everyone? By everyone, in Croydon, for instance, there are 15 families who use something like half of all the public service provision. People who really need help. Normally, the thing that happens is the services aren't made to work for them. The things that are made to work for them are the key workers who work around them. For things to really work and to take the flight and to be manageable over time, they have to work with the people who are providing the service too. We've seen lots of things in the public sector, lots of work-arounds. The number of doctors I've spoken to who find it quicker to watch out for a picture of a patient rather than logging into the system, finding a colleague, bringing them over. For things to work, they need to work not just for the people who need them most, but they need to work for the people who are using them. Lastly, they need to work for all of us because a good service that we're paying for ought to be changing and improving our lives all of the time. That's a very high ambition and I don't know if we're really able to achieve it, but we can try. Just quickly about what our thinking is about prototypes. It's really important to say that we're not at a point where we're building pre-alpha software that's about to go into deploy. This is more things that help us to understand the problems, things that we can show to people, things that we're able to talk about. The thing that is really uncomfortable there is how do we do that without going too far into speculative design? How do we do it without looking like we're talking about the futures that aren't really attainable? A thing that I suppose is really clear is that if you can't imagine properly a thing that you're making, it's very difficult to work out how to make it. If you're talking to people in the NHS, if you're talking to people in the government or a person who works in the library, it isn't up to them to be understanding the implications of machine learning. The job is different. They have no frame of reference or ability to understand, but because they have an expertise, they're likely to have a very compelling story. A thing that happens loads that probably everyone has seen is that the problem with imagining things is that everyone imagines a slightly different thing. Then it never really happens or it's terrible or it's really complicated. It's like little nuggets that show the possibility in order to bring everyone together. The reason to do that is to work out how to do it. I have an example I'll talk about later where we spent quite a long time trying to make some fancy software. When we realised actually the problem was the people who the fancy software before didn't have an internet connection. We understood that very clearly by trying to take it in a tester because it was un-testable. In that example there, the first-order problem is giving them internet, which you're able to start thinking about now, not in a year and a half as the project is about to launch and then it goes wrong. I'm about to do a really horrible thing, which is I'm showing the Gartner hype recycle, which is very grim. The reason I'm showing it is because there's loads of people thinking about this. There's loads of people thinking about all these things over here that are going to happen in five years. They're thinking about the robots and AI and the fancy clever things. But not very many people are thinking about slightly more boring things about making it work now. The thing that tends to happen is if you're over here, zooming off over here, there aren't many people who are looking backwards and thinking, how can I take everyone with me? That is really the thing that we need to do and start thinking about. Actually, if you're in a local library thinking about how to help people use your service, which is over here somewhere, it's not very clear to you if everyone is talking about the clever things about can we automate this, can we make an app, what it actually means. There's lots of bad decisions that are made. To try and move this on, we've been making things. This thing here is a piece of paper with very low tech. There's a lady holding it, giving it to another lady. This is demonstrating a little bit of what we've done around creating an entitlement that was taken before older people. Where you would, for instance, be able to walk into the pharmacy and they would know it's you and have your drugs ready, if you order a macabre, it's the right sort that you're able to get into. Those are things. When we started to think about it, the thing that we realised is there were loads of ethical problems. Prior to thinking about any of the technology or any of the data or any of those are things, the things that we needed to know are, is this a thing that people actually want? Is it very comfortable to send messages to others? Is it feasible? Just as a really simple way of understanding that, we have a piece of paper. The great thing about the piece of paper is that you can show it to anyone and they understand it. I don't have to talk about it for the five minutes, it's really clear. As I was saying earlier, the more that you understand and crystalise a thing, the easier it is to make it and to understand the problems of making it. I will just quickly show some of the different kinds of prototypes that we've made. You'd be quite correct to think that this looks chaotic. There's all kinds of slightly different things that do slightly different things. They're not really drawn together by a kind of common methodology, but they're all different ways of trying to get to the heart of a problem. These here are some postcards that have RFI details in them with audio clips. This was the thing I was talking about earlier where we were thinking about, people in care homes who might be quite isolated, who are quite often quite depressed or lethargic and can find it quite hard to be motivated to pick up the phone or those kinds of things. Could we create quite a simple kind of giving service where you can send a card to a person? Our end-to-end experience involved phoning up a phone line, leaving a recording, and then that got turned into the RFID chip. This felt to us as people who've been thinking about glanceables and ambient tech for ages, to really, really nice thing. Maybe it is, but I don't think it's a thing that anybody wants, but that's the buy. A thing that we learned about it was that actually there's loads of technology in the care home. There's loads of technology that could allow people to communicate. The problem is that people don't have it. It's not that we need to be creating new products. Actually, that feels quite obvious, but it's quite a brave thing to say. It's quite a brave thing when you're talking to the NHS who have lots of innovation funds who are trying to be really sort of modern and forward-thinking and have dozens of groups looking at interoperability. You basically must say don't make any things put internet in. It's almost too easy, but sometimes the things are. This was part of the same project. This is a bot where people could ping each other anonymous gifts, so it might be a recipe, a song, a picture, because we did quite a lot of work specifically, I suppose, looking at the value of reminiscence and reciprocity. There's a really important thing that most people don't really want to be helped, really, and that you get a lot more out of an experience if you're given meaning and the ability to help another. This was an exercise in trying to understand that. We will look at this slightly more in a minute. This is probably getting a little bit more into what people think of as a prototype with some software that the front-end works. It doesn't really speak to anything, but it gives you a demonstrator capability. In terms of context, I think this here took a day and this was more like a month in terms of thinking about the whole experience and the user needs and the context. Then we'd like to add to the general chaos of trying loads of things and seeing if it works. We experimented with putting a few things out on the internet, quite simple sites that try and help us think about or speak to bigger things. This here is a site where people can go and tag legislation that will be affected by Brexit. There's three and a half thousand, 35 thousand. There's loads of laws, basically. It's not really known how big the problem is. We've, as an experiment, created a crime-sourcing wiki. The big project that I was talking about that's taken up lots of time is thinking about care for older people at the end of life. In a way, this was quite a silly thing to start with because it's really, really hard. Dying is the most profound thing that ever happens to us. The NHS is the most complex disorganised organisation. There aren't many people who've created technology in the NHS and come out of that kind of cheering. We've done it quite quickly for a thing that it is, but it's still six months and we're still writing up. I hope some of the things can make a proper change, but I'm not really going to talk about the end result. It's more that this experience of thinking about what older people and the people around them need at the end of life has really helped us to understand how important it is to sometimes tackle the hardest thing first. The classic thing if you're in a meeting at work when people say, I don't know, easy, easy, or on those horrible Boston box things and you're grouping everything. It's often really attempting to do the easy things first, the easy quick things, and that actually doesn't always really help you because if there's 100 things to do and you do 99 easy things, and the 100 is really, really hard and is going to take a year and a half, then that doesn't, I suppose, add to the general quality of understanding. One of the ways we've done this is by really thinking about and understanding people's experiences. So this is an experienced map here that you can't really see. But the thing to note, this is about Mike who is at the beginning in his sixties and quite well and over the time he becomes quite unwell. And the things that we've done is we haven't prototyped things for this whole end-to-end experience. We've looked at, I'll just go over here, the hardest bits, this is really long, it carries on and on and on and on and in here there's about six points where there are lots of people talking to each other, where there's lots of information moving around, where there's lots of change happening, where the actors are not sustainable. And we've chosen to begin there and to kind of take those moments apart and prototype those in the hope that that helps us understand how to make those work. And partly this is in a very emerging understanding about work. The kind of clearest thing is the principle that we ought to be creating things as a message for the people who need it most. Everybody had seen this. It is not true. And I think every incremental change helps. And it's been really interesting looking at the experience of older people. Britain is now the oldest it's ever been and we will continue getting older and older and older and we will live longer. And yet no one really talks about it. People aren't present in the world. I think if I'm lucky I will live, I'm estimated to live when I'm 98. That's a long time, that's a lot of life and there's a lot of living there. So actually it feels really important to address the problem of those people who will be becoming, I suppose, like us, everyone here, I hope, will be coming on person. It's important to all of us. And the thing that we've seen is actually it's not like the niche, it's not like the liars. They're the people who experience the kind of true NHS experience. Because if you're being seen by maybe the six doctors in the three hospitals and you have a district nurse and an occupational therapist, it's like the absolute exploding point of all these systems that don't talk to each other. The three appointments that are booked to happen on a Tuesday afternoon are opposite ends of the city. But actually if we're able to get experience of those people who are generally marginalised and not really thought of as being at the heart of the things, then actually we ought to be able to get them right for everyone. But like a lot of the time when we talk about accessibility, we're thinking about the standards, we're thinking about the design, we're thinking about the code. We're not thinking about the whole experience and situating in a place that people who need it are really able to use. And I think actually prototyping making tiny things is a good way of learning and understanding this because lots of the patterns that we're accustomed to are made for the people here. So when you go to a service and it says, in the Facebook, that presumes you have a Facebook account, for instance. And it's kind of interesting. A thing that becomes attractive to me about making lots of small things and seeing how they work is that it's really different to the things that are happening in the valley. This here is the people who write the Facebook timeline algorithm, all eight of them, all men. And they're making choices about the things that 1.3 billion people will see. So actually, there becomes, just as an intellectual exercise, there's something quite pleasing about moving away when there's really standardised things. Have I turned off? I may have turned off. Okay, cool. Can you hear me if I carry on talking? So the other thing, I don't know if anyone this is really good. This is a great post on Medium. Thank you. Which is about how lots of really common everyday things are designed for men. And this is interesting because men are generally bigger than women or children. And the seatbelts, say this here is a crash test dummy and women are 50% more likely to die in a car accident because the seatbelts are oriented to the amount of body. So if you think women are half of the people, hi, no. Oh, yeah, yeah. If you think that women are half of the people in the world, that isn't the furthest. That's like people who aren't men, right? It's actually not that hard to start just like widening out a bit and thinking about meeting the needs of others. And my kind of favourite worst ever thing I've heard about at the moment is Amazon have patented the design for noise counselling headphones that are interrupted if somebody said your name which is basically people in an office at Amazon have their headphones on and don't know when other people are talking to them so they've painted it a thing. Like it's really easy to just look out into the world slightly more. And like in health care where we've been working everyone's got really Google with deep mind about the power of machine learning when actually wouldn't it be great to book a doctor's appointment online, right? It's really, it can be really hard to go and meet important people at the Department of Health or the NHS and talk about really straight forward everyday things like booking the doctor's appointments when they think they've looked at the future. And so there's a value to making tiny things and taking them in and demonstrating them and showing the value and actually I ought to have said this earlier but like the idea that actually it isn't that those things that look really easy on the strength before word the fact that it could appear to be kind of boring and everyday doesn't mean it's easy. There are something like I can't remember maybe 3,000 doctor's surgeries or something like actually making something work in all of those is the challenge. And lastly so just going to talk about some of the things we've understood through making and this is a bit kind of niche to our project but in the NHS everyone is really excited about the idea of patient records to the extent that it has its own acronym you know PHR PHR is a thing and there's money sloshing around and actually it's really problematic because we have been found in prototyping and making that actually that isn't really a thing that is needed that a thing that is needed is something that gives everybody my voice. Talking to older people we understood that their need wasn't to carry the notes around particularly it was more to be understood, valued, heard and powered they have a lot of expertise in their own addition and other than people in the last year of life only spend about a month in hospital most of their life is lived at home or in a care home then the experts they also have the ability to manage it and there's an obvious problem patient records can go wrong they can go down the loo right the battery on your phone can die it can be locked out the ambulance can come and you're the only person who can get into the record but the reason that patient records are a thing is because they exist they exist offline every child who's born gets a book if you're pregnant you get notes and you carry those around this is a thing that everyone knows which means that a thing they're interested in making is the internet equivalent of the thing they know and what we've been trying to do is create other things to show them different things different refutures to finish I've got a couple of videos of the prototypes so this here shows you thinking about our collaborative health record this is the experience that loo would have looking at that thinking about it's about really giving her the right information at the right time I don't know if anybody here has ever looked at the summary record which we're all legally able to do a very very long list that goes in alphabetical order with lots of clinical language and terminology and long sentences that isn't really about giving people the right information at the right time that is relevant to the next thing they're doing and then we've looked at that from hang on let me just check that's the right side and then we've we've shown you that one what's going on Laura which ones have I shown okay we've shown this one so this one here is about thinking what's happening today what do I need to know it's relevant that actually this information over here is in a different database to this information over here because actually it's all about me and currently the NHS expects you to behave like you have beaches in the morning failing at the afternoon and dementia at night it's not thinking of you as a whole being so that's kind of allowing you to prioritise to think about things we have another version of that where you're able to print things off on the fridge and the family can edit it then where we've heard from lots of people that they want to be able to record consultations that actually it gets really angsty going going to the doctors and that generally the only thing you hear about it is a letter that comes to you like a letter from your consultant to your GP that is copied to you a month later that is slightly hard to understand so actually you'd have your own record then just turning it around we've been thinking about what your experience of this would be as a nurse having allowed someone to add their own information district nurse who's visiting that person today to have a different needs, to be expecting different language and terminology and importantly they have their own needs for capturing the thing that's happened that is based on our experience of going and travelling around with specialist nurses who would drive around from home to home and that actually if you're able to take your notes into the patient record after the visit they can then become available to everyone I'm very nearly finished but basically doing these things and we've made dozens of these kinds of moments that stitch together into an experience really helps us to understand what is standing in the way of making it happen it's not really about a kind of lovely speculative future it's about really thinking about the practicalities what's the data what's the infrastructure what are the skills and devices if it will take us three years to train all the people who commissioned the software and that will improve things more than creating extra software then let's train them now to create more change later on so in terms of the thing that's happening with the work we will be presenting it back to some important people at the NHS we have the potential for quite a number of these things to kind of turn into the next stage one of our challenges is we don't is how not to get absorbed into the five years of delivery how to kind of maintain lightness while actually making things that go into people's home we change their lives give them better opportunities and it feels almost amazing that sometimes those kind of conversations can be opened up by something as easy as a piece of paper that had the drawing on it but you know I think there's a chance and I'm very optimistic so look there we go thank you very much