Derisking a national health system used across 17,000 schools to create a validated roadmap for change

The Department of Health and Social Care (DHSC) runs the National Child Measurement Programme (NCMP), a mandated public health programme measuring the height and weight of more than one million children in Reception and Year 6 each year across over 17,000 schools in England.

Local authorities and school nursing teams deliver the programme, supported by a central IT system that is more than a decade old and has no automatic connection to the clinical and education systems local teams already use.

The impact was being felt across everyday delivery. Measurement data could be lost or rejected as it moved between systems. Parent contact details and eligibility lists could become outdated within the same year they were collected. Opt-out requests passed through multiple people and channels without a shared record, creating a risk that genuine requests could go unlogged.

Manual effort had also become significant. One local authority estimated that duplicate data entry alone consumed more than 260 hours each year.

A previous review had concluded that the national system needed replacing, but the work had stalled. Since then, the technology landscape and DHSC's wider digital strategy had evolved. Before committing further investment, DHSC needed confidence that the original case for change still held and a clear, current picture of what a replacement needed to achieve.

Revalidated the evidence

We ran a structured 12-week discovery, testing every requirement and user need from the previous review against current evidence. This gave DHSC a clear view of what remained relevant, what had changed and what could be retired.

Went to the frontline

We worked directly with the people delivering the programme through workshops, one-to-one interviews and hands-on observation across five local authorities, selected to represent different population sizes, demographics and operating models.

We expanded that evidence base through surveys, gathering 443 responses across 38 local authorities.

Followed the data

Alongside the user research, we worked with NHS England and suppliers of the clinical and education systems that interact with NCMP. We mapped how information moves between organisations and systems, identifying where data was being duplicated, rejected or lost.

Built alignment early

We shared findings with DHSC throughout the discovery, allowing the team to challenge evidence and shape the direction as it developed. This created a shared understanding of the problem and confidence in the resulting recommendations.

91% of old requirements changed or retired

Of the 161 requirements inherited from the 2021 to 2022 review, only 9% remained unchanged. A third were retired completely, while the remainder were updated or expanded.

Simply carrying the previous specification forward would have meant designing against an outdated understanding of the service.

76 user needs across 11 personas

The discovery created a new User Needs Register covering 76 needs across 11 personas, compared with 19 needs and five personas identified previously.

This gives future delivery teams a much richer understanding of the people the national service needs to support and the different environments in which it operates.

122 requirements ready for delivery

DHSC now has a specification of 122 validated requirements, providing a current, evidence-based foundation for designing and testing a replacement service.

10 critical assumptions to prove

We identified 10 areas that need to be proven before further investment is committed. This included surfacing the programme's biggest risk, the legal basis for sharing measurement data with a child's GP, early enough for DHSC to begin addressing it before it becomes a delivery blocker.

A de-risked route forward

DHSC now has a scored appraisal of the available options against 20 weighted criteria, alongside design principles that can be used to assess future delivery decisions.

The recommended direction aligns with the government's 10 Year Health Plan and the Data (Use and Access) Act 2025, giving DHSC a clear route into the next phase of delivery.