Merge branch 'main' into consistent-tagging

Author: frankieroberto

app/manage-breast-screening/2025/12/exit-pause-resume-appointment/exit-appointment-post-images.png

@@ -0,0 +1,79 @@
+---
+title: Exit, pause and resume an appointment
+description: We're creating a way for mammographers to exit, pause and resume a breast screening appointment when it can't continue as planned.
+date: 2025-12-23
+author: Rebecca Cottrell
+opengraphImage:
+  src: /manage-breast-screening/2025/12/exit-pause-resume-appointment/pause-appointment.png
+  alt: Pause appointment page state. An important banner says, ‘This appointment is paused’. There is a button to ‘Resume appointment’ and a link for ‘Appointment cannot proceed’.
+tags:
+  - beta
+  - prototype
+  - screening
+---
+
+We've added the functionality for users to exit, pause and resume a breast screening appointment. 
+
+Users need to be able to leave an appointment. They might need to do this in a few situations: 
+
+* There’s an interruption leading to the appointment needing to be paused and resumed later that day
+* The participant experiences pain during screening, or there’s a technical issue in the clinic which means the appointment cannot proceed 
+* They’ve selected the wrong person from the clinic list and need to switch to another participant
+
+
+## Exiting from the workflow 
+
+Exiting is accessed from a link in the top header ('Exit appointment'). 
+
+We've added the link to the top left because that's a strongly established software pattern: the option to close a window is usually found at the top of the screen. This is normally where our site navigation sits, which we hide during [the workflow](/manage-breast-screening/2025/11/a-new-appointment-workflow/) to allow the user to focus on the task. 
+
+![The 'Confirm identity' step of the workflow. An 'Exit appointment' link is located in the top left corner, directly below the main NHS header.](workflow-with-exit-link.png)
+
+### Exiting an appointment before images have been taken
+
+Before images are taken, we allow users to pause the appointment, discard changes made, or choose 'Appointment cannot proceed'. 
+
+![The 'Exit appointment' page before images have been taken. A radio button question asks, 'Will this appointment be resumed today?' with three options: 'Yes, pause and save changes', 'No, appointment cannot proceed', and 'Discard changes and revert status to checked in'.](exit-appointment.png)
+
+### Exiting an appointment after images are taken 
+
+After images are taken, they must be reported. The only option is to proceed with the appointment – so the user can only pause the appointment. It's not possible to discard changes or stop the appointment. 
+
+![Pause appointment page state after images have been taken. The title says 'This appointment will be paused' with text warning that changes can't be discarded after images are taken. There is a button to 'Confirm' and a link to 'Cancel and return to appointment'](exit-appointment-post-images.png)
+
+
+## Pausing and resuming an appointment
+
+If the appointment is being resumed the same day, saving and pausing allows the appointment to be restarted while the clinic is still open. To allow this, we introduced a new appointment status, 'Paused'. When the appointment is viewed, it can be resumed or stopped.  
+
+Paused appointments are considered to be 'in progress' appointments, and are grouped with the rest of the in progress appointments on the clinic list. 
+
+### Adding flexibility and helping users to recover from mistakes
+
+We're allowing for scenarios where more than one clinician is involved in a screening appointment: for example, if one clinician starts then pauses the appointment, the appointment can be resumed by a different clinician. 
+In future, we'll focus on more robustly supporting multiple clinicians in the screening workflow – this is just the start of this work, and there's more questions to answer and puzzles to solve. 
+
+If this feature works as intended, it should help screening appointments to recover from unexpected disruptions. 
+
+After an appointment is paused, and it turns out it can't be resumed after all, the user can select "Appointment cannot proceed" from the paused appointment page state. 
+
+![Pause appointment page state. An important banner says, ‘This appointment is paused’. There is a button to ‘Resume appointment’ and a link for ‘Appointment cannot proceed’.](pause-appointment.png)
+
+
+## If the appointment cannot proceed
+
+If the appointment cannot proceed, and images haven't been taken yet, the user can choose ‘No, appointment cannot proceed’ to be redirected to the appointment cannot proceed flow. The clinician can then select a reason why it can’t proceed, and can optionally request to reschedule the appointment. For more on ending breast screening appointments, see [ending breast screening appointments](/manage-breast-screening/2025/11/ending-breast-screening-appointments/).
+
+## Selecting the wrong person by mistake
+
+If the clinician mistakenly selects the wrong person and starts to complete information for this person, the clinician can choose ‘Discard changes’ to delete any information entered and reset the appointment status back to ‘checked in’. 
+
+## Next steps
+
+### Exploring an interim review step when data is saved
+
+We might want to explore showing the review page to the mammographer when pausing, discarding, or resuming, so they’re aware of what data has been added during the appointment so far. 
+
+### User research and usability testing
+
+We’ll need to do user research and usability testing to find out how well users understand these options. 

app/manage-breast-screening/2025/12/exit-pause-resume-appointment/exit-appointment.png

@@ -18,7 +18,7 @@ We also provided space for parents to give teams extra information about their c
 
 ## Health questions asked for the nasal flu spray
 
-> ### Has your child been diagnosed with asthma?
+### Has your child been diagnosed with asthma?
 
 This question is used to check for any contraindications for the nasal spray.
 
@@ -34,47 +34,47 @@ Answering ‘Yes’ to this question will show the parent 2 follow up questions.
 
    Hint text: ‘This does not include visits to A&E or stays in hospital wards outside the intensive care unit’.
 
-> ### Does your child have a disease or treatment that severely affects their immune system?
+### Does your child have a disease or treatment that severely affects their immune system?
 
 This question is used to check for any contraindications for the nasal spray.
 
-> ### Is your child in regular close contact with anyone currently having treatment that severely affects their immune system?
+### Is your child in regular close contact with anyone currently having treatment that severely affects their immune system?
 
 Give details hint text: ‘Let us know if they are able to avoid contact with the immunocompromised person for 2 weeks’.
 
 This question is used to check for any contraindications for the nasal spray.
 
-> ### Does your child have a bleeding disorder or are they taking anticoagulant therapy?
+### Does your child have a bleeding disorder or are they taking anticoagulant therapy?
 
 Later in the consent journey a parent can choose to give consent for the injected vaccine if a nurse decides it should be given as an alternative.
 
 This question is used to ensure that if the injected vaccine is given, it is administered safely.
 
-> ### Has your child ever been admitted to intensive care due to a severe allergic reaction (anaphylaxis) to egg?
+### Has your child ever been admitted to intensive care due to a severe allergic reaction (anaphylaxis) to egg?
 
 This question is used to check for any contraindications for the nasal spray.
 
-> ### Has your child had a severe allergic reaction (anaphylaxis) to a previous dose of the nasal flu vaccine, or any ingredient of the vaccine?
+### Has your child had a severe allergic reaction (anaphylaxis) to a previous dose of the nasal flu vaccine, or any ingredient of the vaccine?
 
 Hint text: ‘This includes gelatine, neomycin or gentamicin’.
 
 This question is used to check for any contraindications for the nasal spray.
 
-> ### Does your child have any other medical conditions the immunisation team should be aware of?
+### Does your child have any other medical conditions the immunisation team should be aware of?
 
 This question **does not require triage**. It is used to give parents the opportunity to give any further information about the health of their child. While used for context, answers are not contraindicating.
 
-> ### Does your child take regular aspirin?
+### Does your child take regular aspirin?
 
 Hint text: ‘Also known as Salicylate therapy’
 
 This question is used to check for any contraindications for the nasal spray.
 
-> ### Has your child had a flu vaccination in the last 3 months?
+### Has your child had a flu vaccination in the last 3 months?
 
 This question is used to check or confirm whether the child needs a flu vaccination this year.
 
-> ### Does your child need extra support during vaccination sessions?
+### Does your child need extra support during vaccination sessions?
 
 The hint text is ‘For example, they’re autistic, or extremely anxious’.
 
@@ -84,23 +84,23 @@ This question **does not require triage**. It is used to help teams manage sessi
 
 ## Health questions asked for the injected flu vaccine
 
-> ### Does your child have a bleeding disorder or are they taking anticoagulant therapy?
+### Does your child have a bleeding disorder or are they taking anticoagulant therapy?
 
 This question is used to ensure that if the injected vaccine is given, it is administered safely.
 
-> ### Has your child had a severe allergic reaction (anaphylaxis) to a previous dose of the injected flu vaccine, or any component of the vaccine?
+### Has your child had a severe allergic reaction (anaphylaxis) to a previous dose of the injected flu vaccine, or any component of the vaccine?
 
 This question is used to check for any contraindications for the injected vaccine.
 
-> ### Does your child have any other medical conditions the immunisation team should be aware of?
+### Does your child have any other medical conditions the immunisation team should be aware of?
 
 This question **does not require triage**. It is used to give parents the opportunity to give any further information about the health of their child. While used for context, answers are not contraindicating.
 
-> ### Has your child had a flu vaccination in the last 3 months?
+### Has your child had a flu vaccination in the last 3 months?
 
 This question is used to check or confirm whether the child needs a flu vaccination this year.
 
-> ### Does your child need extra support during vaccination sessions?
+### Does your child need extra support during vaccination sessions?
 
 The hint text is ‘For example, they’re autistic, or extremely anxious’.
 

app/manage-breast-screening/2025/12/exit-pause-resume-appointment/index.md

@@ -0,0 +1,78 @@
+---
+title: Why we’ve stopped breaking up school-age vaccinations into service stages
+date: 2026-01-06
+---
+
+We have always tried to model Mavis and the School Age Immunisation Service (SAIS) as a sequential process, building on the Select/Invite/Book/Record/Report model used in other areas of Vaccinations Digital Services.
+
+At a high level, the Mavis service design looked like this:
+
+[![Diagram showing high-level service stages for each user type.](service-design.png)](service-design.png)
+
+But this structure hasn’t served our design team well and we have often felt that we are fighting against it to meet the complex needs of our users.
+
+## Why it wasn’t working
+
+Our research and continuous improvement have shown that SAIS, as well as Child Health Information Services (CHIS) and other children’s vaccinations services, don’t follow a sequential process. In practice, the NHS staff running these local services work on the same set of complementary, interrelated functions on a daily basis, every day of the year.
+
+Identifying the cohort for a school-age programme is a continuous activity that the whole team contributes to; from initial cohort uploads handled by admin users, through class lists sourced from schools and added to Mavis on a daily basis, to last-minute changes made by nurses whilst vaccinating in a session when a child has recently moved into or out of the area. The cohort changes daily until the last day of the programme.
+
+Scheduling, too, is an ongoing and flexible process. Which children are scheduled to attend a session – and which vaccinations will be on offer – depends on many factors, including:
+
+- their individual vaccination statuses, which change constantly
+- the team’s capacity and vaccine stock
+- the nature of the relationship with the school
+
+Changing session schedules affect who the team needs to seek consent for, how they triage, and how they report their uptake.
+
+Teams are continuously updating their cohorts, reassessing vaccination statuses, re-scheduling and planning new sessions and handling new information from parents. These parallel functions come together organically to make up the School Age Immunisation Service.
+
+Building around a sequential journey has meant we as a team have to treat basic needs for flexibility as exceptions to the process. Handling them became complex because it didn’t fit our default rules. We started to feel like Mavis was made up of more exceptions than rules.
+
+## What we’re doing instead
+
+We decided to update our mental model, our design language, and even our team structure to reflect the parallel, complementary nature of these functions. We’re now thinking about managing vaccinations in schools like this:
+
+[![Diagram showing different tasks grouped by high level user needs.](service-areas.png 'Mavis service areas - click image to see it full size.')](service-areas.png)
+
+We have found that the needs underpinning each of the individual functions listed are broadly the same across teams, within not just SAIS but also CHIS and broader community/outbreak initiatives.
+
+The individuality comes in as local teams bring these functions together differently to form each local special snowflake.
+
+From right to left:
+
+### Get help with Mavis
+
+Our onboarding and support functions – a massive part of making sure that Mavis really works for teams. Doing this in-team has been integral to our team’s agency and our user satisfaction.
+
+### Manage team
+
+Allow teams to manage all aspects of their footprints, including the schools, GPs and geographic area they cover, managing their users and their organisational structure.
+
+Underpinned by the [Care Identity Service](https://digital.nhs.uk/services/care-identity-service) (CIS2) and the Department for Education’s [Get Information About Schools](https://www.get-information-schools.service.gov.uk) (GIAS) (with a gap for team geographies that we would like to address).
+
+### Manage children
+
+Continuous cohorting. Importing of children’s records and parent contacts from CHIS, local authorities and schools, and matching this information against the Personal Demographics Service (PDS) to ensure we maintain a single, up-to-date record per child and deduplicate across teams when children move around. Changing children’s schools, addresses and contacts individually on a daily basis.
+
+Underpinned by [PDS](https://digital.nhs.uk/services/personal-demographics-service).
+
+### Monitor uptake
+
+Producing stats about the vaccination programmes for teams to monitor their own progress, as well as reporting to UK Health Security Agency and commissioners.
+
+### Manage vaccination records
+
+Establishing relevant vaccination history for each child to determine their eligibility for vaccinations. Managing available vaccines and batches. Reporting individual vaccinations given by the team to GPs, CHIS and NHS England.
+
+Underpinned by the [Immunisation FHIR API](https://digital.nhs.uk/developer/api-catalogue/immunisation-fhir-api). Vaccines could be managed through a vaccines API in the future.
+
+### Manage and run sessions
+
+Bringing it all together. Combining the information about schools, clinic locations, children and their vaccination eligibility to schedule sessions, seek consent, triage health information, register attendance, vaccinate and record outcomes.
+
+### Protect your child
+
+This one is a true linear journey: receive a consent request for your child, give or refuse your consent, get updates on what happens next, and if necessary, book and attend a community clinic.
+
+Currently underpinned by [GOV.UK Notify](https://www.notifications.service.gov.uk), in future [NHS Notify](https://notify.nhs.uk) and the NHS App.