Too often, accessibility is treated as an afterthought, with many assuming that because a service is internal, it doesn’t need to meet the same standards as public-facing systems. This mindset can be dangerously limiting, and in the case of the NHS project I’m currently working on, it’s contributed to a 10-year-old legacy system that isn’t accessible to all users. The risk of overlooking accessibility is clear: without action, we perpetuate barriers for people who need to adjust or adapt the way they interact with technology. In this post, I’ll share how we tackled these challenges head-on and the impactful improvements that followed.
Challenging risky assumptions
When I joined this project, the accessibility of one of the key systems within the service was unknown. The system was outdated and not aligned with the NHS design system. The initial internal audit I conducted using a mixture of automated testing tools and manual testing, revealed numerous accessibility failures, particularly against basic A and AA WCAG guidelines.
Despite understanding the scope of the work needed to fix the accessibility issues, it was difficult to persuade the client to prioritise accessibility due to the project’s primary focus on transitioning multiple organisations to our service so that another system could be decommissioned. There was also a prevalent assumption and words continually being mentioned that, as an internal service, we don’t have users with access needs. I knew I needed to challenge these assumptions in order for improvements to be made. To do this, I took a null hypothesis approach and conducted surveys to gather quantitative data on current and soon-to-be users’ access needs and adjustments being made to use the system.
The results disproved the assumptions, revealing that we did have existing and soon to be users who self identified as having an impairment or access need that impacted on their daily life and even those that didn’t have an access need were still having to make adjustments to their equipment to make the system easier to use. It highlighted the key areas our users were being impacted through, such as having to change screen colours and increase screen magnification to improve readability.
31% of respondents have some form of disability or impairment that impacts on their day-to-day life.
41% of respondents make adjustments because they struggle with the readability of the system.
This research was pivotal in reshaping the team’s perception of accessibility. It highlighted the presence of current and prospective users with access needs, emphasising the importance of accommodating diverse user requirements. Some of whom agreed to participate in future user research initiatives.
Armed with this data, I was able to get buy-in for the first major step: improving keyboard accessibility. We focused on key areas, including keyboard operability, navigation, and focus. One of the first major changes was aligning the system’s focus state with the standard NHS design focus state pattern.
Updating design libraries
Some time after implementing the keyboard accessibility improvements, working with a skilled front-end developer, we explored updating the system’s design libraries to align with NHS design standards. Running the updated system through automated testing tools showed an immediate 80–90% reduction in accessibility issues. This achievement was presented to the Head of Delivery, who was impressed with the quick win which could be achieved by making such changes and gave us the approval to push this into live.
Reviewing the impact of the changes
A few months after the changes went live and once users had time to adjust to the new front-end, we decided to evaluate the impact of the changes on the user experience. Using a baseline UX score (UMUX) from previous surveys, we found that while the score increased for one organisation, the others remained unchanged. This was largely due to other usability issues that were still present, which masked the improvements made to accessibility. Despite this, we received positive feedback in the open-ended questions regarding improved accessibility. Users highlighted improvements such as:
“The bigger font and improved layout make it easier on the eyes”.
“Bigger font and layout is presented better so less eye strain”.
“It looks better, and I find it easier to navigate”.
These comments confirmed the positive impact of the changes, underscoring that even incremental improvements in accessibility can lead to a more user-friendly experience.
Although not all accessibility issues have been fully resolved, the quick win of updating the front-end to the NHS design system, delivered a significant reduction in issues, addressing the key accessibility barriers users were facing such as changing screen colours to improve colour contrast for readability. This success demonstrated that even small, focused improvements can have a large and immediate impact on usability and accessibility.
