The challenge

Nearly half of UK deaths happen in hospital, yet few people would choose to die there. After an emergency admission, patients and families expect to get better, and doctors find it hard not to try everything.

Do Not Attempt CPR (DNACPR) forms were often the first time death was discussed at all, and were sometimes completed without the patient or family knowing, causing confusion and distress. As Dr Juliet Spiller put it, there was an “unhelpful focus on DNACPR as the only outcome of a planning conversation”.

What I did

Working closely with clinicians, patients and families, we used design research and information design to reshape emergency care planning. The aim was to design more than a form: to redesign the relationship around it.

At its heart is a visual scale that shows the trade-off between sustaining life and prioritising comfort and dignity, creating space for an honest conversation between clinician, patient and the people important to them.

What changed

• Adopted by around 55% of UK health services since 2017
• Co-designed with over 30 national organisations
• Now being integrated into digital health records

“The visual of the ReSPECT plan is regarded as positive and empowering rather than fear-inducing and misunderstood.”— Dr Juliet Spiller, Consultant in Palliative Care

Team: Ivor Williams, Matt Harrison, Jonny West

Learn about ReSPECT →

The challenge

Most people would prefer to die at home, yet only about half do. Often it's because symptoms can't be managed in time: families wait for community nurses to come and give injections, symptoms escalate, and an emergency admission follows.

Many carers want to do more. 39% of British adults say they would feel comfortable giving a pain-relief injection to someone dying at home, with some training, and trials show carers can do it safely. But the practice isn't widespread.

What I did

Palliate gives carers who have been trained to give subcutaneous ‘just in case’ medications the information and support they need, through an app and a paper version.

When COVID-19 kept nurses out of patients' homes in March 2020, we fast-tracked a web tool with Palliate's training materials, used by NHS and hospice teams across the UK. In 2022 we ran a pre-pilot in North Camden with CNWL NHS Trust, where volunteer families used Palliate alongside nurse-led training.

What changed

• Symptom relief in 20 minutes, down from over 100
• 91% of injections given without a healthcare professional
• Carers rated their confidence 8.7 out of 10

“The ability to give an injection made a massive difference… she was calmer as she trusted me. There was no way to stop the whole thing from being stressful, but it was helpful to be in control.”— Carer

Team: Ivor Williams, Imo Eastwood, Cally Feather, Lily Hoskin, Milo Hill, Greta Castellana, Claudia Hopkins, Cat Kilkenny, Jonathan Gregory

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The challenge

Around half of UK deaths happen in hospital, yet only 8% of people want to die there. Advance care plans help close that gap, recording a person's wishes, the treatments they would refuse and what matters to them, so clinicians can follow them if the person can no longer speak for themselves. But few people make one. Like a will, we all should have one, but few of us bother until it's too late.

What I did

At the Helix Centre, we set out to take advance care planning out of clinics, where clinicians have little time, and into people's homes. Matt Harrison and I co-founded Digital Care Planning, the Helix Centre's first spin-out, with £500,000 of SBRI Healthcare funding, and brought Amber Care Plans to market.

Volunteers from Marie Curie, Parkinson's support groups, dementia memory clinics, retirement communities, GPs and palliative care consultants all shaped and tested the design. We also built an early AI chatbot and a prototype voice bot that helped people think through different scenarios before personalising a tailored plan.

What changed

• 4,600 people signed up, with 500 joining each month at closure
• 40% of users were living with an illness; most of the rest simply wanted to be prepared
• Completed plans equated to an estimated £3m in NHS savings, or £9m including paper and partly completed plans

Team: Ivor Williams, Matt Harrison, Daniel Dickens, Chris McCormack, Mor Bakal, Marius Matei

The challenge

For children with life-limiting conditions, palliative care can transform their quality of life and support the people around them. Children’s hospices offer the most complete care, but there is a chronic shortage of them worldwide.

As more children live longer with their conditions, and care moves beyond hospice walls into the community, the question for Fondazione Seràgnoli was: what does innovative children’s hospice care look like now, and in the near future?

What I did

Alongside Renzo Piano Building Workshop and the design studio Dotdotdot, we shaped the whole hospice experience, from a family’s first contact with the service to the time after a child’s death. We developed four prototypes:

• Connected Garden: interactive living plants, drawing on horticultural therapy, that children and families play with together
• Chiara: an AI chatbot giving parents the right information, from the right person, at the right time
• Moments: a private space for parents and those close to them to hold memories of a child
• Bake: an augmented-reality play-therapy game that children with little movement control using only their head and eyes

What changed

• A new hospice experience designed end to end, from physical space to clinical and social care
• Four prototypes tested with children and families
• A published blueprint for the children’s palliative care provider of the future, with nine critical features

Team: Ivor Williams, Gianluca Fontana, Greta Castellana, Lily Hoskin, Milo Hill, Jorge Alexander

Image © 2026 Renzo Piano Building Workshop

Read the blueprint report →

The challenge

Rates of depression, anxiety and suicide among young people were rising, and technology was part of the problem as well as a possible help.

Cove was inspired by the loss of my best friend, and by one of the stranger rituals of modern life: young people taking selfies at funerals. It made me ask how technology could help people express complex emotions better.

What I did

With Alex Rothera, I brought together designers, developers, audio designers, researchers and clinical advisors, working with psychologists to understand what young people needed.

• Music-making as a way to express feelings for people who find writing harder
• Elemental design, stones and water, instead of musical notation, so anyone could play
• Privacy first: everything stays on the phone, with no push to share on social media

What changed

• Approved for the NHS England apps library
• Independently evaluated and endorsed by Parkinson’s UK
• Rated 4.2 out of 5 by 52 young people in Islington’s child and adolescent mental health services
• Prescribable by GPs through a partnership with EMIS Health

Team: Ivor Williams, Alex Rothera, Dr Stephanie Archer, Mor Bakal, Davide Cairo, Chris Thompson, Mike Colville, Alejandro Santander, Ema O’Donovan. Image © Chris Thompson.

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