For detailed background information please visit the Data Working Group folder on the KONP national website, including the recent article using the London Secure Data Environment as an example of how big tech is being embedded in the NHS in a bid to improve productivity. This news piece is based on work by Martin Blanchard.
Key Points
- big tech is everywhere – providing vital infrastructure in the NHS
- it is linked intimately to the US government and its ambition for ‘all allies to use US digital infrastructure’
- binding us in this way boosts US power and global reach, and as time goes by it becomes more difficult to break free (‘lock in’)
- as with other US companies operating in the UK, the wealth created goes back to the US
- there are alternatives (genuine digital sovereignty) that government must explore as a matter of urgency if it wants to break free of ’colonial’ dependency/exploitation
- this will be essential if the NHS is going to continue as a public service that puts patient interests above those of the profiteers
Introduction
In his book ‘Vassal State – How America Runs Britain’, Angus Hanton takes issue with the idea of the ‘special relationship’ with the US representing a positive advantage for us in the United Kingdom. He asks whether we are really America’s economic partner or more in fact its colony? The book ‘lays bare the extent to which US corporations own and control Britain’s economy: how American business chiefs decide what we’re paid, what we buy and how we buy it. US companies have carved up Britain between them, siphoning off enormous profits, buying up our most lucrative firms and assets, and extracting huge rents from UK PLC [e.g. for Cloud services – JP] all while paying little or no tax. Meanwhile, policymakers, from Whitehall mandarins to NHS chiefs, shape their decisions to suit the whims of our American corporate overlords.’
Perhaps nowhere is this thesis more clearly demonstrated than in the NHS, with Palantir being one recent notable example. Far from being the saviour of the NHS as a public service as suggested in the 10 Year Health Plan, big tech (Microsoft, Google, Amazon Web Service – AWS, Apple and Oracle) represents an existential threat that requires concerted opposition from campaigners. It can now be said in a very real sense that US (big tech) firms are taking over the NHS, fostering long term dependency through making themselves indispensable and bent on extracting huge profits at the expense of investment in the kind of NHS we want and need.
NHS data
Because of the huge potential financial value of our health data (personal information about us, our illnesses and their management) our political leaders want to make it more widely available for use by government and the private sector. To do this requires data protections to be weakened, and this is then justified by the possibility of it driving economic growth. What is not stated is that most, if not all, of the products that may be derived or improved from use of our data will be taken to market by the private developers involved, while the NHS will have to pay for the privilege of using them. Meanwhile, health care commissioners and providers have been charged with saving money, reducing hospital admissions and improving population health. Fortuitously for the private sector, this action relies on the gathering of huge data sets from health and social care, such that it is only private US big tech companies that currently have the capability to collect, store, analyse and utilise the mass of information involved.
Big tech and the 10 Year Health Plan for England
The UK government’s ‘Cloud First’ policy (2013) led to US big tech digital infrastructure (aka ‘public cloud’) permeating our public services. The 10 Year Health Plan for England, for example, makes it clear that tech is central to the key aim of improving productivity. ‘Digitalisation’ (one of the three ‘shifts’) means that all data relevant to our health and care, and gathered together into Single Patient Records, will be stored and managed on ‘cloud infrastructure’ belonging to one or several of the five major global tech companies. This data can then be accessed by data controllers such as care providers and Integrated Care Boards using ‘cloud rented’ services (such as Microsoft Fabric and Power BI) to perform activities including analysis of outcomes, service performance, health trends, and resource utilisation.
The NHS will purchase ‘cloud based’ solutions to productivity problems from any of the hundreds of subordinate private ‘customer service provider companies’ (aka ‘cloud partners’) that themselves pay rent for the use of the ‘cloud’ infrastructure together with any necessary ‘knowledge’ owned by big tech. These ‘partner’ companies are the ones that negotiate with, and carry out work for, the NHS bodies and bring them their ‘cloud-based’ solutions. This big tech ‘infrastructure’ has been likened to a ‘franchise’ or a ‘Global Value Chain’ (such as ‘Nike’ for example), crucially, enabling big tech to control activities and gather most of the profits.
How big tech leaches profit from the NHS
Instead of generating surplus value through capital investment, big tech invests to bring different areas of societal activity under its control. It ensnares individuals, businesses and institutions because its services are in fact ‘infrastructures’ on which society depends. This allows them as monopolists to charge exorbitant rents and to generate endless flows of monetizable data. A major concern, particularly in health and social care, is that the interventions big tech ‘partners’ will offer to achieve greater ‘productivity’ and ‘equality’ of services will be a substitute for future increased workforce investment and will be to the disadvantage of the least ‘productive’ patients. The influence of big tech has been increased through its ‘embrace’ by the US government which will further empower private interests at the expense of public institutions.
How far has this process gone?
In a recent article for KONP, using the London Safe Data Environment (SDE) as an example, Martin Blanchard provides a devastating insight into just how far big tech has permeated all levels of the NHS. If the 11 regional SDEs have the same or similar purpose to London, they will all be sat on big tech ‘cloud’ deemed as necessary for the secure collection, curating and storage of their huge, linked ‘health and care’ datasets and will have similar facilities on big tech for their area’s needs and wealth creation. Government has chosen Microsoft, Google, Amazon (AWS), Oracle and NVIDIA as the infrastructure providers across the SDEs, rather than to develop any state funded and publicly owned infrastructure for use only by the whole NHS ecosystem.
Big tech controls their own ‘cloud markets’ behind a vague appearance of ‘competition’ among partners, and this misleading impression of fairness and separateness may be echoed by what appear to be independent regional ecosystems. In fact, the London SDE can use data from across the country and abroad to help to develop the ‘Nightingale’ model. Critical parts of the model are sent to a partner’s SDE where with big tech help, they can undergo training on the population or specialist data locally. Once local training finishes, the raw medical charts and patient data remain safely locked inside the local environment and only the improved parts of the model are exported back to update the master network. No data needs to be transferred. The 12th or National SDE sits on big tech cloud to gather a Federated overview of all the SDEs to meet its operational need for a ‘single point of truth’ for the whole NHS. Through continuous learning, ‘AI algorithms’ (which are on occasions referred to as ‘workers’) will become totally embedded in services. Unlike any other machines ever created, AI will not wear out but will instead continuously ‘improve’ in its performance and value through ingestion of huge quantities of our NHS data.
Data is the lifeblood of big tech’s current business model, acting as the primary raw material used to generate revenue, train AI, and maintain their competitive monopolies. Without the availability of vast datasets, their ‘foundation models’ would simply collapse. As well as revenue streams from the infrastructure and software services provided for the NHS, it is the marketisation of new knowledge and innovations that come from the commodification of our NHS data that has the potential to be the big money spinner for big tech.
Therefore, it is no surprise to see that the London SDE also has an ‘AI factory’ element built around the new ‘Foundation World AI Model for Healthcare’ sitting within the Artificial Intelligence Centre (AIC) and marketed as ‘Nightingale AI’. While the NHS may and should benefit from the use of innovations developed here, the issue of ‘taking them to market’ is problematic given our dependence on the use of the big tech infrastructure and their monopoly of value chains and markets, together with their long history (indeed some would say ‘raison d’être’) for wealth extraction. The huge amount of finance they have invested in the future digital NHS means that only big returns will be accepted.
All on board against Palantir – but breaking the contract is not the final destination
The campaign against Palantir, while important, cannot be an end in itself. Cutting links with Palantir should be the first sweep of a brush aimed at making us independent of US big tech through establishing digital sovereignty. Not to do this would mean that the new data and knowledge being acquired by big tech over time will allow them to be able to centralise the means of coordination of all public activities, and as public institutions are rendered incapable of organising society’s needs through lack of investment, that task will then fall to big tech with all the power that brings.
These encroachments into our public services by mega-corporations so closely linked to the US administration must be seen for what they are: examples of tech-based ‘colonial’ imperialism. We must reject them if we are to maintain ourselves as a separate, sovereign state. Other countries are trying to create alternatives to big tech control of ‘cloud’ through developing regional state funded sovereign ‘clouds’, digital infrastructure capacity and taking control of their public service ‘cloud’ related resources. Past and present big tech behaviour elsewhere in the world mandates that we should be doing the same.
John Puntis, Martin Blanchard
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