NHS professionals and privacy activists continue to voice strong concerns over Palantir’s bid for a £480mn NHS England data contract. The contract, which will be used to create a Federated Data Platform (FDP) able to collect and share reams of patient information between hospital trusts and integrated care systems, is set to be awarded in September.
The first procurement exercise for the contract was announced in January and has since rejected bids from other UK businesses, including a consortium comprised of Voror Health Technologies, Eclipse, and Black Pear, solidifying Palantir’s bid as the clear favourite. NHS England had already been using the Colorado-based company’s software, known as Foundry, for its Covid-19 vaccination program, which has given Palantir what is known as the ‘incumbent’s advantage’.
This has raised alarm over possible privacy breaches and questions regarding the legality of the procurement not only amongst NHS professionals but also privacy and technology advocates.
In procurement law, the ‘incumbent’s advantage’ refers to the upper hand an existing supplier may have over newcomers. Having been used to a great extent during lockdown, Palantir’s software has already proven itself as a reliable contender.
But Dr Marcus Baw, a Yorkshire GP and health IT specialist, is one of many NHS professionals concerned about the nature of the contract. He said:
“Procurement law is there in order to prevent this kind of backroom deal and lobbying going on. They’ve schmoozed their way in and that’s not good for value, for money, for the taxpayer.”
Unfair and uncompetitive?
Incumbency advantage has been a hot topic of debate for those concerned with procurement law due to the unfair and anti-competitive advantage it can create.
A 2019 OECD paper, submitted for the 18th Global Forum on Competition, revealed small and medium-sized enterprises only account for 45% of the value of public contracts, and showed the number of public tenders with only one bid had increased from 17% to 30% between 2006 and 2016.
However, this is not the only issue with Palantir. In fact, much of the concern comes from the company’s involvement with the US Department of Defence, Air Force, and FBI, in counter-terrorism, intelligence, and defence efforts. Palantir was co-founded by Peter Thiel, one of Silicon Valley’s few high-profile Donald Trump supporters.
According to Dr Baw: “[Palantir] are primarily providers of spyware technology for governments, and that means that their default position is to do whatever they’re told by the government – that’s not an appropriate operating system for something that contains healthcare data.”
Vague about ‘what the thing does’
Since announcing the FDP the government has said the data will be used to make NHS processes faster and more accessible, including reducing the time spent chasing referrals, scheduling appointments, and waiting for test results.
With that said, not much else is known about the ways the data collected will be used.
Dr Baw said: “[The government] told us that they’re going to spend £480 million on a thing, but they haven’t actually got into any detail about what the thing does. They have made vague suggestions, usually in response to what was in the papers that week.”
This raises a lot of questions regarding the boundaries between the government and the health data gathered by hospitals and local practices.
“I’m a medical doctor and people tell me things in strict confidence, that’s one of the fundamental principles of medicine, it’s in the Hippocratic oath,” explained Dr Baw. “It’s a very dangerous precedent to start saying that certain elements of that data are up for grabs.”
Controversial data requests
In late 2016, the government found itself in hot water following a memorandum of understanding outlining arrangements for the Home Office to make data disclosure requests to NHS Digital, in order to track down immigration offenders.
Despite a 2018 House of Commons report categorising this move as “entirely inappropriate”, and emphasising that health data should only be “shared for law enforcement purposes in the case of serious crime”, privacy advocates still refer to this scandal as an example of how governments can easily overstep important boundaries.
Cori Crider, the director of Foxglove, a non-profit technology advocacy group, said: “NHS insiders have warned [us] this system is a huge waste of money, is a dangerous power grab by central government over health data, and will lock Palantir’s monopoly into the NHS for good.”
Dr Baw believes if the fears are justified it could lead to a lower standard of care being delivered to patients in England: “People’s healthcare is going to be potentially worse because we have allowed government to break the doctor-patient relationship.”
A further consideration is that a large amount of money is being allocated to this contract at a time when NHS staff continue to protest for better pay and working conditions, putting into question the government’s priorities.
Crider commented: “The NHS is in crisis. Decades of underinvestment and stagnant staff pay have put the service on its knees — it’s baffling that officials now want to blow half a billion pounds on a Palantir database.
“Officials should pause the FDP process and consult patients and experts on alternatives that use health data better, for the good of the NHS and us all.”