NHS Long Term Plan gives a big shove to revolving door between global companies and NHS quangos

This is a long read (approx 2.7K words). It outlines:

• How corporate interests are now enmeshed in the NHS, through new business alliances aimed at ‘capturing value from the human body as data platform’. That’s right, our bodies are now sources of data that global companies can’t wait to get their hands on.
• How the new 10 year NHS Long Term Plan is crucial to these business alliances. And it has given a big shove to the revolving door between NHS quangos and big digital technology companies.
• How this will radically alter the kind of healthcare the NHS provides: the computer will see you now.
• An unfolding and frequently updated case study of one of these NHS/private companies’ business alliances – Sensyne Health

Corporate interests are now enmeshed in the NHS, through institutionalised new business alliances that aim to transform medicine and healthcare by opening up opportunities for digital and Life Sciences industries

This transformation of medicine and healthcare is based on what Ernst and Young (one of the Big Four accounting firms) calls:

‘capturing value from the human body as data platform’.

The NHS, with its 70 years’ worth of millions of patients’ confidential medical data, is a key object of interest for global life sciences and digitech companies which seek to profit from mining such data.

NHS England’s former Director of Transforming Health Systems Michael Macdonnell recently did a runner to join Google’s Deep Mind Health. His job will be to strengthen DeepMind’s partnerships in the NHS and overseas, with the aim of applying Artificial Intelligence to clinical practice. (Update 29.11.2020: Since then he’s gone on to Google Health and, in Sept 2020, to Sensyne Health -more info here.)

Before working for NHS England, he was Director of the World Innovation Summit for Health , a Qatari Foundation-funded research body at Imperial College London Centre for Health Policy. The World Innovation Summit for Health aims to influence healthcare policy globally.

LiviD

Another senior NHS England worker has also debunked to a digital company, Livi.

In January 2019, NHS England called for a major expansion in the health technology sector. Soon after, the then – Chief Digital Officer for NHS England, Juliet Bauer, announced her departure for Europe’s largest GP video consultation provider, Livi. Her new position includes executive responsibility for NHS partnerships.

Shortly before she left NHS England, Juliet Bauer wrote a high-profile article talking up Livi, without any mention that she was about to jump ship to the company. For this she got a ticking off from Meg Hillier, the Labour MP who chairs the House of Commons Public Accounts Committee.

Part of the DigitalHealth.London Accelerator programme, Livi had already announced in October 2018 that it was launching its online GP video consultations in the NHS, through several NHS contracts.

In a statement confirming their appointment of Ms Bauer, a Livi spokeswoman said she would:

“focus on working in partnership with the NHS and other health systems around the world”.

You bet.

The company (known as Kry in its native Sweden) describes itself
as:

“Europe’s leading digital healthcare company backed by top tier investors including Accel and Index Ventures …”

Where do corporate interests end and the public interest begin? There is no longer any effective distinction in the neoliberal state

From 4 February, Juliet Bauer was replaced at NHS England on an interim basis by Tara Donnelly, then chief executive of the Health Innovation Network – the Academic Health Science Network (AHSN) for south London.

The Health Innovation Network is one of London’s three Academic Health Science Networks that deliver DigitalHealth.London – the “collaborative programme” or “marketplace where digital health solutions are traded”.

As former chief exec of the Health Innovation Network, Tara Donnelly also has links with Livi.

The NHS adoption of Livi’s online GP video consultations kit was promoted by the Digital Health. London Accelerator. According to the Digital Health London Accelerator,

“If your company is seeking engagement and traction within London’s digital health eco-system, taking part in the Accelerator programme can support you with opportunities to connect with NHS stakeholders, industry investors, patients, and other healthtech innovators.”

Tara Donnelly’s 4 year stint at NHSX and NHS England’s Transformation Directorate has seen the quango direct Integrated Care Systems and Provider Collaboratives to work with private health care providers to develop “virtual ward services”

Feb 2023: Tara Donnelly is quitting as NHS England’s director of digital care models in the NHS England Transformation Directorate, where she seems to have carried on her work of enabling private companies to gain “traction” within the “digital health eco-system”, this time across the whole country – not just in London, as in her previous job.

Her departure comes as NHS England combines structures with NHS Digital and Health Education England, and begins a restructure removing 30-40 per cent of their collective posts, according to the Health Service Journal.

Before she took up the Transformation Directorate role early last year, she was chief digital officer of NHSX, a “new joint organisation” set up in 2019 by Matt Hancock as then Health Secretary, to “to deliver on the Health Secretary’s tech vision and the Long Term Plan for the NHS.”

In 2022, NHSX ceased to exist. Together with NHS Digital, it was folded into NHS England’s Transformation Directorate.

In her jobs at NHS England’s Transformation Directorate and NHSX, Tara Donnelly worked on NHS England’s “virtual wards” programme, which had been a key part of the covid-19 response, and on efforts since then to reduce hospital bed occupancy and shift care out of acute hospitals.

As already reported in this NHS Matters blog post, with regard to the use of technology to support long-term patients’ self-care at home, new NHS England guidance is that Integrated Care Systems and provider collaboratives should work with private healthcare providers to develop “virtual ward services” that enable patients to receive treatment and care at home, with the help of digital technology, instead of being in a hospital bed:

“Given the independent sector is already a valued partner in many local health and care systems, as providers of a range of NHS healthcare services, the delivery of virtual wards is an opportunity to build on these relationships.

“Partnerships with independent sector healthcare providers (ISHCPs) may expand local capacity and enhance capability through strong local partnerships with existing acute and primary care providers…

“The national programme is conducting market engagement to support the development of independent sector capacity for virtual wards…”

https://www.england.nhs.uk/wp-content/uploads/2022/04/B1382_supporting-information-for-integrated-care-system-leads_enablers-for-success_virtual-wards-including-hos.pdf

Update – Livi is now hiring

Sept 2019: Livi is now advertising job vacancies for GPs to work flexibly from home providing 15 minute video consultations to NHS patients across England.

Update – Palantir poaches NHSX Artificial Intelligence Lab Director

In August 2019, the UK government launched the National Artificial Intelligence (AI) Lab with a £260m budget to deploy and develop AI systems of health and care.

Under the leadership of NHSX (Matt Hancock’s bonkers organisation to oversee the digitisation of the health and care system, since abolished and absorbed into NHS England) and NHS England’s Accelerated Access Collaborative programme, the AI Lab had £140m to spend on contracts with private companies to “revolutionise NHS care.”

But by April 2022, the AI Lab was rated red by the Infrastructure Projects Authority (p56). A red rating means,

“successful delivery of the project appears to be unachievable.”

Soon after the Infrastructure Projects Authority report was published, the AI Lab’s Director, Indra Joshi, took up a post with the CIA-linked US tech company Palantir, which was bidding for a recently-tendered £240m NHS England contract for a “federated data platform” to deliver “transformational improvements across the NHS”.

Indra Joshi apparently left her AI Labs Director job at NHSX in March 2022, during the NHSX merger with NHS England.

Second NHS England director spins through revolving door to Palantir

By June 2022, a second NHS England official – Harjeet Dhaliwal, deputy director of data services at NHS England and NHS Improvement – had joined Palantir after it was reported that the US software company has emerged as a “front-runner” for the NHS England “federated data platform” contract, which has been boosted to a value of £360million over 5 years.

End of update

New business alliances with the NHS

New business alliances between English universities, NHS hospitals, digital technology companies and life sciences companies are key to the implementation of Accountable/Integrated Care in the NHS.

These alliances are exemplified by Academic Health Science Network companies. Licensed by NHS England, their agenda is:

“to identify, exploit and commercialise innovations that will have national and international significance” predicated on partnership working and collaboration between the NHS, academia, the private sector and other external partners”

The business opportunities this transformation of medicine and healthcare opens up for Life Sciences are extolled in a range of business documents including:

• Ernst and Young’s 2012 Global Life Sciences Report, Progressions – the third place: health care everywhere,
• The government’s Office for Life Sciences/Department for Business, Innovation and Skills ‘Strategy for UK Life Science’,
• The World Innovation Summit for Health (WISH) 2016 Accountable Care Report, with a foreword by WISH founder Lord Darzi (infamous for New Labour’s Independent Sector Treatment Centres).

The messages of these business documents were echoed in Lord Darzi’s 2018 long-term funding and reform plan for the health and social care system, which was launched in partnership with the Institute for Public Policy Research , at a Westminster conference that coincided with the NHS’s 70th birthday. Key speakers were:

• Simon Stevens, Chief Executive of NHS England
• Lord David “Scrap hospital beds” Prior
• Dr Geraldine Strathdee, National Clinical Director for Mental Health, NHS England
• Neil Mulcock, Vice President of Gilead Science , biopharmaceutical innovation company
• Hilary Neiwiss, National Voices – a coalition of healthcare charities
• Hannah Farrar, Partner at Carnall “shocking conflict of interest” Farrar

Post-Brexit, the government’s aim is to export “disruptive innovations” associated with healthcare innovations to China, India, Saudi Arabia, Africa.

NHS Long Term Plan is crucial to these business alliances

Accountable care – the type of healthcare provided by the new Integrated Care Systems and their building blocks the Primary Care Networks – requires digitisation and widely shared access to ALL patient medical data. Through the new business alliances being built into the NHS through Academic Health Science Networks and other institutions, this data will be accessible to corporations.

It is basically a massive rip off of our incredibly valuable public assets. As 999 Call for the NHS pointed out in our response to NHS England’s consultation on proposed primary legislation for the Long Term Plan, medical innovation should be carried out by a fully publicly owned/funded/run NHS:

“The NHS must be run by and accountable to local and national government and devoid of all privatisation, whether privatised administration, healthcare provision, support services or capital ownership. The NHS is concerned with health and social care provision and should not be subject to market forces either internal or external.

This principle extends to medical innovation: the process of devising and implementing strategies and health interventions that improve health outcomes at the community level, which may or may not include using health technologies like diagnostics, medicines, vaccines and medical devices, (often referred to as health commodities).”

Total transformation of the kind of care the NHS provides

The 10 year NHS Long Term Plan – clearly aligned with Lord Darzi’s review – includes a funded programme to upgrade technology and digitally enabled care across the NHS (p9), in order to totally transform the kind of care the NHS provides:

• From face-to-face to your smartphone – if you have one. Oh appy day
• From “reactive to predictive” – Minority Report-style predictive technology for illness (not murder!)
• From human diagnosis and clinical decisions to Artificial Intelligence.

Oh appy day – mobile remote healthcare via your smartphone

“Digitally-enabled primary and outpatient care will go mainstream across the NHS” (p25)

Goodbye to most face-to-face consultations with GPs, community health workers and outpatients consultants. Hello, NHS App, which will:

“provide advice, check symptoms and connect people with healthcare professionals – including through telephone and video consultations.”

Everything that has happened to banking is now happening to the NHS. For those too young to remember, there used to be buildings called banks where you could talk to a human being and they would carry out your banking transaction for you. Now you have to do the work yourself, either online or on the phone.

That is what the NHS is going to be like in 10 years time. This is what the official blurbs mean by ‘empowering patients to self care and self manage their conditions’.

It is called the “left shift”

Just reading about it makes me exhausted.

Empower the person – as if!

As NHS England’s first Chief Digital Officer before she jumped ship to Livi, Juliet Bauer set up NHS GP online services and online consultations. She was responsible for the so-called Empower the Person road map for digital health and care services .

These include GP Online Services, Online Consultations, NHS 111online, and many other digital doodas for the NHS

The Empower the Person scheme is active in Yorkshire and Humber , where Leeds City Council has commissioned the development of a Person Held Record called Helm. (Steer your own boat, right?)

Helm (produced by the community interest company, Ripple Foundation) is available to over 70 organisations through the Yorkshire and Humber Local Health and Care Record Exemplar.

The blurb on the Ripple Foundation website says that Helm allows patients to see and interact with their own records and data on an online platform. It adds the usual bs about this encouraging patients to

“take control of their own health and wellbeing.”

In other words, Look after yourself folks, because no one else is going to.

Minority Report – Surveillance Medicine

The NHS will be like Minority Report (the 2002 Tom Cruise sci-fi thriller, about law enforcers who can predict crime before it happens) – although NHS predictions will be about illness not murders.

And in place of “precogs”, Integrated Care Systems (the healthcare banana republics that will have taken over the NHS across England by 2020/21) will operate on the basis of digital data analytics that predict unplanned/ emergency hospital admissions. This is called Population Health Management.

Primary Care Networks will be financially incentivised to carry out this “Population Health Management”.

Of course the data analytics software and processes are imported from the USA- mostly from Optum, the former employer of Simon Stevens, Chief Exec of the NHS Commissioning Board quango that runs the NHS these days.

The NHS Long Term Plan calls this “deploying population health management solutions.”

What if you don’t want to be identified as “at risk of adverse health outcomes”?

Or to be the subject of predictions about whether you are an individual who is “most likely to benefit from different health and care interventions”?

Or then be hooked up to wearable apps, and your bodily functions remotely monitored?

The civil liberties implications of this look pretty horrific, as healthcare becomes something done to you, on the basis of predictive technology that sifts through your – and everyone else’s – confidential medical records.

Doesn’t sound much like empowering the patient to look after their health to me.

But hey, it’s all right because it’s going to support world-leading research. Surrender your data to the big tech and life sciences companies – you do it on facebook already, so why not via the NHS?

“The use of de-personalised data extracted from local records, in line with information governance safeguards, will enable more sophisticated population health management approaches and support world-leading research. We will make frictionless APIs available to industry and the developer community to stimulate innovation and support integration with other products.”

From human clinical decisions to Artificial Intelligence – the computer will see you now

Clinical pathways – the processes followed in treating specific illnesses – will be redesigned so that technology basically does the job of clinicians.

Clinicians increasingly have to follow decision trees (ie algorithms that tell them what treatments to provide for their patients).

They will have to use referral templates. GPs will also have universal access to ‘one click away’ specialist advice and guidance.

The upshot is that many patients will not be referred for a consultation with a specialist doctor.

Is this a good thing? It depends on the computer, and whether it can replace the human skills of a clinician.

And what happens when the computer says NO? Or even when it says YES? How do patients discuss their values and wishes with a computer?

Many follow up appointments will be avoided through virtual clinics, such as virtual fracture clinics where a fracture patient’s case will be reviewed remotely by the Orthopaedic team within 24-72 hours of the patient’s attendance at the Emergency Department. Following this assessment, a physiotherapist will phone the patient to discuss their management plan.

Artificial Intelligence will automate many tasks, including those carried out by pathology networks and diagnostic imaging networks

Some specialist referrals – eg dermatology – will be managed entirely digitally, via photos and online questionnaires:

“ the rapid transfer of clinical images from care settings close to the patient to the relevant specialist clinician to interpret … will enable both the rapid adoption of new assistive technologies to support improved and timely image reporting, as well as the development of large clinical data banks to fuel research and innovation.”

Private company’s partnership with NHS hospitals to use clinical AI technology in analysing anonymised patient data

A former New Labour science minister, Lord Paul Drayson, has announced a partnership between his company Sensyne Health and EY (the company set on ‘capturing value from the human body as data platform’).

The agreement with EY is to scale up the Sensyne Health business and build on its business model. Sensyne Health has linked partnerships with NHS trusts to analyse allegedly anonymised patient data using its clinical AI technology to accelerate medical research.

Update 30.5.2022 Writing to the NHS Hospital Trusts that are shareholders in Sensyne Health plc, Medconfidential pointed out on 22nd April 2022 that,

“It is clear from information available in the public domain, such as Data Protection Impact Assessments and descriptions of the datasets requested by Sensyne, that data which passed to Sensyne allows linkage, i.e. it is pseudonymised data, and therefore identifiable personal data. Crucially, it is not anonymous data – notwithstanding what labels have been applied to it in the contractual documentation...

“Therefore, presuming that the NHS Trusts have continued to labour under this false assumption, there is a real risk of widespread and fundamental non-compliance with the UK GDPR and Data Protection Act 2018 across all NHS Trusts that have transferred, or intend to transfer, patient data to Sensyne.“

https://medconfidential.org/wp-content/uploads/2022/05/2022-04-22-medConfidential-letter-re.-Sensyne.pdf

It is small or no comfort that Sensyne Health has signed up to the Department of Health and Social Care’s initial code of conduct for AI and data-driven health care technology.

During the New Labour government, Paul Drayson advanced his corporate and political interests through large contributions to the Labour Party. One of these was a £100k donation made in 2002, while he successfully bid for a £32m government vaccine contract, after buying the UK rights to the strain of the smallpox vaccine that the defence ministry wanted to buy from Bavarian-Nordic.

The National Audit Office and the Commons science and technology committee investigated the smallpox vaccine contract and both cleared all parties.

Drayson donated £505,000 to New Labour on 17 June 2004, six weeks after being appointed to the House of Lords by Tony Blair. A further £500,000 followed on 21 December 2004.

After severing executive links with his former company, Powderject (which he sold to GlaxoSmithKline for £100m), he made his maiden speech in the Lords as a champion of the kind of bioscientific enterprise Tony Blair was eager to foster in Britain.

Blair must be well pleased that the NHS under his former advisor Simon Stevens is ensuring his Third Way legacy lives on.

And what about the climate damage?

Update 10.10.2021 – American “activist investor” aims to “create additional shareholder value” for US as well as UK shareholders.

Gatemore Capital Management, an “activist investor” in Sensyne Health, has pressurised the company into dual listing on the NASDAQ exchange as well as on Aim, the London Stock Exchange’s junior market, where Sensyne shares remain below their float price. Sensyne Health is reportedly

“exploring opportunities to drive growth to create additional shareholder value.”

These “opportunities” arose after Gatemoore Capital Management swooped in to buy a significant stake in Sensyne Health in early 2020, after the company’s shares plummeted 78 per cent from the company’s flotation at 175p on the London Stock Exchange’s junior AIM in August 2018.

Sensyne shareholders sold in droves when they discovered £1 million of secret post-flotation ­executive bonuses had been paid in October 2019. £850K was paid to Lord Drayson and £200K to Lorrie Headley, Sensyne Health Chief Finance Officer.

Gatemore Capital Management LLC, registered in New York, is listed on Companies House as “a person with significant control” of Gatemore Capital Management.

What is a load of American shareholders going to mean for the 8.4 million patients in the UK whose confidential medical records Sensyne Health has access to?

And how can Lord Drayson pretend that Sensyne Health is an ethical AI company when he treats it as a cash cow for his own private benefit?

Update 30.5.2022 – As Sensyne delists from London stock exchange, Medconfidential advises NHS Trusts to cut their ties with the company

In April 2022, the Sensyne Health plc Board announced it was delisting the company from the London junior stock exchange, AIM, subject to the approval of shareholders. This was because a cash shortfall threatened the company’s ability to operate. A refinancing deal in January 2022 with the company’s “secured lenders” Gatemore Capital Management and others produced around £6.5 million “loan notes”. This was updated in April 2022 to provide up to an extra £20 million loan notes.  The terms of this extra issue of loan notes include delisting the company from the London AIM.

Lord Drayson, the former Labour science and business minister who set up the company, has been ousted as chief executive of Sensyne Health as part of the planned emergency refinancing and restructuring, that is set to lead to “lots” of job losses, according to The Times.

Medconfidential has now advised the 13 NHS Trusts that are shareholders of Sensysne Health plc to terminate their agreements with clinical data analytics provider Sensyne Health and require that the company returns or deletes all NHS data it holds.

Medconfidential’s letter to the NHS hospital trusts, which include Somerset NHS Foundation Trust, Oxford University Hospitals NHS Trust, Royal Devon and Exeter NHS Foundation, Great Ormond Street Hospital for Children NHS Foundation Trust, George Eliot Hospital NHS Trust and Wye Valley NHS Trust, advises them,

“As shareholders in Sensyne Health plc, whose shares are now worth less than 1% of the value ascribed to them at the time your partnership with Sensyne was announced, you have the option of voting next month to have your stake wiped out, or to terminate your strategic research agreement(s) and/or data sharing agreement(s) with Sensyne.”

The letter points out (as noted above) that NHS patients’ data that has been passed to Sensyne is NOT anonymised, but only pseudonymised, meaning that it is possible to identify the people whose data Sensyne holds. Medconfidential therefore advises the NHS hospital trusts to terminate their contracts with Sensyne Health plc:

“While not all of the contracts NHS Trusts signed with Sensyne have been published, information in the public domain makes it clear that your agreements with Sensyne contain termination clauses which enable the agreements to be terminated in the event of a material breach of any term and/or under a change of control, which will be triggered by these events. Furthermore, on termination, the NHS Trusts are likely to have a contractual right under the terms of any data processing agreement to require the destruction or return of data (as directed by the NHS Trusts) and deletion of all existing copies.

“Given the events that have now taken place, and given that continuing the relationship will make your patients guinea-pigs for business models as yet unknown and undefined, the responsible course of action for now is to terminate your agreements and require the return and/or deletion of the existing data held by Sensyne.

“You paid with your patients’ data in a deal which no longer has value, on the promise of returns to the NHS that have not materialised. As trustees of your patients’ data, the most trustworthy move is to withdraw their data and hand back the mess Sensyne’s former management has left you.”

Monika Sobiecki, partner at law firm Bindmans LLP, which is advising medConfidential, told Techmonitor

“[T]hose who operated on the presumption that neither Sensyne nor the NHS Trusts really had to do anything to comply with the UK GDPR and/or Data Protection Act 2018 because the data was anonymous (and so not ‘personal data’) are completely wrong”.

If Sensyne’s finances difficulties continue, Sobiecki added, it might consider selling the patient data on to a company inclined to re-identify patients.

Update 1 July 2022 – NHS trusts are reviewing their patient data-sharing agreements with Sensyne Health after their shares in the firm were rendered currently worthless following its financial collapse

The Health Service Journal been in touch with NHS hospital trusts with patient data-sharing agreements with Sensyne Health. They report that several trusts are planning to review their agreements with Sensyne Health once the outcome of Sensyne’s restructuring is known, although Great Ormond Street Hospital for Children FT said it would continue its agreement with the firm and Royal Devon University Healthcare FT  also said it would continue its agreement after conducting its own due diligence process.

Update 17.9.22 – medconfidential has been awarded a grant from the Digital Freedom Fund to support Pre-litigation Research in relation the unlawful processing of NHS patients’ medical data by Sensyne Health plc:

“medConfidential is examining possible legal action in relation to the unlawful processing of patients’ medical data by Sensyne Health plc, a private company, which has data sharing agreements with several NHS Hospital Trusts.

“medConfidential has gathered evidence indicating that personal data is being transferred from the NHS to Sensyne without patients’ knowledge or consent, thereby placing the confidentiality and privacy rights of over 12 million NHS patients at risk. The company and Trusts claim that the data transferred is anonymous and therefore not covered by GDPR –medConfidential has evidence that at least some of the data is merely pseudonymised. This means it is still personal data under the law and in practice, and that it exposes patients to privacy risks and potential data protection infringements.”