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.

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.

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.

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

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:

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 anonymised patient data using its clinical AI technology to accelerate medical research.

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?

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