At 7pm on Wednesday 11 March, Dominic Cummings welcomed more than two dozen tech executives into Downing Street. It was the eve of the government’s decision to move from the “contain” to the “delay” phase of its coronavirus strategy, and Cummings – Boris Johnson’s chief adviser – opened the meeting with a warning. Britain, he told his guests, was entering an unprecedented era.
Over the next 90 minutes, executives from Google, Facebook, Uber, Microsoft, Amazon and Peter Thiel’s controversial analysis company Palantir, among other firms, volunteered a range of resources, from engineering and transportation to advertising and data modelling. Government officials, a source who attended the meeting told Spotlight, said they wanted to move fast, but that they also wanted to act ethically.
For an industry that had been frozen out of Downing Street during Theresa May’s premiership, the meeting was emblematic of a new government drive to thaw relations with select UK and Silicon Valley firms. But it’s not the first olive branch the Johnson administration has extended. And, while the coronavirus outbreak may provide an opportunity for tech firms to improve their public image, some are eyeing a bigger prize.
In December last year, leaked documents revealed the scale of the government’s ambitions for the NHS’s work with the tech industry. To date, research partnerships with tech firms have largely been limited to individual hospital trusts. Moorfields Eye Hospital, for example, has worked closely with Deepmind, a London artificial intelligence (AI) lab wholly owned by Google’s parent company, to accelerate the interpretation of eye scans. The leaked documents, published by The Register news site, indicate that the government wants to go further, however.
Two months earlier, senior NHS officials had met with business leaders to discuss the centralisation and potential sale of the NHS’s huge trove of anonymised patient data. According to the leaked documents, the meeting was attended by Amazon’s UK director Doug Gurr and Microsoft UK chief executive Cindy Rose, as well as AstraZeneca’s data science chief. (Rose, Spotlight understands, also represented the company at the Downing Street briefing.)
“Our hypothesis,” a meeting agenda reads, “is that it is now widely accepted among researchers, industry, the NHS and policymakers that NHS health data holds some unique characteristics, such as a large (55 million to 65 million) genetically diverse population, a single payer healthcare system, and access to clinical data.”
It is, in short, the largest patient dataset of its kind anywhere in the world. For researchers and the NHS, the opportunity to see into patients’ pasts and analyse health trends across a nation over time is unparalleled. It could, they hope, lead to seismic medical advances.
For the tech companies that will supply the data tools, algorithms and storage services upon which researchers depend – and, in some cases, carry out analysis themselves – it represents a major commercial opportunity. Alongside financial data, our medical records remain, for the moment, one of the few things tech companies struggle to monetise. For the British government, it is a vast source of untapped revenue. Professional services firm EY has estimated that access to NHS patient data could generate £10bn every year for the Treasury.
Working with the NHS is a priority at the very highest levels of the tech industry. Speaking at a conference in London in November 2018, Microsoft’s chief executive Satya Nadella claimed that the deployment of AI within the health service could improve the Treasury’s finances.
“If you talk about any improvement of the economy here, there’s no way you’re going to think about it without taming the ever-increasing costs of healthcare,” he told delegates. “New tools could change how care is given, how the patient is informed and, most importantly, the trajectory of healthcare costs going up.”
Labour MP Darren Jones, a member of parliament’s science and technology committee and self-described tech evangelist, echoes this sentiment. “We have to modernise our public services,” he told Spotlight. “But it has to be done in the right way.”
Although Jones believes that the private sector has a role to play, he fears that government officials “don’t properly understand what interest private companies have in being able to get access to this data”. He points to the NHS’s deal with Amazon to provide health advice through the Alexa voice assistant. The health service and Amazon both denied that the online retail giant would use queries to build health profiles, but the contract – published following a Freedom of Information request – was signed based on Amazon’s rather than the NHS’s templates. As TechCrunch reported in October, there were no terms to limit what Amazon could do with the health queries users made.
“Patients absolutely have to be part of the conversation about what we do and don’t do with [their] data,” Jones says. “As far I can see there is very little, if not no, attempt whatsoever to provide transparency and accountability around what the government is trying to do around patients’ health data.”
For those who feel encouraged by the opportunities AI could present for healthcare, the Johnson administration’s lack of transparency on the issue – evidenced by last year’s meeting with Amazon and Microsoft – is cause for concern, not least because there’s a risk of recent history repeating itself. Ministers took the decision in 2016 to cancel care.data, NHS England’s original attempt to centralise patient records, as public sentiment, driven by privacy concerns, turned against the initiative.
No matter how much goodwill the tech industry accrues by helping tackle the coronavirus outbreak, if the government continues to hold meetings about patient records behind closed doors, the public’s trust in its plans for NHS data may yet turn again.
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