When NHS England and Palantir talk about “federation,” they may want you to picture the benevolent Federation of Star Trek – Patrick Stewart in a jumpsuit quoting Shakespeare. But the reality is closer to the authoritarian bureaucracy of the 1980s BBC sci-fi Blake’s 7 – low-budget, grim, and reflective of Palantir’s broader clientele.

medConfidential appears in the first episode of a mini-series on the Federated Data Platform (FDP) and Palantir, featured in Dr Baw’s podcast about Digital Health. Part two is due in a few weeks.

The various parts so far:

• Single Patient Record on Palantir’s Federated Data Platform
• Is your Politically Controlled Single Patient Record yours?
• Lack of delivery is political…
• …Delivery is possible
• Data Debacles can have consequences (in economics at least)
• A single patient record but no single patient view
• One way to abolish waiting lists is to abolish referrals
• A 10 year vision for your GP: debenhams–style
• Give the chatbots something to do
• Tribalism
• Immigration Passports create a Hostile Environment (for Taxpayers)

Innovation should serve patients and improve care – not primarily bolster NHS institutions or suppliers.

The Myth of a Single Patient Record – Give the Chatbots Something Helpful to Do

NHS planners continue to chase the illusion of a single, unified patient record – a “single view” of your health. The aim is to enable centralised algorithmic management of care when that record is owned by the Secretary of State. The “Single record” won’t be the patient view but will be the view that is acceptable to the Government of the day. When your single record doesn’t reflect your health, the system will believe it is you as a patient that is in the wrong.

The current structures do not permit a single point of view of your health, as anyone navigating both hospital and social care simultaneously understands. The disconnect between those systems is built-in – let alone the differences between a GP’s view and a hospital’s interpretation.Your GP may refer you for hospital treatment. The hospital might disagree. And “Advice and Guidance” doesn’t even qualify you for the waiting list – the very premise of “hospital to community”. “Advice and Guidance” exists precisely to smooth over these chasms, but they still leak through and it is the patient who is left to manage amongst the wreckage when the NHS insists it is connected but really is not. The 10 Year Plan’s version of “shifting care into the community” places hospitals in charge of the process. This will expose the inaccuracy of patient records – and patients will begin to notice. What appears in the record will reflect what the hospital budgets allow, not the reality of care.

A better approach would show patients where different providers’ views diverge, rather than gloss over the differences. Patients should be empowered to see the friction in their care – and then advocate to resolve it. Perhaps, one day, even with the help of a chatbot.

Providing patients and carers clear information about blockers in their care would be helpful – even if politically inconvenient for the hospitals now determining the shape of local NHS services.

The 10YP’s current vision for AI is uninspired: shave seconds off an appointment, then NHS managers will use that data to pressure doctors to talk faster.

But we’re already at a point where privacy-preserving AI chatbots could provide real value. A patient with unresolved symptoms could privately run their own records through a secure chatbot (e.g., Apple’s Private Compute) that leaves no data behind. It could ask smart questions your doctor wouldn’t know to ask, or things that you wouldn’t know might be relevant. Or give the citations to those who wouldn’t otherwise know how to advocate for themselves.

This technology exists today. It could even scan NHS correspondence to ensure follow-ups happen – the kind of oversight failure that can be fatal. The true potential of AI in healthcare is in doing new, patient-first things, not streamlining bureaucracy or enforcing metrics.

Metrics can lead to mismanagement. What’s measurable often overrides what’s meaningful.

Tribalism – Fear of Corbyn in the Street(ing)s 

Wes Streeting’s political instincts were shaped in the Jeremy Corbyn era – and it shows. He often treats disagreement as sabotage, even when there’s a valid point underneath.

That tribalism is dangerous in government, especially in healthcare, where hospitals and tech companies (with vested interests) had a hand in drafting the 10YP.

Ideologues may insist the plan will work. But reality – like it did with Liz Truss’s economic reforms – will intervene. Patients will see it all in the NHS app: promises made in meetings but unworkable on the ground. For instance, trying to restrict A&E access is politically toxic. Even Jeremy Corbyn would know why. Streeting apparently doesn’t.

If Reform UK offers a simple counter-narrative – “Nigel will let you walk into A&E; Wes tried to ban it” – Streeting’s entire plan, good and bad, could collapse. And we may get a new Health Secretary.

Immigration Passports create a Hostile Environment (for Taxpayers)

Many companies around healthcare aren’t exclusively trying to help patients. They see potential in extracting money from the NHS.

As discussed in the podcast, this is the problem Moorfields complained about – people didn’t go blind, but Moorfields didn’t see that in their budget lines. Government thinks it must micromanage the outcomes of a false choice: improve care or cut costs. It’s rarely told that better alternatives exist that do both.

Even if Streeting waved a wand and abolished GPs, magically replacing them with private providers, someone would still have to cover the healthcare that DHSC currently does – likely the DWP, driving up Universal Credit costs and simply moving costs from one department to another.

If tech entrepreneurs really want a UBI world, it requires merging DHSC and DWP and for that part of a single-payer model anyway – in other words, the NHS.

“Innovator passports” have reappeared in the life sciences plan – the idea of offering one hospital a freebie deal from companies like DeepMind, Palantir, or firms connected to NHS chairs. The catch? That hospital becomes the precedent with a sweetheart deal and loose governance, issuing a “passport” and every other Trust pays full price – both financial and in pays in patient trust.

Inevitable commercial corruption and cheating will develop a ‘hostile environment’ where these passports aren’t worth the time unless the Trust whose paperwork is being relied upon holds the liability to those where the passport is used, in the same way the Government has some responsibility to citizens overseas.

Without those responsibilities, all currently missing, the incentives for irregular entry are obvious, and as every migrant to the UK knows, it’s not enough to have a passport, you also have to go through the visa process. Perhaps Mr Streeting wishes to imitate Theresa May.

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