10 Year Plan – Week two

It’s going to be a very long decade. 

In week two of Mr Streeting’s ten-year plan (10YP), the House of Lords debated the plan and got no new deatils. The gaps are starting to look deliberate. Mr Streeting may soon have his own “P&O moment”—only this time, it’s the government doing the firing rather than condemning it. 

Elsewhere, Dr Morley has her usual wisdom, and the LibDems have had a look from a local political perspective.

Data Debacles can have consequences (in economics at least) 

The economic statistics matter to the government, to the Bank of England, and beyond, so getting those catastrophically wrong had consequences. It is unlikely destroying GP practices and replacing them with AI chatbots will have anything like the interest from finance (well, until they realise that forcing the firesale of local GP practices will make middlemen a lot of money from turning them into flats).

The thinking beyond the 10YP and the Palantir-hosted, politically controlled Single Patient Record is the same thinking behind the ONS Integrated Data Service – practices and failures which have forced the entire leadership of the ONS to resign, and the kind of quotes about the National Statistician that Andrew Morris from GDR takes very personally when we say similar things about his similar worldview and HDR’s approach.

A single patient record but no single patient view

The goal of the single patient record is to display a single view to the patient of their health that the Secretary of State can use to micromanage every patient via algorithms and AIs. 

But, there is no single point of view – as hospitals and social care show. The disconnect between the health and social care systems is unchanged and the cause of people being in hospitals who “do not need to be there” (according to the NHS at least; social care would say the reason they haven’t moved is because they can’t be in social care). Those patients already know of the limbo they are left in. 

Similar limbo will be created for everyone who have gone to their GP, and heard from their GP that they need hospital referral, but where the hospital referral is rejected with “advice and guidance”.

As hospitals are put in charge of GPs and single patient records, the inaccuracy of those records (as only the hospital’s opinion) will become entirely clear to patients who will see that their record doesn’t accurately reflect the reality of their care or their health, but the fiction that the hospital insists is Officially True. Those fictions will be expressed to Government while the public languish.

A single view can be shown to a patient in an app (PKB do it right now) – showing the patient where there are divergences between care providers rather than papering them over and pretending they don’t exist. Giving patients and their carers accurate detail of the blockers to their care might actually be useful (even if politically untenable as it would provide evidence of where the system fails, and how that’s being ignored).

One way to abolish waiting lists is to abolish referrals

Mr Streeting wants to abolish waiting lists, and there are ways to do that which don’t involve treating more people faster. Hospitals are pushing for a different path.

It’s hard to reduce waiting lists, so instead the 10YP abolishes the process that creates waiting lists – it abolishes the boundary between GP and hospitals by your hospital taking over your GP.

In the vision of the 10YP for hospitals, with a politically controlled central patient record there would be no difference between being treated by your “GP” as then, and treated by your hospital as now. You’ll still be waiting, but there’ll be no list as the distinction will be entirely internal. There will be no “referral” in the way it is currently measured – waiting lists measured will be zero because of the changes, but not because anyone got treated faster.

You’ll be perpetually waiting—figuratively stuck in a corridor—while those deemed more “worthy” by a chatbot move ahead of you (in A&E there is triage for saving lives which is entirely visible, but when you have to call 111 to go to A&E that will be something else).

No wonder the hospitals love the idea. Minor treatments, scans, etc will become as convenient getting to your ”local” Community Diagnostic Centre. 

A 10 year vision for your GP: debenhams–style

We usually focus on your medical records, but the key entities who make decisions about them – the Department of Health in England, hospitals, GPs – all matter, as does you and what you want. One reason GP data is high quality and coherent is because it has been GP-led in the interests of patients and the profession for decades, and the Government has never succeeded in interfering (much) or getting their hands on it. GP data has never been dependent upon political horse trading and the series of temporary political bargains. GPs do what was in their patients’ long term interests, as GPs expected (and still expect) to be around to care for their patients later on.

The 10YP makes clear: none of that will continue.

The imposition of ubiquitous and mandatory transcription, the utopia of Zuck’s advertising driven fantasies, will change what people will and won’t tell their doctors. Some on the opposition benches will assume that going private will save you (or them!) – Unfortunately, while access to all your GP notes may be available to private providers, to get any NHS business/access they’ll need to write back too if there is any prescribing involved. The point of what DH/E describes as their Single Patient Record is that it is everything about you.

As a parent, you’ll be able to play back the audio of your daughter talking to their doctor, and should she ever be involved in a court proceeding where physical and mental health are relevant, those recordings because they are accessible, may need to be disclosed to her abuser.


The justification for pushing apps and AI chatbots everywhere seems to be that some people post some things to instagram. Even if that were relevant, you can delete your instagram account and get a new one with no connection to the old one. You can’t delete your medical history from NHS records, because those records don’t belong to you, and won’t belong to you. The deal was always that you got continuity of care and commitments of privacy in return.

Instead, under the 10YP, continuity of care will come from an AI chatbot reading all parts medical notes and deciding what’s next for you. They hope the chatbot will do from training what humanity does by default – future governments will do their own retraining for their own reasons. It is perverse that the benefits bill goes down because the NHS treats people worse – not having a regular GP means patients can’t make the strong claims in Social Security Tribunals that DWP keep losing (DWP ignore evidence from GPs, Tribunals don’t, so DH/E are abolishing the GPs).

The DH/E advisors inspired by tech companies (should) know there are multiple ways to do anything. A government distracted by AI is taking the extractive approach from communities, going all Jeff Bezos and Philip Green which is a choice. A different choice would be inspired by James Daunt and stay grounded in the communities that they serve and live in.

As Mr Streeting repeats the Andrew Lansley decline, the Prime Minister will eventually repeat the replacement, and fire his health secretary for a radical reorganisation on one understood but his advisors. And no10 may want a new health advisor when the ICO investigation into his choices in his previous job reports back. Although maybe he can get away with misusing the medical records of everyone in London without consequences – that too is a political decision.


The NHS brand will become like debenhams.com – confusing but unrelated to what was the high street icon for decades.

The best explainer for Mr Streeting’s personal view of the NHS is this visionary talk from Sir John Bell CH at the RSA – abolish GPs as you know them and replace continuity of care with algorithms, and transform Our Future Health into a pharma-owned insurer to undermine public good and national interest, with pharmacists being paid to inject you with ozempic in the car park of where you work (if you think it’s hyperbole, listen to the talk until he says “it doesn’t need any doctors”). Some decry the NHS as a religion without a god, like Zoe, Sir John assumes Our Future Health is his own cult following him. Joining OFH may be good for his investors, it shows no sign of being good for the NHS or for you.

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