A new Prime Minister is coming.

He will have views on what he wants to do. Good intentions always meet unforeseeable events, and some events entirely foreseen from the decisions made by his predecessor’s health secretary.

A new Secretary of State will come in, and ask about the problems everyone has, as all his predecessors have done. 

• “What do we do about waiting lists?”
• “What do we do about GP appointments?”
• “What can we do about A&E?”

Labour are about to have their “grayling reforms” moment.

Waiting lists 

The Department of Health’s logic on waiting lists is simple – about 1.7m people flow onto a waiting list every month, and about 1.7m people flow off, and the stock is 7m backlog. If no new people joined a waiting list, you’d be done in about 4 months. The “single point of access” was designed to get the 1.7m down by about half – which is impossible if it’s doctors, but it’s not going to be doctors. It’s not going to be humans.

In a Single Patient Record world, it’ll be a central AI, which will decide whether the referral goes through, or whether the “NHS Online Hospital” (NHSE expects this to be even more Palantir AI) will monitor you in the community. That doesn’t count as being on a waiting list.

Waiting lists will come down because the AI will only let through the people most in need of care at the capacity that they can flow through. When the Department of Health in England says half the people on a waiting list don’t need to be there, they mean that they can stop them joining. Without any change in productivity, that will mean the waiting list drops to zero in eight months (in theory – 1.7m people flow off per month, but only 0.85m join, and 8 months later the backlog is magically gone, in theory; not all treatments, etc).

That’s the theory from the tech people that Wes Streeting bought wholesale.

GP appointments

The current 8am rush and botched imposition of mandatory online triage has made no one happy. GPs are constrained by what DH/E will let them do, and suppliers are being bullied by NHS England to not improve what GPs can do. It is almost as if it is actively designed to make everyone miserable, including patients.

As the Single Patient Record rolls out (this financial year), you’ll get a new button in the NHS App, which is to ask the NHS AI whether you can have an appointment (running on the NHS AI platform, which forms part of the Federated Data Platform, provided by Palantir). Now, many things don’t need a GP, but it will be up to the patient to explain to the chatbot what’s up with them, and the AI will decide whether you get to see a GP, or maybe you get to see someone less trained. If you don’t use the NHS app, you’ll be at the back of the queue when the NHS national AIs prioritise appointments.

NHS England will say if you “need” to see a GP, then you can. But it is the NHS England AIs deciding if you “need” to. If the AIs that read your Single Patient Record says no, then those AIs running in Palantir will handle like Palantir’s bouncer handles these NHS records.

The roll-out of Single Patient Record will be imposed by the amalgamation of the existing Summary Care Records, existing GP Connect, (all run by NHS England) and the Shared Care Records schemes (over time, currently run by ICBs). Your local GP won’t get a say – in a Single Patient Record NHS, all GP data will be extracted into the Single Patient Record, and since DH/E controls the NHS App, a GP will never see the patients who are routed elsewhere without their knowledge. It’s not that a GP won’t catch something, it’s they’ll never be given the opportunity to.

The notion of “your GP” will become as irrelevant to you as the notion of “your bank branch’s manager” is – you’ll be expected to use the app for everything, and your branch/GP gets closed.

Banning people from walking into A&E

It used to be that you could walk into A&E while bleeding and get care.

The Conservative Governments of 2010-2024 kept trying to dissuade people from doing that, under the banner “111 first”.

Yes, that image on the right is a bunch of phone booths outside of A&E which you should stand and bleed in, rather than walking in the door.  

One of Wes Streeting’s legacies is that you’ll now be faced with an iPad that’ll potentially not let you register at A&E. If you walk in you’ll be given the same triage as 111 would do over the phone.

You can hang up on 111; the iPad just won’t let you open the door to A&E. 

Every new minister is told the next step down this pathway will help, an incremental step of good political intentions that will ever diminish the service to the public. Both will get endlessly cut as AI and algorithms that are designed to benefit the Department of Health in England, not your care.

The Reform/Restore line will be simple: “we’ll revert ‘Burnham’s ban’ and let you phone your doctor or walk into A&E” (actual progress is harder). While current Ministers chicken out of patient accountability on who has accessed records, political leadership can decide to show patients who has gone creeping. They may even promise to reopen your closed GP…

NHS England is looking at closing over half GP practices – if you halve the floor space, you have to close more than half of practices and move the staff to “Neighbourhood Health Centres”. Wes Streeting has set in train a Labour legacy of your GP practice being sold for flats (in the South – they’ll just be another set of neglected buildings where that’s not profitable)

Follow the money

All the outgoing government’s plans are heavily dependent upon the tech working and getting data.

Where is the funding in the 2027/28 ICB budgets for the Shared Care Records schemes? Go look, we’ll wait, you’ll be a while.

Across the NHS, political priorities come first, and the safety, usability, and safeguards that make a service usable and safe for everyone are only promised for later, and often never get delivered. Summary Care Records were supposed to be safe, with audit trails, in 2005, but DH never delivered. Single Patient Records will be no different – as DH/E will side with the creeps and ghouls given any opportunity – accountability and transparency always get pushed every further back behind other priorities. That’s how politically led organisations work.

When DH/E talks about the Single Patient Record having a summary of your medical history so you don’t need to tell your story again and again, that’ll be an AI summary that maybe you’ll be allowed to edit. DH/E will pick the cheapest AI for the job, which can mean grok and the Palantir AI Platform.

The Politics

Wes Streeting’s NHS never clearly articulated what the experience would be – it was just a promise of tomorrow with no description of how to get there or recognition of the trade-offs that are inherent in those decisions (reflective of Mr Streeting and the Government he served in) – akin to Mr Grayling’s reforms of probation services.

They’re the “winter fuel allowance” of the NHS. The administrators think they have an easy thing to do, but there’s a reason it’s never been done.

Mr Streeting’s belief was that if you fix waiting lists and GP practices, it’ll all be wonderful. As with the rest of the culture of the Blair Government in Exile, the assumption was it didn’t matter how things were done. Mandelson’s approach that human rights are an inconvenience, patient choice is an inconvenience.

Government can tell patients that the only way patients get to see a GP is via the app or showing up in person and begging. They can do this because DH/E controls the phone lines, it controls the app, it controls 111 (and then the slimmed down ICBs will be unable to justify keeping so many GP practices open, and they will be forced to close to move to the “neighbourhood health centre” which will be about as local as your nearest job centre – so if you go to knock on the door, you’ll be met with a permanently closed sign).

Mr Streeting assumed that the public will accept what they’re given. His culture has continued after he resigned (speaking of unchanged cultures, this new drivel is supposed to be the Government’s response to the Biobank debacle, guidance which changes nothing)

GPs are apparently data controllers for material in the Single Patient Record, but will not have access to who has looked at the record. Ministers will cover up the records because that’s what always happens. 

Dr Dash’s Ratner followup

Why didn’t Mr Streeting’s NHS talk about what they were planning? Because when their leadership opened their mouths, they filled them with their own metaphorical foot.

Enthralled by her undisclosed investments AI, the Chair of NHS England had a Ratner moment about doctors. Consequences have been covered elsewhere, some questions:

• Where will these AIs run?
  • Will the “summary” proposed by Ministers be written by Grok?
  • How will patients know?
• Who authorised the reuse of “direct care only” records in One London to be copied and sold for secondary uses?  (the ICO will figure out who the data controller is, and so who is responsible for the breach) Because data was taken for care, no opt outs applied to the GP data that is being sold by One London (on everyone in Greater London).
• While Chair, why did her linkedin appear (click the first name here) on the website of a notorious company which “breaks national [data] guidance”? How did the company Dr Dash advised get their data given those FOIs? 

Under the powers in the new Health Bill to create prizes, will companies who have “unclear” data provenance be able to win prizes out of the NHS budget after their cheating? 

Will Ministers give NHS contracts to companies that stole NHS data and commercialised it?  

According to those same Ministers, the Health Bill means you will have no idea who has accessed your health records even as they are made much more widely available across the NHS (Palantir Inc’s VP for the UK claims “audit” covers only the topics he wants to talk about in the way he wants to talk about them – which isn’t audit it’s just PR)

Why the secrecy and dishonesty?

If Streeting were the politician he believed himself to be, why the secrecy?

If he believed this would work, why not say this is the pathway? We’ll close GPs, ban you from walking into hospitals, AI everything, but care will be better, and you’ll elect me as PM!

Why wasn’t any of this mentioned in advance of the Health Bill with its vague wording and unlimited powers to a Secretary of State who resigned minutes after the Bill was laid – clearly Mr Streeting knew he wouldn’t be around to implement any of this.

Why did the SRO not talk about it in Parliament?

There’s no argument that Government is taking the powers to do what it is claiming. The only question is how to convince patients that once it’s implemented it’s better. Or perhaps they simply hope the “prevention of future deaths” reports will only roll in after the election…

Why did the Minister claim no implementation decisions had been made, only days before it was announced that NHS AIs using the Single Palantir Record will sit between you and your GP, and those AIs will decide whether you should have an appointment. Only if the AI decides you need one will it let you through. If no decision has been made that FDP will remain with Palantir, can they show any contingency planning for this change? Or is the leadership ignoring the topic  until they claim it’s too late to do anything?

Deception and lack of integrity undermines confidence – the way to fix that is absolutely transparency and accountability. Maybe the above will work – Wes Streeting bet the entire NHS on him being right, and he ran away to make sure he wouldn’t be held responsible for the failure. When your GP surgery building has been turned into flats, it can’t be turned back again.

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