There has been much ‘chirping’ about the Covid Inquiry: it’s too wide, it’s too narrow; it’s not looking at the right things; it’s not looking in enough detail at the particular bit of the elephant someone spent their time holding; it’s looking in too much detail at another part or parts of the elephant; etc…

The Inquiry contains multitudes (good work on complex topics inevitably must) and the Inquiry’s modular nature lets everyone complain – much as historians can write very different books on events that were vaguely recorded, and they do. 

And those very same chirping interests tend to dismiss others as “Non-Playing Characters” when they want to remove agency from people and groups who will and should be able to make decisions they disagree with. Today’s decision makers are strong and everyone else must accept that, as if today’s decision makers are all that matter.

Data is a common theme in the Inquiry

Data keeps coming up. Everyone involved wants more data at all times to do more things.

Assumptions being made about data by the Department of Health in England (as it is now becoming) are that they want to be able to do anything they choose, and that they should be able to do whatever they want at all times.

The underlying model of DH/E is that Palantir systems will have all the data, and that DH/E controls the configuration. And if DH/E flips the data controller switch again, they’ll be able to do anything they want.

One advantage of Palantir’s product being based upon Apache Spark software is that its capabilities are public; Palantir just does ads on anything they claim they alone can do. Palantir is not magic.

In effect, DH/E’s position is that Mr Streeting wants to be the data controller for your medical notes, and he alone will decide who can use them. (Until he is replaced, of course – then his successor decides…)

These are self-prioritising claims made without external input. Alternatives exist, but Mr Streeting doesn’t care because he knows what he wants and is going to impose it upon you.

If a national analysis were needed, it could be designed nationally, run per “instance”, and the answer could be collated nationally without the “National data integration tenant” (NDIT) having the data. 

DH/E argues opt outs are an impediment because DH/E wants to copy all of the data for its own purposes, and to avoid accountability to patients (or anyone else) because a civil servant might be held responsible for something. 

Patient wishes get ignored when secrecy makes it it easier to ignore them

GP data was collected from practices under the promise of being “covid only”, a promise torn up by the current Secretary of State who doesn’t keep promises he didn’t make. It’s entirely unclear what he expects his successor to do.

It is the Department of Health in England’s view that expecting to have choices over your healthcare is excessive, and data about that care should be unrestricted within the Department – you are to be expected to accept how politicians choose to use and read your medical notes if you accept any form of care at all. If you seek NHS care, what the NHS does with that care is what’s in the interests of the Department, the personal fiefdom of a politician, and not something about which you should have information. That was also the approach to pandemic procurement, a module of the covid inquiry to come out in future.

The Covid Inquiry shows decisions have consequences, and DH/E staff wish to avoid all of those consequences (especially in the “Privacy, Transparency and Trust” team, which refuses to accept privacy, undermines claims of transparency, and undermines Trust. The disingenuous existence of that team means that other parts of DH/E can entirely ignore those principles, claiming to defend them while undermining them directly. 

When it came to the Federated Data Platform, NHS England decided in secret they didn’t have to do a full impact assessment on their “Privacy Enhancing Technologies” because the name said they were privacy enhancing. That’s the sort of decision that causes inquiries, not respects their findings

The hits keep coming, and at some point, like the decision in the Biobank direction, the bill will come due.

Being within a system distorts your perspective on success

It is blatantly obvious that the current dangerous drop in vaccination rates will not be reversed by allowing home visits for vaccination; but it’s something the system can do, so it does it and exaggerates their claims.

It is equally true, as the covid inquiry reported, that the actions of late March were significant even if the same individuals made catastrophically flawed judgments beforehand and afterwards.

The system is doing what the system does. The system has recognised that what it does is entirely out of step with public expectations (and arguably the law), but the system’s response is to want to lower public expectations towards what is easiest for the PTT team. Good luck with that. 

Some of the criticisms of the Inquiry by former officials is that the Inquiry, like some officials think of the public, should do whatever is best for the officials (thinking that also pervades the think tank glossies about how ID cards will be wonderful for think tanks).

How many people like you should the state allow to suffer and die? Why should that number be any different for people in similar circumstances but not like you?

The new structures of DH/E entirely fail to understand that there is a difference between doing the best you can, and doing what is necessary. There’s a difference between saving as many as you can, and inconveniencing as few as possible (and you as little as possible)

The cultural silo that “we alone must do it all, alone” epitomised by the current US administration’s approach to, well, everything,  is also prevalent across DH/E.

Of course, those with the resources to have their own version of covid events will be able to commission their own books when the documents reach The National Archives in due course.  Your health records are widely available to anyone who applies to use them for now because the system doesn’t want to inconvenience valued colleagues by accepting patients wishes.

You only need to look at the Biobank mess to see how this goes wrong.

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