On Wednesday, it was named the NHS Modernisation Bill; a day later it was published as the Health Bill, with this funny line in Hansard: “Secretary Wes Streeting, supported by the Prime Minister”… oh.

Clause 1 is wonderful: “NHS England is abolished”, but they didn’t stop there.

Below is a short and more technical than normal summary. We’ll go through things a bit more slowly next week.

There is no obligation in the Bill for all uses of NHS data to be consensual, safe, or transparent – indeed, many of the provisions allow the opposite.

The main announcement is that you will have a Single Palantir Record containing all of your medical notes, all your prescriptions, and your DNA sequence – all controlled by a politician, accessible and sold to whoever he sees fit. This wasn’t in the briefing Wes gave to make his plans sound good, but if the SPR regulations are unchanged, your GP opt out will be wiped away so he can sell your data.

To those who think going private will help them, there are powers to demand data from regulated private entities in a range of circumstances – which will become a chew toy of the Secretary of State. Registered medical professionals will be told they are unfit to practice if they don’t use the Single Palantir Record, and if they do use it they’ll be forced to write your private health details back into it. 

Andy Burnham’s Greater Manchester NHS has repeatedly shown how FDP would be a step backwards for them – and this is Wes Streeting using his last vestige of political power (for now) to take a system that works for others, and replace it with a product whose supplier paid his mentor. 

Any good intentions are obscured by the power grab and the complete lack of protections for patients. Indeed, there are more protections in this Bill for the ‘Federated Data Platform’ (i.e. Palantir) to burrow deeper into the NHS than there are protections for the patients’ data within it. How very Wes Streeting, who, when introducing the Bill, knew he wouldn’t be the one to wield those powers himself.

Your medical notes, prescriptions, and DNA will be used however a politician decides; you’ll have no say and no choice. 

Line 20 on page 100 is the key: it says the NHS must do whatever politicians decide, with any medical records they have anywhere. The Secretary of State for Health can take any data (s)he chooses and punish those who complain or push back. Patients will have no rights and no choice. 

The Bill also strips away all of the existing statutory processes, and forces all current data flows to happen through Single Palantir Record. The usual requirement of adulthood for social care uses of data is missing – this also applies to vulnerable children. It’s a very Peter Mandelson Bill.

Clauses 47-57 are all about Data. You will have a Single Palantir Record, and you will not have a choice about your data being in the (former) NHS England data platform, known as the Federated Data Platform, that is provided by Palantir. 

• The test to be met for the Secretary of State to take a copy of your medical notes is if it is “expedient”, or when “the Secretary of State considers that disclosing the information is a proportionate means of achieving a legitimate aim” [Schedule 7 clause 11 (261) (2) (g) & (j)] 
• Secretary of State will collect all data he wishes about you, and share it as he wishes, and only Secretary of State’s views matter [Schedule 7 clause 5, plus Sch 7 cl 6-10]
• You may choose not to look at your Single Palantir Record [Sec State can’t make you]
• You may choose not to look at who in the British Isles has accessed your Single Palantir Record, to the extent that Secretary of State chooses to show you (there’s no punishment if they creep on you) [cl 250E(5)]
• You shall have a Single Patient Record, and you shall have no opt out [none in the Bill]
• Your Record will be updated how the Secretary of State or someone else decides. [cl 49(3) & 49(4)]
• When you talk to one part of the health and care system, the Single Palantir Record will reach into your notes and records at other providers you receive care from, and rewrite those records [page 7 of the impact assessment]
• Your ability to opt out of research appears to be taken away [Sch7 cl 11(261)(2)(d)]
• Commercial users are fine, and you’ll have no choice about that either [cl 48(5)(7)(a)]
• Read and write access reaches “anywhere in the British Islands;” [cl 47(2)205E(c)(ii), also cl 50 & 52]
• And if your doctors don’t like this, they’ll be fined or punished by regulators [cl 47(2)205E (2)(d), 250F]
• The “British Islands” reach also applies to research, so a corrupt cartel outside of England – hence outside England-only enforcement powers – can resell any/all of the data placed in Palantir (i.e. every English patient’s data) under the custom rules of a “British Island” but off-shore tax haven. England also takes over a lot of decision making about anything on the platform, overriding devolution by not simply not caring about others’ views and making it a ‘take it or leave it’ offer [53-56]
• All duties of confidence relating to your records are set aside for whatever purposes the Secretary of State decides [“may” in cl 47(2)250E(3) vs 250E(4) & (5)]
• There should be rules against abuse, but there’s no legal basis for any punishment [cl 47 (2)250E(2)(5)]
• All of the existing data flows around the NHS shall be merged into the Single Palantir Record powers above, as has already begun under ‘faster data flows’ [cl 49(3)251ZF & cl 49(4)277G]

Clause 47(2) covers all health and social care – including both adult and children’s social care, despite children’s social care not being a function of the Department of Health. (We assume the Department for Education will have something to say about this.)

Sharing data across government (or beyond) would be covered by it being either “expedient” or a “proportionate means of achieving a legitimate aim” – the lowest of low bars. This is the sort of test that Peter Mandelson and Tony Blair would love.

References to “the British Islands” are weird. This means that data about English patients can be processed in Scotland under Scottish rules – which is an entirely different mess, which we’ll pick up again soon – and the entire Bill ‘goes GB’; it’s UK-wide, with hooks for Northern Ireland too.  The so-called “Secure Data Environments” in England are trying to harmonise themselves so that decisions by one are binding upon them all, but now data can flow over the border and into UK Biobank-style messes enabled by Scotland on English-only data – not forgetting that HDRUK and UK Biobank share a culture. (The tax haven clauses suggest Mr Streeting was assuming his allies would have control in both Scotland and Wales after the recent elections – an assumption that couldn’t have been more wrong, and which undermines other of his recent actions.)

After this Bill passes – if it passes – then cancer care in the NHS will be limited to a false choice of either ‘all your DNA goes into Palantir’ or ‘you die, US style’. Any promises made risk repeating the precedent of allowing UK Biobank to use “pandemic only” GP data however they cho(o)se, which meant it was all for sale in China and freely available on the internet. Any promises made in the next claim of emergency will get broken, and data once taken in an emergency will be retained – because Wes already decided that can happen.

At this point, and given the Bill was published to surprise everyone, the Bill as introduced is so blunt and far reaching that MPs should vote against the programme motion, to allow sufficient time for notification and responses from those bodies who will be obliged to comply with the Bill. 

Mr Streeting took lessons from his political mentor Mr Mandelson in trying to ram this through by imposition. The House of Commons can tell the new Secretary of State to take some more time. 

Because fixing this mess will take time.

Other clauses

medConfidential and others will pick up clauses 2-46 over time, which are most of Wes’s top-down reorganisation written into law – taking even more powers to himself. 

Clauses 4-7 of this Bill will throw Clauses 1 of the NHS Act 2006 into an utter mess. One of the many organisations jockeying for influence should convene a process to take all of the different clause 1 additions to NHSA 2006, and promise an amendment which leaves something coherent after this Bill – there are 4 clauses to play with, and it might turn chaos into some form of order… 

Bill work

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