During the pandemic, your data was collected from every GP under the promise that its use would be for “pandemic only”purposes. That promise is still on your GP’s website. Mr Streeting has decided to tear up that promise and is seeking to do so behind patient’s backs by instructing GPs not to tell patients of the change. 

This is going to become a very large mess.

GPs were told in 2020 to put on their websites a promise that the data would only be used for the pandemic. That wording is still there. Mr Streeting has Directed NHS England to reuse the data however he wishes, but GPs have been told that “no action” is required and is therefore not monitoring acceptance – despite the fact that taking no action means the practice website will still be telling their patients that the “pandemic only” constraints are still in effect when they have been torn up and Mr Streeting does what he wants with their data. This is the first time, but there are repeats on the horizon.

And this matters even more because Mr Streeting ‘crossed a political rubicon’ when he signed the Direction saying that the NHS can lie to patients about how data is used. Like a Silicon Valley techbro, his actions show he can make a promise today and break it with a swish of his pen tomorrow. (Of course this also means he could choose to reverse this decision and stick to the “pandemic only” promise; if he doesn’t, the die is cast.)

Latest in a line of breached promises

The secretive charity HDRUK already broke the “pandemic only” rules when they trained an AI on “pandemic only” medical records for any purposes they like. When NHS England asked its independent Advisory Group on Data to assess those projects (item 5.1), the majority did not support them. 

NHS England refused to do a meaningful investigation, instead limiting itself to simply asking HDRUK whether a project was only used for pandemic purposes and believing their answer, despite the assessment of their independent advisors. HDRUK persists with the levels of transparency and accountability of the Boris Johnson administration. 

“Lying to the press is not a crime”, says Baroness Mone, OBE – and the shared culture of HDRUK and Biobank has applied that same principle to patient data.

Biobank still sends patient data around the world and does not disclose which users are given exceptions to Biobank’s supposed rules. Our list of unanswered questions is long. Biobank continue to allow the company related to the eugenicists to access their servers (which are subsidised by UK tax payers), and Biobank claims “Byte Dance Ltd” are doing genomics research via their Cayman Islands holding company, despite claims the project is based in the United States from staff in China. (Byte Dance makes the TikTok app). After Biobank angrily insisted there was no problem with Biobank giving to insurers data that was donated for research, they later quietly slipped out that they had stopped; a US shell company called Flying Troika was never investigated, and Biobank approved last month a new project explicitly to give undergraduates in China real NHS/Biobank data to use in exercises.

This all matters not only because of the plans for a Single Patient Record and the Health Data Research Service, but because HDRUK and Biobank share a culture and say they designed the HDRS. This all matters because of the proposals for a Health Data Research Service, and because of the proposal for the Secretary of State to be Data Controller for the Single Patient Record.

If a patient has a National Data Opt Out covering research, none of their data should go into HDRS. The Biobank Direction threatens that. The published Direction is only for “consented cohorts”, but a future second half is under discussion covering “unconsented cohorts”, which likely be as broad as HDR’s past requests; cohorts such as “people who have hearts”, or “who are breathing”.

The extent to which HDRS delivers on the goals, delivers for patients, or does neither of those things depends on decisions not yet officially made. As DHSC takes over NHS England, and takes over the data release registers, those DH registers must include all NS data that flows out of any DH entity, otherwise they are by definition incomplete. The NHS itself has largely avoided data re-use scandals over the last decade by having complete registers of decisions made and where data flowed. They may have got in trouble about new datasets, but the decisions on old ones were clear. (until HDRUK tore up that consensus by breaking the covid-only rules – will HDRS look more like the transparent governance of NHS England or the secretive cartel of HDRUK or the unaccountable club that is UK Biobank). There are now many moving parts, and who will gain a short term advantage is unclear. 

HDRS could be good

The new Health Data Research Service could be good; it could be consensual, safe, and transparent. But there’s widespread concerns that it will not be. (We’ll have more on HDRS soon).

HDRS has the opportunity to get it right from day one, and we see no sign of DH allowing them to do that – the job ad for the Chair/CEO of HDRS said that HDRS decisions will be “directly accountable to Ministers”.

If patients who have opted out of their personal data being used in research are overridden by politicians and HDRS so they have their data used in research against their wishes, then that will likely go as well as some of the other pre-u-turn decisions of this government. 

Patients have choices

Polling says that up to 20% of people think they have opted out, but official statistics show only 5.5% actually have a National Data Opt out. If a patient is concerned about whether they have opted out, they can check with the online system, and then they need to do the two or more step process to actually opt out: online individually for your National data, and then on paper for your GP data for your whole family, and then a different paper form for National data for your kids! (The previous government designed this system to create administrative barriers to opting out; the new Government hasn’t made it worse yet at least)

Government is currently going through a ‘process’ (involving push polls about which we have had complaints from those attending the focus groups) to look at whether opt outs should be “reformed” in ways which mean an opt out after some date in the future may do less than the opt out does today. As seen with HDRUK, some in research think patients views don’t apply to them – and NHS England doesn’t want opt outs to apply to their “planning” (i.e. everything Government does in health).

It is important for patient confidence that there be “no surprises”, and that genuine transparency shows that promises are being kept or being carefully changed. Without this, how can any patient have confidence in the decisions being made as it takes control of their medical notes in the Single Patient Record?

Government is gearing up for a bunch of announcements about taking your medical record and doing what they want with them – there are many moving parts.

To inform future pieces, we’ve published a long piece on many of those moving parts (not all, because we keep some surprises as surprises).

HDRUK, Biobank, and Mr Streeting argue that privacy doesn’t matter, and they and their cronies should be able to do whatever they want with data without consequence.  They use that argument to break pandemic-only promises, then it’ll be imposing Palantir, and then taking away what rights you do have. Mr Streeting is implementing what he learnt from his political mentor, Mr Mandelson.

We’ll see about that – and perhaps this government will change course when it realises it has done something unwise. 

You can read the full document here.

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If you’re looking for medConfidential’s assessment of today’s reannouncement, the details appear materially unchanged from the aborted announcement in October where key the question remains unanswered:

https://medconfidential.org/2025/biobank-want-gps-to-lie-to-patients/

Hello again from medConfidential,

We’re still here! And so, for another few months at least, is NHS England – and hopefully, given Mr Streeting’s stated intentions, is your local GP…

What happened since our last Bulletin

The Government published its “10 Year Plan” (10YP) with most of the deliverables due after the next election, and with improvements to your family doctor coming after 2035. Perhaps you’ll have to “say goodbye to your data (and say goodbye to your GP)”?

We published a short series of longer pieces on the 10 Year Plan, the consequences of which will be felt throughout the life of this Parliament – but some headlines include:

• As people have worked out that “Federated Data Platform” is just another name for Palantir, the term “Single Patient Record” has been coined as the new euphemism.

• You’ll be given a “Single Patient Record”, which you’ll be told you “own” and “control” – over which you will find you have little or no meaningful control or ownership*, as it will contain everything the State wants to record about your health for its own uses, from your DNA to the activity sensors on your device.

• Another of the grand ideas in the 10YP is for hospitals to take over GP practices – making your GP about as ‘local’ as your Jobcentre, while you’ll simultaneously lose the only part of the NHS that treats you as a person over the long term. 

• They’ll be AI recording consultations in these new centres; every word you say, summarised – and they’ll keep the transcripts to check the summaries, and the audio recordings to check the transcripts. Artists made art.

*The contradictions and caveats in the 10 Year Plan mean your opt-outs, both the “National Data Opt Out” and your “GP Data  Opt Out”, may protect you less after some future date (maybe in 2026?) than they do today.

To stay informed and to find out what we publish when we publish it, you can now join medConfidential’s new Substack (for free) which will send you an email to alert you whenever we publish something.

What’s happening now

The Covid pandemic had temporary rules on data and procurement, which assumed that everyone was acting in the best interests of everyone else, and that no-one would be greedy and profiteer for their own narrow gain at public expense. 

The PPE procurement mess with Baroness Mone has been high profile and long running. Less noticeable has been one ‘sockpuppet’ of HDRUK – an organisation which decided that the rules didn’t apply to them, and started cheating by using data for purposes that were not related to Covid (except in the fiction of HDRUK’s own paperwork). Because HDRUK’s paperwork claims that its uses are “for Covid”, NHS England believes the paperwork – and neither the ICO nor NDG will disagree with the details, which is the sort of defence Baroness Mone would entirely agree with. 

In that same spirit, Mr Streeting – or strictly speaking, his Department – has written a Direction to NHS England to re-use the “Covid only” datasets for purposes that are not Covid related. Following the leadership of HDRUK (see previous paragraph) these re-uses will first be for some “consented cohorts” and then for some “unconsented cohorts”, i.e. everyone. The consented cohorts include the volunteers at UK Biobank, which is still refusing to answer questions about where it sent the NHS data of its 500,000 participants, and why. And the new project “Our Future Health” is watching its predecessor closely…

Your ability to opt out has always been a gift of the Secretary of State, and the Department of Health in England’s recent public engagement – parts of which are barely more than a push poll – has provided a wide range of views which the Secretary of State will take as license to do whatever he wanted beforehand.

He could make the National Data Opt Out stronger and more effective – as some people have said they want – or he could try to take away your opt out so that it doesn’t apply to uses of data by the Department of Health and NHS England, which is what NHS England and his Department wants. Mr Streeting’s plan for the new ‘Health Data Research Service’ (HDRS) will take your data even if you have opted out of research – so Wes could decide you have to opt out yet again, even if you opted out before. (And, once again, opting out may involve punishing parents via a different process for their kids…)

One question we’ve been asking for months, to which DH has no credible answer, is if you have opted out of your data being used in research, will your data be included in the HDRS?

As the National Data Guardian put it in her Annual Report 24/25 (p5): “Exemptions granted for essential planning and operational work mean it no longer reflects what many believe it offers. This risks undermining trust.” We agree and would go further, as those exemptions are also deemed to apply to non-essential work.

What’s coming next

Mr Streeting thinks that the solution to NHS problems is to replace your doctors with ‘his’ AIs, many of them running in Palantir – aka “Making Palantir Irreplaceable”, despite the fact that “Palantir isn’t magic”. In the meantime, the 10 Year Plan has started in maternity care with the sickest babies, and will move up the ages from there – while Mr Streeting’s officials remain incentivised to confuse dystopia with efficiency, and Palantir’s vision may be “Making Americans Irreplaceable” to “healthcare”.  

As we wrote back in January, this Government is obsessed with building an ‘Everyone Database’ – the latest incarnation of which hides behind Mr Starmer’s 26 second announcement of the Blair government-in-exile’s “digital ID cards”.

medConfidential will keep the streams separate for as long as government does, but if you would like to follow this aspect of our ‘rest of government’ work, you can visit NO2ID’s new website, subscribe (for free) to the NO2ID Substack, or sign up to join NO2ID’s Bulletin mailing list by sending an email to hello@no2id.uk 

Seasons’ greetings

This will be our last Bulletin before the New Year. We wish you and your loved ones well for the festive season. Should you feel inclined, medConfidential is always grateful for your support, as we also appreciate so many of you being on our mailing list. As ever, please do pass this Bulletin on to anyone to whom you think it may be relevant.

Warm wishes,

Phil Booth & Sam Smith
18th December 2025

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The NHS is watching Mr Streeting speedrun the dictator’s dilemma, powered by Palantir to go ever faster.

Continue reading →

The Department of Health in England claims to value experts by experience – those people who have lived experience of the NHS and care services, and who want to give their time and energy to make those services better for those who come after them. But DH/E’s actions might cause concern.

Lloyds Bank recently got caught looking at staff bank transactions to use the contents against those staff in pay negotiations. Similarly, when “chaotic and incoherent” Mr Streeting gets emotional, he makes decisions in the interests of his leadership campaign politics not patients (and he wants to become data controller for all of your medical notes).

As part of the takeover of NHS England by the Department of Health in England, items 5.2 and 5.3 in the minutes of the 12th June 2025 Advisory Group on Data meeting show that the new Government is allowing civil servants in DH/E to access patient data for their work. (There are two items because there are two systems; at some point Palantir will replace both).

Under the previous government, this capability was only given to the “Private Office Data Science” (PODS) team, working directly on whatever the Secretary of State wanted. There is no transparency over the access when doing policy work for the Secretary of State yet normal civil service rules on access apply – which is, if the politicians ask for something, then a civil servant should give it to them. Instead of applying to policy drafts and consultation responses, the principle gets applied to your medical history and all your doctors’ notes. 

As Labour has made data skills something for all civil servants, all DH civil servants now have data access if they can justify it for any part of their public task – their ‘day job’ – no matter how tangential.  The Department of Health in England does not disclose what it wants these powers for, which suggests they will be used for whatever Ministers of the day want – the same decision Lloyds Bank made. DHSC will have the same capacity –  someone says using your medical history as they want is in line with the Civil Service Code then it will happen. For example, civil servants who staff the new “Patient Experience” directorate at DH/E, whose job over time will become hiding the patient experience from others.

If an ‘Expert By Experience’ discloses to a civil servant (or anyone working for what is currently NHS England) something about their experience, i.e. the topic of expertise, the civil servant will be able to use that “unique” experience you told them about to look at your entire medical history and read about anything you didn’t disclose. 

This access applies to everyone, not just those cooperating with the Department of Health in England. Lobbyists, MPs (especially rebels), public figures, are all equally at risk, whether or not they directly talk to the new “Patient Experience” directorate. This is in addition to the reidentification risk which remains trivial for anyone with a public health event that is uniquely identified in the health events data of the NHS (e.g. a man of a known young age having a kidney removed in a particular week in a particular hospital).

The 10 Year Plan says this:

The NHS never has the right to keep the public in the dark. That it so often does so reflects the centralisation of power and disregard for patient voice we identified in chapter 5.

At its worst, this status quo means the most severe cases of systematic harm go unnoticed and unchallenged for years. The past 4 decades have seen a litany of tragedies. Each of them was avoidable. Each suggests previous lessons have gone unlearned.

That is why we will make the choice to deliver full transparency. We recognise this will be uncomfortable for some in the NHS. We expect transparency to highlight new failings, show new problems with quality of care, and to put a megaphone to the mouths of complainants that have otherwise felt they are shouting into a void. We do this because sunlight is the best disinfectant – there is no other way to restore public faith, and to drive up quality for all.

These are nice words, but they are currently disconnected from both policy and from delivery. Maybe, like GP improvements, they’ll come sometime after 2035.

The NHS is watching Wes speed run the dictator’s dilemma (powered by Palantir). Putting everyone’s medical notes into Palantir for any civil servant to rifle through if they believe it is in line with the civil service code will fall far short of what is required for public trust. Trust requires evidence; by definition, “faith” exists in the absence of it, but when “chaotic and incoherent” Mr Streeting gets emotional, he demands staff do what he wants, and gets very angry when GPs and other doctors all care about their patients going beyond the political headline.

Data always gets shared

Item 9 of the same 12 june minutes also allows any new data held by DH/E to be given out to anyone who had any data for that purpose before. As things stand today, those additional accesses will not be included in the NHS England Data Uses Register, so there’ll be no transparency on whom that data is given to.

Item 5.1 of those same minutes show AGD taking a look at the Michelle Mone style antics of HDR abusing “Covid only” data rules; HDR may have taken a similar approach to the truthiness of its public statements. Of the projects that HDR asked AGD for a view on, the majority did not get support from AGD, showing just how rogue the HDR process has gone: HDR and Biobank share a culture and this may be the precedent for the new “Health Data Research Service” envisaged by the HDR “leader” who argues tearing up the “pandemic only” promise is entirely fine because they’ll gain from the change. 

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10 Feb 2026 update: The Secretary of State for Health and Peter Mandelson’s political protégé has now Directed GPs to do this. GPs have been told “no action” is needed from them, but they must take the action of informing patients that the “pandemic only” dataset will now be used however Mr Mandelson’s political protégé may decide. GP Data Opt Outs will still apply.

Below written in October 2025:

There’s more to come

medConfidential has seen press reports there is a signed but unpublished Direction implementing UK Biobank’s plan to break pandemic-only promises of data uses, which will place GPs in an impossible position with their patients (which is not Biobank’s problem). It was due to be published yesterday (Thursday 16th October), but wasn’t after news leaked.

While NHS England staff considers a Direction to take effect when they publish it, this one will almost certainly require additional implementation actions before it has any effect beyond the destruction of trust and confidence that comes from the signature demonstrating that Mr Streeting believes it is acceptable for him to Direct the NHS to lie to patients.

The Direction can be held by the NHS England Board and sent back to DHSC for additional work (never to return in the same form). It is unclear what would have happened if DHSC had already taken over NHS England.

This page will be updated in future days

The opt out process continues to work.

The Health Secretary has told his friends that the first part of his “Single Patient Record” will be rolled out by the end of the year. 

We expect this rollout will be a “pilot” of the now-merged Department of Health in England (i.e. DH and the “abolished” NHS England) using government powers to impose decisions on the NHS frontline – not a pilot of a real ‘patient record’, nor real patient choice.

The stated policy intent; a politically-controlled centralised database of everyone’s medical notes with the catchy title “Single Patient Record”, potentially could be consensual, safe, and transparent. But given the approach being taken – using a single incumbent tech supplier (which makes political donations) – any political promises made may be no more reliable than their Trumpian equivalents.

This politically-controlled centralised database of medical notes will consolidate all of your medical notes from across the NHS, to be made available wherever the NHS logo is seen (and some government buildings that don’t have such signs).

This could be done well; it could be done badly. 

It could be done in such a way that you can see everywhere your record has been accessed from day one; it could equally replicate the secrecy-by-design of today, where Department of Health in England officials know exactly when and where your GP notes have been read by people other than your GP… but refuse to tell you. 

(If you were to ask the data controller, NHS England, for this information they would simply refuse to confirm that they know when and where your record has been accessed – instead sending you back to your GP, who won’t necessarily know because NHS England is the only one who runs all of those systems.)

You could be offered the option to decline such a risky service – for some, the known risks will definitely outweigh the known benefits – but that would involve consideration of patients, and this Department of Health in England thinks it knows better. This most certainly won’t be a pilot of patient interests.

We asked the Department of Health in England some questions back in April. Five months later, we have had no answers.

This “pilot” announcement appears to confirm supplier suspicions that the pre-contractual “Request For Information“ published earlier this year was a sham, and that Mr Streeting has already picked whatever winner he wanted from the existing NHS England suppliers. (As everyone should by now be aware, NHS England’s existing monopoly supplier for such technology is Palantir.) 

When Mr Streeting decides your medical records will be processed by his AI to determine your priority at A&E, you won’t have a choice. And when your local surgery gets closed and your GP is moved into a neighbourhood health centre, your GP will be required to use the new database – and will have no discretion over the way in which the information they are required to record will be used. (Mr Streeting has already announced that all consultations in all of his new centres will be recorded – and his new database will hold the summaries, the transcripts, and the audio recordings. 

We shall see what Mr Streeting announces, and how it compares to what his Department delivers over his time in office. It is becoming increasingly perverse that Wes Streeting is entirely dependent for delivery on a company whose corporate leadership is actively hostile to the success of his mission. Unfortunately, as ever, patients are caught in the middle.

ID Cards are back

Simultaneously to all this, the Government will try to reintroduce ID cards – starting with a stated policy intent that every employer must treat their British workers with the same assumption of criminality that the Home Office imposes on their colleagues born elsewhere.

There may be additional as-yet-unstated policy intents – or at least, as with the last attempt, further policy intents that won’t be briefed out fully until it’s clear people aren’t buying the previous one. Even before the formal announcement at Labour Conference, people are speaking out.

Digital ID cards policy will run into further trouble when other parts of government assume they are dealing with a “worker” and demand to see their ID. Will police officers have powers to demand you show them your ID by handing over your unlocked phone? Will train ticket inspectors insist on seeing it? How about bouncers outside bars or hotels? 

At this point, the Government seems more interested in grabbing headlines than answering questions. Let’s hope they listen sooner this time as well.

There’ll be more on ID soon, both here and at https://www.no2id.uk/

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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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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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Recently published documents:

• July 2025 talk at the Westminster Health Forum
• Briefing to the ICO and others on the Foresight/AI project
• Letter to NHS England on the Foresight/AI decision making minutes
• Legalities and illegalities in s251 approvals for FDP bodies