[If you’ve seen media coverage and want to help in finding out how to see who’s been creeping on your records, we have a page to help you find out. This piece was first published in August 2026 and relates to continuing high profile investigations and news. The September/October 2026 reannouncements about suspected abuse relate to “high profile” cases only. The NHS in England keeps track of who looks up which patients and when, but is insisting on keeping the audit log that NHS England has away from the patients – in most cases the only person who can provide confirmation of abuse is the patient, who may never be told anything unless it’s already proven. There is no Privacy, no Transparency and no Trust while patients are deliberately kept in the dark by NHS England about potential abusive access to their medical notes.]

NHS England has changed its mind, and decided you’ll still be kept in the dark about what one victim called “repugnant voyeurism” into your medical notes. Ministers promised you’d control your data; what was announced with such fanfare as protecting patients has quietly become its opposite. Promises keep getting broken.

The guidance that is supposed to stop unlawful access now gives creeps, voyeurs and ghouls more excuses to look. It’s easier for them to look, easier for hospitals to cover it up, and not at all easier for you to know anything happened.

NHS staff keep snooping on NHS patients, including terrorism victims. “A disgrace” said the Health Secretary; the Information Commissioner called it a “worrying trend”. Those are only words, and the Department of Health in England is refusing to do what it can to prevent the problem in the first place.

Your NHS record can be read by thousands of staff, and you aren’t allowed to see who read your notes. There is no privacy, no transparency, and no trust. The NHS talks about response in high profile cases, but response only happens after getting caught. It does nothing to remove the reason the day to day creeping keeps happening. The officials who could change that simply refuse to.

The NHS exists to help people. Creeps keep creeping via “Inappropriate access” partly because A&E has to work, and pharmacies have to work, and the creeps, voyeurs and ghouls take advantage. The other part is that nobody can see them doing it.

The Department of Health in England acts as though staff creeping on patients is just a cost of doing business, the same way water companies dump sewage in the river.

Officials insist that there’s nothing which patients can do to know whether anyone creeped on them, or be reassured that their medical notes were not read by people who shouldn’t have looked.

The Department of Health in England treats the hospital as the victim, and neglects the patients as an inconvenience. The official message to patients is, in effect: please stop complaining about staff looking up your records (our guidance is here).

You are generally not allowed to know who has looked at your medical records. The Department of Health in England knows when and where your records are accessed. They keep track in a database. They simply refuse to tell you in the NHS App, because the decision makers know it is worse for them for you to see the abuses than not to see them.

Officials keep things hidden because they can, and because they expect no impact on the NHS from the cover-up, even if that means staff can go creeping without getting caught. The vast majority of the time, that’s what happens.

Computer systems allow abuses to be hidden in a way that’s impossible in the real world

Think of the hospital room. Think of the records like the chart at the end of your bed.

There is a very wide range of things that go on to keep hospitals working. You might not like the number of people, and one of them might be your friend from primary school, but if they’re your doctor or on your medical team they can explain why they’re there. They’re responsible and they’re doing their job.

Anyone who wants to look has to walk into your room, and talk to you about what they’re doing as they look at your chart. You’d expect your doctor to do that, but being a doctor doesn’t automatically make someone your doctor – they should introduce themselves.

Now consider the person you once went on a date with, slinking in, reading your chart, smirking a bit, and leaving without saying anything to you. That’s weird, and most NHS staff would find it abhorrent, whether in the hospital or via a computer.

That NHS staff provide care doesn’t mean they’re providing appropriate care to you. That they can access your record doesn’t mean they have an appropriate reason for doing so. Someone being a teacher at a primary school doesn’t make them a teacher at your child’s school, and it doesn’t entitle them to mark your child’s homework. Being a doctor doesn’t make them your doctor, and only your direct care team gives you direct care. Direct care is the difference between a skilled surgeon in the sterile operating theatre and a stranger walking in.

When a computer is involved, the Department of Health in England thinks that anything a member of NHS staff decides to do must be appropriate because an NHS employee or contractor does it, and the NHS will keep you in the dark. It is a deliberate and institutional failure of privacy, of transparency, and of trust.

And that’s why it keeps happening.

It will keep happening until every NHS staff member knows that if they look up a patient, the patient will see that it happened, and they would have to explain it to the patient the same way a doctor coming into your hospital room can tell you why they’re there. Suspension is a start for cases that come to light. A record of every access, visible to the patient in the NHS App, is what would change behaviour because every case would be visible to the person most interested in your medical records: you.

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Parliament is considering what to do about public bodies ignoring recommendations from Inquiries. Every Inquiry recommendation and Coroner report should appear in the annual report of the Department responsible, every year, until it is done.

When public funds are spent on an Inquiry, the annual report of the Lead Government Department should discuss the Inquiry’s recommendations and how implementation is going, every year, until the report says they are all complete and the National Audit Office has verified that. A “dashboard” is not meaningful scrutiny, particularly now that the Department of Health in England has stopped saying whether it accepts recommendations: a dashboard of accepted recommendations shows nothing if acceptance is never stated.

Why does nothing change even after failings are clear? Those whose past decisions created a scandal often refuse to believe that the continuing mess is their fault, so actively undermine improvements, and inertia lets them get away with it. 

As Grenfell resident Gill Kernick describes in her book, every decision makes sense from some perspective, even if objectively catastrophic: “The point is not to see where people went wrong, but [to see] why what they did made sense… Without this perspective, we cannot learn.” If permitted, institutions will not learn as the people who insist they did nothing wrong are still there to continue unchanged, irrespective of the consequences. Every scandal demonstrates the capacity for institutional denial.

Recommendation 17 of the Thirlwall Inquiry into events at the Countess of Chester Hospital reads: “A new responsibility for auditing the implementation of the recommendations of statutory inquiries into NHS bodies should be given to the National Audit Office. Funding for appropriate additional staffing should be made available so that it may begin its work by September 2027.” 

The NAO should be involved – but the recommendation appears influenced so as to close off and disempower effective scrutiny. (That NHS England didn’t object to it strongly is clearly a bad sign for its effectiveness.) The implementation should instead require the bodies responsible to outline progress in their Annual Reports, which the NAO already considers in their audit. This already happens for spending commitments, and the same explicit response should be applied to recommendations from Inquiries, and for prevention of future death reports. Because unless money is involved, organisations do not want to change – to be effective, bodies should expect to have to justify their failure to the Public Accounts Committee.

1. Inquiries are Public Spending: Follow Up on Delivery of Recommendations
2. A look at Departmental annual reports
3. Health Investigations
4. Someone Has To Be Watching
5. What Parliament Can Do now
   

Inquiries Are Public Spending: Follow Up on Delivery of Recommendations 

The public interest doesn’t end when a report is public, but all too often external interest does. Departmental annual reports are usually scrutinised by the PAC and the NAO, who can see whether the platitudes of last year have been repeated yet again, or if progress has been demonstrated. PAC takes written evidence for outside expert input when the Official Truth stated in a report may not be entirely accurate or consistent with reality on the ground, and one Select Committee can borrow expertise from the members of another.

One of the strengths of the Lead Government Department model is that there’s always a government Department responsible, and it always has Parliamentary scrutiny. The times when a statutory inquiry would report and the recommendations would actually happen are long gone. Parliament has to catch up – it has all the necessary levers, and simply needs the will to act.

When an Inquiry or Review exists, the decision has already been made that this was a worthwhile use of public funds to investigate, uncover, and prevent from recurrence – so it’s entirely within the remit of PAC and NAO to check whether the recommendations to prevent a recurrence are being delivered. It always comes back to money. The status quo that lost the argument against an Inquiry plays a long game, and can prevent recommendations being implemented – nullifying the point of the review, and the political intent that created it.

The Hillsborough Law was paused because of entrenched interests; the first Spycops inquiry has been dragged out for a decade and now the Home Office is “consulting” on closing it before it finishes. (Though when inevitably reopened it will be under Hillsborough Law obligations, which might show discrepancies in past official statements.)

Reports and recommendations that go nowhere are useless when they’re just sitting on a shelf. When officials decide to put a recommendation on the ‘too hard’ shelf, they have to know that it’ll get lifted off again and re-examined. 

A look at Departmental annual reports

The Department for Transport annual report did mention the “two independent reports” it commissioned after the Stonehaven derailment – but it only mentioned them in one year, subsequently talking of recommendations being made (without discussion or description). The only mention after that is the financial penalty in the accounts from the health and safety prosecution.

Each Department for Education annual report studiously lists all of the PAC sessions they gave evidence at, and repeatedly mentions both the Independent Inquiry into Child Sexual Abuse and the Covid Inquiry – with no mention of recommendations from them, or follow-ups. Listing PAC appearances while saying nothing about outcomes shows that Departments record scrutiny events, not actual results.

Tasking the NAO to look at the implementation of recommendations cannot work unless there is material in the annual reports to read and scrutinise – whether by the NAO, PAC, or other committees.

One reason Inquiries are of current Parliamentary interest is the lack of follow-ups to the IICSA in practice, with Baroness Casey being “unimpressed” with changes across the public sector even when they are obviously the right thing to do; an inertia that means abuses of the records of three dead girls in Southport or a live boy has resulted in words not actions.

Health Investigations

In response to the Thirlwall Inquiry, DHSC said they’d have a dashboard for the implementation of the Inquiry recommendations they had accepted. This was claimed as a large improvement. Yet, in DHSC’s subsequent response to Module 3 of the Covid-19 Inquiry and again in Module 4, DHSC simply omitted to state whether they accepted each recommendation or not, sidestepping their previous commitment. A recommendation can’t be shown as failing or undelivered on a dashboard if the responsible body never said whether it had accepted it. Very civil service.

If you read the DHSC annual report, there are pages of descriptions of Inquiries, Reviews and Investigations, and basically nothing about the actual implementation of recommendations – except when it suits the Department to mention it. What is said should be scrutinised by the NAO when they go through the annual reports, and what is missing should be reported by the NAO and scrutinised by Parliament.

For example, the Inquiry into Ian Paterson (para 825) states that a response to the Inquiry was published, with a promise of a “year on” update to come. That “year on update” says “there are many actions and programmes that are still ongoing”, then it’s never mentioned again. DHSC hoped NAO wouldn’t notice the future omission and that no-one in Parliament would ask – and maybe they got away with it.

The Health Services Safety Investigations Body was set up by Parliament to make ‘no-blame’ recommendations about improvements to NHS care. Its recent report on the harms caused by NHS England’s method of rationing places on waiting lists (known as “advice and guidance”) is just brutal.

NHS leadership simply doesn’t want to know about failures, and the politicians have again helped the cover-up. This behaviour is long standing – NHSE was set up when DH didn’t care and didn’t want to know. And much of it still doesn’t. NHS England’s Chair has insisted HSSIB be abolished (alongside abolishing NHS England) because NHSE knows the new Department of Health in England would rather remain in the dark about avoidable harms. HSSIB is threatened precisely because it was created to speak honestly to power. 

Abolition comes after it emerged that DH/E tightly restricts other investigations by limiting how much they can say – refusing to allow them to make specific recommendations, and banning experts from answering questions about their reports. The usual practices of denial. 

The deaths and harms will continue. The only difference is HSSIB will no longer be around to learn from them. It is unclear who, besides the families of new victims, will pick up that baton.

Someone Has To Be Watching

There are always reasons that an accepted recommendation gets dropped – possibly even good reasons, such as the wider environment changing beyond what was called for in the report. But all too often it’s politics moving on as a controversy falls out of the public’s attention, and meaningful change gets kicked into the long grass. Exhibit A: Grenfell, because when the dust settles it always plays out that the poor had no lawyers.

At many of the Post Office Inquiry hearings, or the Spycops Inquiry hearings, the only people not being paid to be there were the victims. Victims who have had to cover costs out of their own pockets while still waiting for compensation; compensation long delayed by people who did not have to wait for their bills to be paid. This shapes priorities and incentives: every official in every room is paid to defend their Department’s decisions, even where those decisions undermine an Inquiry’s recommendations.

The political cycle generates churn, and the civil service moves staff around. It is civil society and academia who remain engaged long enough to measure the effects of any promised change and whether it happens. Victims should be able to get on with their lives – they should not have to keep coming back to their experience because the government has failed them yet again.

HSSIB’s Advice and Guidance report is only the latest in a long line of reports that show what is going wrong, with no power to stop it happening again. Coroners know that despair: promises made at one inquest are found to be undelivered at the next. With the abolition of HSSIB – abolished as punishment for speaking truth to the Department of Health in England – that will fall to someone else. [48 hours after we published this piece, it has been briefed that HSSIB may survive]

Those interested in particular topic areas – whether asthma, mental health, or even you and your local hospital – can use DeathLessons.org and the Preventable Deaths Tracker to see what Coroners notified on topics of interest, and shine a light on the procession of failures repeated and unaddressed. DH/E and NHS England or your local hospital will generally do nothing unless someone is asking why they haven’t.

What Parliament can do now

Since Grenfell and the Infected Blood Inquiries reported, Parliament has been considering what to do about following up on Inquiry Reports. 

The Public Administration Committee should expect that every Inquiry recommendation gets a page in the Lead Government Department’s annual report equivalent to the page that each accountability report item gets. It should say what the recommendation text was, what has happened, what is happening, and what is left to do – and that item should appear every year until the annual report confirms that the recommendation is complete.

As the Public Administration and Constitutional Affairs Committee are currently curating their Inquiry recommendations, in the second session of any Parliament, PACAC can (and should) ask the House Library to summarise the previous Parliament’s Inquiries, reports, and what disappeared. NAO/PAC scrutinise individual reports, with PACAC having the remit to take a broader public administration interest whenever appropriate, and select committees can engage on their particular topics in the normal way.

In the context of the current Health Bill, and the Hillsborough Law questions, and recent evidence of NHS England interfering in inquiries, one or more Parliamentary committees (probably PACAC and Health Select jointly) should write to every lead of health investigations asking them to submit anything they feel they were limited from considering or commenting on previously. Do Inquiry leads feel that the evidence they were given by public bodies would satisfy the Hillsborough Law, or do they feel that what the Inquiry was told was not, to reuse a phrase, “the truth”? Similarly, do coroners feel they’re being fobbed off in their work?

Prevention of Future Deaths reports can be read and are tracked to find major themes; minor themes remain hidden because Inquest findings generally aren’t published – although they easily could be where the coroner wished. Local health organisations can read the reports that relate to them locally, and condition-focused organisations can do the same when Parliamentary opportunities arise (a cheap use of an APPG’s limited time and resources).

Other political structures can do what Jennifer Pahlka calls an Outcomes Review to ask the question: did the intended change happen? Outcomes Reviews are a great idea, but require political power to start, carry out, and act on – and political power is the thing that change often lacks. Those selling new tech/AI will keep selling the tech, and HSSIB being fed into a woodchipper demonstrates what the tech people think of Outcomes Reviews. 

None of this process needs new Parliamentary actions or committees – it would simply be using the system the way it can work today. No government ever failed to have a justification for their actions or inactions. It is up to informed outsiders to assess those claims, and Parliament is where those get challenged.

The victims and their survivors deserve nothing less than lessons being learned. Currently, the victims are being repeatedly failed.

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When an NHS data programme starts flailing around, the Department of Health in England asks the National Data Guardian to bail them out.

DH/E’s institutional dysfunction means they expect an NDG Review will tell them that they’re all doing wonderfully; that the defensive and tone deaf staff are right and the rest of the world is wrong. NDG Reviews rarely turn out that way.

The NDG has put out a survey to health and care professionals, supposedly only them, and only about the Single Palantir Record. It closes on Friday 9th October

NHS England has started referring to many things around the Federated Data Platform as being part of the Single Palantir Record and so we’d encourage NHS staff to respond to the NDG survey as if it covered both the FDP and the SPR – because to NHS England, they are now the same thing. Same Senior Responsible Owner, same culture, same software.

The Single Palantir Record will be used to implement the National Online Hospital and redesign care pathways as the NHS zombies on with Wes Streeting’s vision and the Sunak administration’s changes to the scope of patient opt outs (ie allowing DH/E to use data however they wish).

It seems that neither NHS England nor NDG has published a framework for what the survey sits within, so following the precedent that anything not provided is assumed not to exist, we presume there are no Terms of Reference or any jointly agreed framing. As such, the NDG can comment wherever the survey replies and evidence take her. 

It would be perverse for the NDG to ask NHS staff for their views, and then to outright ignore them. It may be routine for NHSE to do that, but it is odd for the NDG to. It is equally odd that there appears to be nothing for patients – the FDP/SPR programmes assume they can do things to patients rather than with patients as the programme has chosen to reflect the culture of their tech supplier.

We therefore expect the Review must take a view on the minimum requirements for access to systems already shown as being abused in the ongoing series of scandals exposed by Sky News. NHS England is data controller for the nationally held records of access to systems, and the same staff who institutionally deny any contribution to facilitating such abuses are the same senior staff refusing to change on FDP/SPR. When NHS England claims that such abuses are from a “small minority”, the survey and writeup is a chance to show the scale (the survey doesn’t ask of course, but there are free text boxes). Are they a “small minority”? The survey effectively tells those who aren’t “professionals” working in the NHS that their views don’t matter, but they can have equivalent access to systems. 

NHS England continues to burn public credibility on the topics of Privacy, Transparency or Trust as their senior staff hide in Gray meeting rooms, insisting they are right to facilitate the coverup used by creeps, voyeurs and ghouls. After the abolition of NHSE in the Health Bill, there will need to be a leadership and structural reset. DH/E could solve the problem tomorrow by announcing that patients will see how data about them is used, but instead they simply refuse. NHS England wrote two letters, because the first was so woeful. We’d cite the Department of Health’s view, but they seem not to have commented at all. Silence. Curious that…

For its limitations, the survey is important, and if you’re reading this, you should consider filling it out before it closes on Friday 9th October – we have seen no indication that a survey for patients or victims of inappropriate accesses is coming.

Palantir Inc’s Tory-supporting advocacy team will surely be informing employee Tom Watson’s submission. Here’s ours.

• SPR Survey to NDG Review.pdf

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Doctors across the NHS rolled out dexamethasone within hours of clinical trials showing a significant measurable effect on Covid. The difference wasn’t the trial or the doctors – it was finding something materially better for a major pressing need. Most trials don’t.

The problem is not a lack of trials. The problem is all the incentives that influence which trials get done, and who gets to decide. Those incentives are not always aligned with the NHS, and not entirely aligned with patients.

The new Government has inherited an open consultation on allowing data brokers to be ever more creepy, to buy and sell more data with less regulation. It’s coated in the language of helping individuals, but the focus is giving data brokers more permission to sell data about you, and giving you less say in the process. 

The consultation assumes data must be copied to be useful, but on-device AI makes copying unnecessary, so DSIT was envisaging a world that’s already ending.

The consultation isn’t about consent – all the positive use cases discussed are things that are already legal today; it’s about allowing data flows in all aspects of your life that you wouldn’t say yes to if they had to ask you. DSIT internalised that when the law says you should be able to see data about you, they know Government, the NHS, and the private sector just ignore that because it’s convenient to keep data subjects as literal subjects of decisions made by others. 

Open Banking works because it’s a well-defined interface between many different systems, where there is strong regulation and directly measurable gain and loss (it’s money). The first movers are always those who’ll most benefit with least friction. Open Banking was used by landlords to creep on their tenants, because positive new business models take years. If there was a positive example of where the model would work, it would headline the consultation. Instead it’s akin to “smart data” which generally degrades to copying data behind your back for someone else’s financial gain (if you materially disagree, please copy your (positive!) bank balance to our account).

Data policy in DSIT was broken by tech advances

The consultation was conceived a long time ago, before AI got good in the hands of everyone. The former parts of DSIT are being chopped up and spread around. The consultation has outlived the department that envisaged it. There has been much wailing about the change, as it could go either way. In medConfidential’s dealings with DSIT, officials seemed to assume they were the smartest guys in government, so why shouldn’t they do whatever they choose? Because they thought they could, often they thought they simply would – capability was confused with licence. 

The consultation is poor, even before we consider that the tools to empower individuals are moving faster than the consultation could imagine. Copying data is often no longer a necessity and should increasingly become a last resort, but DSIT’s consultation (and the NHS app redesign philosophy) assumes that the tech of 2017 is the same as tech of 2027. That’ll interact badly with real life.

What if we look at the goal another way? Much of the data held is accessible somewhere by the person it is about. It may be deliberately difficult to read, but the AIs don’t get bored and can do the drudgery. 

You can already make some choices to use data. Your device tomorrow will give you more choices than today. 

The future is here, but not yet distributed

The “remarkable new feature” in iOS27 is a Siri that can do things. In a few weeks, any mac user can say “Siri, download the data from the table on this webpage, and add it to mydata.csv on my Desktop” followed by “create and run a shortcut to do that every day”, and it works (more complex cases are “write an applescript to…”). Equivalent instructions work for an iPhone/iPad. One can also task Siri to compare it with the details in your calendar or tone of your emails, to see if it can see a pattern. All on device, no data copied anywhere unless you decide it should be (mostly; different problem).

Those with UK “settled status” – where the right to live and work in the UK is entirely dependent upon the Home Office computers being correct today – get no paperwork. It relies on the website working and people are punished more if you don’t notice the State’s systems have failed. Those who are most concerned could ask Siri to log in twice a week to check their magic code still appears, and warn them if not. That’s currently a website, but if it moves to “app only” with the Digital ID scheme, you’d need to run it on your phone which will supposedly make access harder, but Siri doesn’t care about the hoops – if they’re passable by humans they’re passable by Siri too. (Note to Government Digital Service and NHS App teams: this is not a challenge. We’ll have a more technical piece on the architectural choices/mistakes being made because they give Department of Health in England teams a quieter life at the expense of patients and users). 

No data intermediaries are needed – if it’s useful enough that people can do it for themselves, if it’s used, then there will be innovation around it. DSIT has seen that it could mandate in one place and has decided it should be able to mandate data be sold in other places. If the cart really can go before the horse, where’s the obvious example?

The AI running for you on your devices can pull together all the documents in your NHS app, the test results, and then analyse them for you on your device. You can spend as long as you like asking what those actual figures might mean – the ability to talk to a non-judging machine to interrogate the data is a new option, it doesn’t replace anything (it can’t prescribe for a start). 

As a patient you’ll gain the ability to generate better informed questions when you do see your doctor. You can have confidence that a process working exclusively for you has looked at your paperwork answering the questions you might want to ask, like “is there a test that was recommended that wasn’t done?”, or “is there a test result that was out of normal that was never followed up on?”, or make unseen connections like “my breath/heart rate monitor tells me I feel terrible after being in the office for two consecutive days” or “I sleep terribly when I email this client late at night” or “on days that pollen is very high I feel terrible at home and fine in venues that have filtered air”. None of those will be possible with Palantir’s FDP. The Palantir-managed “Canonical Data Model” could provide data to inform individual on-device processing if patients are allowed a copy of their data. 

Whether the DH/E will empower patients in the NHS App is unclear – the legacy institutions and silos will see removing friction as enabling complete visibility into the mistakes that are made and their cover ups. Unempowered and underinformed patients are less effort to manage, and anything that gives them benefits will be buried in the NHS England treacle (which is one reason NHS England is being abolished). However, improvements will come from the persistence of people who know it will change their care and lives. There are patient centred opportunities that don’t involve copying all data into NHS/Palantir AI Platform where any data written to your Single Palantir Record will be retained and sold. DH/E has many meetings with people who want to buy data, it doesn’t have meetings with those who don’t, so decisions are always about more data and more data sales – meaning they confuse unique magic for commodity analysis.

What DH/E may offer (or refuse to offer) will matter less when Siri can parse what you see on your device, and knows the other details about your environment (it knows the weather in your house, it knows your calendar, it knows where you were and what you did yesterday and the days before, it can measure your voice if you talk to it). Individually empowering approaches were entirely ignored by DSIT in favour of access where there’ll be business traction. DCMS can change direction.

Who will be writing the prompts?

AI and other communities are legitimately concerned that the first use of cheap AI will be creeping on people for profit. After all, the first use of expensive AI was creeping on women for orgasms (and the first use of Facebook was…)

Device by device, there’s no way to creep at scale, only work one app at a time with people who get some benefit from their device working for them.

Who is writing the prompts to show what is possible, and what works today? Whose interest will those prompts be written in? Who will share what knowledge of what works? Who’s going to do things for citizens and patients, not for data brokers – it sure wasn’t DSIT.

Our consultation response is below, but this is a consultation on a project that should die with the closure of DSIT. DCMS can make different choices.

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Enclosures: consultation response on data brokers, and on data and AI

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New ministers will have had their Week One briefings, learning what the NHS and officials wants them to know and think. 

The culture of NHS England, an organisation soon to be abolished, is that whatever is done is always the best it could be, and that whether the outcome is any good should never be questioned. Cover-ups are better than bad headlines, a culture which drives many decisions about data centralisation. Data decisions are made in a Gray meeting room where past precedent protects voyeurs, creeps, and ghouls, prevents improvement and ignores patient wishes. Whether the FDP has a repository is something that mostly in public is undecided, but the suggestions made to ministers may suggest otherwise. What did the briefings say?

The NHSE culture leads to suppression of debate; it leads to cover-ups (uncovered); it leads to greater patient harm, with complicit staff hoping the patient harm won’t be discovered until their successors are in post. Institutional loyalty is to a fiction of Service, rather than to honesty about it. The culture refuses to learn unless made to.

Similarly, contempt of democracy and Parliament is not unusual in tech companies, but after Palantir’s involvement in the NHS, Palantir culture is spreading inside the Department of Health in England (DH/E) – public relations, not reliable statistics.

If you want to see what’s going to happen next, reading the Health Bill is not going to tell you very much – the Bill gives the Secretary of State a lot of power to do whatever they want, but there are no written proposals, no detailed speeches, no discussion of what that’ll be. It is Wes Streeting’s Health Bill, now in the hands of Andy Burnham’s government (which is a definite improvement).

The new Health Secretary, Yvette Cooper, has been around long enough to realise that reducing spending on a major NHS supplier, which is willing to hold cancer patients hostage and whose PR agency also represents the Opposition, is going to be a tricky needle to thread. Government has pathways forward, if there is a political choice to explore them.

Under the previous political leadership, only the most optimistic lines got briefed out by DH/E, on their own timescales, with the best possible framing.

“NHS App AI” “to help avoid the 8am rush” is the headline – unless the AI thinks you didn’t need an appointment,  in which case you’ll go towards the back of the queue, but maybe still ahead of people who didn’t use the App. (We’ll write on the App soon.) The thinking of DH/E staff is that pesky general practice will go the same way as your local bank branch. When NHSE says “neighbourhood health centre”, what they mean is “neighbourhood” like that served by your ‘nearest’ large post office, jobcentre, or bank.

“GPs have too much space” is the DH/E framing. Post-merger DH/E expecting well over half of GP surgeries to close in 2027/28 is the same story, with the same outcome. The ICB will cite the App as accounting for the majority of appointments and simply not give the GPs the budget that pays their rent. When other decision makers propose closing the last bank branch, the last pub, or the last post office in a village (or town), MPs write strongly worded letters in the face of public campaigns. Because NHSE won’t be around by then, NHSE’s planning assumes that MPs will be ignored, an assumption proven true in business, but in public service?

The NHS AI Platform, on which DH/E will run the AIs over the Single Patient Record, is the Palantir AI Platform with a new name. The Platform will be processing all your health notes, all your diagnoses, all your prescriptions. You will have to write your (mental) health needs down in a text box that the AI will analyse and the SPR will store, and an AI will compare every future time you ask for an appointment. The algorithmic transparency report will be ‘interesting’ – and show all the flaws that were simply never considered.

What was Wes’s choice will become Burnham’s burden.

Andy’s government has choices that new ministerial briefings might have omitted.

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