When the whole 10 year plan comes out tomorrow we’ll start reading it, but the night before what’s out is the last press release before the 10 year plan – ie only the bits that Government most wants to talk about because they think they’re the best parts… 

Mr Streeting’s 10 year plan will replace your GP surgery with a “neighbourhood health centre” in the same way you have a “neighbourhood job centre (plus!)”, with the service promises that applied to your local sure start centre (and it’ll go the same way). 

The “single patient record” controlled by the Health Secretary will replace your GP record with a politician owned medical history, taking control of all the medical notes made by doctors across your life. Everything you’ve told a doctor in the last 35 years is in those notes – it may have been sensitive and important at the time, and it’s all still sitting there. 

Your GP has responsibilities to you over your health records; the Secretary of State will do whatever the politician of the day wants, because the data controller for your medical records is the politician of the day. They will make decisions for political reasons.  

Your GP writes your notes for the importance of your health and future treatment. But the creepy centres will be incentivised to confuse dystopia with efficiency and use “ambient voice technology” with microphones in the rooms to transcribe everything and have an AI summarise it for your permanent notes. “Clinical safety” will require a full transcript is kept to protect the organisation, and then the audio recordings will be kept because they too are needed to protect the organisation. The effects on individual patients matters less to the hospitals – your GP receptionist might feel like a bit of an ogre at times, but they work for your GP who has some responsibility to you. In contrast, the neighbourhood health centre’s bouncer works for someone far away, and hospitals are barely responsible to anyone, which is why Mr Streeting wants Palantir’s AIs to monitor every birth in every maternity unit. 

If you want any doctor to see the sensor data recorded by your smartwatch or phone (how you sleep, how you walk, how you’re breathing or your heart rate) you’ll be required to share it all with the national health record and Palantir in order for any of it to be seen by your doctor. Mr Streeting wants to know how often you masturbate while wearing a smartwatch (or get laid, and yes, his algorithms can tell the difference), and he’ll share how often you go for a walk with DWP and sell it all off to anyone who wants to buy all the data..

As parents know from their children’s health, Government finds it easier to blame families for kids being repeatedly off school with illness and not do prevention to avoid kids getting sick in the first place. Kicking people off PIP doesn’t make them less sick, and closing GPs doesn’t decrease the hospital backlogs, but it does help hide them.

Details aren’t out yet

Today is the best day the 10 year plan will have in its lifetime. We’ll read it all when it’s out and see what the consequences are.

Perhaps there’s no real need to worry, because Mr Streeting will u-turn like all his cabinet colleagues, and should do because the good things they want can be delivered in other quicker ways. As we saw in our recent look at community health centres, policy says that in theory GPs can refer for a scan directly, but the hospital running the centres says in practice they can’t. But the hospitals must have forgotten to mention that in meetings.

Writing the 10 year plan Mr Streeting only listened to people who run hospitals, so the plan calls for hospital outposts to replace your GP practice (and is why GP isn’t getting more money, and why the priority is “from hospital to community” not “do more in primary care”. Your hospital will come into the community for a while, other services will go away, and then the hospital will withdraw once again.

We’ll be here.

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If your baby is born with a rare disease today, or might have one of those rare diseases, the NHS can and will already DNA sequence them to help figure out what’s wrong. When Wes Streeting “announces” every baby should have their DNA sequenced at birth, that’s not a new revelation in a gift to the Telegraph (chosen because of his leadership ambitions; here’s a free to read version or BBC). 

What is new is that Government wants to sequence every newborn, all the kids who aren’t sick, because it ‘might be useful’. It’s definitely good for those who sell sequencing machines; it’s good for Palantir and Amazon who will be processing all this data, and it’s the preclude to the 10 year plan for the NHS which will move money from your human GP to prioritise AI chatbots that will always demand ever more data. 

Genewatch UK have detailed resources on the sequencing process and the long history of this proposal.

DNA is yours for life, not just for one government

This will be the DNA sequence of every baby born in the country, and it will be going into the politically controlled health record in the Platform they bought from Palantir – so Labour are relying on the stability of Donald Trump and his allies (today!). 

Will your kid’s DNA be as well protected as Wes Streeting’s DNA? All these records have to be kept safe and secure. Which means stopping the Americans copying it off their servers, because they always do what they say, it means UK Ministers can’t ever make a bad decision, which never happens, and it means stopping the Chinese from stealing it – do we want to still have a Secret Intelligence Service in the 2050s? Data always leaks. The UK Biobank is still vigorously defending giving half a million genetic records to eugenicists who have a startup doing designer babies. This data will be available for that research too.

The data won’t help your kid if they get sick later

If you needed one of the supposed targeted treatments, the NHS would do the tests today.

The new plan is not about curing your cancer, and it’s not even going to be used if you do get cancer. If you come down with cancer, where sequencing can be useful, your doctors will want to know your DNA sequence but they also want the sequence of your cancer, and those need to be done on the same machine ideally at the same time, and you need to be there for that anyway. Those who’ve had their cancer sequenced in the past would have it sequenced again .The argument that this’ll be so cheap to be worthwhile for newborns works here too – it’s why cancer isn’t the example, instead it’s a disease almost no one gets.

The assumption of the tech bros who have captured Wes Streeting’s vision is that health advances will flow in line with their business plan, and then no one else will ever compete with them again. It’s good for a business plan but not for the NHS. 

By the end of this Parliament there’ll be a bunch of cancers that you can cure in your cat by taking them to your usual vet – it’s up to Wes Streeting whether those same cancers will also be curable in people, on the NHS, but it’s politically indefensible not to. 

Sequencing baby blood spot tests

For nearly a decade the baby blood spot test cards have been retained to sequence every kid born in the last decade. If this was actually useful, they’d have done something with it. Instead they’re waiting for a moral panic to go back and pay even more money to sequence the lot. It clearly had no clinical benefit.

The Home Office will want the data as those kids start to become of interest to law enforcement and they’ll probably find the money. Once the data is sequenced, it’ll be available in your “patient passport” where parents may be quite surprised to read that “daddy” isn’t.

10 year plan

Instead of focusing on patients, Wes Streeting’s 10 year plan will be about managing you via data dependent algorithms designed by politicians not driven by doctors; decisions that mean you can’t use the NHS app unless it can copy any sensor readings off of your device that politicians want, and they’ll get shared across Government and beyond. 

The “high” light of replacing your GP with a chatbot is that you can fool all of them into adding whatever you like to your medical notes, including that you should get the really fun drugs; the sort of thing a human GP wouldn’t fall for but the AIs do.

I’m sure Wes Streeting has had some great feedback on his proposals – the tech companies will love it, research will love it, it doesn’t detract from medicine, and which patient group opposes something they’re told would help treat babies. As with all patient engagement, it’s what they’re not told that can destroy a project because of the deception.

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