The National Health Service (NHS) and many public healthcare systems around the world are in a state of crisis. For years they’ve been allowed to deteriorate — for long enough, in fact, that plenty of powerful forces now see an opportunity to pursue profitable reforms.
When people think of private healthcare, their minds naturally turn to the delivery of services for profit — either paid by the public system or with a significant charge for the patient. Instead of taking place in public facilities, new private practices are established beyond the public system. Politicians frame these moves as ‘innovation’, when they’re really a return to the very thing we were trying to get away from by building a healthcare system that was free at the point of use. In reality, however, the most visible form of privatisation may not be the most pernicious.
For years, outsourcing has been a persistent problem in the NHS; everything from the provision of care and janitorial duties to administration has been contracted out. This has resulted in some workers making less than the living wage and others losing their jobs entirely. Research from Oxford University also found it resulted in hundreds of preventable deaths. Yet the problem doesn’t end there. New technology is often positioned as a silver bullet that will allow the system, and the doctors and nurses who work in it, to do more with less. Unfortunately, adopting digital tools developed by the private sector can have severe consequences.
One example is Babylon Health. In 2016, it launched a GP clinic called ‘GP at Hand’, which eventually registered over 115,000 patients in London — more than ten times the number of an average clinic — with the promise of shorter waits for video appointments, along with an AI chatbot to prescreen symptoms. Not only was the chatbot found to be wildly inaccurate at times, but the system as a whole undermined the NHS by targeting younger (and more profitable) patients while leaving those with complex needs to existing clinics. According to NHS Digital data, just 1.5 percent of its patients were over 60 years of age, compared to 23 percent for the average practice.
Private companies are also interested in getting access to the NHS’s data. Google’s AI arm DeepMind has previously been sued over its access to patients’ medical records, but data analytics firm Palantir is even worse. The company is backed by right-wing political donor Peter Thiel, who has described the British people’s affection for the NHS as a kind of ‘Stockholm syndrome’. Palantir got a £23 million contract to work with the NHS during Covid, and it recently obtained an £11.5 million extension. It is now bidding for a much larger £480 million contract to build the Federated Data Platform that will be central to NHS operations well into the future.
Palantir sees a huge opportunity to profit from the NHS outsourcing its technologies instead of building them in-house. According to reporting by Bloomberg, Palantir pushed TechUK, an industry lobby group, to ensure government agencies buy commercial technologies instead of developing their own bespoke tools. Rosie Collington, co-author of The Big Con: How the Consulting Industry Weakens our Businesses, Infantilises our Governments and Warps our Economies, argues that these efforts lock public institutions into ineffective technological systems that can hamper their ability to serve the public.
Even more than that, outsourcing technology erodes the public sector’s capacity not just to develop its own digital tools but to assess the capabilities of the ones they’re contracting to use. That’s a serious problem when we know the tech industry has a long history of overpromising on how their products will improve people’s lives. We can see it with Babylon’s chatbot, but Palantir has also been accused of overstating the capabilities of its tools. If the NHS — or any health system — is adopting digital technologies with the expectation that they’re going to make up for a lack of doctors or nurses, they’re likely to be sorely disappointed.
In the early stages of the Covid pandemic, companies and health systems eagerly adopted digital contact tracing and other tools using artificial intelligence. We were all expected to download apps to our phones that would track our proximity to others, while other systems were designed specifically for deployment in health settings. Yet, a series of studies on these tools have found they were basically useless, and some may even have been harmful to the response.
The takeaway here isn’t that the NHS shouldn’t adopt new technology, but that it needs to be realistic about what it hopes to achieve. Technologies must first and foremost serve the public, not the bottom lines of private companies that want to profit from healthcare delivery. Ideally, this would mean building out the capacity internally to develop the digital tools that the NHS needs.
The root of the problem in our healthcare systems is rarely a lack of technology, but the austerity they’ve long been subjected to that’s left them without the staff and the resources to properly deliver the quality of care that the public rightfully expects. The workers are doing their best; it’s government that’s letting them down. And new tech-nologies won’t be enough to change that.