In the past five years, electronic records have replaced paper in most UK health environments. Twenty years of trying, buying, and connecting these systems has created more digitised data on wellness and illness than any group of humans could meaningfully explore in a lifetime.
Data scientists can now unleash algorithms into those seas of data to seek insights. This is a positive development for the transformation of healthcare in the UK. But it is also causing some health leaders to sleepwalk uncritically deeper into a dangerous tech monoculture.
In 2023, there was a flutter of horror at the idea that the British health service was spying on citizens’ health data. The service had hired Palantir – the tech company widely viewed as the core of American electronic espionage – to facilitate its Federated Data Platform, where disparate regional and national networks would share data.
Some were horrified because someone – even if that someone were a machine – could peep into our health records. And because Palantir’s leadership are Americans with strong political views that don’t always align with UK policy and interests. Palantir got its foot in the door by giving the health service its product for free during the Pandemic.
It wasn’t the only one, either. Microsoft gave the NHS free access to its video conferencing app. Which one, you might ask? The one that bundles with Office 365: Teams.
This led to a standardisation in which the NHS began to migrate its entire secure email system onto Microsoft’s Azure cloud platform, creating a single virtual office environment on a single cloud platform. NHS managers who used other operating systems were pressured to accept laptops running Microsoft Windows.
The implications of this standardisation are far-reaching. All texts, statistics, spreadsheets and emails – a corpus of every bit of information held by the largest employer in Europe – will now be archived on Microsoft Azure. And Microsoft’s licensing conditions mean it may stay this way for a long time, cutting the chances of British rivals from adding competing products or platforms into the mix – even those that are better suited to solving the NHS’ core challenges.
The Microsoft monoculture is also forward-looking in its reach, encompassing emerging areas like artificial intelligence (AI). NHS budget cuts are going to invite data scientists to use their paid-for Microsoft Azure as their development environment, and the paid-for M365 Copilot – the consumer version of OpenAI’s GPT AI – as their generative AI tool. How can anyone suggest funding an alternative when Microsoft’s Copilot is being integrated by default into the Microsoft 365 suite on every desk?
You may ask: Why is this bad? It’s nothing compared to Palantir, who called last week for “a common operating system solution” for all health and care data in the UK, implying they should provide it.
Not only does Copilot’s consumer product push personal health data back to Microsoft’s headquarters, but Microsoft has also had challenges with security. Putting £10Bn a year’s worth of NHS eggs into one basket is therefore not short of risk. After all, a single technology provider for the health service just means a single attack surface for any willing hacker.
It’s also unclear whether Copilot is already priced into the current five-year contract for Microsoft to supply M365, or whether it will suck up part of the £2Bn investment that has been promised to NHS Digital every year since 2022.
Either way, the NHS has to awake from this sleepwalk, understand that its trove of citizens’ data is priceless, protect it, and ensure it doesn’t become the domain of only one business. Perhaps it’s time to embrace the thriving UK tech sector and look for solutions closer to home.
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