Earlier this month, Health Secretary Matt Hancock announced a team-up between the Department of Health and Amazon that would allow the technology company’s ‘virtual assistant’ Alexa to give health information drawn from the NHS. This inspired many questions. Is Hancock handing over bits of the health service to tech giants? Would Amazon algorithms get hold of our personal health data? Can Alexa really help someone having a heart attack, or would she just recommend adding ‘sudden dizziness’ and ‘shortness of breath’ to your Amazon Wishlist?
There was plenty of media speculation, but less serious examination into what, exactly, Hancock’s Alexa announcement means for the NHS.
The basic question of where Hancock – who kept his job in Johnson’s cabinet reshuffle this week – shared the news is important. The MP gave his speech at the Future of Healthcare Investor Forum, a conference held inside the concrete-and-plate-glass headquarters of the London Stock Exchange. The event was organised by the Stock Exchange, with support from mega-bank JP Morgan, specifically to gather investors who want to make big money out of health.
Hancock’s speech wasn’t just about Alexa, or even about health. The MP said he had come to the “beating heart of the City” to ensure that “everyone feels the benefits of free enterprise and economic growth.” The way we achieve this, he told attendees, is “by opening up our health service to innovators, wherever we may find them: business, academia, or from anywhere around the world.”
More than that, Hancock explained that he wants to “create more porous borders into the NHS” for these innovators. Essentially, his announcement about the Alexa partnership was a stunt to highlight how business could take over new NHS territories. (When VICE contacted the Department for Health and Social Care, a spokesperson argued that Hancock’s appearance at the investors conference was nothing to do with privatisation, and was instead an effort to make sure the health service’s existing technology spend was made more wisely and to the benefit of patients.)
There have been different attempts to privatise slices of the UK’s huge state-run health service for decades. In the 1980s, Margaret Thatcher focussed on handing hospital cleaning and catering to favoured private contractors. She wanted to go further, but retreated in the face of health workers strikes and protests. Tony Blair’s New Labour government allowed big businesses to take over the ownership and maintenance of hospital buildings under the Private Finance Initiative, and let private hospitals take on bunches of NHS operations through the Independent Sector Treatment Centre scheme. Subsequent Tory-led governments built on these privatisations by breaking up the NHS into more competing units open to commercialisation.
Hancock’s digital privatisation is a new variation. This January, he launched the NHS Long Term Plan, which includes online GP consultations for patients as one of its central aims. GPs are in fact already private businesses serving the NHS, but they seem to be the wrong kind of private business: they are small and led by doctors, so tend to focus on health. Both New Labour and Tory governments prefer dealing with large corporations that focus on profit. As such, the last Labour government took ‘out of hours’ services from GPs and handed them to big companies like Serco, often with disastrous results.
In Hancock’s plan, patients would consult GPs over smartphones or laptops – a service offered by companies like Babylon Health, a private health service provider Hancock has relentlessly promoted, speaking at Babylon Health’s HQ and using the company’s GP at Hand app. (Babylon Health CFO Charlie Steel was also at the investors conference where Hancock made the Alexa announcement.)
Dr Tony O’Sullivan, retired paediatrician and co-chair of campaign group Keep Our NHS Public warns of the dangers of partnering with private health tech companies. “In healthcare, one cannot afford to jump first and ask questions later,” he tells VICE via email. “Matt Hancock has gone hell for leather in introducing apps and new technology into the NHS run by private companies that have not been first open to independent trial and peer review, casting huge doubts over their safety and effectiveness.”
Indeed concerns have already been raised that GP at Hand’s AI-driven services aren’t actually any good, forcing the rest of the NHS to pick up the mistakes.
Hancock’s promotion of Babylon Health shows what creating “porous borders” between the NHS and contractors looks like. Babylon Health’s director of NHS services is Paul Bate, who was David Cameron and Nick Clegg’s health policy adviser during the coalition. Cameron hired Bate because he wanted to bring in former Blair advisers – Bate was also in Blair’s Prime Minister’s Delivery Unit on Health Targets, when the New Labour government met its ‘health targets’ by outsourcing NHS operations to private providers. A Babylon Health spokesperson told VICE that the company hired Bate because it seeks to “employ great people who are hugely experienced in their fields.”
The walls get even more porous around Hancock himself. Babylon Health pays the Evening Standard, edited by George Osborne, an estimated £500,000 a year in a partnership deal. Under the deal, Hancock – who worked as Osborne’s chief-of-staff – appeared in a Babylon Health-funded Standard supplement, under the firm’s logo, promoting GP at Hand. In a statement responding to criticism of the piece, the newspaper said that “articles in the supplement were not advertorials” and that it “retained full editorial control over them.”
Worries about Babylon Health stem the GP at Hand app’s focus on younger, less sick patients, making easy profits while leaving the older and less well to regular GPs. “Babylon’s GP at Hand undermines traditional general practice in the way it operates,” explains O’Sullivan, “cherry-picking the easiest (most profitable) patients and leaving the NHS to care for the others, reducing its income in the process.”
The Babylon Health spokesperson rejected the charge of cherry-picking, arguing that “GP at Hand is open to anyone who lives or works within London or Birmingham – just like any other GP practice.”
In a 2017 report, official NHS watchdog the Care Quality Commission (CQC) found that Babylon Health was “not providing safe care.” The company responded by going to court to stop the CQC publishing their report but the injunction failed and Babylon had to pay the CQC’s legal costs. Despite these worries, and against the objections of local GPs, NHS England is allowing Babylon Health to take on NHS services in Birmingham and London.
The Alexa-NHS hookup also points to the possibility that big corporations will exploit the health service’s data. Tech giants want to monetise personal data for advertising and marketing, while the drug giants want to monetise health data for drug research. However, other, more substantial deals with tech companies have not worked so well for the NHS. In 2015, London’s Royal Free Hospital went into a secretive partnership with Google subsidiary DeepMind to share patient data in order to develop an app to improve treatment of kidney patients. The Information Commissioner’s Office ruled that the deal broke privacy laws.
While some of the implications of digital commercialisation of the NHS are alarming (trade in NHS data is already implied in a possible post-Brexit trade deal with the US), we should not get too caught up in Hancock’s tech boostering. He has also overseen even more expansion of the existing, very analogue NHS privatisation measures, where physical services are handed to corporations. Just last week, the Department of Health and Social Care annual report showed that a record £9.2 billion had been given to private firms.
It was a similar story at the Future of Healthcare Investor Forum where Hancock gave his Alexa announcement. One session included a top executive from Ramsay Health Care. The Australian-owned private hospital firm profits from selling operations to the NHS, and has a UK turnover of £41.6 million. In the beating heart of London’s finance world, CEO Andy Jones spoke on a panel about balancing healthcare with, chillingly, ‘improving returns.’