Do we really want Palantir embedded in the NHS?

Beware bad policy made in haste because of coronavirus, say campaigners

Tough times call for strong measures. During the Second World War, the British public accepted the need for ID cards to manage rationing and monitor the population as a necessary restriction on their liberty. After the war, ID cards were dropped, although some of the monitoring mechanisms and restrictions remained in place. In response to the coronavirus crisis, governments around the world have brought in sweeping and occasionally Draconian measures to control the movement of their citizens by digital means, including tracking of smartphones to enforce social distancing and quarantine. The measures taken in the UK currently enjoy the support of the public who recognise the necessity of fighting the virus, but their efficacy is in most cases unproven, and as lockdowns drag on inevitably these constraints will start to chafe.

Transparency and accountability

In a democracy, trust is an essential ingredient. People must have faith that these measures really are necessary or they will work around them, blunting the attack on the virus and possibly leading to social disorder. To retain trust, the authorities to be crystal clear and consistent when communicating why interventions are necessary and we also need to be reassured that once the emergency is over they will be rolled back: the power and reach of digital technologies means that drifting into a Chinese-style surveillance state where all of our activities are pinned to a central ID is an all too realistic scenario and one that must be avoided.

Which is why NHS England's announcement last week that it is to employ the services of Palantir to help coordinate the distribution of ventilators and other equipment to hospitals sets off alarm bells. Over the years, Palantir, the secretive, CIA-funded data-mining company set up by Paypal billionaire Peter Thiel has become a watchword for intrusive surveillance through its involvement in the US ‘War on Terror', predictive policing and Immigration and Customs Enforcement (ICE) deportations. Palantir employees are also implicated in the Cambridge Analytica scandal and the company is accused of helping political operatives smear their opponents. A Bloomberg article Palantir Knows Everything About You alleges that Palantir was only dropped by investment bank JP Morgan after senior executives found out that they themselves were being spied on by overzealous operatives.

"Palantir Foundry is a very powerful data integration tool that allows you to take a view of data across disparate systems, disparate schema, in very different forms and with very mismatched metadata, and to overlay that with certain things," said Phil Booth, coordinator of medConfidential - a group campaigning for medical data privacy. "But, I really doubt that proper procurement processes were gone through at this before for this particular project. It's obviously one that's been assembled at that scale, speed."

Never has there been a more important time for citizens to trust its government

Without exception the privacy campaigners we spoke to recognised the need for emergency data access measures. All were broadly supportive of the provisions rolled out so far, as allowed for under GDPR and other data protection legislation provided it is evidence-led, and all wanted to ensure public trust is maintained so that the interventions can be as effective as possible. However, they were critical of the tendency for officials to communicate via leaks instead of being up-front.

"Never has there been a more important time for citizens to trust its government. I, and the average citizen want to trust our government," said Geoff Revill of Krowdthink.

He continued: "There are three pillars to trust - transparency, control and accountability. As citizens are disempowered and lose control in lockdown and the coronavirus legislation, it becomes ever more critical for the government to explicitly increase its transparency and accountability."

Avoiding overreach

The big tech companies have been trying to get into the NHS for years, says Booth, and while their expertise is welcome, we must be careful during this crisis not to make bad policy based on a particularly hard case.

Which brings us back to Palantir. Do we really want a powerful, secretive data-mining company based outside of our jurisdiction and with little prior healthcare expertise embedded in the NHS? The precedents aren't good. Google was given access to patient data in a way that was later ruled to be illegal and in December health minister Matt Hancock and the Department of Health and Social Care granted Amazon access to healthcare data in a manner that was heavily criticised by campaigners. "Matt Hancock tends to be a bit of a tech fanboy and reaches for the big shiny object," said Booth, who obtained details of the deal via a Freedom of Information request. "Amazon's people clearly wrote the contract. They got far more out of it than anyone else would have done."

As well as Palantir, NHS England is deploying the services of Microsoft, Google and UK software consultancy Faculty AI. On the face of it, the Covid-19 intervention announced last week, which aims to create a data platform to track occupancy levels at hospitals and capacity of A&E departments and collate aggregated statistics about the lengths of stay for patients, does not involve access to personal data. And to its credit, although a little late, NHSX, the cross-departmental health initiative, addresses privacy concerns head-on.

"The data brought into the back end datastore held by NHS England and NHS Improvement and NHSX will largely be from existing data sources, for example, data already collected by NHS England, NHS Improvement, Public Health England and NHS Digital. All NHS data remains under NHS England/ NHS Improvement control," its directors say in an open letter.

They also state the Covid-19 datastore will be closed once the outbreak has been contained. This is welcome news and a good example of the sort of transparent communications that have often been lacking during the crisis. However, the border between personal and non-personal data can be hazy (what about information on NHS staff and volunteers for example?), and, crucially, there's no mention of what will happen to the platform and the key players after that. Will they become an integral part of the NHS, and if so what will that mean?

Palantir is not a company that inspires confidence

"Palantir is not a company that inspires confidence," said Jim Killock, executive director of privacy and free speech advocates Open Rights Group on a public conference call on Friday. "For them to suddenly be involved through government fiat without any kind of procurement procedure or competitive tendering process is concerning, although understandable. Now, currently, that's non-personal data, but do we think that this company's ambitions are going to stop at that point? I think that's very debatable.

"It would be really helpful to hear the government say, ‘this is only temporary, they will cease at the end of this crisis and Palantir will not be invited to share personal data in this period until there are competitive tendering arrangements in place'."

This is at the heart of the dilemma. For years, going back to NPfIT and before, NHS has been crying out for some sort of dashboard-based integrated system to coordinate resources, and now suddenly there's a chance to build it. If it can be created properly, with all the right checks and balances then it should be welcomed. But it's a big if. There's a danger that bad policy could be made on the hoof that will have damaging long-term consequences.

"I deeply fear mission creep," said Revill. "Data in the hands of a company like Palantir is knowledge, and knowledge is power. I don't know of any politician that voluntarily relinquishes power once they have it."