The Byline Intelligence Team and The Citizens explore the implications of the tech firm’s ever-expanding role in British healthcare

If recent reports are to be believed, the private company Palantir is set to become NHS England’s operating system of choice for health data, being seen as the favourite to win the contract for a new ‘Federated Data Platform’ (FDP). In effect, this would mean the company being able to process vast amounts of information, spanning GP and hospital records to social care data.

This has led to concerns, provoked by Palantir’s global track record. The American firm, co-founded by former Donald Trump donor Peter Thiel, has been extensively employed by Immigration and Customs Enforcement authorities in the US, notably under the Trump administration. The company has a history of building and supporting predictive policing software, as well as helping both the NSA and GCHQ to ‘spy on the whole world’ by creating tools that have bolstered mass surveillance programmes.

More recently, the company has been working on an ad-hoc basis on the UK’s beleaguered ‘Homes for Ukraine’ scheme.

Even ignoring Palantir’s history of scandals, its track record within the NHS is at best questionable, and its encroachment into health infrastructure has been accompanied by a glaring lack of transparency and honesty from both the Government and NHS England.

Despite Palantir’s original involvement in the NHS being sold to the British people as a “short-term, emergency COVID response”, it seems that neither Palantir nor the Government was ever committed to a time-limited partnership.

Indeed, the likely award of this new single platform contract for integrated health data would not only cement Palantir’s position in our health service for good, but would represent a huge step towards the company’s proprietary platform – Foundry – becoming the ‘operating system for the NHS’.

Some even argue the decision is a “done deal”, given that key requirements in the pre-tender documents clearly favour Palantir as the incumbent provider. 

The FDP contract is currently still in pre-engagement, with the formal bidding process due to begin in August after delays and the work to start in November. This is one month before Palantir’s last major NHS contract, worth some £23 million, is set to finish. The FDP is currently estimated to be worth £360 million over five years, up from an initial £240 million, which NHS England told Byline Times was because the organisation was previously looking at a three-year contract.

The award has been described as ‘a must-win deal’ for Palantir by sources with inside knowledge of the company’s expansion plans. 

The FDP will compile a raft of different datasets into a single ‘point-of-use’ and “near real-time” intelligence gathering that NHS England has planned for years – central to the Government’s new top-down reorganisation and digitisation of the NHS.

The new FDP is described in the pre-award notice as “an ecosystem of technologies and services implemented across the NHS” that will act as “an essential enabler of transformational improvements”, consisting of five use cases:

  1. Population health and person insight
  2. Care coordination (ICS)
  3. Elective recovery
  4. Vaccines and immunisation
  5. Supply chain

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Some of these are areas in which Palantir is already working – in others the firm is either being heavily promoted by the Department of Health and Social Care (DHSC) and central NHS bodies, or is heavily promoting itself – adding further speculation that this is anything but a true ‘open procurement’ process, but rather one that favours Palantir.

The language of the FDP contract seems to lean towards the firm. The data platform will manage access to data based on “purpose-based access controls” – language used specifically to describe the functionality of Palantir products.

“If this new Federated Data Platform requires access to data to be managed by ‘purpose-based access controls’, then this is functionality unique to Palantir – quite distinct from the ‘roles-based access controls’ commonly used in NHS systems”, says Phil Booth, of the campaign group medConfidential.

Despite this, NHS England has said that it has held “pre-market engagement sessions which were well attended by a large number of suppliers” – allegedly numbering more than 80. This point was reiterated by Lord Syed Kamall, a minister at the DHSC, who stated on 20 June that he had “been in conversation with NHS England, particularly the transformation directorate, and it has been quite clear with me that it is an open tender. There is no preferred bidder”.

Palantir is already involved in several of the functions that the FDP will take on, including “cleansing” elective care waiting lists across 30 hospital trusts.

“A company that mainly supports cops and spies isn’t a healthcare company and shouldn’t be given this extremely sensitive access,” Cori Crider, the legal director of Foxglove, a data and transparency non-profit, told Byline Times.

“But there’s a more basic question with this federated data platform. And that question has nothing to do with Palantir. Who do you trust with your most sensitive health records? We and our partners are clear: if the Government aren’t willing to talk to people or honour their choices over what they want done with their health records, we’ll see them in court”.

NHS England maintains that the provider awarded the FDP contract will not be able to access individual patient data.

“Safe and secure use of patient data allows the NHS to build services that are more responsive to patients, and the software we are seeking to use for the FDP will put the NHS in control of its data and ensure that sensitive patient information is kept in a secure environment that meets the highest national standards,” an NHS spokesperson said.


A ‘Single Source of Truth’

NHS documents seen by Byline Times already refer to Palantir’s Foundry platform in terms of being the ‘NHS National Data Platform’, and the software is touted as being applicable to at least 18 use cases within NHS settings. Most of these tasks are an extension of the firm’s COVID-related work.

The use of Palantir Foundry also seems to have stepped outside the lawful basis provided by the Control of Patient Information (COPI) Notices drawn up during the pandemic for data processing. The powers afforded to NHS England by the COPI Notices, due to end on 30 June, are limited to COVID-only processing – such as NHS England’s giant COVID-19 Data Store – and supply chain work for vaccine distribution. 

But the documents seen by Byline Times also reference a Palantir-run ‘Flu Dashboard’, for seasonal flu vaccinations; a tool that will evidently be used in wider NHS settings that have nothing to do with pandemic-related work. When quizzed in the House of Lords on the legality of Palantir processing data on non-COVID vaccinations, Lord Kamall gave a vague response. 

Another key feature of the FDP is intended to be care coordination of Integrated Care Systems (ICSs). The 42 ICSs, each with their own respective governing Integrated Care Board (ICB), will become legal entities on 1 July and will subsume the current Clinical Commissioning Groups (CCGs) as part of the Government’s new approach to integrated health, social care – and data.

Palantir already advertises a ‘Foundry for Integrated Care Systems’ package, which includes “a set of applications that empower every ICS to provide truly joined-up care by removing barriers to collaboration”. 

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The NHS Confederation, a healthcare members’ organisation which acts as the “only independent network for integrated care systems”, and caters to “all 42 ICSs across the country” has also heavily promoted Palantir as a key potential partner in the future of the ICS infrastructure, and the company has co-hosted NHS Confederation webinar events which “explore strategies ICSs can adopt to deliver joined-up care”.

In an article on the NHS Confederation website written by two Palantir health leads, it’s argued that Palantir could be crucial to ICS infrastructure “to ensure decisions can be made and metrics are tracked across trusts, primary, social, and community care, leaders across the many diverse constituent organisations need to hold a single source of truth” – a phrase favoured by NHS England and Palantir alike.

Booth argues that the ICSs are being pushed by NHS England management into adopting Palantir, on the basis that “You’ll get to see things in your area or region, and NHS England and DHSC will get to see everyone’s data to monitor and drive things centrally”.

And yet, healthcare researchers have complained about NHS England management restricting access to datasets on Foundry – while Palantir employees, as data processors, retain access to it all. The National Data Guardian (NDG) – which provides statutory oversight and guidance on confidential patient and user data – remains unsatisfied with who is accessing information on NHS England’s COVID Data Store.

In the run-up to the latest reorganisation of the NHS in England, as first reported by The Citizens in April, Palantir has also now poached several senior NHS tech leads. Harjeet Dhaliwal, former deputy director of data services at NHS England, joins former NHSX AI Lead Indra Joshi among the firm’s ranks as Palantir looks to become a permanent fixture in the NHS.

And another, previously unreported, conflict of interest is the appointment last June of Paul Howells, now director of health and care partnerships for Palantir, who formerly held a position as ‘leader of the national data programme’ for the NHS Wales Informatics Service.

Former NHS employees are not allowed to lobby the health service for six months on behalf of their new employer.


Digital Disaster

Palantir poaching Government talent is nothing new. There is also a revolving door between the US firm and the Ministry of Defence, currently its largest public-sector supplier, with £71 million in work awarded since 2015. An investigation by the Bureau of Investigative Journalism also found Palantir had been engaging NHS chiefs in a charm offensive since at least summer 2019.

Despite this, Palantir’s work was only ever sold to the public as a “short-term” COVID-19 response. Following its original contract, for which Palantir ostensibly charged only £1 for ad-hoc work building NHS England’s COVID-19 Data Store, the company has been awarded a further £25 million within the NHS and by the DHSC, most of which was tied to continued Data Store work, cementing Palantir in the health ecosystem until December 2023. 

The company made a £22 million profit from that deal, which gives an indication as to why the Thiel-backed company is so fervently pursuing permanent installation in the NHS and access to patient data.

The contracts for the initial COVID-19 Data Store work were only released to the public on the eve of legal action being taken on the deals, and the Government was taken to court again following the award of a further £23 million contract. Under threat of judicial review, the Government eventually said that it wouldn’t extend the deal without consulting the public, saying future deals “will be transparent”. This now appears not to be the case. 

When asked in the House of Lords to list “the projects that have been given access to the Palantir Foundry parts of NHS England’s COVID-19 Data Store”, Lord Kamall only highlighted six use cases, not the 18 mentioned in the NHS’s own Foundry product catalogue, seen by Byline Times.

It’s also worth noting that NHS England and DHSC seem to have spent at least £37 million on Palantir software since 2020, as per the AdviceCloud public spending tracker. This exceeds the amount that the firm has officially been awarded through published contracts, though it’s unclear whether this represents further work, expensive renewals and maintenance, or whether the NHS is running over budget on Palantir. 

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Attempts at top-down “digital transformation” and the “integration” of patient record systems have been tried before within the NHS – most notably the National Programme for IT – and many attempts to date have ended in disaster or disgrace.

“The way NHS England is going about commissioning this Federated Data Platform makes its £360 million tender look like it is intended to underpin the whole of this Government’s £8 billion digital transformation programme for the NHS,” said Booth. “We’ve been here before, over 20 years ago. The National Programme for IT, under a Labour Government, spent £12 billion trying to digitise hospitals with a top-down driven favoured supplier approach, which failed spectacularly for entirely predictable and predicted reasons”.

Foundry “support licences” also continue to be granted to Palantir across the NHS, most recently one for £125,000 on 20 June – to assist firms and departments using the existing Foundry software.

Meanwhile, we wait to discover what exactly the procurement papers for the Federated Data Platform will reveal.  

Palantir did not respond to our request for comment.

This article was produced by the Byline Intelligence Team – a collaborative investigative project formed by Byline Times with The Citizens. If you would like to find out more about the Intelligence Team and how to fund its work, click on the button below.

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