30 June 2017 — medConfidential

So, we have a new Government (after a fashion). And, whatever else, there’s some continuity at the Department of Health…

Given this continuity, the completely unambiguous Conservative Manifesto commitment, and cross-party support for the National Data Guardian, it was a bit disappointing that a statutory footing for NDG was absent from the Queen’s Speech.

We can’t help but note – with a Data Protection Bill on its way, arbitrary data-sharing powers available in the Digital Economy Act, and Theresa May threatening to roll back human rights – that it is protections such as these that underpin the privacy of all our medical records.

What just happened?

The election put a lot on hold, but you may remember a dodgy deal with the Royal Free Hospital that got Google DeepMind into a spot of trouble with the ICO and National Data Guardian when we complained about it.

The NDG’s formal view came out during the election period, and we await the ICO’s ruling – due any day now. We are therefore entirely unsurprised that DeepMind’s “Independent” Reviewers’ report is also delayed. One might question “independence” when a whitewash coincidentally comes out a day after the regulator’s critique…

What’s happening next?

We don’t comment on every future project press release from Google DeepMind – its PR flacks cost many times our annual budget. But last week’s announcement that its next project will be to provide a hospital IT system for Taunton is worthy of attention; the relevant detail is at the bottom of page 2 of this document.

[N.B. This section has been shortened for this email newsletter; there’s more detail in the online version athttps://medconfidential.org/news ]

NHS England certainly felt the people of Taunton were most in need of better data infrastructure – this area being one of the ‘pathfinders’ for the cancelled care.data scheme (more on its successor next time) – so starting in Somerset seems as good a place as any.

As recently as January, DeepMind assured Regulators that its tools were not used for clinical decision making, yet in June it has signed contracts to run a hospital using it. It’s transparent that the future model for the service will be ‘AI assistants’ offering hints and references to doctors via the Streams app; the principle of A&E triage, applied hospital-wide.

But to be used in direct care, the central IT system of a hospital has to be a closely regulated system – these are, after all, systems used to run Intensive Care – although Google, chasing profits rather than patients, probably won’t choose to help those in most acute need.

Has Google started the Regulatory process to run that system, or is it trying ‘deployment via press release’?

Until the situation is clear, questions as to whether DeepMind’s approach to Regulators is the same as Uber’s (they do, after all, share investors) will remain. DeepMind Health has no Chief Medical Officer who is accountable to their Hippocratic Oath – and Google’s position can change at any time, purely for business reasons.

We should point out, as DeepMind buried it in the small print, that no money is changing hands on this deal – and neither party is obligated to do anything. This may yet be just another Silicon Valley startup that puts out a stream of press releases, delivering for investors over patients.

What’s happening where you live? And what can you do?

Wherever you live, in England, there are changes coming to your local NHS.

The ever-so-subtly again renamed STPs (now “Sustainability and Transformation Partnerships”, not just Plans) and their further regional reorganisation – over “several years” – into Kaiser Permanente-style Accountable Care Organisations represent the Government’s and NHS England’s view of the future.

Bearing in mind the massive democratic deficit in the NHS, will accountability be to patients or to the analogue administrators?

Given that – most of the time at least – care records follow patients, one of the best ways to see how the NHS works is to look at the data trail that you leave behind you.

So if you have a login for your GP practice’s website, we encourage you to look at the letters that have been scanned into your record, and to simply count the logos. (If you don’t already have a login for online access, here’s how to get one.) Then, as your NHS changes over the next few years, keep count; over time do you see more commercial logos, or fewer?

While you’re at it, you might also want to check who’s accessed your GP record. Both EMIS and TPP have now switched on basic access to your GP record’s ‘audit trail’ – and as more and more people use it, this vital transparency feature should improve over time.

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Things are clearly going to stay busy for a good while yet. Four years in, medConfidential exists entirely through your donations and the generosity of the Joseph Rowntree Reform Trust, to whom we are applying for a further grant. We appreciate all donations – and your support helps with other funding.

Phil Booth & Sam Smith

30th June 2017