Even those not amongst the various digital healthcare networks will have been aware of the recent announcement from NHS England about the initial £330 million award to Palantir, plus optional additional extensions worth a further £120 million, for the delivery of the Federated Data Platform (FDP).
The FDP is a platform that will sit across NHS trusts and integrated care systems, allowing them to compare, analyse, and share data across geographical, demographic and organisational boundaries.
The announcement makes bold claims about the impact of the FDP on some of the long-term challenges experienced in healthcare. The benefit of a safe, efficient and inclusive way of sharing data would be an incredible advance for healthcare in England.
However, the NHSE contract with Palantir has also raised a number of questions from experts within the digital healthcare community, including those highlighted in a position paper from April 2023 from the Faculty of Clinical Informatics.
Opportunity and link with PHIS
The CSP has long supported the better collection, use and sharing of data in physiotherapy as part of wider healthcare. Amongst other things, data is a critical part of the Physiotherapy Health Informatics Strategy (PHIS), launched in November 2022.
Therefore, the CSP supports the concept of a federated data platform, with physiotherapy data included in it. However, it must be delivered in a way that builds understanding, inspires confidence and delivers practical value back to those individuals and services who contribute data to it.
Dr Nicola Byrne, the current National Data Guardian shared in a blog published in November 2022 about the FDP, that she balances support for using data while emphasising the importance of maintaining trust throughout this procurement, including noting the importance of upholding the NHS core values.
There have been questions raised about the process by which the FDP platform provider has been procured. In January 2023, medConfiential, an independent, non-partisan organisation campaigning for confidentiality and consent in health and social care, published a series of blogs, raising numerous concerns about the procurement of Palantir and the proposed implementation of the FDP.
They highlight that this is not the first time a similar ‘big data’ project has been attempted in the NHS in England. The CSP shares their hope, along with many others, that lessons learned in care.data, GPDPR and other national platforms are not repeated.
The timing and scale of the project award also came as a surprise to many. Experts in the digital health field had been expecting an announcement along the lines of that delivered by NHSE on 21 November but it landed with mixed reaction.
Few had envisaged such a large sum of money, particularly when it was announced just a week before that funding to frontline digitisation projects throughout the country is being slashed to support funding gaps in other budget areas.
There is also discussion on social media that Palantir’s foundry is based on Apache Spark, a free, open source platform, bringing further challenges around the commercial process in to focus.
The organisation procured by NHSE to deliver the FDP, Palantir, has also come into question.
With a background working with, amongst others, Amazon, military and defence data in the USA, the FDP will be their first entry at scale to the healthcare market. Experience from their previous projects may provide valuable insight and transferrable learning, but the healthcare market is notoriously challenging and nuanced. This is also their first movement anywhere near this scale in the UK market.
Comments made by the Palantir chair earlier this year have also come to light with Peter Thiel saying that “the NHS makes people sick” and that the British public’s affection for the NHS was a case of Stockholm syndrome – the term for hostages who feel a bond with their captor. Mr Thiel did try to backtrack those comments, claiming to have made them as a private individual and not as the chair of the organisation.
Security and confidence
It is well documented that in previous contracts, Palantir, have experienced some challenge around data security and confidentiality. Their contract with the NYPD ended uncomfortably with public disagreement around intellectual property.
We know that health data is notoriously valuable to those who wish to use it nefariously, so it is imperative that the healthcare data of a nation is particularly locked down to those only for whom access and use is essential.
There must be the opportunity for members of the public to opt out of any platform. Palantir and NHSE have undertaken to a national engagement on use of health data but the impact of this group must be central to the development and implementation or public and subject matter expert support cannot be expected.
What does it mean for CSP members?
Such huge investment in the data and digital infrastructure in England is very welcome. The inclusion of physiotherapy data amongst all other health and social care data is a potentially ground-breaking opportunity.
However, the length of the contract awarded calls for moderation of expectation. Nothing will change overnight. Nothing is likely to change in the next few months, even years.
However, if and when it does, the proliferation of standardised data cannot come at the cost of data security and public confidence. The concerns raised by subject matter experts in data security, confidentiality and digital infrastructure must be addressed before we can give our comprehensive support.
Until then, the CSP commits to lobbying stakeholders on behalf of members to understand and ensure best practice is followed, including working collaboratively with NHSE and other partners towards the mutual goal of safe and effective use of data in our profession.
If this blog leaves you wanting to know more about the use of data, digital and informatics in physiotherapy then please view the digital physio pages on the CSP website and consider joining a network of your peers, the Digital and Informatics Physiotherapy Group (DIPG).
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