“Platform Health” and digital privatisation

A couple of weeks ago I went to a conference about the UK government’s new digital strategy which is spearheaded by a department of the civil service called the Government Digital Service. Central to the strategy is a new “platform” system for all public services and one of the key targets of the next 15 years was highlighted as a move towards “platform thinking”. Here I will reflect on what I think might be some of the consequences of this for health.

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Under this new approach users will be provided with a single digital identity through which they can access all government services. This, we were told, is a response to the reality of the digital world and is necessary in order to keep up with public expectations. It is part of a move from government of the industrial age to government of the digital age.

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Central to this was the government’s new “verify” and “pay” systems. These are ways of proving your identity and paying for government services or transactions in a secure way online. They were compared at this event to Google and Facebook’s methods of verifying identity which are used across different platforms; this was seen as the model for the government service.

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The introduction of this platform system is, however, also a means of stimulating and creating markets. As can be seen in the quotation below from the GDS blog, platforms are seen as being inherently connected to the constitution of markets and competition.

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Platforms stimulate markets, and markets drive innovationGovernment’s current siloed approach stifles innovation, and leads to various problems such as:

  • rent-seeking behaviour from incumbent suppliers
  • new suppliers being excluded, even if they have newer, more innovative ideas
  • encouraging proprietary activity and technology

If we create platforms based on open standards and interoperability, we automatically create competition and drive innovation. That means more providers and lower costs.We can boost a nascent market of providers, building upon our open services – a market that has, until now, been held back by the contracts that locked us into those closed, proprietary systems.Companies, charities, clubs and co-ops can use the same infrastructure to set up additional services that government can’t justify, or can’t afford.For example: look at GOV.UK Verify, which is stimulating the identity services market. It is setting standards, aggregating demand across government and government services, building a whole new market for identity services in the UK. New identity services are springing up and moving from “clever idea” to “commercial product” very quickly.Programme Director Janet Hughes explains it brilliantly in the presentation she gave recently at the Follow the Entrepreneur conference: without that market influence, if government had tried to procure a solution a few years ago, the specification would already be hopelessly out of date. The market brings innovation, and innovation brings better identity services.

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 It is clear from the discussion around the introduction of this “platform thinking” that the real target is not technological but cultural. As the Minister for the Cabinet office Matt Hancock stated in his speech to the national digital conference in June 2016:

“… Everyone here knows that digital is the easy part of digital transformation. The hard part is the transformation. It’s easier to write new software than to rewrite an organisational culture. Easier to upgrade to the latest device going to upgrade to the latest skills. Old technology can be replaced but old habits die hard.”

Later he stated that “… The most important aspect of business transformation is transforming the way we think about delivery”. This platform approach is intended is to be disruptive and to create new markets and opportunities in new methods of procurement of public services.

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One of the visions for this platform approach to government was presented at the event I attended by a representative of Nesta (who are a charity who advocate for the expansion of innovation capacity in the UK).

As part of their “connected councils” vision they suggest that within a few years we could be engaging with council services through “personalised portals”. Their “2025 vision” is that “Like the best tech companies future councils will be lean, agile and data driven”.

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Amongst the benefits of this approach will be greater “market segmentation” and “algorithmic content” enabling “hyperlocal content”. This system would work on a similar principle to Amazon’s recommendation system with only the most specific local council information being directed towards you based on knowledge of your location and previous interactions with the system.

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The digital strategy for healthcare is also clearly built around a commercial model as stated in the “Personalised Health and Care 2020” framework for action:

“in other parts of our lives, we see the benefits of technology, one on the way we book our travel and holidays, manage our bank accounts and utility bills, buy groceries, connect and communicate with our friends and family.”

A recent report by the Nuffield trust bemoaned the fact that the NHS is stuck in the pre-Internet and pre-mobile phone era. But as is also stated in the report

Culture change is crucial. The majority of the issues faced by the journey of transformation of people problems, not technology problems. This means that organisations need to invest least as much into the programmes of organisational change and transformation as they do in the technology itself”

But what is this change they describe? One of the speakers at the event I attended recounted a story they had heard from a nurse which they saw as being instructive of this kind of change.

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The nurse told of an incident in which a patient came in to accident and emergency and upon being told there is a significant wait  ahead of her asked if the nurse could send her a text message when her turn was coming up so that she could pop across to New Look in the meantime. This was presented by the speaker as indicative of the kinds of demands which the NHS should now welcome and adapt to.

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Although I am not an expert on either it seems to me that both the government and the NHS have a somewhat patchy record of implementing large new systems. The extent to which this new “platform” approach seems to ape that of Google, Facebook, Microsoft, et cetera seems to me to open up a potential for a player of their kind to enter this field.

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It is certainly conceivable that in a few years time the government will realise that they do not have the capabilities to properly implement this kind of approach and will look to the “experts” in this for help. The emphasis which has been placed so far on changing the culture and organisation of government, and health, services into a form which is similar to that of large tech companies (and crucially one which is focused on markets, disruption and innovation) seems to make this an even more desirable field of intervention for these kinds of companies.

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I expressed this concern to a civil servant working for the Department of Health at the event who stated this kind of access for big tech companies was not possible due to the protections on patient data. I mentioned Public Health England’s new “One You” initiative a central part of which is the “One You Health Hub” which is hosted on Amazon. I have described on the Cost of Living Blog how this largely consists of bland health advice and links to pages to enable users to buy Fitbits and Wi-Fi enabled bathroom scales.

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This seems to me to be consistent with the “platform” approach to health. I also mentioned the access which Google have been granted to over 1.5 million health records in London (I have since learned of access they have got to NHS eye records). They had not heard of either of these cases and expressed disbelief as to how Google were allowed this especially considering how difficult it was for them to move data from one department to another.

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While privatisation of health and the NHS has an established history this “platform” approach to public services seems to be producing a different kind of privatisation. The cultural change which is seen as crucial to the implementation of new digital technologies might also be a softening up of the services specifically for the encroachment of digital industries.


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