Climbing the UK public sector's tallest totem pole - how Palantir positions its work in transforming the NHS approach to data management

In British political circles, there is no more ‘holy of holys’ than the National Health Service (NHS). It has been, according to governments right and left, the envy of the world since its formation in the post World War II years to provide the nation with free at the point of use medical care to the whole population. No-one should go without medical care due to lack of money or status, a noble aim.

Over the decades since its founding in 1948, the NHS has inevitably gone through a large degree of what critics would call ‘mission creep’ as its early basic remit extended into other areas, while the UK itself evolved and changed. Today the UK looks very different to the way it was in 1948 and so too does the NHS and the demands made upon it, not least because the service has been under funding pressure for a long, long time.

Successive administrations - both Conservative and Labour - have pledged to find a new operating balance for the NHS, with both sides also signed up, implicitly and explicitly to varying degrees, to the idea that it sticks to that ‘free for all’ public service remit and never ends up as a privatized, 'if you can afford it' system as seen in the likes of the US.

Squaring circles...again

With the competing needs of venerating that public service totem and trying to balance the books, government after government has sought to square the circle of providing adequate funding to operate the service successfully without heaping ever greater burdens on the taxpayer. Working with third party private sector providers is clearly one obvious mechanism here, but immediately leads to howls of protest from those who fear such deals are a step towards back-door privatization of the NHS.

And so the saga rumbles on. The current Labour administration under Keir Starmer, now into its second year in office, has just published the latest 10 year plan to overhaul the service, complete with another stab at creating a single electronic patient record inside the NHS app, which has been successfully rolled out this year in England, Wales and Northern Ireland. (The Nationalist devolved administration in Scotland rejected taking part in the national rollout in favor of pursuing something unique for the Scots. The result to date is that the Scottish NHS has no equivalent app to offer its population.)

There can be little doubt that the latest 10 year plan will inevitably mean private sector co-operation and contracts, so stand by for another round of paranoiac finger-pointing every time a deal is struck. We’ve saw an example of that in 2023 with the awarding of a £300 million contract  by NHS England to US provider Palantir to create a new data management system called the Federated Data Platform (FDP) that aims to provide ‘joined up’ NHS services. In April 2024, more than 100 health workers, patients, and others protested outside the offices of NHS England to demand that the contract is cancelled.

For its part, Palantir plays up its ‘Anglophile’ credentials. It’s operated in the UK for around 10 years and the country is now its second largest market in the world, with 25% of its global workforce there, “far larger than any comparable top 25 tech company in the world” insists company EVP Louis Mosley.

Palantir’s main entry into the NHS came during the pandemic when it offered to help manage COVID data for the token sum of £1. This inevitably brought charges that the firm was exploiting the crisis to buy itself into the lucrative NHS ecosystem, allegations that Mosley strong rejected during an evidence session with the Science, Innovation and Technology Committee of the UK House of Commons last week, when he argued:

It was a national emergency. We were invited to No. 10, along with pretty much every other tech company that has a presence in the UK. That was in February 2020. There was the leadership of the NHS and key members of the Government. Each of us was asked what we could contribute to help tackle the covid pandemic. The list of needs was read out. One of those was aggregating data—that was what they described it as—and that was something that fitted squarely into our bailiwick, so we offered to support it.

Given the national emergency, there was no time to run long procurement processes. A decision was taken to expedite that. We offered, because it was a national emergency, to provide our support free. The decision was made to charge £1 because of some procurement process whereby we needed to be on a payment system in order for the contract to be stood up, but it was really a token.

The nature of procurement processes and practices - and the potential for abuse and corruption by organizations and individuals - has been the subject of considerably controversy in the UK and is being examined as part of a wider national inquiry into how the response to the pandemic was handled. That inquiry is still ongoing and its conclusions remain uncertain. That said, Mosley noted:

Of course, I remind everyone that we did not know what we were facing at the time or how long it might last. It was a three-month trial, in effect, of the software. As to the question around whether it is the proper way to run procurements, it is very common in lots of sectors to have a ‘try-before-you-buy’ kind of approach.

That is why we have always offered our public sector clients the opportunity to do that. It can come in the form of a free trial or a discounted trial, very much in the same way that you might subscribe to a newspaper or a magazine. You get the first few issues discounted or free and then, if you like what you read, you sign up for full price. That was actually, in substance, how that procurement unfolded.

It is also something that I believe the technology Code of Practice and the Chief Commercial Officer of government recommends as an approach for government procurement.

We’ll doubtless see in due course what the opinion of the COVID Inquiry is.

Trust and privacy

Regardless of that, Palantir’s £300 million deal does make it now a fully paid-up participant in the NHS supplier market, which brings the argument away from questions of procurement to questions of operational public trust. In the case of the NHS, Palantir stores data in the public cloud in the London regional instance of AWS. No data is processed or stored outside of the UK, according to Mosley:

The critical thing to bear in mind about the way our software works and the way it is deployed in the NHS is that the data controllers, the organisations that have legal responsibility, which in the NHS are typically trusts, maintain control over their data. Each of them gets their own instance of our software and they control who has access to it. They control what data is integrated into it. In effect, they implement and enforce the data protection policies that they deem appropriate.

Of course, much of that is determined from laws that you make here, down to policies that are made in Whitehall and down to the trust level as well. What our software does is provide the best-in-class capabilities for enforcing those protocols to ensure that nobody ever sees a piece of information that they are not entitled to see. It is possible to audit who has seen what at any point in time. Those are the two most important assurances that you can give in terms of protecting patient privacy over their own data.

He added:

This may be unfair on other tech companies, but we have a fully UK-based cyber protection capability. For example, the logs associated with users in the NHS instances are not exported to the US in the way that is often typical. That monitoring and that assurance is all provided here on UK soil.

And Palantir is not generating additional revenue streams from processing NHS data, he emphasized:

Our business model is to license the software. We do not derive any economic benefit from the data. The data belongs to the customer. We do not derive any economic benefit from the logic or code that they write to transform that data. Again, that is intellectual property that belongs to the customer. Our interest is purely in the tooling itself. In effect, they license or rent that from us.

Mosley also took pains to convince Committee members that there was any danger of parts of the NHS operation becoming locked into Palantir’s systems is “technically…extremely low”:

Interoperability is our bread and butter. One of the core value-adds of the software is the fact that it can interact with and read and write data from pretty much every system out there. Its nature is that everything is in open-source languages and everything is stored in open-source formats. That will mean that as technology progresses, and if the NHS or any other customer decides that there is something better on the market, they will be able to lift and shift the intellectual property and the data that they have developed in our software and put it into another platform.

In fact, he appeared to entertain the prospect that there might be alternatives to the current AWS platform in the future:

Oracle provides an equivalent service to AWS, like a public cloud provision, which at some stage may be used to store data in the same way that we use AWS. But that would be in a UK region of Oracle as well.

And he took off his metaphorical Palantir hat for a moment to talk as an NHS user and welcome more transparency around data management:

I would welcome the ability to see in the NHS app every purpose for which my data was being processed, including research, and that I would have the opportunity to opt in to or out of different research programmes, for example. Technically, that is possible and I would love to see a world where that is standard for all of us.

But…

Nonetheless, for all Mosley’s assurances, it was clear that some members of the Committee remained skeptical. They join the British Medical Association which last month passed a motion arguing that:

Palantir (inclusive of any associated companies) is an unacceptable choice of partner to create a Federated Data Platform for the NHS. It recognises that this partnership threatens to undermine public trust in NHS data systems, due to a lack of transparency in how the data will be stored and processed, a track record of creating discriminatory policing software in the US, and close links to a US government which shows little regard for international law.

Mosley was ready for that one:

I was very disappointed to see that. I think the accusation that we lack transparency or that this is secretive is wrong. I am here partly to be as transparent as I possibly can and I hope that, in every way that you and other stakeholders require, we are meeting you where you need us to be. If I may be frank, I think that the BMA has chosen ideology over patient interest. I think our software is going to make patients’ lives better, by making their treatment quicker and more effective, and ultimately by making the healthcare system more efficient. As a patient and a user of the NHS, I want it to be as quick, effective and efficient as possible. I am very sad that ideology seems to have taken precedence over those interests.

He also took time out to make a wider point about the NHS’s often-troubled relationship with, and track record around, IT programmes, not to mention the question of who should be leading the transformational charge here. Back in 2020, Palantir talked to three different IT departments - NHS Digital, NHSX as a sort of shadow IT department in the Department of Health, and NHS England, which was also running, in effect, a shadow IT department of its own:

All three were dysfunctional in different ways, and that was exposed very clearly to everyone when the pandemic hit. The unintended benefit, perhaps, of the COVID pandemic was, in an inexorable way, to discover which parts of the system were competent and worked—the classic, ‘When the tide goes out, you see who’s wearing shorts’. The system as a whole has greatly benefited from that process. The organisational re-design has been trying to tackle that dysfunctional beginning, with the tech sides of the NHS finally being centralised into a single organisation. The merger of DH and NHS England is a step further with that.

Of course, at the [local NHS] Trust level there is, again, a high degree of variability, but there are outstanding examples of tech leadership. The challenge is to help those to continue to improve and to bring up the long tail of others that are, if you like, relative technical laggers. The big challenge that the NHS has had historically, at trust level, is chronic under-investment in capital, particularly IT. It is a lived experience of all of us users of the NHS that many of the systems are very old, and in some cases there is no system at all, with things still done on pen and paper. I really welcome the steps that the [current Labour] Government have taken in the 10-year-plan, with the ambitious digital plans to address that. But the challenge will be the implementation.

My take

I mean on that last point of praising the latest transformation plan from the current paymasters, you'd hardly expect any other response. Nonetheless it was fascinating to see Mosley’s deliberate distancing of himself and Palantir from the outspoken views of company chairman Peter Thiel, who has accused the UK electorate of having Stockholm Syndrome in terms of its attitude to the NHS, arguing:

In theory, you just rip the whole thing from the ground and start over…In practice, you have to somehow make it all backwards-compatible in all these ridiculous British ways.

Mosley’s spin on this:

He was speaking in an entirely personal capacity, he was not speaking for Palantir, and he certainly was not speaking for me. I think there would be general disagreement across the company with the views he holds about the NHS. I also note that our Chief Executive, Alex Karp, is on record as saying, effectively, the diametric opposite. He is a US citizen as well, and he wishes the US had a healthcare system like the NHS, which is an exemplar to the world; I think that is the term he used. He sits on a different end of the political spectrum in the US from Peter Thiel. 

Palantir is not, therefore, political. We represent a diversity of political views and do not take political positions as a company. That is a foundational element to Palantir’s approach to the world. We do not—unlike some tech companies, I am afraid—pick and choose which Government policies we will support and which ones we will not. 

It was a strong rebuttal, but unlikely to convince those ‘ideologues’ who still fear the encroachment of the private sector on the public service vision of the NHS founders. Such skeptics will still point to the fact that after Prime Minister Starmer made his trip to Washington earlier this year to visit President Donald Trump, the second stop on his itinerary was to the offices of Palantir.

This one, as they say, will run and run.