Vaishnavi Behl, a communications specialist and MSc candidate in LSE’s Department of Media and Communications, writes about the implications of tech company Palantir’s contract to manage the British National Health Service’s technology and data systems.

In 2023, NHS England contracted Palantir Technologies for a £330 million, seven-year project to overhaul its current technology system and develop a new repository called the Federated Data Platform (FDP) to handle patient’s medical data. This deal between Palantir Technologies and NHS England has ignited a crucial debate on the role of technology giants in public services. The agreement, centered on developing the FDP, which will be the largest single point of access to healthcare data in the UK, represents more than a mere technological upgrade; it signifies a paradigm shift in how health data is managed and utilized within the UK’s healthcare system.

The Federated Data Platform (FDP) aims to centralize patient information and facilitate comprehensive health trend analysis across the UK’s healthcare system. This ambitious project promises to enhance the efficiency and effectiveness of healthcare delivery through improved data sharing and evidence-based decision-making. However, the selection of Palantir as the architect of this system raises significant concerns. The company’s background in surveillance and security, coupled with its lack of healthcare expertise, presents a stark contrast to the specialized knowledge typically required in medical informatics.

This partnership exemplifies what scholars term “sector transgression,” a phenomenon explored by Michael Walzer and further developed by Tamar Sharon. It describes the entry of tech companies into specialized domains without the requisite field-specific expertise or value alignment. Palantir, known for its work in state security and defense, brings neither neutral technology nor expertise to the healthcare sector. The process by which Palantir secured this contract described by critics as pandemic opportunism and intensive lobbying, raises questions about the intersection of corporate interests and public health policy. It blurrs the lines between public and private sectors in critical services and demands rigorous academic and public scrutiny.

The integration of Palantir’s technology into the NHS risks falling into the trap of techno-solutionism, where technological efficiency is prioritized over the healthcare sector’s traditional values of protection, safety, and transparency. The healthcare sector’s needs are multifaceted and often require nuanced, human-centered approaches that may not always align with technological solutions. While technological advancements can certainly improve efficiency and data analysis, it is crucial to balance these with a comprehensive understanding of healthcare’s broader needs, including adequate staffing, funding for essential services, and addressing operational challenges.

As companies like Palantir gain a stronger foothold in healthcare, there’s a danger that the sector’s core mission of serving the unwell and vulnerable may be compromised in favor of technological optimization. This shift can have the following long-term consequences for how we conceptualize healthcare and the services we expect from the government.

1. Control

The implications of this deal also extend far beyond immediate privacy concerns. While data protection is undoubtedly crucial, focusing solely on this aspect risks overlooking the broader issue of infrastructural power. By integrating its proprietary Foundry software into the NHS’s core systems, Palantir is poised to gain unprecedented influence over the UK’s healthcare infrastructure.

2. Private sector dependency

This situation raises critical questions about long-term dependencies and the potential for monopolistic control over essential public services. The NHS could find itself increasingly reliant on Palantir’s technology, potentially hindering future innovations and integrations with other systems. This scenario echoes past incidents, such as the New York Police Department’s difficulties in data retrieval post-Palantir, highlighting the risks of deep technological entanglement with private entities.

3. Accountability and transparency

The digitization of healthcare, with its reliance on complex computational infrastructure, creates a potential for deep dependency on Palantir’s platforms for essential public services. This raises significant concerns about accountability and transparency. Unlike public institutions, Palantir and its executives are not subject to the same level of public scrutiny or regulatory oversight. The algorithms and systems they develop often operate as “black boxes,” lacking the transparency necessary for thorough public examination. This opacity in decision-making processes and data handling practices stands in stark contrast to the accountability expected from public entities, especially those handling sensitive health information.

4. Public Trust

Public trust, a cornerstone of effective healthcare systems, is also at stake. Recent polling suggests a significant portion of the population might opt out of the FDP if managed by a private company, underscoring the delicate nature of public confidence in health data management. Palantir’s controversial history, including its ties to US intelligence agencies and its founder’s political leanings, has further fueled public mistrust. The company has been also linked to controversial practices such as predictive policing and the targeting of migrant populations.

The Palantir-NHS partnership exemplifies a broader trend of tech giants’ expanding influence in critical public sectors, fundamentally reshaping civil society. This case study highlights the urgent need for a comprehensive reassessment of our approach to data governance and the role of technology in public services.

To address these challenges, I propose the following recommendations:

1. Legislative Reform: Develop robust legal frameworks that hold tech firms accountable to the same standards as public institutions. This should include:

• Mandatory transparency requirements for algorithms used in public services
• Strict data protection measures beyond current GDPR compliance
• Regular independent audits of tech companies’ practices in public sector contracts

2. Enhanced Public Oversight: Investigation of the FDP procurement process and ongoing implementation by Parliament.

3. Patient-Centric Data Governance: Implement a clear, accessible system for patients to control their data, including:

• Granular consent options for data sharing
• Easy-to-use opt-out mechanisms
• Regular updates on how their data is being used

4. Comprehensive Data Lifecycle Management: Move beyond privacy-centric approaches to examine the entire data lifecycle within these new infrastructures. This includes:

• Scrutiny of data collection methods
• Oversight of data analysis techniques, particularly those involving AI and machine learning
• Regulation of data application and commercialization

5. Public Sector Tech Capacity Building: Invest in developing in-house technological expertise within the NHS and other public institutions to reduce dependence on private tech companies.

These measures aim to challenge the assumption that big tech’s expansion into public services is inevitable or uncontrollable. By implementing these recommendations, we can work towards a digital ecosystem that truly serves the public interest, maintaining the core values of public institutions like the NHS.

The path forward requires a delicate balance between leveraging technological advancements and safeguarding public interests. It demands active participation from policymakers, healthcare professionals, technologists, and the public to shape a future where digital innovation enhances rather than compromises our public services. Ultimately, the goal is not merely to mitigate harm, but to proactively shape a digital landscape that prioritizes public good over private profit. This approach requires continuous vigilance, adaptability, and a commitment to upholding the fundamental principles of public service in the digital age.

This post represents the views of the author and not the position of the Media@LSE blog, nor of the London School of Economics and Political Science.