What about our Care Data?

Nick Kempe – February 17th, 2022

What’s happening to our health and care data?

Following its award of a £546k contract to KPMG to help re-design social care,  a Freedom of Information response has revealed that the Scottish Government’s contract to review what data systems are being used across social care is worth £450k.  It is due to be awarded on Friday February 18th 2022.  The work, described as a ‘landscape review’,  is split into three packages, starting with local authorities and then moving on to map the systems used in the voluntary and private sectors:

“The intended outcome of this review is a comprehensive map of the digital software systems that support care services in Scotland.

This work will inform the delivery of the National Care Service in Scotland.

The specific purpose of this review is establishing the breadth of the services, software systems and supporting organisations across Scotland.  This information needs to be sufficient to identify the scale and commonality of services and systems to map patterns that can inform a digital delivery strategy.”

There appears nothing particularly complex about this, the initial work requires the design of a questionnaire and could then be potentially completed by administrative staff.   But if you go first to organisations like PWC or KPMG, whose 571 partners’ pay jumped 20% to £688k last year, you end up spending a ridiculous amount of money on very little.  The Scottish Government doesn’t appear to have asked local government to do the work even though they are far better placed to do so as they know their own systems and know who the providers are.

The value of this work to whoever wins the contract should not be underestimated.  At present organisations are vying to get their hands on our personal health and social care information and understanding what systems are currently in use is likely to give the successful tenderer a huge commercial advantage within th emarket.  Under procurement law the name of the successful tenderer does not have to be announced for 28 days, so it may be a few weeks until we learn who that is.

This contract is part of a wider world-wide move to outsource health and care data to the private section, driven by people within government on the one hand and by business lobbying and influencing on the other.  

In 2019 EY (Ernst and Young), another of the big four,  claimed the value of health and social care data held by the NHS to be worth £9.6bn a year, taking account of the potential for savings and its commercial potential.  These mouth-watering sums appears is appears to have been too much to resist for the civil servants, senior NHS managers and Ministers, who all start from the flawed premise that top-down management is the way to improve health and social care and that organisation centred databases are key to that. 

Last year the Ferret  revealed the existence of a £63m plan dubbed “data loch”, managed by the University of Edinburgh and NHS Lothian and funded as part of the South East Scotland City Region Deal to make private medical records available for the benefit of private companies.  Scotland’s Digital Health and Care Strategy, published last October, has a section on Data Driven Services and Insights.  In this the Scottish Government commits to producing a new strategy on data which “will include detailed consideration of how to increase citizens’ trust and transparency in data sharing, how to unlock the value of health and care data and how the tricky challenges around safeguarding our data can be addressed, as well as consider aspects such as ethics, standards, relationship with industry and legislative requirements.”  

There are now a plethora of government sponsored initiatives designed to support this, including engagement with the third sector through The Health and Care Alliance, which the Scottish Government funds.  The risks, however, remain high.  For example, it would only take a few Local Authorities and Third Sector organisations to refuse to hand over details of their software systems to a private supplier and the £450k tender could collapse.

To illustrate the growing strength of the private sector in public service provision, next week Holyrood Events, which styles itself as Scotland’s top public policy conference provider (and is part of Holyrood communications which produces the Holyrood magazine) is holding its 11^th Digital Health and Care Conference.  In the final session “Leaders from across Scotland’s health and social care sectors will come together to reflect on the key messages that have come out of the two-day conference”.  The three leaders are:  Donald MacAskill, Chief Executive of Scottish Care, which represents private care providers in Scotland and who is also one of the conference organisers; Paula Speirs of NHS Scotland who is ex-Capita, KPMG and Ernst & Young; and Professor George Crooks, Chief Executive of the Digital Health and Care Innovation Centre and former medical director of NHS 24.  The whole programme, despite being billed as being about health AND care, is dominated by health bureaucrats and the private sector.  Speakers from local authorities, the third sector and people representing the “lived experience” are notable by their absence.

One needs to understand too why such conferences – free to people working in the public sector and third sector happen.  Holyrood Events is part of the Merit Group PLC, which describes itself as a Data and Intelligence Company.  The Merit Group is controlled by Lord Michael Ashcroft, the former Tory Party Treasurer whose registered address is in the tax haven of Belize.  There is no such thing as a free lunch.  

What is at stake here is whether health and social care technology and data remains the servant of a system which puts the health and care needs of people first or whether it becomes a vehicle to drive further privatisation and commercialisation of health and care services.