“This is about the standards you want to abide by as a country”

So uttered Theresa May in defending a ‘carve out’ in a mythical trade agreement with the U.S.

We do not know what these standards are. For all I know, the NHS could be about to launch innovations which are the equivalent of ‘chlorinated chicken’.

 

Donald Trump, POTUS, admitted this week that he didn’t give Theresa May ‘advice’ on negotiating with the European Union, but he did make a ‘suggestion’. It eventually turned out that Trump advised May to ‘sue the EU’ according to May in her interview on the Andrew Marr show. But it seems that the British Government is trying to claim that it will be freed up to make a free trade deal with the U.S. if it is not tied into the single market. It certainly will be freed up to make a free trade deal with the U.S.  if the European Union rejects the U.K.’s proposals. Theresa May might be forced to do a John Major, and say, “Back me or sack me!” Falling off the cliff edge into the abyss means that junior doctors would no longer be protected by the European Working Time Directive – which has long been argued, particularly by some surgeons, to be a barrier to training. Doctors too tired to function safely? Nah.

 

But whisper it softly – actually, things are quite bad now.

 

The British Government has been uniquely bad in offering to the European Union a platform for which they could work together. Even in the unlikely event that the European Union wants to make a deal with the U.K., the British Government is proposing that goods not services would be harmonised. So in this unlikely event any innovations invented in the NHS would have to comply with E.U. rules, if that market was to be tapped into. But that might entail protections on data privacy and retention which multi-national corporates might not find desirable. The British Government might wish to cut costs, by farming out as much as possible to the “cloud”, which could mean that patient data fall under the Chinese jurisdiction.

 

So, far from ‘taking back control’, patient data could be stored internationally and could easily be subject to cyberattack. This could be a ‘Project Fear’, but it could likewise be a major problem with the current Government’s desire to make money out of the NHS. It is clear that previous Governments have considered patients a nuisance to running a service which is a sink for money, and would much rather make the NHS profitable or an ‘export’. Apps are one way of doing this.

 

If an app generates anxiety in a patient, there would be no come back apart from lodging an administrative complaint.

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Private equity investors could invest in research and development, and market software for prompt diagnosis here and abroad, for example to cut down GP ‘waits’ etc.  It would not actually be possible to ‘strike off’ a dodgy app under current legislation, if for example it suggested that a ‘textbook’ heart attack was in fact an innocuous bit of indigestion. But it’s often been the dream of some to put offshore diagnostic services, e.g. interpreting a x-ray, even perhaps interpreted by ‘artificial intelligence’ which we are repeatedly told is superior in performance to an experienced clinician. Diagnoses of dementia could be made simply by tracking how many times you went to your local bank, or did online banking, for example.

 

Successive governments had had little interest in valuing the workforce, knowing that many NHS staff are indeed so loyal they would want to stay in the NHS for their whole career. Private companies take advantage of this by badging their services fraudulently using the NHS logo. It will suit the new Secretary of State for health and social care to pretend it values very much the workforce, while trying to flog off property or apps to make a healthy budget sheet. For too long, the NHS has had a split identity of wanting to run the NHS as cheaply as possible (in the name of efficiency), while trying to avoid ‘quality’ from going through the floor, but still trying to make bits of it discrete and profitable for international markets for goods. It has no interest in selling off unprofitable services. And it doesn’t particularly mind if the quality can go through the floor, and hopefully nobody notices – for example, by annihilating services for mental health rehabilitation. The only hope that NHS England has for selling off services internationally is from reducing liabilities (e.g. litigation costs of patient safety) or debts (hard to do with PFI), and if it can somehow turn an integrated NHS and social care into “bite size chunks” (hence the rumpus about the future of accountable care organisations).

 

If it were up to “innovators” and “entrepreneurs”, there would be no altruism any more. Data are a source of money, and it doesn’t matter if NHS England shills blandly claim ‘patients own data’. Self-management is a convenient cover for cutting services, shifting accountability and blame, and a way for the private sector to flog more products with little evidence base to a gullible public. The genomes of each and every one of us could be pumped into a giant Big Data computer, so that ‘population segmentation’ goes down to the level of n = 1, to ascertain whether the population which is at ‘high risk’ for ‘avoidable admissions’ is YOU, based perhaps on your genomic code. The future is here – embrace it. British inventors could patent their A.I. algorithms, and sell them to the US or Chinese. And the U.S. and Chinese could sell us their computer screens and drugs. “Fuck business” for EU services, as Boris Johnson might say.

 

So Donald Trump might want to get his little tiny hands on the NHS after all – and Jeremy Hunt in the cockpit is ably qualified to lubricate the future.

 

@dr_shibley

 

 

 

 

 

 

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