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It's true that the UK public sector could save insane amounts of money by working together better (e.g. 150 NHS trusts should not all be procuring their own sys

It's true that the UK public sector could save insane amounts of money by working together better (e.g. 150 NHS trusts should not all be procuring their own systems, but they do - or rather, if they do, they shouldn't be complaining about a lack of money). It's also true that Palantir should be nowhere near this, both from an infosec perspective and a "why do we keep giving money to US companies?" perspective. I've thought quite a lot about how to establish key software infrastructure in the UK, particularly regarding EHRs. Has anyone else (Louis Mosley no need to respond)? How do we do it? What challenges/benefits did you spot?

newsclues 2y ago
Why is it up to Palantir to make this suggestion rather than other (local) parties?
- robertlagrant 2y ago
  I don't think I understand the question - I wouldn't say it's up to them in particular.
  - newsclues 2y ago
    Why isn’t anyone else (with a local stake in the issue) coming up with the solutions?
- actionfromafar 2y ago
  It's not? They just try to sell their wares.
- KaiserPro 2y ago
  Politics. Palantir are operating nationally, and have the government’s ear, as does delloitte. They also have the expertise, time and motivation to write out a plan for making things better, rather than local firefighting. After all, who are you going to listen to? one single admin in a trust somewhere, or a very large data company who you've paid lots of money to do all this stuff?
- p_l 2y ago
  "Local" parties (tories) split NHS trusts into smaller pieces which heavily impacted efficiency (Scotland IIRC escaped it)
  - robertlagrant 2y ago
    It's not the number of trusts that's the problem - it's the massive trust-based pushback against centralisation. Remember NHS Digital? NHS England? Things keep being established to try and centralise for efficiency, and it's not working. My observation (caveat emptor) is that trusts push back so hard, and aren't necessarily staffed with technical top performers in the first place, and have such misaligned incentives to centralisation from IT to doctors to everything else, that it can't happen.
    - soco 2y ago
      They way I read it around here, those trusts would love it very much to get a healthcare system similar to the US one. Aren't they already well on the way?
      - robertlagrant 2y ago
        I don't know - what do you mean by "healthcare system"?
    - p_l 2y ago
      I see it as a case of forced decentralisation leading to bad incentives. When you had few NHS trusts covering entire UK, you could easily handle common issues because their scale matched close enough to cover entire vertical slice. Now you have trusts cut in size creating incentives against cooperation if only because of how funding is going to be arranged, and even if there's centralised service like NHS Digital... it's not the entity that is going to fight for budget for trust-local employee training and support needs.
- zimpenfish 2y ago
  > Why is it up to Palantir to make this suggestion It isn't but also people have been saying this kind of thing for years and it just doesn't get anywhere or make the news. e.g. https://publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/390/390.pdf https://publications.parliament.uk/pa/cm200607/cmselect/cmpu... from 2006 is all about « The National Programme for IT in the NHS (“the Programme” or NPfIT) was set up to provide such services, using centrally managed procurement to provide impetus to the uptake of IT and to secure economies of scale." »
  - robertlagrant 2y ago
    > The National Programme for IT in the NHS (“the Programme” or NPfIT) That programme definitely made the news because it was a ludicrously expensive disaster. Some useful things came out of it (e.g. better hardware and bandwidth for trusts) but so much money was wasted. It's one of the UK's most famous failures. It's good you bring it up, though.
    - mattlondon 2y ago
      IIRC there was talk of that being a disaster because they wanted to avoid giving the contract to one single company and mandated it was split up with different companies doing different bits. So they deliberately sharded the contract and so there was endless bureaucracy and politics and blame-gaming between the companies who are normally competing against each other for work and so on. It's kinda interesting really. I don't think it would have gone much better if a single company did everything as the often seems to be a clusterfuck regardless (example: post office horizon system)... Then you look at a big company like meta or Google and they're churning out systems that pretty much work and at huge scale.. are the people incompetent at consulting companies? Are the customers incompetent? Perhaps there are a million legacy dependencies that needs to be dealt with (but that is true with meta etc al too). Interesting interesting. I know freelancers whose line of work is basically to get contracted in while Fujitsu or Accenture or IBM or whoever is there doing work, and basically just try to stop them pulling the wool over the eyes of the clients. Their whole careers have basically been calling bullshit on consultants.
dent9876543 2y ago
We should not be giving money to these mega corps because that also implies giving them our most personal health data. For sure they'll say that we can trust them — maybe it's even true right now, but that can change on a dime, and I don't want to have no option but to trust a crook with no way to pull our public money and my personal data out. We do need to make things more efficient. But it's lazy of us tech types to fall for centralisation in its most naive form — centralisation of personal data storage always comes with huge risks. We overstate the benefits, and we're not around to pay the price when the benefits fail to pass and the hidden costs creep out. Instead, we should be pushing the health record out to individuals, and away from the centre. We should own our own data — perhaps it should even reside on our own device. Our governments should be pushing to store less data, not more.
- robertlagrant 2y ago
  > Instead, we should be pushing the health record out to individuals, and away from the centre One of my observations was that trusts think the opposite. I was in a call with one, and I said at one point, "Of course, the patient is the Data Owner" and I was corrected by a trust staff member who said, "No, the trust is the Data Owner". Because - as I learned and saw later - trusts will sell data for studies. So they want the data.
  - linker3000 2y ago
    Yes, however in the UK and EU the patient is the Data Subject and has legal rights on what processing is done with the data about them.
    - mistrial9 2y ago
      see "even true right now, but that can change on a dime" above ...
    - robertlagrant 2y ago
      They have legal rights until the data is detached and deidentified.
chckens 2y ago
My favourite anecdote on health service bureaucracy - a few years ago significant other worked for local NHS trust using software A to record all their interactions with service users. Trust decided to migrate to software B, and spent significant time and money migrating data from one to the other. Mere months later, the service contract is won by the neighbouring trust. Their standard system is, of course, software A! Migration happened in reverse, but without budget to move historical records back over. Staff were left scrabbling around manually copying data for current cases from one system to the other…
linuxftw 2y ago
> "why do we keep giving money to US companies?" What is a US company, and what is the disadvantage for UK people that money is paid to a US company rather than a UK company? Are you arguing for protectionist tariffs to support local wages?
- ndsipa_pomu 2y ago
  As a UK citizen, my concerns are that U.S. companies are difficult to trust with PII data as they're not really covered by a sane equivalent of GDPR that I know of. If they do break UK law about how they treat our data, then there's a good chance that the U.S. administration may step in and tell the UK to get lost and start imposing punitive measures against us. There's a remarkable lack of trust over here now with regards to U.S. companies.
  - robertlagrant 2y ago
    This is a bit of recency bias, I think. Privacy Shield, the regulation governing US<->EU (and then, UK) data transfer, was struck down in 2020. Its replacement is on the table between US<->EU, and, hilariously, here is Nick Clegg (yes, that Nick Clegg) from Meta talking about it: > the deal “will provide invaluable certainty for American & European companies of all sizes, including Meta, who rely on transferring data quickly and safely.” I don't know of any news for US<->UK data agreements, but I haven't been keeping track.

newsclues 2y ago

Why is it up to Palantir to make this suggestion rather than other (local) parties?

robertlagrant 2y ago
I don't think I understand the question - I wouldn't say it's up to them in particular.
- newsclues 2y ago
  Why isn’t anyone else (with a local stake in the issue) coming up with the solutions?
actionfromafar 2y ago
It's not? They just try to sell their wares.
KaiserPro 2y ago
Politics. Palantir are operating nationally, and have the government’s ear, as does delloitte. They also have the expertise, time and motivation to write out a plan for making things better, rather than local firefighting. After all, who are you going to listen to? one single admin in a trust somewhere, or a very large data company who you've paid lots of money to do all this stuff?
p_l 2y ago
"Local" parties (tories) split NHS trusts into smaller pieces which heavily impacted efficiency (Scotland IIRC escaped it)
- robertlagrant 2y ago
  It's not the number of trusts that's the problem - it's the massive trust-based pushback against centralisation. Remember NHS Digital? NHS England? Things keep being established to try and centralise for efficiency, and it's not working. My observation (caveat emptor) is that trusts push back so hard, and aren't necessarily staffed with technical top performers in the first place, and have such misaligned incentives to centralisation from IT to doctors to everything else, that it can't happen.
  - soco 2y ago
    They way I read it around here, those trusts would love it very much to get a healthcare system similar to the US one. Aren't they already well on the way?
    - robertlagrant 2y ago
      I don't know - what do you mean by "healthcare system"?
  - p_l 2y ago
    I see it as a case of forced decentralisation leading to bad incentives. When you had few NHS trusts covering entire UK, you could easily handle common issues because their scale matched close enough to cover entire vertical slice. Now you have trusts cut in size creating incentives against cooperation if only because of how funding is going to be arranged, and even if there's centralised service like NHS Digital... it's not the entity that is going to fight for budget for trust-local employee training and support needs.
zimpenfish 2y ago
> Why is it up to Palantir to make this suggestion It isn't but also people have been saying this kind of thing for years and it just doesn't get anywhere or make the news. e.g. https://publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/390/390.pdf https://publications.parliament.uk/pa/cm200607/cmselect/cmpu... from 2006 is all about « The National Programme for IT in the NHS (“the Programme” or NPfIT) was set up to provide such services, using centrally managed procurement to provide impetus to the uptake of IT and to secure economies of scale." »
- robertlagrant 2y ago
  > The National Programme for IT in the NHS (“the Programme” or NPfIT) That programme definitely made the news because it was a ludicrously expensive disaster. Some useful things came out of it (e.g. better hardware and bandwidth for trusts) but so much money was wasted. It's one of the UK's most famous failures. It's good you bring it up, though.
  - mattlondon 2y ago
    IIRC there was talk of that being a disaster because they wanted to avoid giving the contract to one single company and mandated it was split up with different companies doing different bits. So they deliberately sharded the contract and so there was endless bureaucracy and politics and blame-gaming between the companies who are normally competing against each other for work and so on. It's kinda interesting really. I don't think it would have gone much better if a single company did everything as the often seems to be a clusterfuck regardless (example: post office horizon system)... Then you look at a big company like meta or Google and they're churning out systems that pretty much work and at huge scale.. are the people incompetent at consulting companies? Are the customers incompetent? Perhaps there are a million legacy dependencies that needs to be dealt with (but that is true with meta etc al too). Interesting interesting. I know freelancers whose line of work is basically to get contracted in while Fujitsu or Accenture or IBM or whoever is there doing work, and basically just try to stop them pulling the wool over the eyes of the clients. Their whole careers have basically been calling bullshit on consultants.

dent9876543 2y ago

We should not be giving money to these mega corps because that also implies giving them our most personal health data. For sure they'll say that we can trust them — maybe it's even true right now, but that can change on a dime, and I don't want to have no option but to trust a crook with no way to pull our public money and my personal data out. We do need to make things more efficient. But it's lazy of us tech types to fall for centralisation in its most naive form — centralisation of personal data storage always comes with huge risks. We overstate the benefits, and we're not around to pay the price when the benefits fail to pass and the hidden costs creep out. Instead, we should be pushing the health record out to individuals, and away from the centre. We should own our own data — perhaps it should even reside on our own device. Our governments should be pushing to store less data, not more.

robertlagrant 2y ago
> Instead, we should be pushing the health record out to individuals, and away from the centre One of my observations was that trusts think the opposite. I was in a call with one, and I said at one point, "Of course, the patient is the Data Owner" and I was corrected by a trust staff member who said, "No, the trust is the Data Owner". Because - as I learned and saw later - trusts will sell data for studies. So they want the data.
- linker3000 2y ago
  Yes, however in the UK and EU the patient is the Data Subject and has legal rights on what processing is done with the data about them.
  - mistrial9 2y ago
    see "even true right now, but that can change on a dime" above ...
  - robertlagrant 2y ago
    They have legal rights until the data is detached and deidentified.

chckens 2y ago

My favourite anecdote on health service bureaucracy - a few years ago significant other worked for local NHS trust using software A to record all their interactions with service users. Trust decided to migrate to software B, and spent significant time and money migrating data from one to the other. Mere months later, the service contract is won by the neighbouring trust. Their standard system is, of course, software A! Migration happened in reverse, but without budget to move historical records back over. Staff were left scrabbling around manually copying data for current cases from one system to the other…

linuxftw 2y ago

> "why do we keep giving money to US companies?" What is a US company, and what is the disadvantage for UK people that money is paid to a US company rather than a UK company? Are you arguing for protectionist tariffs to support local wages?

ndsipa_pomu 2y ago
As a UK citizen, my concerns are that U.S. companies are difficult to trust with PII data as they're not really covered by a sane equivalent of GDPR that I know of. If they do break UK law about how they treat our data, then there's a good chance that the U.S. administration may step in and tell the UK to get lost and start imposing punitive measures against us. There's a remarkable lack of trust over here now with regards to U.S. companies.
- robertlagrant 2y ago
  This is a bit of recency bias, I think. Privacy Shield, the regulation governing US<->EU (and then, UK) data transfer, was struck down in 2020. Its replacement is on the table between US<->EU, and, hilariously, here is Nick Clegg (yes, that Nick Clegg) from Meta talking about it: > the deal “will provide invaluable certainty for American & European companies of all sizes, including Meta, who rely on transferring data quickly and safely.” I don't know of any news for US<->UK data agreements, but I haven't been keeping track.