Sticking with a hugely expensive plan to develop a ‘mythical beast’ of a fighter plane in the 1960s did not end well for the government of the day. The Federated Data Platform may be similarly doomed, writes Joe McDonald

Two of my kids are junior doctors. I often tease them that the two hardest selection processes in the world are medical school entry and fighter pilot training, and I passed in both. An attack of political insight in my teens steered me away from the place I was offered in the RAF fast jets training programme in favour of medicine. But make no mistake, I remain an Aerospace anorak.

As a boy in the 1960s, the next big thing was going to be the BAC TSR-2. Experts were split at the time on whether manned fighter planes were already made obsolete by high-speed heat seeking missiles or whether we just needed better faster planes. A hugely ambitious spec was written for a plane that would replace both the Spitfire and the Lancaster Bomber. It would operate at high altitude and low altitude, high speed, low speed, drop nuclear bombs and do ground attack, all while being six metres longer than the Lancaster and considerably heavier.

The issue of whether this plane for all seasons was pie in the sky or the great leap forward became politically polarised. As the budget for this mythical beast spiralled out of control and test flights were underwhelming, the Labour opposition used it as evidence of a profligate Tory waste of money that post-war Britain could not afford. For the Tories, it would set Britain apart and make the British Aerospace Corporation the world’s best aircraft manufacturer – if they pulled it off.

They spent so much money on it that it became too expensive to cancel. The Tories lost the election and the new Labour Prime Minister, Harold Wilson, immediately cancelled TSR2. Every penny spent was wasted.

Cut from the same cloth

Now there is another project on the runway with a price tag of nearly half a billion pounds. The Federated Data Platform (FDP) has twice been the subject of the Digital Health Debate Series, most recently on Friday last week, where a very knowledgeable audience moved from 60:40 in favour of the programme to 51:49 against it. Quite a swing. Why?

During the debate it became obvious to that the FDP and TSR2 were cut from the same cloth. The FDP, like the fighter plane, would solve all the problems we could think of, but nobody could explain exactly how or when, or even what the problem was that it was supposed to be solving. It wasn’t clear what we are getting for our half a billion pounds over seven, yes seven, years.

There was no clarity about whether it was for direct care or research. There was no clarity about how citizens would be consulted about their health record being shared with bookies’ favourite in the procurement race, the controversial, Trump-supporting, and openly hostile to the NHS, AI peddlers, Palantir. There was no clarity about the data model to overcome – the unacknowledged GIGO elephant in the room.

There was some acknowledgement from those in favour of FDP that the comms has been suboptimal, but I’m sorry that doesn’t wash. This is not the first time NHS England has gone for a massive national data grab and the comms is always absent because they know what will happen if they tell people what’s going on. Emboldened by Covid we are clearly in the middle of Care.Data 3.0.

Normally this goes the same way. The project’s sponsors will press ahead, a great deal of public money will be wasted and the project will ultimately fail, dying on the altar of people who are passionate about privacy but who were not properly engaged and who function as canaries in the privacy mines for the general public. The general public will take their opinion from those privacy experts and not from the government.

National vanity project

However well-intentioned the FDP undoubtedly is, some of us have put 10 years of work into gaining citizen’s trust to deliver regional shared care records so that the IG weather has changed from ‘no sharing’ to ‘sharing by default’. We have moved slowly and with citizens’ consent. The Local Shared Care Records community are within an understandable ‘diameter of trust’ for the citizen, the government is not. We have respected privacy campaigners and not dismissed them as ‘tin foil hat wearers’. The worry with this latest national vanity project is that it is now politically too expensive to cancel, just like TSR2.

I predict the contract will be awarded in the next few weeks, and it will be awarded to Palantir. In the ensuing furore two things will happen. Firstly, a great opportunity to improve the basics of NHS IT will disappear in a half billion pound puff of AI hype. My junior doctor children will continue to have to “fight six nurses for a turn on the ward PC”.

Secondly, there will be a further loss of trust in the NHS. Every time the government decides they are trusted with the citizens’ personal health record, people opt out of information sharing, which might affect their health. Actual patient harm in return for a set of benefits from FDP which have not been convincing to a very well-informed crowd in the Digital Health Debate. What will Joe Public make of it? What will this seven-year project look like after the next general election which is 18 months away. What might a new Prime Minister make of it? Will there be a pause for thought?

Professor Joe McDonald is medical director at Sleepstation, SARD JV, Parsek and Ethical Healthcare Consulting