Conservative health secretary Matt Hancock continues to push digital as the answer to the National Health Service's woes, but does his language mask a shift towards greater privatisation within the NHS?
"Interoperability", "digitally enabled", "innovation", "revolutionary", "connectivity", "empowerment", "integration", the NHS "-as-a-platform", "culture change", and "cutting-edge" technology - is just a selection of the technology industry cliches Hancock has said since taking the role.
This phraseology might be fresh in Westminster, where technology literacy is notoriously poor, but anyone that has been around the industry will be all too familiar with this kind of empty jargon. Saying one thing and meaning quite another is practically a tradition among senior Conservative politicians.
When Theresa May became the leader of the Conservative party (de facto, and then prime minister of a government with the DUP), she made similar attempts to use softer phrasing than the outwardly austere language of her predecessor David Cameron - publicly promoting concepts like equality despite her own track record of deportations and support for anti-LGBT legislation.
Now, Hancock appears to be playing a similar trick. In a way that will be familiar to anyone who has taken a cursory glance at the political history of Britain's current prime minister, Boris Johnson, words and deeds often seem diametrically opposed: they promise one outcome but work behind the scenes to deliver its opposite.
Just yesterday, Hancock struggled to rebuke the Nuffield Trust's claim that £1.8 billion in 'new' funding earmarked for the NHS is actually the result of incentive payments for rounds of cost-cutting - that hospitals had been prevented from spending. The total cost for fixing the NHS' repair backlog, reports the Daily Mirror, would cost well over £6 billion.
Hancock pledged to MPs in January this year that there will be "no privatisation of the NHS on my watch". But it emerged recently that the Department of Health and Social Care, in the last year, awarded a staggering £9.2 billion in contracts to private healthcare companies, such as Virgin Care and The Priory group.
The record amount was almost half a billion pounds more than the £8.8 billion figure for 2017-2018.
Last month Hancock was accused by The Guardian of burying a document with proposals that would aim to decrease public alcohol consumption, obesity, and smoking. It was reported that in a dispute with Theresa May, Hancock hadn't wanted the green paper published, especially not so close to the appointment of successor Boris Johnson.
The document was published shortly after 7pm on a Monday, fuelling speculation that its findings were likely to aggravate Johnson, who has historically favoured a laissez-faire approach to regulations, and has promised to make Britain as business-friendly as it can possibly be – while paradoxically pushing for a hard Brexit, should that be the only option left on the table by October.
Hancock inherited the notorious legacy of Jeremy Hunt, who has never shied away from his belief in market solutions to public services. It follows the long tail of private finance initiatives, or PFI, first instituted by John Major's Conservative government, before becoming widespread under New Labour – with hospitals struggling to pay back debts to businesses to this day.
One of Hancock’s biggest moves so far as health secretary was creating NHSX, a "new joint organisation for digital, data and technology". In a speech explaining the decision, he said that it would be up to the new unit to take a similar approach to innovation as the major Silicon Valley businesses, referring by name to Google, Apple, and Amazon – with the latter now enjoying a partnership with the NHS for healthcare information via the Alexa device.
Should these "market-leading", in the parlance of Hancock, businesses really be offering a framework for driving change at the beleaguered, chronically under-funded National Health Service, which has flitted from crises to crises over the past nine years? Should healthcare be 'disrupted' at all? Innovation, future-gazing, cutting wastage, digital, and disruption. All this sounds harmless enough at first glance, but what will it actually mean?
In a parallel sense to the language that surrounds the fourth industrial revolution – a laser focus on the productivity gains made possible by technology, while ignoring the human cost of mass labour dislocation – the obsession with digital in healthcare risks elevating the shiny new applications over the right to a decent standard of care for all.
To return to Hancock's adulation of the Silicon Valley companies, it is worth stressing the unaccountability of titans like Apple, Google, Facebook, and Amazon: their free and easy attitude towards their users' data sovereignty, their questionable ethics, their general business practices, and the wellbeing of their employees, at least at the bottom rungs of the pay grade.
Cosying up to the technology players might well prove an expedient political decision. Amazon, for example, has totally dominated the ecommerce market in much of the world, but especially in the United States where it accounts for about half of all consumer product spend. Google is a backer of the 23AndMe DNA testing service, which is selling user information to huge pharmaceutical corporations.
With Brexit predicted by some to pave the way for a predatory one-sided trading relationship where the American corporations pick the bones of what's left of our public services, could this be a sign of further things to come?
Advances in technology doubtless offer incredible opportunities, as Hancock is keen to state, particularly in areas like genomics, preventative care, and telemetry - but as with most tools, they are inherently neutral. The question is: are leaps forward in technology first and foremost used to benefit the public good - or will they be used for backdoor privatisations and the creation of for-profit databases?
Even seemingly benign private GP surgeries – such as the Hancock-favourite online solution Babylon Health – have caused their share of consequences, as this in-depth report from Wired shows, forcing millions of pounds in extra funding from the NHS in order to assess and offset its impact.
It also sought to sue the Care Quality Commission health regulator for what Babylon described as an "inaccurate and misleading" report that alleged information was not being properly shared with GPs, and that there were concerns over the potential for prescriptions issued by it to be misused.
Hancock has been open about wishing to help companies like Babylon further entrench themselves within the NHS. He has been upfront about what he sees as the potential for healthcare apps, remote care, technologically-enabled predictive treatment, and cost-saving.
Perhaps most crucially, he has also been transparent about his desire for the British "healthtech" industry to thrive – but surely, there is a conflict of interest between the for-profit motive of companies within these industries and a world-class public healthcare system, which cannot be reconciled by the convenience of new forms of digital delivery.
We should be wary, then, when technology is touted as a magical salve for the well-documented economic problems foisted upon the NHS. Hancock's successful branding exercise as an evangelist for digital – replete with individual quirks like his very own Hancock smartphone app – must, like Boris Johnson, be carefully viewed through the lens of his own policy decision-making, not the image he has carefully cultivated.
Public trust in Big Tech is understandably at an all-time low, following revelation after revelation about mass surveillance, malicious data practices, and worse. We can't afford to wait for the mask to slip from their adoring devotees in the halls of power - before it's too late to do anything about it.