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Signify Premium Insight: Palantir in Pole Position for NHS Deal, but Uncertainty Reigns

Some time after 9 February, the winner of a £360M contract to supply NHS England with a new national data aggregation platform will be announced. For many in the industry, the result is a foregone conclusion. US data analytics firm Palantir, which has a deep (and not without controversy) footprint in the NHS, is widely tipped to clinch the five-year Federated Data Platform (FDP) deal.  

But it is not just controversy around Palantir which triggers questions about the FDP. Notably, there are striking parallels with a major regional platform roll out by Integrated Care Systems (ICSs) over the last two years. On the face of it, the FDP smacks of duplication, albeit offering aggregated data at national level.  

The Signify View 

The FDP will aggregate and interrogate anonymised and non-anonymised data from different EHRs and IT systems within ICSs, Acute Trusts, Primary Care and other providers in England. It will replace the NHS COVID-19 Data Store (run on Palantir’s Foundry software), which was delivered in 2022. The NHS claims the FDP, a national platform, will reduce the time NHS staff spend chasing referrals, scheduling appointments and waiting for test results. 

But, far from being a pioneering project with potentially transformative impacts, the FDP is an almost identical system to one that ICSs have been procuring at regional level over the last two years, often referred to as Shared Care Records. The below diagram outlines the main building blocks set out in the new FDP tender and compares them with the building blocks for the ICS tenders. The similarities are clear.  

Vendors supporting that $480M roll out include Oracle Cerner, InterSystems, Orion, Patients Know Best, Graphnet, Kainos and Black Pear (the table below summarises these contracts by number of ICS contracts each has). These platforms are aggregating data from acute trusts, GP practices, mental health and social care, and offer a population health analytics tool very similar to that envisaged for the FDP, but at a localised ICS level.  

A Question of Duplication? 

The FDP tender document states that these platforms being rolled out in the ICSs will be able to integrate into the FDP. This implies that the FDP platform will essentially be a duplicate, and this potentially undermines the ICSs, or at least introduces confusion on IT strategy for ICSs. 

A look at the use cases for the platform in the FDP tender document reinforces the duplication argument. The document specifies five use cases. Three of them (population health and ‘person insight’, elective recovery and care co-ordination) are already intended when the ICS solutions were procured. The other two are vaccination (where Palantir’s experience with the NHS COVID-19 Data Store is a clear advantage going forward) and supply chain. 

While the FDP will offer the key advantage that it provides a national system, it also indicates that solutions procured by ICSs are not living up to expectations.   

The Horse has Bolted  

The FDP will not be compulsory. NHS Trusts and ICSs will be encouraged to use it to support their own use cases, however, it is difficult to see how many will actually do so. ICSs are already spending nearly half a billion dollars on the rollout, and have had challenges implementing Shared Care Record systems. They might justifiably wonder what would be gained from the FDP that they will not reap from their own projects. 

They might also justifiably ask NHS England Director of Transformation Dr Timothy Ferriss for his answer on this. The FDP has his stamp all over it. Just last week he authored an article, published on the NHS website, promoting the FDP and the scale and benefits he says it will offer. 

Dr Ferris is known as a champion of large, national-scale projects. The American is frustrated with the fragmented nature of NHS IT systems. There were rumours circulating around a year ago that he wanted every NHS hospital to migrate to a national Epic-based EHR. It was only a rumour (and it is hard to see such a scenario ever playing out), but Dr Ferris’ reputation clearly precedes him. And in the FDP, he will at least get his wish for that national system. 

That said, the ICS Shared Care Record rollout has not been particularly smooth. To date the vast majority put in place are only being used to provide healthcare providers within the ICS a summarised view of each patient. Few ICSs have yet leveraged their full potential from a more strategic Population Health Management perspective. Only a small number employ analytics solutions on top of the aggregated dataset that they offer.  

Therefore, there is still pent-up demand for ‘better’ solutions, and a sense of frustration with the solutions put in place in terms of the original promise and vision. However, technology is not always the barrier. Leveraging the full potential of these solutions is more down to changes in workflow and structure within providers. Putting in place a national system on top of the local ICS solution will not address this.  

Rough Ride 

If Palantir are, indeed, chosen to deliver the FDP, they can be sure of a lukewarm reception (at best!) from many different stakeholders.  

Its critics point to its alleged poor record on data management and procurement policy on other NHS deployments. The company can expect a rough ride from the media, too. The ICS Shared Care Record initiative has not escaped media scrutiny, with many questions around why patient data was being shared for research. On a national-level project the stakes will be even higher. The idea that a large American tech firm has access to NHS patient healthcare record data and will be sharing it at national level will cause unease. 

That is one reason why the FDP tender document clearly emphasises the use of anonymised data.  

A Line of Other Suitors 

The fact that such a large NHS contract will likely be awarded to a non-UK vendor who will then have access to huge amounts of patient data from England is a moot point. Palantir may not be everyone’s cup of tea, but Oracle Cerner, InterSystems and Orion all have good track records with the ICSs, and may have a competitive chance of winning the FDP contract. Last June, Oracle Cerner stated its ambition to develop a solution for a US national EHR database (which we analyse in this Insight). It may want to extend its ambitions across the Atlantic. Epic, which is only number six in the UK in terms of number of hospitals using its EHR, will also feel it has a solution that fits the FDP bill. InterSystems has a strong footprint in the UK via its HealthShare product, as does Orion.  

Big Tech will also be circling around this opportunity. Amazon’s HealthLake aggregator is, for example, a natural fit for the FDP, as is Google Cloud’s Healthcare Data Engine (HDE). 

Market Opportunity 

The FDP contract will also have provision for the creation of a marketplace where vendors can develop third-party applications that then use the aggregated FDP data as well. This is an interesting concept that means that some of those existing solutions that have been developed can plug into the new FDP to use that national level data. Further ICSs, Primary Care Networks and Acute Trusts have also been working with other third parties to develop analytics solutions for Population Health Management, as well as developing their own tools in-house. This marketplace concepts suggest that these solutions have a potential place for any healthcare provider looking to leverage the FDP.  

Inspiring Confidence 

The NHS has had an uneasy relationship with data projects for more than a decade. Whoever wins the FDP contract will face resistance and intense scrutiny, and the spectre of patient data privacy concerns will never be far. To succeed, they will not only need the products to support the creation of a robust FDP, but also the skills to inspire confidence and garner support from stakeholders across the board. Given Palantir’s chequered history in this respect, the next five years could be a rocky ride.