The Great Health and Social Care Reset for the Big Data Economy Part 1.3: COVID-19 – the Watershed Event for Digital Transformation

The COVID-19 event: a natural laboratory accelerating the transition to biodigital world

Following the government announcement of a stay-at-home order on the 23^rd March 2020, ¹ the National Health Service cancelled all but the most urgent of non-COVID-19 care, advising even A&E cases to stay home. ² This state of affairs continued on and off over repeated lockdowns for the next several years.

Boris Johnson’s speech announcing the first lockdown specifically and repeatedly emphasised that protecting the NHS from facing demand levels that exceeded its ‘ability to cope’ was a central reason for the shut-down directive. A later government document divulged that

The steps people took to protect each other from the pandemic contributed to a drop in demand for A&E of over 30 per cent in 2020-21, with ten per cent fewer general practice (GP) appointments in the first 12 months of the pandemic than in previous years, and a marked reduction in dental treatment. ³

Behind closed doors, however, a whirl of activity was set in immediate motion to actualise the remodelling of NHS service delivery to a digital-care-first template. The rationale given for these changes — the mitigation of COVID-19 infection risk — is belied by the incontrovertible evidence of conspiracy by NHS senior management in collusion with government ministers to engineer such a transition from at least 2011, as evidenced in Parts 1.1 and 1.2.

The research study Academic health science networks’ experiences with rapid implementation practice during the COVID-19 pandemic in England describes COVID-19 as a ‘natural laboratory’, which ‘enabled rapid implementation through an urgency for change, the need to adhere to social distancing rules, new enabling governance structures, and stakeholders’ reduced risk averseness toward change.’ ⁴

Policy Horizons Canada, the Government of Canada’s ‘foresight’ unit characterised the COVID-19 event as ‘the first global-scale biodigital experience’, declaring, ‘The COVID-19 pandemic is acting as a driver of change, accelerating the transition to a biodigital world. . .We are simultaneously encountering the profound evolution of biodigital innovations and witnessing the emergence of a new domain.’ ⁵

UK Research and Innovation were explicit about COVID-19’s function in ushering in the new economy in their 2020 study on the future of impact investing in healthy aging, where they pronounce, ‘The response to COVID-19 we have seen to date proves that a reset is possible towards a model of “stakeholder capitalism.” The time is now to make this the new normal.’ ⁶

What’s more, the digital transformation of health and social care continues apace, ⁷ despite the COVID-19 ‘state of emergency’ having long since receded.

The NHS Reset

NHS Confederation, in partnership with The Health Foundation and The Academic Health and Science Network, launched an ‘NHS reset’ campaign ⁸ in May 2020, with the stated goal of translating and adapting ‘the best of COVID-19-related innovations and initiatives into everyday practice’. ⁹ 

It was part funded by a sponsorship from Novartis Pharmaceuticals UK Limited, whose Chief Executive chaired the 2012 World Economic Forum summit in the UK, ‘Sustainable Health Systems: Visions, Strategies, Critical Uncertainties and Scenarios’, covered in Part 1.1. Novartis is a WEF partner ¹⁰ and in September 2022 launched the AI4HealthyCities Health Equity Network ¹¹ in collaboration with Microsoft AI for Health, the successor to Novartis’ prior ‘Better Hearts, Better Cities’ programme. ¹²

On their website Novartis boast that they offer ‘unique partnerships with the UK health and care system to help improve patient outcomes at both a local and national level by developing new models of sustainable patient care, and introducing innovative technologies into the NHS.’ ¹³

The September published NHS Reset report relates that NHS Confederation led nearly 50 webinars, roundtables and private meetings with ‘more than 2,500 senior leaders, frontline clinicians, stakeholders and parliamentarians’, to explore ‘the shift in culture, regulation, reporting, assurance and behaviour that accompanied the response to COVID-19.’ ¹⁴

NHS Confederation sets out its mission for the NHS as, ‘an anchor institution to drive local economic growth’ ¹⁵ as follows:

Whole system culture change is needed across public services, and the NHS at national and local level can take the lead on this. A joint approach is essential and should include local authorities, social care, the voluntary sector, private sector providers, housing, environmental, employment and education and training services. ¹⁶

The NHS Reset report enthuses about the pace of digital transformation that COVID-19 had enabled in the health and social care sectors stating that ‘changes that would have taken years have been delivered in weeks’, ¹⁷ and resolves to retain such shifts:

During the pandemic the regulatory burden on local leaders has been reduced, giving way to leaner and more agile ways of working. . .we need to hold on to this different way of doing things and strip away the unnecessary bureaucracy, reporting and regulation that for too long has stifled the service. ¹⁸

The notion that COVID-19 represented a fast-forward button for the adoption of digital innovations across health and social care is a repeated refrain throughout NHS and government documents from 2020 onwards. For instance, NHS England’s 2022 report Delivering a Net Zero National Health Service (discussed in more detail below) proclaims ‘The response to COVID-19 rapidly accelerated the digitisation of outpatient and primary care appointments, with implementation of a five-year delivery plan being reduced to weeks.’ ¹⁹

Similarly, the Academic Health and Science Network report Reflecting on the COVID-19 pandemic to inform the health and care system of the future: the AHSN Network experience, describes the COVID-19 pandemic as ‘a watershed moment for digital transformation’, ²⁰ which enabled the development and deployment of digital products, ‘within days, compared with the multi-year timelines projected before the pandemic.’ It remarks on the ‘astonishing acceleration’ ²¹ during 2020 of the Digital First Primary Care Programme, ²² launched in2019.

The report repeatedly emphasises the importance of capitalising on a ‘time-limited window of opportunity to help shape the health and care system of the future’, ²³ and to lock in the ‘new normal’. ²⁴ This, they define as, ‘digital innovation at scale; joint working with industry; rapid implementation of new products and pathways; the adoption of new technologies across the board, co-production of services with communities’; ²⁵ and, ‘shortened procedures for approval and appraisal of drugs, digital technologies, equipment, and guidance.’ ²⁶

In a webinar delivered in September 2020 to local, regional and national level leaders, by organisations leading the Reset campaign, examples of ‘illustrative COVID mindsets and beliefs’ that have help helped to positively shift expectations of patients and professionals are given. Included in those that they judge to be ‘likely largely in place’ are, ‘I do not need to go to hospital to get the care that I normally need’, and, ‘Digital consultation can offer high quality clinical interaction.’

The role of the Academic Health and Science Network/ Health Innovation Network

The Academic Health and Science Network (AHSN) — now renamed the Health Innovation Network — was established in 2013 as 15 separate but interlinked regional networks, with the remit of assisting ‘the adoption and spread of innovation at pace and scale to improve health outcomes and generate economic growth.’ ²⁷ At the outset of the COVID-19 event, ANSN members became ‘embedded members of integrated teams, working with NHS England and NHS Improvement, NHSX, NHS Digital, commissioning support units (CSUs), and local health systems to move towards a digital first approach.’ ²⁸

They played a key role — through their ‘Patient Safety Collaborations’ — in mass implementation of a ‘COVID virtual ward pathway’ from December 2020, following pilots earlier in the year which supported ‘early discharge of patients with coronavirus with a pulse oximeter and oversight from secondary care.’²⁹ 100% of Clinical Commissioning Groups in England had launched the ‘COVID Oximetry @home pathways’ by the end of December 2020. [²⁹]

Other activities included supporting GP practices in the rolling out of online and video consultations, GP Connect and GP information technology (IT), and care home digitisation. [²⁸] Thanks in part to their work, between March and June of 2020 virtual consultations (including telephone) increased from 6.5% of all consultation appointments to 48%. ³⁰

This work was carried out through ‘strategic partnerships’ between the AHSN and the National Institute for Care and Excellence (NICE), the National Institute for Health Research (NIHR), the Business Service Authority (BSA), and the Medicines and Healthcare Regulatory Agency (MHRA); the latter as part of the ‘Innovative Licensing and Access Pathway’ for medicines. ³¹

The AHSN’s influential position is revealed in one report which discloses, ‘AHSN leaders are included in relevant policy and public discussions relating to healthcare innovation, and are in regular contact with Ministers and very senior officials in the NHS and Government.’ ³²

The AHSN endorsed the relaxed regulatory approach to patient identifiable data adopted at the start of the COVID-19 event and advocated for its continuation:

With the need to shift from face-to-face consultations. . .[the Information Commissioner’s Office] regulatory approach towards mobile apps such as WhatsApp and Skype (which breach NHS and UK Data Protection Act rules for the handling of patient identifiable data (PID)) was relaxed to facilitate digital consultations. . .Many of these apps have become a fundamental part of delivering patient care and are returning significant benefits, so it would be wrong simply to stop using them as the pandemic starts to abate. ³³

This move by the Information Commissioner’s Office aligned with broader regulatory relaxation towards Patient Identifiable Data introduced from 20 March 2020. The government used the 2002 Health Service Control of Patient Information (COPI) regulations ³⁴ to issue ‘time-limited notices requiring public sector organisations to share patient information to support the COVID-19 response.’ ³⁵ This information included personal data not consented to by patients — and was used to build the COVID-19 Data Store managed by Palantir using their Foundry platform. ³⁶ (See below section: The role of NHSX.)

Although the COPI notice expired on 30 June 2022 [³⁵] (after several renewals), the NHS Confidentiality Advisory Group advised those carrying out permissible data processing under the COPI to transition to Regulation 5 of Health Service (Control of Patient Information) Regulations 2002 before the COPI’s expiry, to enable a ‘permanent legal basis for your activity.’ ³⁷ Elsewhere NHS England claims application of Regulation 3 provides the lawful basis for ongoing dissemination of ‘confidential patient information to NHS England by organisations that were previously required to do so by their COPI notice.’ [³⁶]

The Beneficial Changes Network

The ‘Beneficial Changes Network’ (now renamed the ‘Collaborative NIHR ARC/AHSN partnership’) ³⁸ was set up by (the now disbanded) NHS Improvement. By May 2020 ³⁹ it was engaged in work to ‘capture the opportunity that COVID-19 has given us to do things differently’, and to ‘maximise the groundswell of support within NHS England Improvement and across the NHS’, for ‘good and best practice’, ⁴⁰ with the goal of scaling and spreading what they deemed to be ‘beneficial changes’ across the health system from the start of 2021. [³⁹]

In a video presentation released in October 2020, spokesperson Rob Wakefield enthuses about the ‘amazing’ coordination between the Beneficial Changes Network’s efforts and that of ‘a lot of the national bodies’ who were both ‘carrying out similar. . .kind of pieces of work’, and ‘all coming to the same conclusions as well.’ ⁴¹ This presumably made the Network’s objective ‘to steer and influence the political agenda’, ⁴² as stated in the presentation, easier to realise.

The network — which welcomed staff of all levels of seniority from the NHS as well as external health organisations including ‘NHS Confed, NHS Providers, the Kings Fund, Academic Health Science Networks, and local authorities’ — was involved in establishing a ‘FutureNHS’ platform for the sharing of narratives and case studies. ⁴³

Their ‘5 key areas of shortlisted priorities’ were

• Remote triage and reducing unnecessary admissions;
• Video and remote consultations
• Remote monitoring (apps, sensors, home equipment and wearables) and;
• New ways of working for staff (i.e. increased use volunteers, redeployment of paid staff in different roles and use of mental health apps by staff). ⁴⁴

Novel methods of virtual education for staff is mentioned as a shortlisted priority in the area of ‘clinical change’, ⁴⁵ in alignment with recommendations in The Topol Review (see Part 1.2).

Another example of a ‘positive’ change highlighted in the presentation to be retained and further developed that are ‘new referral pathways set up during COVID’ that ‘avoid Emergency Department[s]’ for certain cohorts of patients including those designated as ‘end of life’ and ‘frail’. ⁴⁶

The journeys saved through staying home and not having access to face to face medical treatment during lockdowns is seen as a success story. The ‘outpatients Transformation Team’ calculates that the NHS has ‘avoided patient journeys totalling over 58 million miles’ saving ‘8000 tonnes of CO2 admissions’, and (rather bizarrely) celebrates having avoided the need for ‘over 1.5m hospital car park spaces.’ ⁴⁷

The impacts of lockdowns on the Social Care Program and collaborative robots trials

A social care programme to accelerate the digital maturity of the social care sector and to link electronic NHS and social care records took place through a number of different workstreams between 2016-2021, with £22.7 million of funding from NHS Digital, and overseen by the Local Government Association. ⁴⁸

The programme encompassed 100 separate projects directed by local councils and NHS Digital and, later, NHSX. ⁴⁹

Projects from the 2019-2021 Social Care Digital Pathfinders Programme (Pathfinders) include the ‘Friends of the Elderly’ charity led pilot of integrated acoustic monitoring technology with digital care planning in three care homes; ⁵⁰ Wolverhampton City Council’s scheme to extend the range of data available for ‘artificial intelligence (AI) and machine learning’ by incorporating streams from ‘delayed discharges, housing, education, police and crime, socio-economic factors, the environment, [and the] private sector’; ⁵¹ and Worcestershire County Council’s project of extending ‘AI and data modelling to include telecare and assistive tech data.’ [⁵⁰]

In the Social Care Programme Evaluation Overarching Report, it is noted that ‘The broader awareness and foundations laid by the programme allowed for easier acceptance of the digitisation in response to the pandemic, and meant that there were established approaches, advice, and information for the sector to learn from.’ ⁵²

In addition, several projects were ‘able to galvanise and speed up their own progress and implementation as a response to the pandemic.’ ⁵³ Supplementary initiatives were executed, including a helpline set up to support the sector in harnessing technology during the crisis, with ‘a team of experts available to help providers access practical advice for technical problems.’ ⁵⁴

NHSX (discussed below) commissioned Digital Social Care and the Institute of Public Care to carry out ‘rapid action research and analysis’ of adult social care provider services, ‘in order to better understand the changing use of technology during the pandemic.’ ⁵⁵ This research recommended that a further review be carried out on ‘how to prepare the adult social care workforce to deliver the digital future.’ [⁵⁵]

Worth special mention is the research carried out under this programme into Physical Assistive Robotic Technology/collaborative robots or ‘exoskeleton cobots’ ⁵⁶ for informal carers ⁵⁷ in Hampshire and the Ilse of Wight.

The Hampshire/Isle of Wight pilot was not the first time robots had been trialled to respond to the ‘persistent and increasing challenges’ in the care sector. ⁵⁸ In 2017 Southend Borough Council invested in a ‘PEPPER’ robot: a ‘humanoid companion robot’ developed by Japanese company Softbank. It was trialled in Southend ‘with dementia sufferers, in Primary schools, at business breakfasts and with children and young people on the Autistic spectrum.’ [⁵⁷]

Another robot of the same model, owned by Middlesex University, gave a ‘speech’ in Parliament in 2018 at a session on the Fourth Industrial Revolution. It relayed that its rollout was part of the ‘Caresses’ programme, jointly funded by the EU and Japanese government, to develop culturally aware robots ‘to relieve pressure in hospitals and care homes’ and promote ‘independent living for the elderly people.’ ⁵⁹

In 2017, Stockport Borough Council participated in two EU Horizon project robotics trials: Project Mario ⁶⁰ — a robot designed to provide companionship and interaction for people living with dementia, and Project Silver ⁶¹ — a robotic walker to help support mobility. The Mario robot trial also involved cohorts of patients from Italy and Galway, Ireland. [⁵⁹]

The ‘cobots’ used in the Isle of Wight and Hampshire were Cyberdyne lumbar support cobots: ⁶² computer-controlled robotic devices worn around the waist and lower back to provide support in lifting, holding, and moving people without assistance. ⁶³

A trial was begun in Hampshire in February 2020, the result of a partnership between the County Council, PA Consulting, and Japanese robotics company Cyberdyne, ⁶⁴ which deployed six leased cobots in residential care settings, then redeployed them into people’s homes ⁶⁵ in response to the ‘COVID-19 crisis’. The trial found that cobots supplanted the need for a second carer for service users who would normally require ‘double up care’, which the authorities saw as advantageous both from a financial point of view as well as for reducing ‘the numbers of different carers required to be in physical contact with their patients. . .during the lockdowns and social distancing requirements.’ [⁵⁶]

A report from the parallel trial in the Isle of Wight highlights the cobots potential to ‘enable a[n unpaid] carer to continue to provide support for a loved one beyond the point when they might otherwise be forced to give up because of their own frailty.’ ⁶⁶

Whilst neither physically assistive co-bots nor the other robot models mentioned above existed within the UK care market by 2021 (they were already being used in some paid care settings in Japan), in March the Hampshire team tendered to source a significantly greater number of prototype cobots, ‘with a view to mainstreaming the deployment over the next few years.’ [⁵⁷]

The Isle of Wight discovery phase report references existing research findings that ‘one of the biggest barriers to utilising robotics in caring scenarios is public perception.’ [⁶⁴] To help overcome this resistance the Hampshire team engaged in a variety of activities like ‘targeted webinars’ with Carers UK, ‘ongoing promotion and debate through articles for relevant publications (such as HomeCare Insight)’, and careful framing of terminology about Cobots, ‘to avoid immediate negative perception linked to robots.’ [⁵⁶]

‘For a greener NHS’ campaign launch: net zero and the digital transformation agenda

Several months prior to the declaration of the first UK lockdown NHS England launched their campaign ‘For a Greener NHS’. ⁶⁷ As part of the campaign a NHS Net Zero Expert Panel was established, tasked with formulating recommendations for the path to a ‘net zero NHS’ by 2040-45. [⁶⁷] The panel chair is Dr Nick Watts of University College London: the medical executive director of ‘Lancet Countdown’, a Wellcome Trust (Gates Foundation) funded international research and lobby organisation for ‘the health threats of climate change.’ ⁶⁸

Additionally, Simon Stevens was enlisted to ‘advise’ the UK Climate Assembly ⁶⁹ and a ‘grassroots campaign’ was initiated to encourage NHS staff and hospitals to reduce their climate impact, supported by the UK Health Alliance on Climate Change, which includes representative bodies covering over 650,000 NHS staff. [⁶⁹]

The report Delivering a Net Zero National Health Service released in Autumn 2020 declared the intention of the NHS leadership to become the world’s first ‘net zero’ health service. ⁷⁰ This goal was enshrined into legislation through the 2022 Health and Care Act, which placed new duties on NHS England, all trusts, and integrated care boards, to contribute towards statutory emissions and environmental targets. [⁷⁰] This cemented and extended its legal obligations — from the 2008 Climate Act and section 5 of the 2021 Environmental Act ⁷¹ — to reduce emissions, adapt to current and future climate risks, and consider health equity and environmental targets in decision making. ⁷²

In the report the COVID-19 response is viewed as offering ‘key learnings’ on approaches to be maintained long-term, due to ‘future carbon reduction benefits’:

The NHS will ensure that a trajectory compatible with a net zero health service is embedded in the digital transformation agenda. . .digitally enabled care models and channels for citizens. . .will significantly reduce travel and journeys to physical healthcare locations, with care closer to home being delivered through remote consultations and monitoring. ⁷³

Future opportunities for net zero identified in the report include digitising the estate and creating smart hospitals; large-scale migration of trust data centres into the hyper-scale cloud; [⁷³] and the new ‘Greener NHS’ national programme, which builds on the work of the former Sustainable Development Unit with a ‘focus on net zero healthcare and the broader sustainability agenda.’ ⁷⁴

It recommends further ‘decarbonising’ the NHS through introducing zero emissions ambulance fleets by 2032; ⁷⁵ and an internal carbon fee to incentivise consideration of carbon impacts of financial transactions between NHS organisations.⁷⁶

I would argue that in evidence here is an ideological flexibility in how the introduction of care models that enable remote surveillance and digital health-data harvesting, in place of face to face medical care, will continue to be packaged to the public to engineer buy-in. The narrative around the necessity of changes for the ‘greater good’ of reducing CO2 footprints, and thereby helping to avert climate catastrophe, appears to be interchangeable with that of ‘staying home to save lives’ through reducing the risk of potentially deadly infection spread, which was inculcated into the public with a large measure of success throughout 2020-2022. ⁷⁷

The COVID-19 health volunteerism surge and the drive to harness it

The declaration of a pandemic emergency saw an ensuing estimated 400,000 UK citizens answer the call for ‘NHS Volunteer Responders’ between 2020-2022. ⁷⁸ This wave of volunteerism was harnessed to provide unpaid social care for those ‘isolating’, medical research subjects, PCR test processors, ⁷⁹ and staff for vaccination centres, with ‘steward volunteers. . .fulfilling 360,000 vaccination site shifts.’ [⁷⁸] Volunteer roles at vaccination centres extended to actual administration of the (in some cases deadly or disabling ⁸⁰) injections, for which as little as one hour of training was provided, in lieu of any requirement for medical qualifications. ⁸¹

This ‘territorial army to combat the spread of Covid-19’ ⁸² went some way to fulfilling The NHS Long Term Plan’s objective of doubling the number of NHS volunteers in the next 3 years, ⁸³ itself derived from Imperial College’s Institute of Global Health Innovation and the WEF’s directives to exploit human capital to reduce healthcare expenditure (see Part 1.1). The Beneficial Changes Network highlighted the ‘golden opportunity to embed coproduction as services restart’ thanks to ‘community assets built (e.g. volunteering and community based support)’ during the pandemic event. ⁸⁴

In January 2022 the NHS Volunteering Taskforce was set up to bring together ‘clinicians, volunteers, voluntary organisations, policy makers and civil servants. . .[to] better understand how to harness and build on the outpouring of help and support that we witnessed during COVID-19.’ [⁷⁸] Recommendation 3.4 focuses on adapting NHS Volunteer Responders to provide a pool of volunteers who can be mobilised in an emergency. [⁷⁸]

COVID-19 as catalyst for smart hospitals trials

In 2019 the Cambridge Centre for Digital Built Britain began a research project with Moorfields Eye Hospital in London to explore transformation of the service into a ‘smart hospital of the future’. ⁸⁵ By the start of 2020, digitisation of services was already well underway through the exploration and implementation of innovations such as AI and machine learning, cloud technologies, virtual platforms, telemedicine and digital twinning. The digital transformation of services during and post the COVID-19 event, including a huge expansion in teleconsultations in place of physical appointments (from 0 to 10,000 in 3 months), ⁸⁶ was then fed into the research study to inform the reconfiguring of care provision to help plan the move to a new physical hospital hub at St Pancras hospital. [⁸⁵]

Professor of Information Systems and Innovation Studies at Cambridge Judge Business School, Michael Barrett, testified that the infrastructure already in place meant that ‘readiness was there to really scale very quickly’, ⁸⁷ and that thanks to the ‘catalyst provided by Covid-19, this research on digital service transformation for the Smart Hospital of the Future could not have been more timely.’ [⁸⁵]

During the pandemic Dr Michael Barrett and Dr Karl Prince led a smart hospital partnership between Moorfields Eye Hospital in London and Sheba Medical Center in Tel Aviv — the largest hospital in Israel and the Middle East — to trial a telemedicine intensive care unit. ⁸⁸

The trial set up ‘clean’ and ‘contaminated’ zones at the Sheba facility — based underground and originally designed as an emergency hospital ‘for times of war’ — with staff supervising patients from inside a glass screened control room, using remote monitoring and digital twinning technologies.

In a case study video Dr Michael Barrett claims, ‘The use of robotics was seen as. . .the most humane of the care-givers because the robot had a screen which showed the person whereas other clinicians had on PPE which obscured [their] faces.’ ⁸⁹ This statement is arguably revealing of one way in which mass mask wearing served the Great Reset agenda: i.e. habituating people to interactions with faceless/less-than-human-appearing ‘others’ in public spaces, in preparation for a robotised service and care industry.

COVID-19 and the fast tracking of health tech innovation collaboration between the UK and Israel: A shot in the arm, the 2030 roadmap for UK-Israel bilateral relations, and the Israel-UK health tech gateway

The 2021 published report jointly authored by UK-Israel Business and the All Party Britain-Israel Parliamentary Group, A shot in the arm: Israel and UK healthtech innovation, recommends that more such partnerships between Israeli and UK hospitals be developed through a ‘Hospital-to-Hospital Clinical Collaboration Platform’ i.e.: ‘An institutionalised network of partnerships between hospitals with parallel clinical research specialisations’ to provide for ‘joint research projects, piloting and publications.’ ⁹⁰

The report was unveiled at a UK-Israel HealthTech Forum event, sponsored by UK-Israel Business. UK-Israel HealthTech Forum members include ‘NHS technology and innovation leaders’, and ‘academic health networks’, with two senior NHS employees sitting on its advisory board. ⁹¹

UK-Israeli hospital-to-hospital collaboration is one of a number of recommendations made in the report to ‘ensure the bilateral relationship in this sector is well-placed to take advantage of opportunities created by the [global health] crisis’; ⁹² These ‘opportunities’ entailed ‘more rapid interest in and assessment of new health technologies, especially in the United Kingdom in areas such as remote diagnostics, patient monitoring and at-home sampling.’ [⁹¹]

Further recommendations for capitalising on these changes in the report include

• The creation of an Israel-UK health tech ‘landing pad’ ⁹³ (i.e. an accelerator programme which provides financial, guidance and immigration support for ‘top Israeli health tech companies’) and a ‘start-up VISA’ ⁹⁴ or entitlement to a visa without work restrictions for eligible Israeli entrepreneurs.
• Formalisation of frameworks for research collaborations including through The National Institute for Health Research (NIHR) and between The Engineering and Physical Sciences Research Council (EPSRC) and the Israeli Innovation Authority (IIA); ⁹⁵ and
• Big data sharing and opening up of health datasets to health tech researchers in both countries. [⁹³]

The Israeli health system is held up in the report as a model for the UK for having operationalised Electronic Health Records since 2014 ⁹⁶ to build a ‘national data exchange programme for sharing clinical patient data and linking hospitals and health maintenance organizations for caregiving purposes.’ ⁹⁷ Additionally, its culture of hospitals as ‘innovation laboratories’ ⁹⁸ is seen as meriting emulation:

For HMOs like Clalit, the incentivisation structure rewards clinicians who save the system money by conducting virtual consultations or through remote diagnostics, as well as by proscribing treatments that keep patients out of the system. . .UK health system cultures need to change and. . .exposure to Israelis may help to inculcate a change in perception and practices. [⁹⁸]

Significantly the report clearly links ‘advances’ in the Israeli healthtech sector and ‘smarter treatments for health challenges’ ⁹⁹ to the key growth sector of ‘Emerging frontiers of Bio-convergence’: [⁹⁷] i.e. ‘advanced engineered drug delivery and diagnostics, tissue engineering, bioelectronics and synthetic biology.’ ¹⁰⁰

The Israel Innovation Authority provides further specifics — listing the following as key emerging bio-convergence fields with the collective potential to become Israel’s biggest tech growth sector:

• Nanorobotics for targeted drug delivery to cells;
• New means of drug testing through ‘micro-physiological systems’, for example: ‘organ-on-a-chip technology’;
• Regenerative medicine such as ‘3D Tissues Bio Printing technologies’ and ‘“smart” hybrid implants’, i.e. ‘cyborg tissue’;
• Biological sensing using antibodies, enzymes and nucleic acids, and bacteria to discover and identify specific materials;
• Optogenetics: i.e. the activation of specific neurons in the brain using light;
• “Living” materials for uses such as medical devices that possess the characteristics of biological systems i.e.: replication, self-healing and regulation, response to surroundings, and self-sustainability; and
• Bioelectronics: the use of nano-electronics to monitor or regulate biological systems, with medical applications like implantable pulse generators to treat a wide range conditions. ¹⁰¹

The intersection between healthcare, healthtech and biodigital convergence happening on a worldwide scale will be explored in more depth in Part 2 of this series.

A shot in the arm: Israel & UK healthtech innovation states that the Israeli Innovation Authority’s ‘promotion of global collaborations via bilateral programs’ in this sector is likely to be ‘critical’ for the UK. [⁹⁸]

Deepening the partnership across the UK and Israeli healthcare sectors as a response to COVID-19 is a similarly prominent theme in the 2030 roadmap for UK-Israel bilateral relations, released in March 2023. The roadmap allocates a key role for Israel in‘strategising improved preparedness and competency in the [UK] healthcare system pertaining to pandemic responses in the future.’ ¹⁰²

Additionally, it promises — through the UK Israel health-tech gateway, amongst other programmes — to explore ‘tailor made Israeli technological solutions to current challenges’, including AI in healthcare, engineering biology, bio-tech and life sciences. This gateway builds on the work of the UK-Israel Tech Hub, which since its inception in 2011, by 2023 had facilitated over 250 partnerships worth £1.2 billion to the UK economy. [⁹¹]

Through the ‘leadership’ of the UK Israel Tech Hub, ¹⁰³ in 2018 the Northern Health Sciences Alliance (See Part 1.2 for information on the Northern Health Science Alliances’s Connected Health Cities project) had signed an memorandum of understanding with Israel to ‘increase collaboration between the two countries by offering support to Israeli healthcare companies to establish a research presence’ in the North of England. ¹⁰⁴ The Northern Health Science Alliance (NHSA) went on in 2022 to launch the ‘Pan-Northern health-tech gateway.’ [¹⁰⁰] One of the programmes initiated by this new phase in partnership was the ‘International Health-Tech Partnership programme’: a £6 million IIA funded scheme to set up Israeli companies at leading NHS trusts to develop and run health technology pilots. [¹⁰³]

The Taliaz and Rotherham, Doncaster and South Humber NHS Trust pilot ¹⁰⁵ was the first of these to launch following, ‘a delegation from the Northern Health Science Alliance (NHSA) to BioMed Israel’, earlier in 2022. ¹⁰⁶ The (AI) software mental health prescribing platform uses genetic information from the patient obtained from a saliva sample to proscribe pharmaceuticals, based on predictive algorithims constructed from genetic and clinical data from patients around the world. ¹⁰⁷

Taliaz features in a Forbes article, ‘Why Greater Access To Global Data is Vital to the Fight Against COVID-19 and Future Pandemics’, which describes COVID-19 as a,‘“once-in-a-plaguetime”’ opportunity for Israeli entrepreneurs to fast track entry of novel technologies into the market.’ ¹⁰⁸

Parenthetically, the COVID-19 event was also a great market ‘opportunity’ for healthtech innovations focused on mental health solutions, as per the NHSA’s Parallel Pandemic report, which details the mass mental health decline precipitated by

The fear generated. . .social isolation from lockdowns and school closures, fear over future employment and income (especially for those on furlough or unemployed), comorbidity with COVID-19 illness, lack of access to support services (especially for those with a pre-existing condition), lack of control and fears for the future. ¹⁰⁹

The ‘economic hit’ is also specifically mentioned in the report as a factor negatively impacting on people’s mental health in the North. [¹⁰⁹]

It is well documented that many of Israel’s tech startups have clear links to Israeli intelligence operations, in particular through the prevalence of company founders who are alumni of Israel’s cyber-intelligence Unit 8200. [¹⁰²] A shot in the arm confirms the connections where it reveals

Israel’s heath technology sector is fast becoming a destination sector for the country’s top technology talent, such as graduates of the Israeli Defence Force’s famed 8200 technology unit. Last December, the organization of 8200 graduates opened its own course, 8200bio. It is aimed at promoting the connection between life sciences and medicine and computer science. Similarly, 8400, a Public benefit company launched in 2017 created by Spearhealth, which is a programme supporting alumni of army intelligence units to form healthtech communities. ¹¹⁰

Unit 8200 personnel have previously attracted controversy for ‘acting as proxy agents for Israeli intelligence’, whilst involved in commercial contracts in the private market. ¹¹¹ Corporate Watch’s investigation found that at least one initiative between the Hub and the NHS disclosed its aim to push back on Boycott, Divestment, Sanctions activism in the UK — in line with the UK-Israel roadmap for bilateral relations, which states that the UK is committed to ending any BDS campaigns by public bodies, ‘including through legislation’. [¹⁰⁰]

The role of NHSX

Matthew Gould was the founder of the (above mentioned) UK-Israel Tech Hub, which had a ‘substantive impact’ ¹¹² on the acceleration of UK-Israel tech collaboration, during his time as the ambassador of the UK to Israel from 2010-2015. ¹¹³ Following a number of roles at the heart of government, ¹¹⁴ in 2019 he was appointed CEO of the newly formed NHSX — established to lead ‘the largest digital health and social care transformation in the world.’ ¹¹⁵ His appointment — initially cited as temporary — attracted criticism as Gould was confirmed in the role without advertisement or an interview process, and had no previous experience in health and social care. ¹¹⁶

Gould’s ambassadorship had also proved contentious when Craig Murray — on the basis of disclosures made to him by a whistleblowing senior civil servant in the Cabinet Office — in 2011 accused avowed Zionist Gould ¹¹⁷ of deep state maneuvers to conspire with other rogue actors including members of MOSSAD for ‘diplomatic preparation for an attack on Iran’. ¹¹⁸ Yet more disrepute tailed Gould at his latest position as CEO of the London zoo, when it was recently reported that he resigned from the role after an investigation was launched over ‘unacceptable workplace behaviour’ [¹⁰²] (of an undisclosed nature).

A blog by Gould announcing NHSX’s merger with NHS England and NHS Improvement from November 2021 listed the achievements of NHSX during its three years of operation. This included setting up 44 ‘virtual wards’ since the first months of the pandemic; getting 200,000 people with long-term conditions into remote medical monitoring programmes; and rolling out the ‘Covid Pass’ through the NHS app. ¹¹⁹

The blog is celebratory of the fact that by Feb 2022 the NHS app had 24 million users compared to 2 million pre-COVID-19 event, thanks to uptake of the digital Covid Pass. Increasing the number of NHS app users was a primary goal of the organisation: shortlisted as one of their ten ‘priority areas’ in July 2019. ¹²⁰

NHSX also created a ‘Care Workforce App’ which provided care workers with access to information on COVID-19, learning resources, and discounts. The app attracted criticism from GMB Union who flagged the fact that it allowed employers to access workers’ smartphone webcam and their private messages. ¹²¹

Similar criticisms were levelled at NHSX over a partnership with Amazon forged in 2019 to provide health advice using Amazon Alexa devices, as, ‘The deal afforded Amazon free access to copyrightable content and data, information that could be used to develop “new products, applications, cloud-based services and/or distributed software” (Walker, 2019).’ [¹⁰⁸]

Another initiative coordinated by NHSX during the COVID-19 pandemic, which launched in June 2023, was the OpenSAFELY COVID-19 service — a software platform which allowed ‘users approved by or on behalf of NHS England’ to run queries on pseudonymised electronic health record data of millions of NHS patients, ‘for certain COVID-19 purposes’. ¹²² The unresolved privacy risks attached to the practice of pseudonymisation of data are well documented. ¹²³

OpenSAFELY was built by a collaboration of academic initiatives including the University of Oxford’s Bennett Institute for Applied Data Science. ¹²⁴ GP patient records have been described by Professor Ben Goldacre — responsible for the Goldacre Review into using health data for research and analysis — as, ‘the jewel in the crown of NHS data.’ ¹²⁵

Two years later, in June 2025, OpenSAFELY expanded into the ‘OpenSAFELY Data Analytics Service’ pilot, ¹²⁶ which broadened the scope to more general purposes including ‘health surveillance, research, service evaluation, and health and social care policy, planning and commissioning.’ ¹²⁷

The Track and Trace Programme

In his NHSX directorship role, Gould began collaborative work on the development of a ‘track and trace’ smartphone app for COVID-19 infection control several weeks before lockdowns, testifying to attending the first meeting on the subject on 7 March. ¹²⁸ Many questioned why the app required a centralised database architecture ¹²⁹ when there were alternative ‘exposure notification’ models, which did not incorporate this feature. ¹³⁰ A leaked government memo discussed the option ‘to enable de-anonymisation if ministers judge that to be proportionate at some stage’. ¹³¹

The app never moved beyond the pilot stage of rollout, before being scrapped. ¹³² The Serco managed manual tracing programme received similarly negative press coverage to the app, ¹³³ with damning testimonies from employees of having virtually no work to do over weeks or months. ¹³⁴ Mainstream narratives portrayed both schemes as financially wasteful ‘shambles’. ¹³⁵

Whilst it is true that NHSX spent hundreds of millions on over-paid consultants — at an average of £1100 per person per day, as confirmed in a House of Commons Committee report ¹³⁶ (these figures are from across all of NHSX’s programmes) — the NHS Test and Trace app, along with the manual tracing programme’s strikingly poor performance arguably indicate that these functions were incidental to other underlying or covert aims of the £13.5 billion Test and Trace programme.

Such goals likely include contributing to the building of ‘a parallel system [information database] with the help of Faculty and Palantir’, ¹³⁷ from amassing data from app users, which Gould confirmed would be permanently stored on the centralised database. ¹³⁸ He also revealed that additional data including the ‘social graph’ of an app user, i.e. a map of the individuals the person has physically met over a period of time was ‘aimed for by NHSX.’ ¹³⁹

The programme was also successful in distributing high numbers of lateral flow tests: 691 million, 96 million of which were ‘registered’ online, providing another huge data bank. [¹²³] Evidence for the swab test’s possible role — like that of COVID-19 vaccines — in progressing the Internet of Bio-Nano Things will be explored in Part 2 of this series.

The embedding of Palantir into the NHS during the ‘state of emergency’

In 2020 NHSX and NHS England Improvement established the NHS COVID-19 data store, in line with NHSX’s (pre-COVID-19) mandate to build a ‘data ecoystem’. ¹⁴⁰ The store utilised Palantir’s Foundry platform and implemented COPI notices to harvest the necessary data. [³⁶] Through the platform Palantir built ‘analytical dashboards for access by NHS England staff, together with staff in the following organisations working under contract: Faculty AI, McKinsey and Deloittes.’ [³⁶]

A similar system led by Palantir, ‘HHS Protect Now platform’, ¹⁴¹ was launched in the U.S around the same time.

The platform’s tools included a ‘Strategic Decision Makers Dashboard’ to aid senior national figures in making ‘strategic policy decisions’, and an ‘NHS Operational Dashboard’ for local and regional NHS leaders, and local government officials. [³⁵] NHS teams were given ‘access to predictive technology to help them save lives by forecasting COVID-19 hospitalisations.’ [³⁵]

Palantir was awarded the Foundry platform contract the day after a Downing Street meeting was convened by Dominic Cummings to bring together technology and business CEOs to ‘share skills and talent with the government in order to tackle the coronavirus pandemic’, at which Matthew Gould, a Palantir representative, and then-NHS Chief Executive Simon Stevens were all present. ¹⁴² The meeting attendee who leaked news of it to the press ascribed to Gould the leadership role in ‘coordinating technology responses across the whole system’. [¹²⁹]

Gould — who had been meeting with Palantir management since at least 2019 ¹⁴³ — stated on record that the 2020 Foundry pilot contract was awarded on the basis of his recommendation to the government to use emergency powers to enable Palantir’s access to the data. ¹⁴⁴

This initial three month contract translated into multiple extensions. The longest (at seven years) ¹⁴⁵ and most lucrative of which was for the £330 million ¹⁴⁶ Federated Data Platform awarded in November 2023 — projected to be the world’s largest centralised healthcare data platform when completed. ¹⁴⁷ In 2025 Palantir contracted to build a ‘real-time data-sharing network. . .that will incorporate data about citizens’ political opinions, philosophical beliefs, health records [my emphasis] and other sensitive personal information’ for police forces in the East of England, ahead of a potential national rollout. ¹⁴⁸

Another contract overseen by NHSX was that of the development, by Faculty, of an NHS AI lab which has since carried out 80 separate AI projects. ¹⁴⁹ The government refused to respond to Freedom of Information requests about both the Faculty and Palantir contracts, and other ‘data deals’ with Microsoft, Google and Amazon ‘struck at the height of the COVID-19 crisis’, ¹⁵⁰ until threatened with legal action by campaigners Open Democracy and Foxglove. ¹⁵¹ The documents’ release revealed that the contracts originally granted intellectual property rights (including for the creation of databases) to the companies, and allowed them to ‘train their models and profit off the unprecedented data access.’ [¹³⁸]

Palantir has faced significant opposition for its NHS contracts, including from a ‘No Palantir in the NHS’ campaign, ¹⁵² due to their reputation for human rights abuses, particularly their provision of AI models and data analysis to the Israeli occupation. ¹⁵³ The adoption of the Federated Data Platform by Foundation Trusts was initially proposed as voluntary, until NHS England announced it would be mandatory in August 2024: a highly unusual move with ‘unclear legal basis’, according to critics. [¹⁵¹] However, only a minority of Trusts were ‘actively using the platform and its products’ by August 2025. ¹⁵⁴

Palantir also has direct links to emerging social impact markets. The company was the evaluator (on a pro-bono basis) of one the earliest pay for success (social impact bond) contracts in the U.S: the 2015 launched ‘Welcome Home’ program, which offered ‘evidence-based’ housing services for a cohort of ‘chronically homeless’. ¹⁵⁵

Liverpool’s CIPHA (Combined Intelligence for Population Health Action) and the COVID-SMART Community Testing Pilot

Liverpool’s CIPHA (Combined Intelligence for Population Health Action) and the COVID-SMART Community Testing Pilot

Another programme set up by NHSX, ¹⁵⁶ in partnership with Cheshire and Mersey Integrated Care Systems (ICSs), was the Combined Intelligence Population Health Analytics System (CIPHA).

CIPHA — a data and analytics platform ‘supporting ICSs with access to data sets and with the development of technical capabilities required for mature population analytics’ — was developed out of the pre-pandemic established ‘world’s first Civic Data Cooperative’, ¹⁵⁷ created by Iain Buchan, Associate Pro Vice Chancellor for Innovation at the University of Liverpool. [¹⁴⁶] The Civic Data Cooperative iterated into CIPHA, launched in April 2020 with the goal of supplying, ‘a real-time analytics platform to manage the crisis and drive a strong recovery.’ ¹⁵⁸

The programme went live across 40 organisations and 359 GP practices over 3 months, ‘providing dashboards covering three broad areas: capacity and demand; epidemiology; and population stratification.’ [¹⁵⁷] The scope of the project has since grown to 17 million patients. [¹⁵⁷]

CIPHA utilises Graphnet Health’s ‘Shared Care Record’ software, which integrates personal care records of patients comprising consolidated data from ‘GPs, hospitals, mental health, community, and social care’, with Population Health Management Software; and offers options for building patient registers according to ‘tailored care plans’ for ‘long-term conditions, frailty, or end-of-life preferences.’ ¹⁵⁹ Graphnet Health’s website boasts that their health tech solutions ‘address all aspects of the government’s transformation agenda as outlined in The NHS Long Term Plan.’ ¹⁶⁰

CIPHA’s set up enabled the data collection of Liverpool COVID SMART (‘Systematic, Meaningful, Asymptomatic and Agile, Repeated Testing’ ¹⁶¹) pilot: ‘the world’s first COVID-19 voluntary mass testing for people without symptoms of Covid-19.’ ¹⁶²

Through a number of delivery partners — namely, Liverpool City Council; NHS Test and Trace (DHSC); the 8th Engineer Brigade; NHS Liverpool Clinical Commissioning Group; Merseycare NHS Trust; Cheshire and Merseyside Health and Care Partnership; Merseyside Local Resilience Forum and Liverpool Charity and Voluntary Services (LCVS) — the testing pilot ambitiously aimed to ‘engage the city’s whole population’ through an estimated 48 test sites, ¹⁶³ including some at schools. Approximately a quarter of the population volunteered to get tested in its first month of operation (November 2020). ¹⁶⁴ The pilot got off the ground whilst Liverpool was enduring Tier 3 lockdown restrictions – the highest level.

The pilot’s official objectives were to generate understanding of

• how offering large-scale testing would be received by the local community;
• how lateral flow [LF] testing would perform in large-scale asymptomatic testing; and
• whether large-scale testing would help to contain the pandemic, reduce adverse health outcomes such as hospital admissions, and support social and economic functions. ¹⁶⁵

The Liverpool Covid-SMART Community Testing Pilot: Evaluation Report mentions Liverpool resident’s suspicions around government use of collected DNA fuelling testing hesitancy. ¹⁶⁶ Given that CIPHA’s precursor project ‘Connected Health Cities’, also led by Buchan, [¹⁴⁵] admits to collecting and recording genomic data of participants including samples for the UK Biobank ¹⁶⁷ (See Part 1.2), such misgivings seem reasonable. What’s more through the CIPHA platform, PCR and LF test results were linked to each individual via a unique identifier (bar code) ¹⁶⁸ and connected to digital records of their ‘GP and partial hospital and social care records.’ Buchan’s work on data linkage across health and social care systems, through the Health Security Agency and under the guise of ‘pandemic preparedness’, is discussed further below (see section: The wellbeing economy and the creation of the Health Security Agency and the Office for Health Promotion).

Dashboards that pilot teams used to ‘coordinate actions’ provided socio-demographic data about testing uptake. ¹⁶⁹ An online video presentation from the Cheshire and Merseyside Health and Care Partnership reveals that data on lateral flow testing rates by ward was used to determine relocation of testing sites for maximum uptake. ¹⁷⁰

CIPHA also delivered ‘risk-mitigated experimental reopening of mass cultural events’, [¹⁴⁶] as part of the Government’s Events Research Programme ¹⁷¹ to deliver interventions at indoor and outdoor venues, along with a number of other partnerships of Councils and event organisations across the country. The events in which CIPHA was involved deployed a ‘test to ticket system which was used to invalidate the tickets of attendees with a positive or voided LFT result.’ [¹⁵⁶] Their ticket system employed ‘live linkage of NHS-wide and study results to tickets, with consent.’ ¹⁷²

CIPHA has since been expanded nationally; the 2021 white paper Data saves lives: reshaping health and social care with data references CIPHA as, ‘an NHS England programme that is core to COVID-19 recovery and the building of data-led integrated care systems.’ [My emphasis.] [³⁵]

The 100 Days Mission (2021) and the WHO Pandemic Treaty

In June 2021 the government released a report co-authored by Melinda Gates and Patrick Vallance called The 100 Days Mission to respond to future pandemic threats: Reducing the impact of future pandemics by making diagnostics, therapeutics and Vaccines available within 100 days. The document sets out a World Health Organisation led agenda to establish the following:

• The compression of vaccine development timelines to 100 days;
• Protection of the financial viability of vaccine production ‘between pandemics’ (i.e. mass adult vaccination for common diseases to ‘keep warm’ manufacturing); ¹⁷³
• Interoperable data sharing, citizen surveillance and biological data collection (‘We recommend. . .a system that enables biological samples to be collected and shared immediately and unhindered in a pandemic’) ¹⁷⁴ and;
• The deregulation of safety standards for medical products (‘Inefficient and overly complex regulatory systems and processes slowed the activation and overburdened the conduct of clinical trials. More simplified and proportionate approaches are needed’) ¹⁷⁵ and full capture and control over state medical regulatory agencies, internationally. ¹⁷⁶

The report stresses a need to be ready for the next pandemic by 2026. ¹⁷⁷ It urges as part of the anticipated WHO Treaty on Pandemic Preparedness¹⁷⁸ that, ‘[The] WHO should work with governments, other international organisations and industry to set rules of the road for pandemics, including for supply chains, indemnification and data sharing.’ ¹⁷⁹

Further, it states

A concrete plan must be developed to address the challenges in health data sharing, highlighted by the COVID-19 pandemic. The first step will be to develop and implement a roadmap with data and analytics as its bedrock. Safeguarding the readiness of ongoing global health data systems will ensure a more effective timely response during future health crises. ¹⁸⁰

It endorses ‘normalising public health as part of global governance’, including through a Global Health Board to be set up under the auspices of the G20 which would incorporate the One Health Organisation, The Global Fund, the Gates Foundation offshoots GAVI and CEPI, as well as the International Monetary Fund and the World Bank. ¹⁸¹

There is a strong emphasis on retaining population wide testing:

[T]he legacy of COVID-19 should be to mainstream the use of testing across populations for surveillance, diagnosis and treatment. The new familiarity with self-use diagnostics may also herald a new era in the management of winter respiratory pathogens. ¹⁸²

The authors expand on the specifics of their biosecurity mandate later in the report:

We can embed new digital technology and data management in diagnostics by linking serial numbers to a digital system. . .[so that] results can be linked to surveillance systems, clinical care and public health responses for control, tracing and isolation. . .¹⁸³ Smart data capture and flexible trial management information systems that integrate diverse health datasets should be the norm to support trial set-up and patient enrolment and ensure that information is transparent and easily accessible for subsequent decision-making and licensing. ¹⁸⁴

The degree of alignment between the work of CIPHA and the above stated goals of CEPI/Gates and WHO is apparent, and perhaps unsurprising given Buchan’s previous role as advisor for the Wellcome Trust.

Less than a year after the report’s publication, the UK government held a Global Pandemic Preparedness Summit in London where they pledged $160 million to the Coalition for Epidemic Preparedness Innovations to help kick-start the 100 days mission. ¹⁸⁵

In May 2025, the World Health Assembly — the World Health Organisation’s main decision making body — adopted the Pandemic Treaty proposals discussed in the report, ‘follow[ing] three years of intensive negotiation’, and with 124 in favour and 11 abstentions by member states. ¹⁸⁶

The Wellbeing Economy and the creation of the Health Security Agency and the Office for Health Promotion

The UK Health Security Agency (HSA) was established in April 2021, consolidating Public Health England’s infectious disease control responsibilities, NHS Test and Trace, and the Joint Biosecurity Centre into a single body which brings together ‘the UK’s cutting-edge capabilities in analytics and genomic surveillance with our growing test and trace capability. . .[to] form a permanent part of our national defences.’ [My emphasis.] ¹⁸⁷

At a Royal Society of Medicine Lecture several months after the HSA’s establishment, Dr Jenny Haries, then director of the Health Security Agency as well as of the Medicine and Healthcare Products Regulatory Agency (MHRA) stated that the Health Security Agency now had, ‘the same national infrastructure and importance as things like GCHQ.’ ¹⁸⁸ At a HSA ‘expert panel’ session in 2024 working directly with security services was on the agenda. The slideshow summary states that collaborative work via the Defense Science and Technology Laboratory will be undertaken to prepare ‘countermeasures to cyber-terror/misinformation impeding risk-mitigations’, and ‘large-scale counter-measures against systematic misinformation’, which they view as fuelling testing and vaccine hesitancy. ¹⁸⁹

The summary of the discussion — which was led by Iain Buchan — outlines a plan to ‘Prepare now for future pandemics by data linkage.’ This is to involve rehearsal of ‘best practice data/information/AI governance across agencies for health protection’, including an ‘information governance plan’ for pandemics, which it states, is ‘likely applicable in “peacetime” to improving public health services.’ ¹⁹⁰ The access by the HSA to ‘NHS person [i.e. individual patient] level data’ is to be improved, along with potential leveraging of ‘non-traditional datasets. . .e.g. mobility, consumer, veterinary, social media’. Maximising public involvement and earning the public’s trust for such data sharing through, ‘for example the civic data coop model’ is mentioned, as well as the development of protocols for ‘data linkage’ to digital certification for ‘pandemic test-to-access e.g. test result to event/travel ticket activation.’

The work of the HSA is part of the cross-sectoral vision for public health set out in the March 2021 policy paper Transforming the public health system: reforming the public health system for the challenges of our times which states, ‘Health will no longer only be the business of the DHSC, but a core priority for the whole of government.’ ¹⁹¹

The paper announces a new cross-government ministerial board on prevention ‘to drive forward and co-ordinate government action on the wider determinants of health’, in addition to a new Office for Health Promotion (within the Department of Health and Social Care). It explains, ‘Transforming public health requires very different ways of working across government, with joined-up action and investment from many departments and partners.’

Changing citizen behaviour through the use of behavioural science is a key focus throughout. The paper discloses, ‘We are using this approach to develop a new way of supporting people to make healthier food choices and engage in more exercise by testing the role incentives and rewards can play in encouraging these behaviours.’ This will involves public-private partnership led ‘cutting edge’ incentivisation programmes, which focus on priority prevention areas such as obesity and smoking.

An earlier (2019) consultation document introduced a proposed ‘new health index to help us track the health of the nation’ linked up to, ‘data held by the NHS, and generated by smart devices worn by individuals,’ which will usher in a new wave of ‘intelligent public health where everyone has access to their health information and many more health interventions are personalised.’ ¹⁹²

Scotland’s National Strategy for Economic Transformation (March 2022) ¹⁹³ reveals that Scotland is leading England on introducing a new health index – the ‘Wellbeing Economy Monitor’ – as a member and secretariat ¹⁹⁴ of the ‘Wellbeing Economy Governments network’ (WEGo) with New Zealand, Iceland, Finland, Wales and Canada as fellow members.

The WeGo network is ‘the world’s only living laboratory of governments implementing wellbeing economic policies at scale.’ [¹⁹⁴] It represents one strand of the ‘Wellbeing Economy Alliance’ (WEAll) — established in 2018 with the lion’s share of funding from the Rockefeller Brothers Fund and Partners for a New Economy — the latter in turn financed by Rockefeller Foundation and Omidyar Network, who are responsible for setting up the metrics for ¹⁹⁵ and/or catalyzing the emerging impact economy. ¹⁹⁶ Scotland’s National strategy clarifies that the outcomes set for Scotland’s future wellbeing will align with the United Nations Sustainable Development Goals and explicitly promises to ‘promote the stakeholder capitalism model with business leaders’. Part 2 of this series will delve into the aims and activities of WEGo and WEAll in more detail. [¹⁹³]

A report by Partners for a New Economy published this year positions their number one ‘principle of the new economy’ as a ‘purpose shift’ to ‘reject GDP growth as the primary goal, and replace it with wellbeing within ecological limits.’ ¹⁹⁷ They explicitly frame COVID-19 as a ‘key turning point’ for instituting such change, stating, ‘New economy organisations have historically surged in response to crises — from the 1970s environmental movement to the 2008 crash and later Covid-19.’ ¹⁹⁸ They predict future windows of opportunity through further ‘inevitable’ ‘ruptures’: ‘from AI-driven unemployment to converging climate, financial, and geopolitical crises that are already testing the limits of our institutions.’ ¹⁹⁹

Laying the framework for the SMART data economy: the Health and Care Act 2022 and the Data (Use and Access) Act

The Health and Care Act 2022, passed in March of that year, legislated for a number of important reforms — some of which were already illicitly in implementation. In Stevens’ words from the House of Commons Public Accounts Committee in 2017, this legislative footing represented ‘a welcome recognition of where the health service will have moved to in the meantime.’ ²⁰⁰ 

Public Matters have claimed Stevens was made a Lord in 2021 when the bill was being debated in order to stymie the kind of staunch opposition put up by the House of Lords to the 2022 Act’s 2012 predecessor. ²⁰¹

One such key reform was the end of GP run Clinical Commissioning Groups (CCGs) and their replacement by 42 Integrated Care Boards (ICBs). The Act awarded ICBs — which include private representatives — statutory powers to authorise legislation, in addition to control over local authority estates and capital assets, ²⁰² and provision and spending for all patients (with profit to be made from savings and/or awarding themselves contracts for services provided) within their regional jurisdiction. ²⁰³ Unlike with CCG’s, the public are no longer permitted to attend and pose questions at ICB meetings. ²⁰⁴ ICGs also cover larger areas, distancing the public further from decision making around their care. ²⁰⁵ According to NHS Confederation, ICS’s ‘becoming formalised’ in July 2022 was part of harness[ing] the way ‘many health and care organisations worked together. . .to deliver care in the face of a public crisis.’ ²⁰⁶

The Act also removed Section 75 of the Health and Social Care Act 2012, which subjects private contractors to the Competition and Markets Authority: effectively deregulating the sector to allow private companies to be awarded multi-billion contracts behind closed doors without competition. ²⁰⁷ This move potentially enables, on a permanent basis, the kind of cronyism (or chumocracy) ²⁰⁸ that occurred during the pandemic event with PPE and Test and Trace contracts. ²⁰⁹

Keep Our NHS Public raised concerns over the sweeping powers the Health and Social Care Act accorded to NHS Digital to share data in connection with health or adult social care, as well as giving executive powers to the Secretary of State ‘to require data’ from any NHS or social care, or private organisation involved in health care. ²¹⁰

The Data Protection and Digital Information Bill was introduced in July 2022, shortly after the Health and Care Act was passed. It failed to make it through the previous Parliament ahead of the July general election but was superceded by the Data (Use and Access) Act passed in the summer of 2025 which retained many of the same ‘grave threats to privacy and data protection rights in the UK.’ ²¹¹

The Data Act’s reforms overall lowered ‘the standard of privacy protections granted by the current UK data protection framework’; ²¹² this framework comprising the UK General Data Protection Regulations, the Data Protection Act 2018, and the Privacy and Electronic Communications (EC Directive) Regulations 2003. [²¹⁰]

One such critical weakening was Clause 70 which altered the definition of ‘legitimate interests’ under which personal data can be processed (by the data controller or third party) to allow for ‘agile’ enablement of additional purposes, ²¹³ as decided by the Secretary of State who gained executive power (through Henry VII powers) to make this determination. ²¹⁴ Examples of qualifying ‘Recognised Legitimate Interests’ listed in the Act include national security, public security and defence, emergencies, and crime. ²¹⁵ This undoubtedly includes future pandemic emergencies.

Campaign group Open Rights noted that ‘The government has generally argued that these powers would allow ministers to update the law and to adapt it to technological progress [my emphasis].’ ²¹⁶ Legal firm Lewis Silkin’s (favourable) analysis of the Act specifically mention technological advances in the ‘biometric and neural tech sectors’ as reason for including these powers.²¹⁷

Rights groups criticised the Act’s extensive use of Henry VII powers, (i.e. delegated legislative powers that allow the government to override or amend primary legislation as it was enacted by Parliament) throughout the (then) Bill. [²¹³] ²¹⁸ Similar such concerns were raised by Keep Our NHS Public regarding the Henry VII powers in the Health and Social Care Act 2022. Both Acts follow a trend of an exponential growth in the use of ‘democracy weakening’ Henry VII powers which ‘marginalise the traditional law making and scrutinising power of the legislature.’ ²¹⁹

Other symptoms of the transition into stakeholder capitalism apparent in the Data Act were the removal of the general inhibition on subjecting citizens to solely automated decision making, and the introduction of frameworks for digital identity verification services (which did not include provision for the right to use non-digital ID alternatives where reasonably practicable) and for smart data schemes: i.e. ‘the rules, standards and agreements that governs data sharing between customers, third parties and data holders.’ ²²⁰

Open banking is ‘the only active example’ ²²¹ of a smart data scheme thus far in the UK, however the government is in the process of targeting financial services, energy, telecoms, transport, retail loyalty programmes, and homebuying services ²²² to actualise their vision for a ‘world-leading Smart Data economy’. [²²¹]

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2 British Medical Association. ‘COVID-19: Impact of the pandemic on healthcare delivery.’ 18 September 2024. [Online]: https://www.bma.org.uk/advice-and-support/covid-19/what-the-bma-is-doing/covid-19-impact-of-the-pandemic-on-healthcare-delivery (https://archive.is/O1FAj)

1 Prime Minister’s Office. ‘Speech; PM Address to the Nation on Coronavirus: 23 March.’ Gov.uk.; 23 March 2020. [Online]: https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-23-march-2020 (https://archive.is/VnrbU)

3 The Department of Health and Social Care. Build back better: Our plan for health and social care. 7 September 2021. [Online]: https://www.gov.uk/government/publications/build-back-better-our-plan-for-health-and-social-care/build-back-better-our-plan-for-health-and-social-care (https://archive.is/Vl9Ri)

4 Robens, S., Scarbrough, H., Sibley, A., Tuvey, S., Ziemann, A. ‘Academic health science networks’ experiences with rapid implementation practice during the COVID-19 pandemic in England.’ Front Health Serv. August 2022. [Online]: https://pubmed.ncbi.nlm.nih.gov/36925804/ (https://archive.is/Su8qt)

5 Policy Horizons Canada. Biodigital today and tomorrow. 31 May 2022. [Online]: https://horizons.service.canada.ca/en/2022/05/31/biodigital-today-and-tomorrow/ (https://archive.is/wsl9o)

6 Crampin, H., Woods, T., Collider Health, UKRI. The future of impact investment in healthy aging: Report of key findings and recommendations from a study commissioned by UKRI. November 2011. [Online]: https://www.ukri.org/wp-content/uploads/2020/11/UKRI-131120-SocialInvestmentReport-V2.pdf

7 MedConfidential. ‘10 Year Plan: Say Goodbye to your Data (and Say Goodbye to your GP).’2 July 2025. [Online]:

https://medconfidential.org/2025/goodbye-to-data-and-gp/ (https://archive.is/c1SGc)

8 NHS Confederation. NHS Reset: A new direction for health and care. September 2020. [Online]: https://www.nhsconfed.org/system/files/media/NHS-Reset-a-new-direction-for-health-and-care_4.pdf

9 The Health Foundation. ‘NHS Reset: Best Practice and Innovation.’ [Online]: https://www.health.org.uk/funding-and-partnerships/our-partnerships/nhs-reset-best-practice-and-innovation (https://archive.is/zjrhf)

10 World Economic Forum. ‘Our Partners.’ [Online]: https://www.weforum.org/partners/#N (https://web.archive.org/web/20251113072207/https://www.weforum.org/partners/#N)

11 Novartis Foundation. ‘Global AI Network Aiming to improve Urban Heart Health Equity Launches in New York City.’ 19 September 2022. [Online]: https://www.novartisfoundation.org/news/media-release/global-ai-network-aiming-improve-urban-heart-health-equity-launches-new-york-city (https://archive.is/x2Z3D)

12 Monroe, J. ‘Better Hearts Better Cities.’ CDC Foundation. 14 December 2017. [Online]: https://www.cdcfoundation.org/blog/better-hearts-better-cities (https://archive.is/8x9rU)

13 Novartis. ‘Novartis in the UK.’ [Online]: https://www.novartis.com/uk-en/about/novartis-uk

14 NHS Confederation. NHS Reset: A new direction for health and care. September 2020. [Online]: https://www.nhsconfed.org/system/files/media/NHS-Reset-a-new-direction-for-health-and-care_4.pdf p. 8

15 Ibid., p. 28

16 Ibid., p. 14

17 Ibid., p. 4

18 Ibid., p. 6

19 NHS England. Delivering a ‘Net Zero’ National Health Service. July 2022. [Online]: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf p. 41

20 The Academic Health and Science Network. Reflecting on the COVID-19 pandemic to inform the health and care system of the future: the AHSN Network experience. June 2021. [Online]: https://thehealthinnovationnetwork.co.uk/wp-content/uploads/2021/06/02757-A4-Reset-Report-WEB.pdf p. 6

21 Ibid., p. 32

22 NHS England. ‘Securing Excellence in Primary Care (GP) Digital Services: The Primary Care (GP) Digital Services Operating Model.’[Online]: https://www.england.nhs.uk/digitaltechnology/digital-primary-care/gp-digital-services-operating-model-21-23/funding/ (https://archive.is/h8UEZ)

23 The Academic Health and Science Network. Reflecting on the COVID-19 pandemic to inform the health and care system of the future: the AHSN Network experience. June 2021. [Online]: https://thehealthinnovationnetwork.co.uk/wp-content/uploads/2021/06/02757-A4-Reset-Report-WEB.pdf p. 59

24 Ibid., p. 2

25 Ibid., p. 5

26 Ibid., p. 8

27 NHS England. ‘The Health Innovation Network.’ [Online]: https://www.england.nhs.uk/ourwork/part-rel/healthinnovationnetwork/ (https://archive.is/Z3psE)

28 The Academic Health and Science Network. Reflecting on the COVID-19 pandemic to inform the health and care system of the future: the AHSN Network experience. June 2021. [Online]: https://thehealthinnovationnetwork.co.uk/wp-content/uploads/2021/06/02757-A4-Reset-Report-WEB.pdf p. 32

29 The AHSN Network. The AHSN Network impact report 20-21. January 2023. [Online]: https://thehealthinnovationnetwork.co.uk/wp-content/uploads/2023/01/AHSN-Impact-Report-Final.pdf p. 8

30 The Academy of Fab Stuff. Beneficial changes network. Youtube; 31 October 2020. [Online video]: https://www.youtube.com/watch?v=Pbs7kDRFNc0&t=258s (Timestamp, 10:10)

31 The Academic and Health Science Network. AHSN Network strategy 2021-2026. 30 March 2021. [Online]: https://thehealthinnovationnetwork.co.uk/wp-content/uploads/2022/10/AHSN-Network-Strategy-2021-26-.pdf p. 33

32 Ibid., p. 18

33 NHS Confederation. NHS Reset: A new direction for health and care. September 2020. [Online]: https://www.nhsconfed.org/system/files/media/NHS-Reset-a-new-direction-for-health-and-care_4.pdf p. 55

34 The IBD Registry. ‘Privacy Notice for COVID-19 (COPI): How your Data may be Handled during the Covid-19 Pandemic.’ [Online]: https://ibdregistry.org.uk/copi-information/ (https://archive.is/UGUxJ)

35 Department of Health and Social Care. Data saves lives: reshaping health and social care with data. Last updated June 2022 at time of publishing. [Online]: https://www.gov.uk/government/publications/data-saves-lives-reshaping-health-and-social-care-with-data/data-saves-lives-reshaping-health-and-social-care-with-data (https://archive.is/aaj35)

36 NHS England. ‘NHS COVID-19 Data Store.’ [Online]: https://www.england.nhs.uk/contact-us/privacy-notice/how-we-use-your-information/covid-19-response/nhs-covid-19-data-store/ (https://archive.is/vB1BD)

37 NHS Health Research Authority. ‘COPI Notice Transition Applications.’ Last updated 18 March 2022 at time of publishing. [Online]: https://www.hra.nhs.uk/covid-19-research/guidance-using-patient-data/copi-notice-transition-applications/ (https://archive.is/rHOTn)

38 The AHSN Network. The AHSN Network: Impact Report 20-21. January 2023. [Online]: https://thehealthinnovationnetwork.co.uk/wp-content/uploads/2023/01/AHSN-Impact-Report-Final.pdf p. 2

39 The Academy of Fab Stuff. Beneficial Changes Network. Youtube; 31 October 2020. [Online video]: https://www.youtube.com/watch?v=Pbs7kDRFNc0&t=258s (Timestamp, 06:10)

40 Ibid., timestamp, from 04:20

41 Ibid., timestamp, from 03:53

42 Ibid., timestamp, from 04:17

43 NHS. ‘Futures Collaboration Platform.’ [Online]: https://future.nhs.uk/ (https://archive.is/bFNvr)

44 The Academy of Fab Stuff. Beneficial Changes Network. Youtube; 31 October 2020. [Online video]: https://www.youtube.com/watch?v=Pbs7kDRFNc0&t=258s (Timestamp, from 07:43)

45 The Academy of Fab Stuff. Beneficial Changes Network. Youtube; 31 October 2020. [Online video]: https://www.youtube.com/watch?v=Pbs7kDRFNc0&t=258s (Timestamp, from 08:40)

46 The Academy of Fab Stuff. Beneficial Changes Network. Youtube; 31 October 2020. [Online video]: https://www.youtube.com/watch?v=Pbs7kDRFNc0&t=258s (Timestamp, from 09:40)

47 Ibid. (Timestamp, from 10:10)

48 NHS Digital. ‘Social Care Programme.’ [Online]: https://digital.nhs.uk/services/social-care-programme (https://web.archive.org/web/20240903162431/https://digital.nhs.uk/services/social-care-programme/)

49 Impower, the Institute of Public Care, and RSM UK Consulting LLP (RSM). Social care programme evaluation overarching report. March 2021. No longer available for download, originally sourced from: https://digital.nhs.uk/services/social-care-programme p. 2 of report

50 Whitehead, H. ‘Friends of the Elderly Cuts Hospital Admissions by 20% with New Tech.’ Civil Society; 13 October 2020. [Online]: https://www.civilsociety.co.uk/news/charity-uses-technology-to-reduce-hospital-admissions-from-care-homes-by-20.html

51 Impower, the Institute of Public Care, and RSM UK Consulting LLP (RSM). Social care programme evaluation overarching report March 2021. No longer available for download, originally sourced from: https://digital.nhs.uk/services/social-care-programme p. 84 of report

52 Ibid., p. 52

53 Ibid., p. 55

54 Ibid., p. 27

55 Ibid., p. 27

56 Hampshire County Council, Isle of Wight Council, Local Government Association, NHS Digital, PA Consulting. Social care digital innovation discovery programme: Discovery phase report for exploring the potential for cobots to support carers. [Online]: https://www.local.gov.uk/sites/default/files/documents/IoW%20final%20deliverable%20FINAL%20for%20publication.pdf p. 2

57 Local Government Association. ‘Case Studies: Taking the Strain with Cobots in Care.’ 30 March 2021. [Online]: https://www.local.gov.uk/case-studies/taking-strain-cobots-care (https://archive.is/icRzQ)

58 Hampshire County Council, Isle of Wight Council, Local Government Association, NHS Digital, PA Consulting. Social care digital innovation discovery programme: Discovery phase report for exploring the potential for cobots to support carers. Local government. [Online]: https://www.local.gov.uk/sites/default/files/documents/IoW%20final%20deliverable%20FINAL%20for%20publication.pdf p. 14

59 House of Commons Education Committee. Fourth Industrial Revolution. Parliamentlive.tv; 16 October 2018. [Online video]: https://www.parliamentlive.tv/Event/Index/49d8117b-09e8-45f4-89f4-1af11b643e9f

60 D’Onofrio, G., Sancarlo, D., Raciti, M., Burke, M., Teare, A., Kovacic, T. et al. ‘MARIO Project: Validation and Evidence of Service Robots for Older People with Dementia.’ J Alzheimers Dis. 2019;68(4):1587-1601. [Online]: https://www.researchgate.net/publication/332235962_MARIO_Project_Validation_and_Evidence_of_Service_Robots_for_Older_People_with_Dementia

61 European Union. ‘Supporting Independent Living for the Elderly through Robotics.’Archived on 18 June 2024. [Online]: https://cordis.europa.eu/project/id/287609 (https://archive.is/OcyzR)

62 TSA -The Voice of Technology Enabled Care. Day 2 – PA Consulting and Hampshire County Council demo exoskeleton cobot at ITEC Conference 2019. Youtube; 2020. [Online video]: https://www.youtube.com/watch?v=KYPIrsKbDfs (Timestamp, 05:00)

63 Hampshire County Council. Cobots – Collaborative Robots in Care. Youtube; 2020. [Online video]: https://www.youtube.com/watch?v=sF-XYdVF3MY&t=107s (Timestamp, 01:07)

64 Clarke, S. ‘Watch: UK Care Sector Trials Collaborative Robots in European First: The Collaborative Robots are Being Trialed in Care Settings to Explore How they can Support Stretched Staff and Make the Social Care System More Resilient.’ Home Care Insight. 21 July 2020. [Online]: https://www.homecareinsight.co.uk/watch-uk-care-sector-trials-collaborative-robots-in-european-first/ (https://archive.is/k4Y7S)

65 European Social Network. ‘“Cobots” in care.’ February 2023. [Online]: https://www.esn-eu.org/system/files/2023-02/Hampshire.pdf (https://archive.is/tp9z9)

66 Hampshire County Council, Isle of Wight Council, Local Government Association, NHS Digital, PA Consulting. Social care digital innovation discovery programme: Discovery phase report for exploring the potential for cobots to support carers. Local government. [Online]: https://www.local.gov.uk/sites/default/files/documents/IoW%20final%20deliverable%20FINAL%20for%20publication.pdf p. 2

67 NHS England. ‘Greener NHS Campaign to Tackle Climate “Health Emergency.”’ 25 January 2020. [Online]: https://www.england.nhs.uk/2020/01/greener-nhs-campaign-to-tackle-climate-health-emergency/ (https://archive.is/rSKLh)

68 Lancet Countdown. ‘The 2024 Global Report of the Lancet Countdown.’ [Online]: https://lancetcountdown.org/2024-report/ (https://archive.is/xLqbk)

69 NHS England. Delivering a net zero National Health Service. July 2022. [Online]: https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/ (https://archive.is/8zgBS)

70 NHS England. Delivering a ‘net zero’ National Health Service. July 2022. [Online]: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf p. 4

71 UK Health Security Agency and Centre for Climate and Health Security. ‘The Impact of Climate Change on Health and Social Care Services.’ 12 November 2025. [Online]: https://www.gov.uk/guidance/the-impact-of-climate-change-on-health-and-social-care-services (https://archive.is/iUClB)

72 Mahase, E. ‘New Legislation Places Duty on NHS to Tackle Climate Change.’ British Medical Journal; 7 July 2022. [Online]: https://www.bmj.com/content/378/bmj.o1681.full (https://web.archive.org/web/20220709093552/https://www.bmj.com/content/378/bmj.o1681.full)

73 NHS England. Delivering a ‘net zero’ National Health Service. July 2022. [Online]: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf p. 40

74 Ibid., p. 46

75 Ibid., p. 6

76 Ibid., p. 44

77 Department of Health and Social Care. ‘Press Release: New TV Advert Urges Public to Stay at Home to Protect the NHS and Save Lives.’ 10 January 2021. [Online]: https://www.gov.uk/government/news/new-tv-advert-urges-public-to-stay-at-home-to-protect-the-nhs-and-save-lives (https://archive.is/5pcAV)

78 NHS England. NHS volunteering taskforce – report and recommendations. 9 June 2023. [Online]: https://www.england.nhs.uk/long-read/nhs-volunteering-taskforce-report-and-recommendations/ (https://archive.is/HdYA9)

79 Ulhuq, F,R., Berry, S,K., Kelly, L., Stansfield, B., Deal, A., Lester, H. ‘Collaboration During a Crisis – the Lighthouse Lab Volunteers.’ Microbiology (Reading)166(7):597-599; July 2020. [Online]: https://pmc.ncbi.nlm.nih.gov/articles/PMC7657505/ (https://archive.is/eCySA)

80 McTaggart P. ‘”We’ve been ignored and abused for the past year” says Vikki Spit.’ News and Star. 24 June 2022. [Online]: https://www.newsandstar.co.uk/news/20231337.weve-ignored-abused-past-year-says-vikki-spit/ (https://archive.is/fuYCy)

81 University Hospitals Birmingham NHS Foundation Trust. ‘Vaccinator Training FAQs.’ Last updated 24 January 2025. [Online]: https://www.uhb.nhs.uk/coronavirus-staff-archive/vaccinations/covid-19-vaccinator-resources/vaccinator-training-faqs/ (https://archive.is/KskpU)

82 ITV News. ‘How do you Apply to be an NHS Covid Volunteer and What will you be Doing?’ 15 December 2021. [Online]: https://www.itv.com/news/2021-12-06/how-do-you-apply-to-be-an-nhs-covid-volunteer-and-what-will-you-be-doing

83 The NHS. The NHS long term plan. Version 1.2. The National Archive; Web Archive. January 2019. [Online]: https://webarchive.nationalarchives.gov.uk/ukgwa/20230418155402/https:/www.longtermplan.nhs.uk/publication/nhs-long-term-plan/ p. 90

84 The Academy of Fab Stuff. Beneficial Changes Network. Youtube; 31 October 2020. [Online video]: https://www.youtube.com/watch?v=Pbs7kDRFNc0&t=258s (Timestamp, 10:07)

85 University of Cambridge Centre for Digital Built Britain. ‘Research Profile – Smart Hospital of the Future: Digital Technologies, Service Innovation, and Hospital Design.’ 4 October 2022. [Online]: https://www.cdbb.cam.ac.uk/news/research-profile-smart-hospital-future-digital-technologies-service-innovation-and-hospital (https://archive.is/3rFhs)

86 Cambridge Centre for Digital Built Britain. The Smart Hospital of the Future: Part 1 – Case Studies | A Digital Twin Journeys video. Youtube; 2021. [Online video]: https://www.youtube.com/watch?v=kOTsoHeZWtY&t=33s (Timestamp, 02:00.)

87 Ibid. (Timestamp, 01:00)

88 Kemp Van Ee, S., McKelvey, H., Williams, T., Shao, B., Lin, WT., Luu, J., Sunny, D., Kumar, S., Narayan, S., Urdaneta, A., Perez, L., Schwab, H., Riegle, S., Jacobs, RJ. ‘Telemedicine Intensive Care Unit (Tele-ICU) Implementation During COVID-19: A Scoping Review.’ Cureus. 19;14(5):e25133. May 2022. [Online]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9206410/ (https://archive.is/kVmNe)

89 Cambridge Centre for Digital Built Britain. The Smart Hospital of the Future: Part 1 – Case Studies | A Digital Twin Journeys video. Youtube; 2021. [Online video]: https://www.youtube.com/watch?v=kOTsoHeZWtY&t=33s (Timestamp, from 08:00)

90 UK Israel Business, All-Party Britain-Israel Parliamentary Group. A shot in the arm: Israel and UK healthtech innovation. 2021. [Online]:https://www.ukisrael.biz/_files/ugd/6c2eb5_b117fba385a4488ead12ef3c6850acaf.pdf p. 10

91 UK-Israel Business. ‘The UK-Israel HealthTech Network: Bridging Innovation for Global Health.’ [Online]: https://www.ukisrael.biz/sector-focused-networks (https://archive.is/xDYSG)

92 UK Israel Business, All-Party Britain-Israel Parliamentary Group. A shot in the arm: Israel and UK healthtech innovation. 2021. [Online]: https://www.ukisrael.biz/_files/ugd/6c2eb5_b117fba385a4488ead12ef3c6850acaf.pdf p. 5

93 Ibid., p. 30

94 Ibid., p. 32

95 Ibid., p. 33

96 Ibid., p. 19

97 World Health Organisation. Israel: Advancing interoperability and data sharing in the health system (2021). 15 August 2021. [Online]; Available for download at: https://www.who.int/europe/publications/m/item/israel-advancing-interoperability-and-data-sharing-in-the-health-system-(2021) p. 2

98 UK Israel Business, All-Party Britain-Israel Parliamentary Group. A shot in the arm: Israel and UK healthtech innovation. 2021. [Online]: https://www.ukisrael.biz/_files/ugd/6c2eb5_b117fba385a4488ead12ef3c6850acaf.pdf p. 28

99 Ibid., p. 19

100 Ibid., p. 20

101 Israel Innovation Authority. ‘Bio-Covergence.’ [Online]: https://innovationisrael.org.il/en/report/bio-convergence-2/ (https://archive.is/tnc2w)

102 Foreign, Commonwealth and Development Office. ‘Policy Paper: 2030 Roadmap for UK-Israel Bilateral Relations.’ 21 March 2023. [Online]: https://www.gov.uk/government/publications/2030-roadmap-for-uk-israel-bilateral-relations/2030-roadmap-for-uk-israel-bilateral-relations (https://archive.is/HVUEf)

103 UK Israel Business, All-Party Britain-Israel Parliamentary Group. A shot in the arm: Israel and UK healthtech innovation. 2021. [Online]: https://www.ukisrael.biz/_files/ugd/6c2eb5_b117fba385a4488ead12ef3c6850acaf.pdf p. 22

104 Corporate Watch. ‘The UK Israel Tech Hub: Fast-Tracking Israeli Tech Companies into the NHS.’ 6 November 2024. [Online]: https://corporatewatch.org/the-uk-israel-tech-hub-fast-tracking-israeli-tech-companies-into-the-nhs/ (https://archive.is/iCiiK)

105 Health Tech Newspaper. ‘Rotherham Doncaster and South Humber NHS partner with Israeli Health Tech Company.’ 17 October 2022. [Online]: https://htn.co.uk/2022/10/17/rotherham-doncaster-and-south-humber-nhs-partner-with-israeli-health-tech-company/ (https://archive.is/f2etb)

106 The Northern Health Science Alliance. ‘BioMed Israel Fosters UK Collaboration: Grounded Research to Work with Israeli Digital Health Company, Taliaz.’ 9 November 2022. [Online]: https://www.thenhsa.co.uk/2022/11/biomed-israel-fosters-mental-health-treatment-collaboration/ (https://archive.is/4vl3k)

107 Taliaz. Predictix BY Taliaz: Setting a new standard in personalized medicine. Youtube; 2016. [Online video]: https://www.youtube.com/watch?v=6n4ab9UCK60&t=105s

108 Carni, Y. ‘Why Greater Access To Global Data Is Vital To The Fight Against COVID-19 And Future Pandemics.’ Forbes; 4 May 2020. [Online]: https://www.forbes.com/sites/startupnationcentral/2020/05/04/big-data-covid19-coronavirus-israeli-startups/ (https://archive.is/7qYNJ)

109 Bambra, C., Munford, L., et al. The parallel pandemic: COVID-19 and mental health. [Online]. Northern Health Science Alliance: Newcastle; 2022. [Online]: https://www.thenhsa.co.uk/app/uploads/2022/07/NHSA-MENTAL-HEALTH-REPORT.pdf p. 4

110 UK Israel Business, All-Party Britain-Israel Parliamentary Group. A shot in the arm: Israel and UK healthtech innovation. 2021. [Online]: https://www.ukisrael.biz/_files/ugd/6c2eb5_b117fba385a4488ead12ef3c6850acaf.pdf p. 18

111 Youvan, D. ‘The Controversial Legacy of Unit 8200: From the USS Liberty Incident to Modern Espionage Allegations.’ ResearchGate;September 2024. [Online]: https://www.researchgate.net/publication/384039211_The_Controversial_Legacy_of_Unit_8200_From_the_USS_Liberty_Incident_to_Modern_Espionage_Allegations

112 UK Israel Business, All-Party Britain-Israel Parliamentary Group. A shot in the arm: Israel and UK healthtech innovation. 2021. [Online]: https://www.ukisrael.biz/_files/ugd/6c2eb5_b117fba385a4488ead12ef3c6850acaf.pdf P. 22

113 Smith, B. ‘NHSX Marks the Spot: Diplomat-Turned-Digital Chief Matthew Gould Talks Patient Data and AI.’ Civil Service World; 27 March 2020. [Online]: https://www.civilserviceworld.com/in-depth/article/nhsx-marks-the-spot-diplomatturneddigital-chief-matthew-gould-talks-patient-data-and-ai (https://archive.is/92gW0)

114 Boffey, D. ‘London zoo boss quits amid claims of “unacceptable workplace behaviour”.’ The Guardian; 28 November 2025. [Online]: https://www.theguardian.com/uk-news/2025/nov/28/london-zoo-boss-matthew-gould-quits-amid-claims-of-unacceptable-workplace-behaviour (https://archive.is/Zw96X)

115 UK Israel Business, All-Party Britain-Israel Parliamentary Group. A shot in the arm: Israel and UK healthtech innovation. 2021. [Online]: https://www.ukisrael.biz/_files/ugd/6c2eb5_b117fba385a4488ead12ef3c6850acaf.pdf p. 14

116 Hamblin, K., Whitfield, G. Technology in social care: spotlight on the English policy landscape, 2019-2022: Centre for Care Working Paper 1. CIRCLE: University of Sheffield; December 2022. [Online]: https://centreforcare.ac.uk/wp-content/uploads/2022/12/Technology-in-social-care-report-Dec-2022_FINAL.pdf p. 5

117 Jewish Telegraph. ‘New Envoy’s a Passionate Horse-Loving Zionist.’ 2010. [Online]: https://www.jewishtelegraph.com/prof_67.html (https://archive.is/5ixkM)

118 Murray, C. ‘Matthew Gould and the Plot to Attack Iran.’ 14 November 2011. [Online]: https://www.craigmurray.org.uk/archives/2011/11/matthew-gould-and-the-plot-to-attack-iran/ (https://archive.is/YcVE)

119 Gould, M. ‘NHSX moves on.’ 4 February 2022. [Online]: https://web.archive.org/web/20220801044927/https://transform.england.nhs.uk/blogs/nhsx-moves-on/

120 Macaulay, T. ‘What is NHSX? Inside the Government’s New Healthtech Unit.’ ComputerWorld. 8 July 2019. [Online]: https://www.computerworld.com/article/1656394/what-is-nhsx-inside-the-government-s-new-healthtech-unit.html (https://archive.is/LkK1j)

121 Hamblin, K., Whitfield, G. Technology in social care: spotlight on the English policy landscape, 2019-2022: Centre for Care Working Paper 1. CIRCLE: University of Sheffield; December 2022. [Online]: https://centreforcare.ac.uk/wp-content/uploads/2022/12/Technology-in-social-care-report-Dec-2022_FINAL.pdf p. 6

122 Department of Health and Social Care. ‘NHSOpenSAFELY Data Analytics Service Pilot Directions 2025.’ [Online]; Available to download at: https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/directions-and-data-provision-notices/secretary-of-state-directions/nhs-opensafely-data-analytics-service-pilot-directions-2025 p.2 of report

123 House of Commons. Science and Technology Committee oral evidence: The right to privacy, digital data, HC97. London: The Stationary Office; 11 May 2022. [Online]: https://committees.parliament.uk/oralevidence/10197/pdf/ pp. 23, 24

124 Bennett Institute for Applied Data Science. ‘OpenSAFELY.’ [Online]: https://www.bennett.ox.ac.uk/opensafely/ (https://archive.is/5poC6)

125 House of Commons. Science and Technology Committee oral evidence: The right to privacy, digital data, HC97. London: The Stationary Office; 11 May 2022. [Online]: https://committees.parliament.uk/oralevidence/10197/pdf/ p. 22

126 NHS England. ‘NHS Expands Use of Secure COVID-19 Research Platform to Help Find New Treatments for Major Killer Conditions.’ 17 November 2023. [Online]: https://www.england.nhs.uk/2023/11/nhs-expands-use-of-secure-covid-19-research-platform-to-help-find-new-treatments-for-major-killer-conditions/ (https://archive.is/JJl47)

127 Department of Health and Social Care. ‘NHSOpenSAFELY Data Analytics Service Pilot Directions 2025.’ [Online]; Available to download at: https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/directions-and-data-provision-notices/secretary-of-state-directions/nhs-opensafely-data-analytics-service-pilot-directions-2025 p. 3 of report

128 Parliamentlive.tv. Science and Technology Committee. 28 April 2020. https://parliamentlive.tv/Event/Index/2be4e8b1-ba23-4a07-b261-320355ffe6d3 (Timestamp, from 10:21)

129 Hewson, V. The NHSX Contact Tracing App: Unresolved Civil Liberties and Privacy Issues. Institute of Economic Affairs. 8 May 2020. [Online]: https://iea.org.uk/the-nhsx-contact-tracing-app-unresolved-civil-liberties-and-privacy-issues/ (https://archive.is/ukhu1)

130 Apple. ‘Privacy-Preserving Contact Tracing.’ [Online]: https://covid19.apple.com/contacttracing

131 Lewis, P., Pegg, D. ‘NHS Coronavirus App: Memo Discussed Giving Ministers Power to ‘De-anonymise’ Users.’ The Guardian. 13 April 2020. [Online]: https://www.theguardian.com/world/2020/apr/13/nhs-coronavirus-app-memo-discussed-giving-ministers-power-to-de-anonymise-users (https://archive.is/GJSHV)

132 Morgan L. ‘Test and Trace: Isle of Wight Coronavirus App Scrapped over Apple Issues.’ Ilse of Wight County Press. 18 June 2020. [Online]: https://iwcp.newsquestdigital.co.uk/news/18526533.test-trace-isle-wight-coronavirus-app-scrapped-apple-issues/ (https://archive.is/5CVvE)

133 UK Column. UK Column News – 14 August 2020. [Online video]: https://www.ukcolumn.org/ukcolumn-news/uk-column-news-14th-august-2020 (Timestamp, 03:50)

134 The BBC Panorama Team. ‘Test and Trace: “I Spoke to One person in Four Months”. 28 September 2020. [Online]: https://www.bbc.co.uk/news/health-54284095 (https://archive.is/cQCD8)

135 Boyle, S. ‘Whistleblower Exposes ‘Test and Trace’ Shambles: Operators who aren’t Properly Trained – and had No Idea the System was Going Live: Tech Blunders. Woeful Security and Abject Apologies.’ The Daily Mail. 29 May 2020. [Online]: https://www.dailymail.co.uk/news/article-8370899/Whistleblower-exposes-test-trace-shambles-Operators-no-idea-going-live.html (https://archive.is/F6jqP)

136 House of Commons Committee of Public Accounts. Test and Trace update: Twenty-third report of session 2021–22. London: The Stationary Office; 27 October 2021. [Online]: https://committees.parliament.uk/publications/7651/documents/79945/default/ p. 7

137 Molloy, C. ‘We Mustn’t Let Silicon Valley Thinking Infect our NHS: Secretive COVID Contracts Show how Big Data Firms are Taking Over Our Healthcare: What are they – and the British Government – Hoping to Get Out of it?’ openDemocracy. 5 August 2020. [Online]: https://www.opendemocracy.net/en/ournhs/we-mustnt-let-silicon-valley-thinking-infect-our-nhs/ (https://archive.is/gzHl0)

138 McCarthy, K. ‘UK Finds Itself Almost Alone with Centralized Virus Contact-Tracing App that Probably Won’t Work Well, Asks for your Location, May be Illegal.’ The Register. 5 May 2020. [Online]: https://www.theregister.com/2020/05/05/uk_coronavirus_app/ (https://archive.is/SnFlV)

139 Joint Statement. 29 April 2020. [Online]: https://drive.google.com/file/d/1uB4LcQHMVP-oLzIIHA9SjKj1uMd3erGu/view (https://archive.is/TlIVn)

140 Baroness Blackwood and the Department of Health and Social Care. ‘Embracing AI and technology to improve patient outcomes: Baroness Blackwood spoke at CogX, the festival of artificial intelligence (AI) and emerging technology.’ 12 June 2019. [Online]: https://www.gov.uk/government/speeches/embracing-ai-and-technology-to-improve-patient-outcomes (https://archive.is/qfGqT)

141 Statt, N. ‘Peter Thiel’s Controversial Palantir is helping Build a Coronavirus Tracking Tool for the Trump Admin.’ The Verge. 21 April 2020. [Online]: https://www.theverge.com/2020/4/21/21230453/palantir-coronavirus-trump-contract-peter-thiel-tracking-hhs-protect-now (https://archive.is/uE4ZP)

142 Volpicelli G. ‘Inside Dominic Cummings’s Coronavirus Meeting with Big Tech: For the Prime Minister’s Startup-Loving Advisor, it’s Big Tech Versus Bad Virus.’ Wired. 12 March 2020. [Online]: https://web.archive.org/web/20240404104131/https://www.wired.com/story/dominic-cummings-coronavirus-big-tech/

143 Downey, A. ‘NHSX Chief Met Palantir to Discuss Data Deals Months Before Covid-19.’ DigitalHealth. 25 February 2021. [Online]: https://www.digitalhealth.net/2021/02/nhsx-chief-met-palantir-to-discuss-data-deals-months-before-covid-19/ (https://archive.is/q9ch4)

144 Advisory Committee on Business Appointments. ‘Decision Advice Letter: Matthew Gould, Member of the Advisory Board, Quantexa.’21 September 2023. [Online]: https://www.gov.uk/government/publications/gould-matthew-director-general-for-digital-transformation-at-dhsc-and-national-director-for-digital-transformation-at-nhs-england-acoba-advice/advice-letter-matthew-gould-member-of-the-advisory-board-quantexa (https://archive.is/kqfSP)

145 NHS England. ‘Federated Data Platform: Frequently asked questions (FAQs).’ Last updated 3 October 2025 at time of publishing. [Online]: https://www.england.nhs.uk/digitaltechnology/nhs-federated-data-platform/fdp-faqs/#what-has-been-procured-and-whats-the-value-of-the-contract (https://archive.is/UCGcK)

146 Chipman, A. ‘Palantir’s Road to the Federated Data Platform Contract: a Timeline.’ DigitalHealth. 21 November 2023. [Online]: https://www.digitalhealth.net/2023/11/palantirs-road-to-the-federated-data-platform-contract-a-timeline/ (https://archive.is/ooTbM)

147 Corporate Watch. ‘Palantir in the UK: From the Ministry of Defence to the NHS.’22 March 2024. [Online]: https://corporatewatch.org/palantir-in-the-uk/ (https://archive.is/hXWoc)

148 Milmo, C., Wilding, M. ‘The Nectar Project Offers “Advanced Data Analysis” Using a Wide Range of Sensitive Personal Information.’ Liberty Investigates and the I. 16 June 2025. [Online]: https://libertyinvestigates.org.uk/articles/uk-police-working-with-controversial-tech-giant-palantir-on-real-time-surveillance-network/ (https://archive.is/o4Fpm)

149 NHS England. ‘AI knowledge repository.’ Last updated 5 November 2025 at time of publishing. [Online]: https://transform.england.nhs.uk/ai-lab/about-the-nhs-ai-lab/

150 Crider, C., Fitzgerald, M. ‘We Need Urgent Answers about the Massive NHS COVID Data Deal.’ openDemocracy. 7 May 2020. [Online]: https://www.opendemocracy.net/en/ournhs/we-need-urgent-answers-about-massive-nhs-covid-data-deal/ (https://archive.is/1NdkM#selection-1321.0-1321.60)

151 Crider, C., Fitzgerald, M. ‘Under Pressure, UK Government Releases NHS COVID Data Deals with Big Tech:

Hours before openDemocracy was Due to Sue, Government Releases Massive Data-Sharing Contracts with Amazon, Microsoft, Google, Faculty and Palantir.’ openDemocracy. 5 June 2020. [Online]: https://www.opendemocracy.net/en/ournhs/under-pressure-uk-government-releases-nhs-covid-data-deals-big-tech/ (https://archive.is/uKQLI)

152 MedAct. ‘No Palantir in the NHS! Campaign Toolkit.’ 6 November 2024. [Online]: https://www.medact.org/2024/resources/toolkits/no-palantir-in-the-nhs-campaign-toolkit-1/

153 Newman M. ‘Thiel’s Palantir, Israel Agree Strategic Partnership for Battle Tech.’ Bloomberg. 12 January 2024. [Online]; Available at: https://www.palantir.com/assets/xrfr7uokpv1b/3MuEeA8MLbLDAyxixTsiIe/9e4a11a7fb058554a8a1e3cd83e31c09/C134184_finaleprint.pdf (https://archive.is/qNPHt)

154 Corporate Watch. ‘No Palantir in the NHS and Corporate Watch Reveal the Real Story Behind the Federated Data Platform Rollout.’ 13 August 2025. [Online]: https://corporatewatch.org/foi-requests-reveal-palantirs-nhs-fdp-rollout-failures/ (https://archive.is/x4srx)

155 Palantir. Stabilizing Chronically Homeless Individuals with Project Welcome Home. Youtube; 2016. [Online video]:https://www.youtube.com/watch?v=dFF4gN56Bhg&t=240s

156 University of Liverpool. Liverpool Covid-19 community testing pilot: Interim evaluation report. 23 December 2023. [Online]: https://www.liverpool.ac.uk/media/livacuk/research/Liverpool,Community,Testing,Pilot,Interim,Evaluation.pdf p. 3

157 University of Liverpool. ‘Professor Iain Buchan.’ [Online]: https://www.liverpool.ac.uk/people/iain-buchan (https://archive.is/cA8Yo)

158 Graphnet Health. ‘Case Studies: Combined Intelligence for Population Health Action (CIPHA).’ 18 June 2021. [Online]: https://www.graphnethealth.com/knowledge-hub/case-studies/combined-intelligence-for-population-health-action-cipha (https://archive.is/uxh8z)

159 Graphnet Health. ‘Shared Care Records (ShCR): What are Shared Care Records?’ [Online]: https://www.graphnethealth.com/solutions/shared-care (https://archive.is/JSueC)

160 Graphnet Health. ‘About Graphnet Health.’ [Online]: https://www.graphnethealth.com/about-us (https://archive.is/NhqRX)

161 University of Liverpool, Buchan, I. ed. Liverpool Covid-SMART community testing pilot evaluation report. University of Liverpool; 17 June 2021. [Online]: https://www.liverpool.ac.uk/media/livacuk/research/Mass,testing,evaluation.pdf p. 8

162 University of Liverpool. ‘Covid-SMART Rapid Antigen Community Testing Evaluations.’ [Online]: https://www.liverpool.ac.uk/research/research-themes/infectious-diseases/coronavirus-research/covid-smart-pilot/

163 University of Liverpool, Buchan, I. ed. Liverpool Covid-19 community testing pilot interim evaluation report. University of Liverpool; 23 December 2020. [Online]: https://www.liverpool.ac.uk/media/livacuk/research/Liverpool,Community,Testing,Pilot,Interim,Evaluation.pdf p. 3

164 The Pandemic Institute, UK Health Security Agency, University of Liverpool. ‘Programmable Risk-Mitigation for Pandemic Preparedness: Data, AI and Testing: UKHSA Expert Panels 1-4; 2, 12, 28 February and 7 March 2024.’ [Online]: https://www.dropbox.com/scl/fi/69cl9epj28ctpvdvs8g9n/Programmable_Risk_Mitigation_UKHSA.pdf p. 11

165 Department of Health and Social Care. ‘Policy paper: Data Saves Lives: Reshaping Health and Social Care with Data.’ Last updated 15 June 2022 at time of publishing. [Online]: https://www.gov.uk/government/publications/data-saves-lives-reshaping-health-and-social-care-with-data/data-saves-lives-reshaping-health-and-social-care-with-data

166 University of Liverpool, Buchan, I. ed. Liverpool Covid-SMART community testing pilot evaluation report. University of Liverpool; 17 June 2021. [Online]: https://www.liverpool.ac.uk/media/livacuk/research/Mass,testing,evaluation.pdf p. 21

167 UK Biobank. ‘What is UK Biobank?’ https://www.ukbiobank.ac.uk/ (https://archive.is/sHGAY)

168 University of Liverpool, Buchan, I. ed. Liverpool Covid-SMART community testing pilot evaluation report. University of Liverpool; 17 June 2021. [Online]: https://www.liverpool.ac.uk/media/livacuk/research/Mass,testing,evaluation.pdf p. 10

169 Ibid., p. 14

170 Cheshire and Merseyside Health and Care Partnership. CIPHA programme presentation. Youtube; 17 June 2021. [Online video]: https://www.youtube.com/watch?v=Ur_RwOTDgAk&t=35s (Timestamp, from 07:30)

171 Department for Digital, Culture, Media and Sport. ‘Policy paper: Events Research Programme: Phase I findings.’ 25 June 2021. [Online]: https://www.gov.uk/government/publications/events-research-programme-phase-i-findings/events-research-programme-phase-i-findings

172 The Pandemic Institute, UK Health Security Agency, University of Liverpool. ‘Programmable Risk-Mitigation for Pandemic Preparedness: Data, AI and Testing: UKHSA Expert Panels 1-4; 2, 12, 28 February and 7 March 2024.’ [Online]: https://www.dropbox.com/scl/fi/69cl9epj28ctpvdvs8g9n/Programmable_Risk_Mitigation_UKHSA.pdf p. 18

173 Gates M, Vallance P. 100 Days Mission to respond to future pandemic threats: Reducing the impact of future pandemics

by making diagnostics, therapeutics and vaccines available within 100 days. A report to the G7 by the pandemic preparedness partnership. 12 June 2021. [Online]: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/992762/100_Days_Mission_to_respond_to_future_pandemic_threats__3_.pdf p. 18

174 Ibid., p. 55

175 Ibid., p. 42

176 Ibid., p. 19

177 Ibid., p. 30

178 Ibid., p. 54

179 Ibid., p. 19

180 Ibid., p. 41

181 Ibid., p. 37

182 Ibid., p. 36

183 Ibid., p. 54

184 Ibid., p. 41

185 CEPI (Coalition for Epidemic Preparedness Innovations). ‘Global Community Comes Together in Support of 100 Days Mission and Pledges over $1.5 billion for CEPI’s Pandemic-Busting Plan.’ 8 March 2022. [Online]: https://cepi.net/global-community-comes-together-support-100-days-mission-and-pledges-over-15-billion-cepis-pandemic (https://archive.is/RyuN9)

186 World Health Organisation. ‘World Health Assembly Adopts Historic Pandemic Agreement to Make the World More Equitable and Safer from Future Pandemics.’ 20 May 2025 [Online]: https://www.who.int/news/item/20-05-2025-world-health-assembly-adopts-historic-pandemic-agreement-to-make-the-world-more-equitable-and-safer-from-future-pandemics (https://archive.is/Fd5rP)

187 Department of Health and Social Care. Policy paper: Transforming the public health system: Reforming the public health system for the challenges of our times. 29 March 2021. [Online]: https://www.gov.uk/government/publications/transforming-the-public-health-system/transforming-the-public-health-system-reforming-the-public-health-system-for-the-challenges-of-our-times (https://archive.is/EZwxJ)

188 Royal Society of Medicine. RSM COVID-19 Series | Episode 78: UK health security with Dr Jenny Harries. Youtube; 10 June 2021. [Online video]: https://www.youtube.com/watch?v=QChisaD7RuM

189 The Pandemic Institute, UK Health Security Agency, University of Liverpool. ‘Programmable Risk-Mitigation for Pandemic Preparedness: Data, AI and Testing: UKHSA Expert Panels 1-4; 2, 12, 28 February and 7 March 2024.’ [Online]: https://www.dropbox.com/scl/fi/69cl9epj28ctpvdvs8g9n/Programmable_Risk_Mitigation_UKHSA.pdf p. 33

190 The Pandemic Institute, UK Health Security Agency, University of Liverpool. ‘Programmable Risk-Mitigation for Pandemic Preparedness: Data, AI and Testing: UKHSA Expert Panels 1-4; 2, 12, 28 February and 7 March 2024.’ [Online]: https://www.dropbox.com/scl/fi/69cl9epj28ctpvdvs8g9n/Programmable_Risk_Mitigation_UKHSA.pdf p. 29

191 Department of Health and Social Care. Policy paper: Transforming the public health system: reforming the public health system for the challenges of our times. 29 March 2021. [Online]: https://www.gov.uk/government/publications/transforming-the-public-health-system/transforming-the-public-health-system-reforming-the-public-health-system-for-the-challenges-of-our-times (https://archive.is/EZwxJ)

192 Department of Health and Social Care. Closed consultation. Advancing our health: prevention in the 2020s – consultation document. 22 July 2019. [Online]: https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document (https://archive.is/O6Yqm)

193 Chief Economist Directorate and Economic Development Directorate of Scotland. Scotland’s National Strategy for Economic Transformation. 1 March 2022. [Online]: https://www.gov.scot/publications/scotlands-national-strategy-economic-transformation/pages/3/ (Section 1.6.) (https://archive.is/km3h4)

194 Wellbeing Economy Alliance. ‘Frequently Asked Questions: Questions about WEAll. 4: What is WEGo?’ [Online]: https://weall.org/faq

195 The Rockefeller Foundation. ‘Global Impact Investing Network (GIIN).’ [Online]: https://www.rockefellerfoundation.org/bellagio-bulletin/from-the-archives/global-impact-investing-network-giin/ (https://archive.is/DshRP)

196 Mcdowell A. ‘Omidyar Network and National Education Standards in Brazil.’ Wrench in the Gears. 21 January 2022. [Online]: https://wrenchinthegears.com/2022/01/21/omidyar-network-and-national-education-standards-in-brazil/ (https://archive.is/78QYi)

197 Monaghan, C., Joury, S., Laláková, E., Woerdeman, S. Fertile ground: A mapping and analysis of the vibrant ecosystem of organisations across Europe working to transform our economic system. Partners for a New Economy; October 2025. [Online]: https://www.metabolic.nl/publications/fertile-ground/ p. 25

198 Ibid., p. 6

199 Ibid., p. 87

200 Harrington, D. ‘Another “Fudge” for the NHS as Simon Stevens Takes Over NHS Improvement.’ Public Matters; 3 March 2019. [Online]: https://publicmatters.org.uk/2019/03/03/another-worrying-fudge-for-the-nhs-as-simon-stevens-takes-over-nhs-improvement/ (https://archive.is/3kpff)

201 Public Matters. Health and Care Bill 2021: the NHS, the law, and democracy. Youtube; 26 July 2021. [Online video]: https://www.youtube.com/watch?v=7vjoR7LnDqU (Timestamp 09.10)

202 Public Matters. Corporate agenda for integrated care. April 2021. [Online]: https://keepournhspublic.com/wp-content/uploads/2021/04/Corporate_Agenda_for_Integrated_Care-1.pdf p. 11

203 NHS Confederation. Parliamentary briefing: What are Integrated Care Systems? June 2022. [Online]: https://www.nhsconfed.org/system/files/2022-07/NHS%20Confederation%20parliamentary%20briefing%20-%20Integrated%20Care%20Systems%20%28ICS%29.pdf

204 Public Matters. Corporate Agenda for Integrated Care. April 2021. [Online]: https://keepournhspublic.com/wp-content/uploads/2021/04/Corporate_Agenda_for_Integrated_Care-1.pdf p. 14

205 Keep Our NHS Public. ‘Oppose the Health and Care Bill 2021.’ [Online]: https://keepournhspublic.com/wp-content/uploads/2021/11/Health-and-Care-Bill-Summary-leaflet-Oct-2021.pdf

206 NHS Confederation. Parliamentary briefing: What are Integrated Care Systems? June 2022. [Online]. https://www.nhsconfed.org/system/files/2022-07/NHS%20Confederation%20parliamentary%20briefing%20-%20Integrated%20Care%20Systems%20%28ICS%29.pdf p. 3

207 Patients4NHS. ‘How is the NHS being Privatised?’ (Last updated 2021 at time of publishing.) [Online]: https://web.archive.org/web/20250213091738/https://www.patients4nhs.org.uk/how-is-the-nhs-being-privatised/

208 BBC News. ‘Timeline: Covid Contracts and Accusations of “Chumocracy”’. 20 April 2021. [Online]: https://www.bbc.co.uk/news/uk-56319927

209 Public Matters. Corporate agenda for integrated care. April 2021. [Online]: https://keepournhspublic.com/wp-content/uploads/2021/04/Corporate_Agenda_for_Integrated_Care-1.pdf p. 4

210 Keep Our NHS Public. ‘The Health and Care Bill and Private Companies’ Access to Patients’ Health and Care Data.’ [Online]: https://keepournhspublic.com/campaigns/scrap-the-health-and-care-bill/access-to-patients-data/

211 Big Brother Watch. Big Brother Watch Briefing on the Data (Use and Access) Bill for Second Reading in the House of Lords. November 2024. [Online]: https://bigbrotherwatch.org.uk/wp-content/uploads/2024/11/Big-Brother-Watchs-Briefing-on-the-Data-Use-and-Access-Bill-2024.pdf p. 5

212 Big Brother Watch. Big Brother Watch briefing on the Data (Use and Access) Bill for second reading in the House of Lords. November 2024. [Online]: https://bigbrotherwatch.org.uk/wp-content/uploads/2024/11/Big-Brother-Watchs-Briefing-on-the-Data-Use-and-Access-Bill-2024.pdf p. 6

213 Lewis Silkin. ‘What You Need to Know about the Data (Use and Access) Act.’ 25 June 2025. [Online]: https://www.lewissilkin.com/insights/2025/06/25/what-you-need-to-know-about-the-data-use-and-access-act (https://archive.is/TGXAI)

214 Big Brother Watch. Big Brother Watch briefing on the Data (Use and Access) Bill for second reading in the House of Lords. November 2024. [Online]: https://bigbrotherwatch.org.uk/wp-content/uploads/2024/11/Big-Brother-Watchs-Briefing-on-the-Data-Use-and-Access-Bill-2024.pdf p. 4

215 Big Brother Watch. Big Brother Watch briefing on the Data (Use and Access) Bill for second reading in the House of Lords. November 2024. [Online]: https://bigbrotherwatch.org.uk/wp-content/uploads/2024/11/Big-Brother-Watchs-Briefing-on-the-Data-Use-and-Access-Bill-2024.pdf p. 7

216 Delli Santi, M. DUA BILL: Henry VIII powers threaten democracy and UK adequacy. Open Rights Group. March 2025.[Online]: https://www.openrightsgroup.org/app/uploads/2025/03/BRIEFING-Data-Use-and-Access-Bill-Henry-VIII-Powers.pdf p. 3

217 Lewis Silkin. ‘What You Need to Know about the Data (Use and Access) Act.’ 25 June 2025. [Online]: https://www.lewissilkin.com/insights/2025/06/25/what-you-need-to-know-about-the-data-use-and-access-act

218 Delli Santi, M. DUA BILL: Henry VIII powers threaten democracy and UK adequacy. Open Rights Group. March 2025.[Online]: https://www.openrightsgroup.org/app/uploads/2025/03/BRIEFING-Data-Use-and-Access-Bill-Henry-VIII-Powers.pdf

219 Wallace, S. ‘The Hidden Threat: How Henry VIII Powers Weaken Democracy.’ The Constitution Society. 9 April 2025. [Online]: https://consoc.org.uk/henry-viii-powers-weaken-democracy/ (https://archive.is/dn7nE)

220 Department for Energy Security and Net Zero. Developing an energy smart data scheme: A call for evidence. January 2025. [Online]: https://assets.publishing.service.gov.uk/media/6784d6e4f041702a11ca0eb6/developing-energy-smart-data-scheme-cfe.pdf p. 9

221 Department for Energy Security and Net Zero. Developing an energy smart data scheme: A call for evidence. January 2025. [Online]: https://assets.publishing.service.gov.uk/media/6784d6e4f041702a11ca0eb6/developing-energy-smart-data-scheme-cfe.pdf p. 10

222 Moreno, N. The UK’s Data (Use and Access) Bill: Latest Amendments and Legal Implications.’ Kennedys Law. 6 March 2025. [Online]: https://www.kennedyslaw.com/en/thought-leadership/article/2025/the-uks-data-use-and-access-bill-latest-amendments-and-legal-implications/ (https://archive.is/DJCgf)