• Former health minister says further merging of ALBs needed
  • Lord O’Shaughnessy backs Matt Hancock’s NHSX tech unit, citing fragmentation of digital leadership
  • Says NHS should seek profit and equity stake from sharing patient data with tech companies

A recently departed health minister has called for the merging of more national health bodies, and said fragmentation at the centre is slowing down much-needed transformation.

Lord James O’Shaughnessy resigned as under-secretary at the Department of Health and Social Care in December, where he had responsibility for technology, innovation, estates and Brexit.

Speaking to HSJ this week, Lord O’Shaughnessy said getting anything done in his role “was quite complicated” and it required bringing together many different central bodies with differing interests.

“I think there is a case, as you are seeing now with NHS England and NHS Improvement to give an example, of coming together and merging some aspects of the operation,” he said.

“There is definitely a case for simplifying the landscape a bit.”

He also backed health and social care secretary Matt Hancock’s plan for a new central tech unit NHSX, as reported by HSJ this week, to bring together disparate digital functions.

“What was becoming clear is that they were several different organisations and the minister tries to hold that ring together.

“Ministers are not delivery organisations, the department isn’t set up in that sense. So, you need something with the strategic capability and delivery capacity that sits on top and delivers what Matt wants to do. The current set-up is a bit fragmented, and that’s what led to this idea.”

He said NHS England, which currently leads on NHS IT strategy, was a commissioning body not a “transformation delivery body” and areas of transformation, like digital, need a clear central strategic leadership across the system.

“When you have big transformation projects, it makes sense to have something at the apex and, of course, great leaders.”

He cited the establishment of the accelerated access collaborative, chaired by Lord Ara Darzi, as a model of strategic leadership that could work in other areas. Following a review, there were plans to boost the powers of the collaborative to give it more power to direct innovation policy and strategy across the NHS nationally, he said.

The collaborative, set up in response to the accelerated access report to fast-track take-up of breakthrough medical products, has faced several delays.

Trust should profit share with tech companies

The NHS needs to be more robust in extracting value for sharing patient data with commercial companies, including demanding a portion of any subsequent profits, according to Lord O’Shaughnessy.

During his time at the Department of Health and Social Care, Lord O’Shaughnessy led the development of a new code of conduct for tech companies accessing NHS patient data, prompted in part by the controversial deal between Google Deepmind and the Royal Free London Foundation Trust.

Speaking to HSJ this week, he said it was vital that the NHS and individual trusts demand an “upside” from providing access to patient data for commercial gain.

When the data might be used to make a drug or build an algorithm for commercial use, the NHS should expect an equity and profit share rather than charge a fee for access.

“I think increasingly we will see models like that”, he said, “The data is like capital. What do you do if you invest in a company and it’s successful? You get equity and you get royalties.”

Provided the right safeguards, anonymisation and patient consents were in place, the public would support these arrangements, he said.

“Do I think people would welcome these things? Of course, I do. This is money that will be invested in new doctors and nurses, new wings in hospitals.”

Royal Free’s arrangement to share patient data with Google Deepmind to develop the Streams app, a deal later deemed unlawful, did not give the trust any equity stake in the product. Google has now taken direct control of the Streams project and has plans to sell it to health services globally.

“Not only did they fail the ICO test…but what’s their upside in having invested in the creation of this thing? That’s the risk.”

Some trusts have already started taking equity stakes in digital health companies, such as South Warwickshire FT in company Sensyne.