As the government attempts to deflect concern about the Greensill affair onto the behaviour of civil servants, former Financial Times editor Lionel Barber commented this week that the real reason the Greensill scandal matters is because “Greensill is the privatisation of the NHS writ large: access to data and billing was the big prize and Greensill met everyone who mattered”, referring to the likes of health secretary Matt Hancock, NHS Improvement chair Dido Harding and NHS England boss Simon Stevens.

Greensill’s NHS product appears somewhat esoteric to the uninitiated – an app called ‘Earnd’, which allowed NHS employees to get paid immediately after a shift, rather than waiting for their monthly salary payment. The app was explicitly targeted at lower-paid NHS workers.

As Gabriel Pogrund, the Times journalist who broke the story has commented, it was David Cameron’s lobbying Hancock –including at a ‘private drink’ in 2019 – not chancellor Rishi Sunak, that actually bore fruit and led to a deal being signed.

At first glance, Greensill’s app appears an obscure product for Cameron to stake his reputation on – his statement this week suggests he remains an “enthusiastic advocate” – and an odd one for “everyone who mattered” at the top of the NHS to allow themselves to be lobbied about, in what they surely knew was an inappropriate fashion.

But, in fact, the use of apps – both patient-facing and internal – has been a key bridgehead to cementing NHS privatisation and shovelling valuable data into the hands of the private sector in a plethora of ways, and looks set to remain so under the rubric of ‘digital transformation’.

Hancock, of course, has a longstanding reputation as an enthusiastic advocate for all manner of ‘apps’ currently downloading themselves all over the British health system.

‘Digital transformation’ as a key route to privatisation

Many of us might have encountered some of these apps in the past year.

At the start of the pandemic, the government encouraged GPs to choose one of 11 private suppliers of online video consultations and online ‘triage’ systems – the latter collecting our health data before we get to speak to a doctor. The providers were chosen in a tender period that lasted just 48 hours.

Reasonable in a pandemic, perhaps, when GPs wanted to communicate with their patients with the least risk of infection possible. But now NHS England plans to ’embed’ these systems in general practice, post-COVID – despite reservations expressed by doctors as to the suitability of these approaches. Many point out that these offerings might work for busy, tech-savvy people but tend to be far less popular amongst the older and technologically poorer people who actually use healthcare services the most.

It’s part of a wider direction of travel of ‘digital transformation’ of our NHS, repeatedly held up by prime minister Boris Johnson and Hancock as the key to everything from curing cancer to staff wellbeing – and, just as significantly, held up by key government advisers as being crucial to Britain’s global business offering.

GPs in England were already contractually obliged to offer systems to allow patients to view their medical records online, and were expected to offer video or other online consultations by 2021. But rather than building public infrastructure to deliver these services, the government is outsourcing them.

And many of the privately provided apps doctors are being encouraged to push their patients towards offer much more than a video call or chance to view your records. Depending on which apps and systems your practice has signed up to, you might well find yourself in an ecosystem that upsells you the option of paying for additional tests or allows you to pay to jump the queue to speak to a private healthcare provider. We might chafe against this if our GP brought it up in conversation – but this kind of fudging and nudging of the boundaries between NHS and private healthcare, and who has access to our health data to boot, is so much more frictionless when it’s done at the push of a button.

This post was originally published on Radio Free.