The reasoning behind the Single Palantir Record is incomplete without considering the National Online Hospital. The NOH is entirely missing from the Health Bill, but is a key part of the 10 Year Plan.

The initial argument for the National Online Hospital is that simple cases, check-ins and monitoring can be done via the App at home by a virtual team of doctors (and eventually AIs) who you don’t need to meet with unless you actually want to. That consultation meeting could have been a text message…

Government may respond today at Second reading of the Health Bill about the ghouls and creeps who abuse hospital (and GP) records, most notably recently of Southport and Nottingham victims, and the abuse was deliberately covered up.

A light touch option for light touch cases? Or for all cases?

If your blood pressure is normal and you do your own readings, there’s no need to go to the clinic for that unless you want to – or if a medic spots something is up.

For some conditions, that’s entirely reasonable and it’s what some patients want. 

Indeed, the first nine specialties being addressed by the National Online Hospital all fall into the ‘measurable at home’ bucket – or where many patients report they fall between different silos of the NHS, where remote specialism care might create a better option with no risk of a postcode lottery.

Even if what you end up needing is a blood test or a physical scan of some kind, the online hospital will book you in to wherever is most convenient to you to have it done: your local Community Diagnostics Centre, hospital, or GP.

Care can be prioritised, but it can also be deprioritised – and decisions about new care pathways are being politicised (e.g. ADHD, trans care) which is only possible at national scale. The consequences of national decision making on General Practice will be bad for your local GP, even if it makes DH feel good. 

Also, dealt with from a distance, the overriding imperatives will be about counting patients and showing that process was followed, rather than actually giving individuals the good care that they want.

The Online Hospital will have to keep records

To make this work, there needs to be a universally visible and accessible patient record – maybe on a Data Platform which is “Federated” across the NHS? Enter the Single Palantir Record.

The NOH is starting with low-hanging fruit where there’s clear desire and patient benefit for the new operating model – which will be highly dependent upon the provider of the EPR to make it work, and to design the pathways. Enter Palantir.

There are many reasons to do a National Online Hospital, as well as Community Diagnostic Centres, but when you put them together in this way, the logic becomes clear.

By definition, the Electronic Patient Record for the new NHS Online Hospital will be the Single Palantir Record, because that’s what DH has decided the SPR is for. Arguing that the NOH should have its own different EPR would undermine the reasoning for both the National Online Hospital and a Single Palantir Record. 

Over time, DH will then argue that having a Single Patient Record with everything in it as well as a separate GP record is duplicative – and so the core funding for GP record systems will be cut off, as DH refuses to pay for the duplicate service. (If GPs want to maintain their own systems, they’ll have to pay for them) 

The NHS has to figure out how to deliver care when the Secretary of State may meddle in every minor structural decision they take. When they’re sure the new Hospital is good, they’ll give it the Royal imprint. But not yet.

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