is crucial, but government incompetence risks undermining the project

Ministers will only receive our backing if they offer three clear safeguards on the use of patients’ data.

A growing population, an ageing population, the rise of co-morbidities and the necessary drive to improve the quality of care and treatments available to patients means that the future success of the NHS will increasingly rely on the data to which it has access. is designed to link together medical records from general practice with data from hospital activity and eventually extending to cover all care settings inside and outside of hospital.

The improvement of healthcare in England in the future depends upon removing the barriers between primary and secondary care, between the GP surgery and the district general hospital and between social care providers and traditional health care providers. Integration is key to meeting the needs of patients in the future and the availability of integrated data is central to shaping the services that will meet these needs.
It’s in this context that the need for should be seen. Labour supports the principle behind it, but not the way this government is going about it. Ministers will only receive our backing if they amend the Care Bill currently passing through Parliament to agree to three clear safeguards.

1. The government should make it easier for concerned patients to opt-out of the proposals, especially online.

2. Data must be genuinely anonymous. They must ensure that any unique identifiers, such as postcodes or NHS numbers, are removed.

3. They must make the Secretary of State accountable for the use of patients’ data.

Mistrust of is not surprising, given the nature of the data involved and the typically haphazard way in which the government has overseen the opt-out programme for patients not wishing to take part.

If you haven’t yet received one, every home in England should have received a leaflet titled "Better information means better Care." Questions to ministers during the recent committee stage of the Care Bill (in which the approval for sits) shows that they don’t yet know if every house has received a leaflet, what the opt-out rate is or what the regional variations in this are.

Incredibly, those who do wish to opt out of the system have to make an appointment with their already over-burdened GPs to do so. They have to take a valuable appointment away from a patient in medical need. Only Jeremy Hunt could pile an unnecessary task upon GPs at a time when primary care is creaking and A&E services across the country take the strain for his repeated policy failures.

That's not all. The chief executives of Mencap, Sense, RNIB, National Autistic Society and Action on Hearing Loss have written to Jeremy Hunt expressing real concerns that information about the scheme is not being communicated in an accessible way to disabled people and that subsequently they are being deprived from making an informed choice about the future of their medical records.

We want to work, it's in everyone's interests that it does. But the government needs to get a grip before the aims of the project are lost on a suspicious public anxious about what is for and how their personal data will be used. Right now, its trademarked incompetence risks compromising this vital project.

Jamie Reed is shadow health minister and MP for Copeland

Health Secretary Jeremy Hunt waits to deliver a speech during his visit with David Cameron to the Evelina London Children's Hospital on July 5 2013. Photograph: Getty Images.

Jamie Reed is Labour MP for Copeland.

Photo: Getty
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Cambridge Analytica and the digital war in Africa

Across the continent, UK expertise is being deployed online to sway elections and target dissidents.

Cambridge Analytica, the British political consultancy caught up in a huge scandal over its use of Facebook data, has boasted that they ran the successful campaigns of President Uhuru Kenyatta in the 2013 and 2017 Kenyan elections. In a secretly filmed video, Mark Turnbull, a managing director for Cambridge Analytica and sister company SCL Elections, told a Channel 4 News’ undercover investigative reporting team that his firm secretly stage-managed Kenyatta’s hotly contested campaigns.

“We have rebranded the entire party twice, written the manifesto, done research, analysis, messaging. I think we wrote all the speeches and we staged the whole thing – so just about every element of this candidate,” Turnbull said of his firm’s work for Kenyatta’s party.

Cambridge Analytica boasts of manipulating voters’ deepest fears and worries. Last year’s Kenyan election was dogged by vicious online propaganda targeting opposition leader Raila Odinga, with images and films playing on people’s concerns about everything from terrorism to spiralling disease. No-one knows who produced the material. Cambridge Analytica denies involvement with these toxic videos – a claim that is hard to square with the company’s boast that they “staged the whole thing.” 

In any event, Kenyatta came to power in 2013 and won a second and final term last August, defeating Odinga by 1.4 million votes.

The work of this British company is only the tip of the iceberg. Another company, the public relations firm, Bell Pottinger, has apologised for stirring up racial hostility in South Africa on behalf of former President Jacob Zuma’s alleged financiers – the Gupta family. Bell Pottinger has since gone out of business.

Some electoral manipulation has been home grown. During the 2016 South African municipal elections the African National Congress established its own media manipulations operation.

Called the “war room” it was the ANC’s own “black ops” centre. The operation ranged from producing fake posters, apparently on behalf of opposition parties, to establishing 200 fake social media “influencers”. The team launched a news site, The New South African, which claimed to be a “platform for new voices offering a different perspective of South Africa”. The propaganda branded opposition parties as vehicles for the rich and not caring for the poor.

While the ANC denied any involvement, the matter became public when the public relations consultant hired by the party went to court for the non-payment of her bill. Among the court papers was an agreement between the claimant and the ANC general manager, Ignatius Jacobs. According to the email, the war room “will require input from the GM [ANC general manager Jacobs] and Cde Nkadimeng [an ANC linked businessman] on a daily basis. The ANC must appoint a political champion who has access to approval, as this is one of the key objectives of the war room.”

Such home-grown digital dirty wars appear to be the exception, rather than the rule, in the rest of Africa. Most activities are run by foreign firms.

Ethiopia, which is now in a political ferment, has turned to an Israeli software company to attack opponents of the government. A Canadian research group, Citizens Lab, reported that Ethiopian dissidents in the US, UK, and other countries were targeted with emails containing sophisticated commercial spyware posing as Adobe Flash updates and PDF plugins.

Citizens Lab says it identified the spyware as a product known as “PC Surveillance System (PSS)”. This is a described as a “commercial spyware product offered by Cyberbit —  an Israel-based cyber security company— and marketed to intelligence and law enforcement agencies.”

This is not the first time Ethiopia has been accused of turning to foreign companies for its cyber-operations. According to Human Rights Watch, this is at least the third spyware vendor that Ethiopia has used to target dissidents, journalists and activists since 2013.

Much of the early surveillance work was reportedly carried out by the Chinese telecom giant, ZTE. More recently it has turned for more advanced surveillance technology from British, German and Italian companies. “Ethiopia appears to have acquired and used United Kingdom and Germany-based Gamma International’s FinFisher and Italy-based Hacking Team’s Remote Control System,” wrote Human Rights Watch in 2014.

Britain’s international development ministry – DFID – boasts that it not only supports good governance but provides funding to back it up. In 2017 the good governance programme had £20 million at its disposal, with an aim is to “help countries as they carry out political and economic reforms.” Perhaps the government should direct some of this funding to investigate just what British companies are up to in Africa, and the wider developing world.

Martin Plaut is a fellow at the Institute of Commonwealth Studies, University of London. He is the author of Understanding Eritrea and, with Paul Holden, the author of Who Rules South Africa?