Can UK Health Trust US Tech?
A remarkable article by a Cambridge-based computer scientist Quentin Stafford-Fraser has set all sorts of alarm bells ringing for me. It is called Living without America and it describes a scenario where the US invades Greenland, territory owned by our NATO ally Denmark, leading to a serious falling out between the UK and the Trump administration.
That, he argues, could then lead Donald Trump to do all sorts of things to disrupt UK access to what have become vital services such as Amazon’s AWS, used by countless organisations in the public and private sectors. He might order all the tech giants to jam UK users from access to Google’s cloud services, Apple’s iCloud or Microsoft Azure, or employ his favourite weapon, tariffs.
This could then see a robust UK government response - stay with me here - with UK firms ordered to remove their data from American data centres.
It would not take more than a few hours for us to realise how totally dependent we are - at home and at work - on American technology. Tens of thousands of my photos and videos would be trapped in the iCloud, my email account, provided by Google, would become inaccessible, even this Substack would sputter to a halt - Google’s AI Overview (something else I wouldn’t be able to access) tells me most of Substack’s servers are located in the United States.
This set me thinking about the digital revolution finally happening in UK healthcare and how reliant on American technology it is. Just a few years ago, a rift with the US would not have been a big problem - so glacial was the pace of change that most medical records were still on paper.
But now the big hospitals are moving to electronic patient records and the supplier of choice for many is Epic, a huge, quite quirky American company whose EPR systems receive lots of praise but not for their openness. Sign up to Epic and it wants everything in your hospital to work on its software, not someone else’s.
Another big supplier to the health service is Microsoft, whose Teams video conferencing platform is becoming as ubiquitous across the NHS as it is in many businesses. AWS is becoming a major provider of cloud services in the health service, as is Google, whose AI division DeepMind has collaborated with UK medical researchers, amid concerns from some privacy campaigners.
And then we have Palantir, the AI software company co-founded by Peter Thiel, who was a Trump backer in the President’s first term, long before his Silicon Valley peers decided that it was safer to bend the knee. Despite growing controversy over its role as a supplier to the US immigration enforcement police ICE, Palantir has been given a £330 million NHS contract to run a platform bringing sensitive patient health data together to deliver new insights.
Now, you might argue that Quentin Stafford-Fraser is being unnecessarily alarmist, first in imagining that the US might invade Greenland, and then that this might lead to a UK/US tech cold war. Well, as far as a US invasion goes, surely the last few weeks have taught us that when Donald Trump gets an idea in his head, however ill-considered, destructive or offensive, he is inclined to act upon it. And we have also learned that he responds to criticism by going on the offensive - TACO (Trump Always Chickens Out) really only applies to countries he regards as equals to the USA, and the UK does not fit into that category.
But surely the American tech giants would not actively conspire with their government against the interests of their British customers? Don’t bet on it. While few share Elon Musk’s vitriolic hatred of our country and its values there is little evidence that any of them are prepared to resist orders from the Trump administration. Witness the incident quoted by Quentin Stafford-Fraser where, following the sanctions imposed by the US on the International Criminal Court, the chief prosecutor suddenly lost access to his Microsoft services. Now, Microsoft’s President Brad Smith vehemently denied that it had acted in this way, but the ICC soon decided that it could do without Microsoft Office and rely instead on some German open-source software.
It is impractical to think that the NHS could do anything in a hurry about its dependence on American technology. But Trusts need to at least consider the open-source alternatives and be wiser about the way they negotiate huge contracts for technology they may not understand. As for politicians of all parties, they need to wean themselves off their pathetic hero worship of Silicon Valley titans - remember Rishi Sunak’s cringeworthy interview with Elon Musk? - and start asking some hard questions about where their loyalties lie.
With China’s Huawei we finally decided that its loyalty was to the Chinese Communist Party and so it could not have a role at the heart of the UK’s 5G networks. Right now, the US and the UK are the closest of allies, sharing intelligence and sworn to defend any Nato member that comes under attack. But if the American President destroys that relationship by invading Greenland, then he will also shatter any trust in US technology.
Great piece. People need to get real -what ever Trump does or doesn't do next, whoever is the next President it should be clear by now that the transatlantic alliance is over -the US can no longer be trusted and Europe has to do all it can to decouple -and fast. Sadly, De Gaulle was right.
I agree that major procurement decisions should always take risk into account. That said, the argument here relies on a large number of nested “what ifs”, many of which pull in different directions.
Achieving genuine independence from US technology and hosting would likely take a decade or more. Over that timeframe, political and economic conditions could change significantly. For example, a change in control of Congress could materially reduce the perceived risk within a year. Equally, a major correction in US tech valuations, whether driven by current politics or an AI-related bubble would itself have political consequences that make some of these scenarios less likely to persist.
International responses also matter. Coordinated action by the EU and UK would be very different from unilateral action, while future UK governments could take markedly different approaches to both the US and the EU. Beyond that, global risks such as a potential conflict over Taiwan would have implications for all world trade, not just US-linked supply chains. Perhaps a Farage government pivots to the US and puts tariffs on EU trade.
All of these are legitimate procurement risks and should be weighted accordingly in long-term decisions. One possible mitigation would be large-scale public investment, tens of billions over several years building domestic capability, though that comes with its own costs and uncertainties. In practice, there are more nuanced and flexible ways to manage risk than assuming a single worst-case trajectory and optimising solely for that.