Palantir, the NHS, and the Art of Selling Hope

I do not hate Palantir. They employ some smart people, and they have done good work in various places. They’re almost certainly worth engaging on projects across the UK public sector. I have written a lot of data connector in my time, and take a weird delight in them. I would probably enjoy working there.

The NSA already has your X-Rays.

The cost of building NHS computer systems genuinely secure from the US (or Chinese) security establishment will never be acceptable.

I, for one, would rather worry about the outdated copies of Windows in every clinic and the widespread use of WhatsApp. The NSA has your X-rays, and can probably read your heartbeat off your Whoop band right now. If for some reason they couldn't, rest assured the UK gov would just give it to them anyway ¯\_(ツ)_/¯

Why NHS IT sucks

My view is as an informed IT professional with no health care experience. If the NHS struggles with IT tasks that are routine to Tesco (itself not a model of efficiency), then we need to look at how the NHS differs from Tesco. We would expect improvement to lie in catching up with other organisations, not in innovating as if its problems are unprecedented.

The NHS is not a single coherently managed thing. There are many trusts, many providers, and dramatically different levels of sophistication across all of them. (Generally lower than you’d want as there’s little pressure to improve.) No-one can fine a family GP for failing to share data properly, and the BMA would probably be hysterical if someone tried.

Changing any of this would require a sustained and politically fraught effort by Ministers with real support from MPs and the Civil Service. It is unlikely they would be thanked for this, and any benefits would mostly come long after they had left.

And so every few decades there is a Ministerial top-down initiative to Fix All The Things. That’s a lot of budget, so distributional coalitions form inside and outside the State around that money. After a while it disappoints, The One True Solution collects bad press, and is orphaned. A process probably better understood in the context of The Rise and Decline of Nations, than any enterprise architecture book.

I don’t think Palantir should be the core of the NHS system because I don’t think their engagement breaks with those failures.

The FDP is just a database actually.

The promise of Palantir’s Foundry software, used for the NHS’s Federated Data Platform (FDP), is a single information space for the NHS. That is not a bad thing.

But the NHS already buys systems to run its hospitals. Joining them all into Foundry means getting them to agree on both on the information and what can be done with it. A hospital’s rules for discharging a patient need to work with Foundry’s without causing inconsistencies.

An effort to join all those systems back into Foundry probably exceeds the effort of writing a single health care management system for the NHS.

A single system is not a terrible national goal, but politically it requires big changes to the NHS before it can be done. Brazil has a single locally developed health management system, Estonia has their own, and a lot of Africa and Latin America are on DHIS2 which is open source. It is not impossible, but it would be a huge change. Particularly when GPs are legally speaking, no more a part of the NHS than my own freelance company.

I have been unable to find a normal trade press review of Foundry. Or any buying guide that compare Foundry and other systems. As a result I will be using anonymous Reddit comments a lot here. That's not what I'd like, but if Palantir want something different they'll have to give a review copy to PCMag like Tableau did 🙂

The existing NHS Spine already requires systems to exchange information in agreed formats. Vendors are unmotivated to do that properly. I do not see them failing in that, and then carrying out the far more challenging task of keeping everything in step with Foundry. Presently, it seems NHS workers are just entering the same data twice. Which may explain its unpopularity more than the politics of the company!

Linking information to rules about what can be done with it isn’t new. I can't find any claims about it that are genuinely novel. An incredible amount of work has been done on business modelling (what Palantir calls "ontology") over decades. Arguably half a century! Read Martin Fowler et al.

Our eternal war on Excel.

Turning to the case for Foundry as a replacement for people making their own little tools. Yes, people using spreadsheets is a problem. Yes, people keeping critical care data on whiteboards is bad. But you can make space for this with Sharepoint or a dozen other platforms. (I hear good things about Baserow.)

Ultimately ad-hoc end user computing will always be with us. The problem is when something intended for 20 people turns into 20,000 users without anyone managing that. But the problem is the lack of management. Visual app builder tools that let someone knock together applications quickly have been with us for a very long time.

There's even quite a lot of work on rapid application development specifically within health care. For example, if a hospital uses DHIS2 (very popular open source Electronic Patient Record software) you can make a new functional module with just a few files, and the WHO has maintained a “solutions exchange” of these for years.

There’s even an emerging app standard across health management systems called SMART-on-FHIR, which is already good enough to support a complex pneumonia treatment tool that’s saved over a 100 lives.

Platform Economics

If Foundry truly solves all the issues it claims, that would be revolutionary. A true mass product that can, and should be implemented by almost any organisation. So why is Palantir’s client base mostly governments and a few very large corporates? Why is it always sold packaged with consultancy?

Could it be that Foundry is too powerful to risk falling into Russian Chinese Iranian hands? Are they, as patriots to the West, choosing to work only with the most critical institutions of our world order?

Or does it actually require large numbers of people to spin plates in the background, while not hugely improving on what already exists on the open market? My money would be on the latter.

For NHS apps that rely on Foundry, everything will need to be built on Palantir’s tools. They even seem to have their own dialect of the Python programming language.

This means retraining everyone. Palantir workshops, Palantir certification, Palantir everything all down the NHS supply chain.

Two (but genuine) Cheers for Palantir

I can’t bring myself to hate Foundry. I like a lot of systems that very similar to it. The whole Digital Twin, business-as-code thing, sings to my heart.

I've had a look through the initial Palantir Learn course, and they don't tell me much about how it works technically, but it is a beautiful vision (even if they insist on renaming things).

If I was coming back from a dusty village in Afghanistan to my field base feeling utterly confused that nothing in the briefing is actually really how things work, I can completely understand how Palantir’s Gotham (from which I think Foundry was extracted) could be perfect.

I can get on my laptop and just start throwing together a little model, share it with my neighbouring commanders and develop it out over time. I can start with an entity that’s just Big Man, and weeks later have a shared database showing Merchants, Taxi drivers, Judges, Sheiks, etc, with little lines between them showing who’s friends with who, who’s buying what from where. It would be great!

The latest versions let you call in AI-managed drone strikes. Amazing! I just don’t feel that’s the environment the NHS operates in 😄

They are not assembling strike teams, they aren’t dealing heroically with unprecedented intelligence situations, they’re running boring systems that already exist, tackling problems that have been largely stable for decades. They need reliable ways for systems to exchange information, a way for patients to login once across the whole NHS, a secure data analysis with tools analysts already know, etc. Palantir is a distraction from that.

What Palantir actually sells

Ultimately, the raison d'être of a lot of consulting-ware companies is to go into backward organisations to sell basic analytics and data capabilities as proprietary magic. This is not the worst thing. At least the light eventually shines in.

And it allows the buyer org to get a lot of custom development work done without HR or procurement rules! Consulting-ware shops do often hire very capable people, and that work will be valuable.

The downside is that all of this is tied to proprietary systems, and the client is hooked on continuing consulting engagements just to keep up to date.

Even if their proprietary software is meh, their consulting and business analysis skills are reportedly great. The UK government should poach lots of their staff!

How Palantir sells it.

Yes, they’re political, but it’s just part of their marketing, which is exceptional.

Against online disinformation when Biden was president. Now they're Team MAGA. In 6 months, they’ll delete all the references to “The West” from their website, and be at the forefront of the US/China AI partnership 🙂

Watch their videos. Palantir is absolutely on point in every single one. Presentation, business focus, nice UI for everything. The messaging on flexibility, decision making, breaking out, etc is consistent in everything Palantir does.

They clearly even do their engineer's hair before shoots 🤩

And their marketing is boosted by quick high impact pro-bono project delivered competently under stress during crises.

Just look at the production quality on this!

You just watch it and want to support Labour Together, the Heritage Foundation, hunt down illegal migrants, oppose Russia China Russia, and put your kids in NATO run NGO projects all at once!

“Buying is an activity understood by economists. Shopping is a phenomenon of interest to anthropologists and sociologists.”
― Marc Gobé, Emotional Branding

They auramaxx their brand exquisitely 🤌 I admire them for it!

They've created an energised base of supporters who resemble crypto token holders more than equity investors.

No small Twitter account will make accusations of being against “Western civilisation” for not wanting to buy Business Objects or Microsoft SQL Server 😀

But Palantir's excellence in brand and buying connections exacerbates the main issue with every NHS IT overhaul: false hope.

What is to be done.

The NHS doesn’t need another platform. It really doesn’t. It needs to catch up with Citigroup or Tesco in 2007. Many trusts have.

1. Fix the spine. Fire vendors, fire staff, bully people as necessary, but get them to correctly use the Spine that is there.
2. Spread best practices across NHS trusts. The Eastern England Secure Data Environment looks excellent! It seems like Manchester's Data Environment was good enough to serve as an example of what the FDP could deliver! Enforce security standards.
3. Pay more. Someone should see moving from Google to the NHS as a promotion. UK gov shouldn’t be sneaking contract work into software deals in 2026. The NHS competes for talent with finance and Silicon Valley.

If individual NHS Trusts want to pay for Palantir through their normal budgets, I think that's fine. Some are using the little FDP tools, I don't think we should disrupt them.

Perhaps there’s an advantage to having some shared records across the NHS to coordinate access to resources. I would suggest those are best built by NHS Digital with a little help from contractors. Maybe get in some people from Ocado 🙂

Aura and parting thoughts.

Ask yourself sincerely, how many senior Ministers and Civil Servants involved in this decision making know that DHIS2 exists? Or how to use a database reporting tool? In a sense, should they?

They know that Palantir is on their side against The Blob/Rightwing Extremism/Woke/Those Annoying Students/ISIS etc, that it did amazing work for the country during Covid, that NHS tech just seems slightly confused and hapless, and that they might get a job in California after leaving government with the next outgoing PM 🇬🇧🚀

Tech has never been pure. Oracle was CIA funded. Everyone has defence contracts. The less asked about IBM's WW2 history the better 😬

Morally perhaps, we should grant Palantir the grace we grant ourselves every day. But if we're going to take politics out of supplier evaluation, we need to take it all out.

Again, Palantir do not bravely weather public critique. They incite and feed on it as a deliberate marketing strategy. It avoids questions like "Why we would pay a bunch of outsourced engineers to re-implement known functionality on an expensive niche platform?" 🙂

Palantir should be a data tooling and consulting supplier. One of many.

But being hated by The Canary, or protested by activists, does not magically make Palantir a solution for preserving "The West", or indeed, helping an overworked hospital manager cope with their patients.

A condensed version of the original, made with love and ChatGPT 6.