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House of Lords Hansard
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National Health Service: Healthcare Advice
16 July 2019
Volume 799

Question

Asked by

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To ask Her Majesty's Government what analysis they have conducted of the impact of the National Health Service introducing the use of devices such as Amazon’s Alexa for health care advice.

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My Lords, digital technology will play a key role in making the NHS sustainable. The Secretary of State’s technology vision sets the foundation for a new generation of digital services focused on user need, privacy and security, interoperability and inclusion. The collaboration with Amazon simply connects people to medical information and is already freely available through the NHS website. This service does not provide advice or any form of diagnosis. More modes to access medically verified NHS information can only give UK citizens a better understanding of different medical conditions. The agreement with Amazon is convenient for those who rely on voice-activated technology, in particular blind and visually impaired people.

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My Lords, I thank the Minister for her response and might I say it was a good defence? While I have absolute confidence that Matthew Gould—our previous ambassador to Israel who leads on the project—will get it right, voice-recognition technology has its problems. It must recognise the correct phrase, word and accent. It might be interesting to hear the answers that the Opposition Chief Whip were to get if he asked a question with his accent. I asked five questions at the weekend; all health-related. One I repeated twice and got two different pieces of advice: one was to call 999 and the other was to go to bed and rest.

I know that it is not a diagnostic technology, but it runs the risk of a diagnosis being made, so the key questions are what trials are being carried out, what data protection do we have against Amazon collecting vast amounts of data, and what is the risk of misdiagnosis?

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The noble Lord makes very important points. It is important to understand that this is not a technology to offer advice or diagnosis. NHS Digital and NHSX have built an interface to connect the NHS website so that other organisations can make NHS information available on their own sites. That is so that a greater number of people can access NHS information. It has already been made available through a number of other examples such as NHS Go, which is designed to inform young people, accuRx and eConsult. No health data is collected by Amazon. No money is exchanged via this route and all data protection laws, such as GDPR and the NHS data protection rules, still apply. Data protection is still required to protect data through this system.

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My Lords, it is exciting to contemplate the new world of communication technology and how it might help in all kinds of ways, but the noble Lord, Lord Patel, has raised some important points. The NHS-Alexa partnership has to be seen in the context of Amazon’s ambitions for our wider healthcare industry. I seek assurance. I am sure that at the moment the data is being protected, but I want to know what will happen in the future. If Amazon collects yet more data on patients raising medical concerns, what use might be made of that in the future?

I do not know how other noble Lords are getting on with their Alexa in the corner of the sitting room, but ours regularly joins in with conversations and tells us very bad jokes. My granddaughter thinks it is wonderful because she knows what noise a unicorn makes, so I am not sure, as the noble Lord said, how that plays if one is trying to have a serious discussion about a medical condition.

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I thank the noble Baroness for that. I would be interested to know what jokes she has heard from Alexa in her family conversations. However, patients look on well-known search engines for medical advice and at the moment they may receive advice from all sorts of untested sources. NHS.uk is clinically based advice which has been approved by NHS England. The purpose of making that advice more available through the Open API, which is available through the developer system, is to ensure that that clinically based advice is more widely available and more readily searchable for patients. A reasonable point has been raised which is to ensure that the right advice reaches patients and that patients go through the right triage system, whether it is 111 or another system, but that is the intention of the programme. It will be carefully monitored and managed by NHSX, NHS England and the department.

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My Lords, there is a wider principle here. Even if effective, anonymised data is gathered and generated, where does the value lie in that data? Can the Minister tell us whether the Government have discussed and agreed with Amazon where the value lies and who gathers that value? On the overall principle, can the Minister tell us that when this data generates value, it is the NHS that benefits and not the private sector?

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Amazon is not sharing any of the information that it gathers from third parties. It is not selling products or making product recommendations based on health information, nor is it building a health profile on patients. It has strict technical and operational safeguards in place so that Amazon employees will not have direct access to information that can identify any person or account. As I have already said, it does not have access to any health data based on this contract. No health data is being shared between the NHS and Amazon. Just yesterday we launched some new data-sharing principles which are designed to improved clarity around health data-sharing between the NHS and private companies so that we can improve public and clinician confidence on this issue.

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The Minister has just given a very eloquent explanation of her view of the relationship with Amazon, but does she agree that it is a bit counterintuitive to assume that a company as big and commercially successful as Amazon is not getting some value from the relationship with the NHS? Can she explain what that value is?

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Amazon is seeking to ensure that it provides a service to its customers. In this instance, we have ensured that we have provided an open API: any company that chooses to develop a service linking to the information on the NHS website is able to do so. This is not an exclusive contract with Amazon. As I have already said, other companies are able to do so and some already have done. It is not a specific benefit for Amazon. It is something that other companies have already availed themselves of and is of benefit to the NHS and NHS patients.