Category Archives: care.data

AI, care.data, change management, transparency

The power behind today’s AI in public services

The power behind today’s AI in public services

Thinking about whether education in England is preparing us for the jobs of the future, means also thinking about how technology will influence it.

Time and again, thinking and discussion about these topics is siloed. At the Turing Institute, the Royal Society, the ADRN and EPSRC, in government departments, discussions on data, or within education practitioner, and public circles — we are all having similar discussions about data and ethics, but with little ownership and no goals for future outcomes. If government doesn’t get it, or have time for it, or policy lacks ethics by design, is it in the public interest for private companies, Google et al., to offer a fait accompli?

There is lots of talking about Machine Learning (ML), Artificial Intelligence (AI) and ethics. But what is being done to ensure that real values — respect for rights, human dignity, and autonomy — are built into practice in the public services delivery?

In most recent data policy it is entirely absent. The Digital Economy Act s33 risks enabling, through removal of inter and intra-departmental data protections, an unprecedented expansion of public data transfers, with “untrammelled powers”. Powers without codes of practice, promised over a year ago. That has fall out for the trustworthiness of legislative process, and data practices across public services.

Predictive analytics is growing but poorly understood in the public and public sector.

There is already dependence on computers in aspects of public sector work. Its interactions with others in sensitive situations demands better knowledge of how systems operate and can be wrong. Debt recovery, and social care to take two known examples.

Risk averse, staff appear to choose not to question the outcome of ‘algorithmic decision making’ or do not have the ability to do so. There is reportedly no analysis training for practitioners, to understand the basis or bias of conclusions. This has the potential that instead of making us more informed, decision-making by machine makes us humans less clever.

What does it do to professionals, if they feel therefore less empowered? When is that a good thing if it overrides discriminatory human decisions? How can we tell the difference and balance these risks if we don’t understand or feel able to challenge them?

In education, what is it doing to children whose attainment is profiled, predicted, and acted on to target extra or less focus from school staff, who have no ML training and without informed consent of pupils or parents?

If authorities use data in ways the public do not expect, such as to ID homes of multiple occupancy without informed consent, they will fail the future to deliver uses for good. The ‘public interest’, ‘user need,’ and ethics can come into conflict according to your point of view. The public and data protection law and ethics object to harms from use of data. This type of application has potential to be mind-blowingly invasive and reveal all sorts of other findings.

Widely informed thinking must be made into meaningful public policy for the greatest public good

Our politicians are caught up in the General Election and buried in Brexit.

Meanwhile, the commercial companies taking AI first rights to capitalise on existing commercial advantage could potentially strip public assets, use up our personal data and public trust, and leave the public with little public good. We are already used by global data players, and by machine-based learning companies, without our knowledge or consent. That knowledge can be used to profit business models, that pay little tax into the public purse.

There are valid macro economic arguments about whether private spend and investment are preferable compared with a state’s ability to do the same. But these companies make more than enough to do it all. Does it signal a failure to a commitment to the wider community; not paying just amounts of taxes, is it a red flag to a company’s commitment to public good?

What that public good should look like, depends on who is invited to participate in the room, and not to tick boxes, but to think and to build.

The Royal Society’s Report on AI and Machine Learning published on April 25, showed a working group of 14 participants, including two Google DeepMind representatives, one from Amazon, private equity investors, and academics from cognitive science and genetics backgrounds.

Our #machinelearning working group chair, professor Peter Donnelly FRS, on today’s major #RSMachinelearning report https://t.co/PBYjzlESmB pic.twitter.com/RM9osnvOMX

— The Royal Society (@royalsociety) April 25, 2017

If we are going to form objective policies the inputs that form the basis for them must be informed, but must also be well balanced, and be seen to be balanced. Not as an add on, but be in the same room.

As Natasha Lomas in TechCrunch noted, “Public opinion is understandably a big preoccupation for the report authors — unsurprisingly so, given that a technology that potentially erodes people’s privacy and impacts their jobs risks being drastically unpopular.”

“The report also calls on researchers to consider the wider impact of their work and to receive training in recognising the ethical implications.”

What are those ethical implications? Who decides which matter most? How do we eliminate recognised discriminatory bias? What should data be used for and AI be working on at all? Who is it going to benefit? What questions are we not asking? Why are young people left out of this debate?

Who decides what the public should or should not know?

AI and ML depend on data. Data is often talked about as a panacea to problems of better working together. But data alone does not make people better informed. In the same way that they fail, if they don’t feel it is their job to pick up the fax. A fundamental building block of our future public and private prosperity is understanding data and how we, and the AI, interact. What is data telling us and how do we interpret it, and know it is accurate?

How and where will we start to educate young people about data and ML, if not about their own and use by government and commercial companies?

The whole of Chapter 5 in the report is very good as a starting point for policy makers who have not yet engaged in the area. Privacy while summed up too short in conclusions, is scattered throughout.

Blind spots remain, however.

  • Over willingness to accommodate existing big private players as their expertise leads design, development and a desire to ‘re-write regulation’.
  • Slowness to react to needed regulation in the public sector (caught up in Brexit) while commercial drivers and technology change forge ahead
  • ‘How do we develop technology that benefits everyone’ must not only think UK, but global South, especially in the bias in how AI is being to taught, and broad socio-economic barriers in application
  • Predictive analytics and professional application = unwillingness to question the computer result. In children’s social care this is already having a damaging upturn in the family courts (S31)
  • Data and technology knowledge and ethics training, must be embedded across the public sector, not only post grad students in machine learning.
  • Harms being done to young people today and potential for intense future exploitation, are being ignored by policy makers and some academics. Safeguarding is often only about blocking in case of liability to the provider, stopping children seeing content, or preventing physical exploitation. It ignores exploitation by online platform firms, and app providers and games creators, of a child’s synthesised online life and use. Laws and government departments’ own practices can be deeply flawed.
  • Young people are left out of discussions which, after all, are about their future. [They might have some of the best ideas, we miss at our peril.]

There is no time to waste

Children and young people have the most to lose while their education, skills, jobs market, economy, culture, care, and society goes through a series of gradual but seismic shift in purpose, culture, and acceptance before finding new norms post-Brexit. They will also gain the most if the foundations are right. One of these must be getting age verification right in GDPR, not allowing it to enable a massive data grab of child-parent privacy.

Although the RS Report considers young people in the context of a future workforce who need skills training, they are otherwise left out of this report.

“The next curriculum reform needs to consider the educational needs of young people through the lens of the implications of machine learning and associated technologies for the future of work.”

Yes it does, but it must give young people and the implications of ML broader consideration for their future, than classroom or workplace.

Facebook has targeted vulnerable young people, it is alleged, to facilitate predatory advertising practices. Some argue that emotive computing or MOOCs belong in the classroom. Who decides?

We are not yet talking about the effects of teaching technology to learn, and its effect on public services and interactions with the public. Questions that Sam Smith asked in Shadow of the smart machine: Will machine learning end?

At the end of this Information Age we are at a point when machine learning, AI and biotechnology are potentially life enhancing or could have catastrophic effects, if indeed “AI will cause people ‘more pain than happiness” as described by Alibaba’s founder Jack Ma.

The conflict between commercial profit and public good, what commercial companies say they will do and actually do, and fears and assurances over predicted outcomes is personified in the debate between Demis Hassabis, co-founder of DeepMind Technologies, (a London-based machine learning AI startup), and Elon Musk, discussing the perils of artificial intelligence.

Vanity Fair reported that, “Elon Musk began warning about the possibility of A.I. running amok three years ago. It probably hadn’t eased his mind when one of Hassabis’s partners in DeepMind, Shane Legg, stated flatly, “I think human extinction will probably occur, and technology will likely play a part in this.””

Musk was of the opinion that A.I. was probably humanity’s “biggest existential threat.”

We are not yet joining up multi disciplinary and cross sector discussions of threats and opportunities

Jobs, shift in needed skill sets for education, how we think, interact, value each other, accept or reject ownership and power models; and later, from the technology itself. We are not yet talking conversely, the opportunities that the seismic shifts offer in real terms. Or how and why to accept or reject or regulate them.

Where private companies are taking over personal data given in trust to public services, it is reckless for the future of public interest research to assume there is no public objection. How can we object, if not asked? How can children make an informed choice? How will public interest be assured to be put ahead of private profit? If it is intended on balance to be all about altruism from these global giants, then they must be open and accountable.

Private companies are shaping how and where we find machine learning and AI gathering data about our behaviours in our homes and public spaces.

SPACE10, an innovation hub for IKEA is currently running a survey on how the public perceives and “wants their AI to look, be, and act”, with an eye on building AI into their products, for us to bring flat-pack into our houses.

As the surveillance technology built into the Things in our homes attached to the Internet becomes more integral to daily life, authorities are now using it to gather evidence in investigations; from mobile phones, laptops, social media, smart speakers, and games. The IoT so far seems less about the benefits of collaboration, and all about the behavioural data it collects and uses to target us to sell us more things. Our behaviours tell much more than how we act. They show how we think inside the private space of our minds.

Do you want Google to know how you think and have control over that? The companies of the world that have access to massive amounts of data, and are using that data to now teach AI how to ‘think’. What is AI learning? And how much should the State see or know about how you think, or try to predict it?

Who cares, wins?

It is not overstated to say society and future public good of public services, depends on getting any co-dependencies right. As I wrote in the time of care.data, the economic value of data, personal rights and the public interest are not opposed to one another, but have synergies and co-dependency. One player getting it wrong, can create harm for all. Government must start to care about this, beyond the side effects of saving political embarrassment.

Without joining up all aspects, we cannot limit harms and make the most of benefits. There is nuance and unknowns. There is opaque decision making and secrecy, packaged in the wording of commercial sensitivity and behind it, people who can be brilliant but at the end of the day, are also, human, with all our strengths and weaknesses.

And we can get this right, if data practices get better, with joined up efforts.

Our future society, as our present, is based on webs of trust, on our social networks on- and offline, that enable business, our education, our cultural, and our interactions. Children must trust they will not be used by systems. We must build trustworthy systems that enable future digital integrity.

The immediate harm that comes from blind trust in AI companies is not their AI, but the hidden powers that commercial companies have to nudge public and policy maker behaviours and acceptance, towards private gain. Their ability and opportunity to influence regulation and future direction outweighs most others. But lack of transparency about their profit motives is concerning. Carefully staged public engagement is not real engagement but a fig leaf to show ‘the public say yes’.

The unwillingness by Google DeepMind, when asked at their public engagement event, to discuss their past use of NHS patient data, or the profit model plan or their terms of NHS deals with London hospitals, should be a warning that these questions need answers and accountability urgently.

As TechCrunch suggested after the event, this is all “pretty standard playbook for tech firms seeking to workaround business barriers created by regulation.” Calls for more data, might mean an ever greater power shift.

Companies that have already extracted and benefited from personal data in the public sector, have already made private profit. They and their machines have learned for their future business product development.

A transparent accountable future for all players, private and public, using public data is a necessary requirement for both the public good and private profit. It is not acceptable for departments to hide their practices, just as it is unacceptable if firms refuse algorithmic transparency.

“Rebooting antitrust for the information age will not be easy. It will entail new risks: more data sharing, for instance, could threaten privacy. But if governments don’t want a data economy dominated by a few giants, they will need to act soon.” [The Economist, May 6]

If the State creates a single data source of truth, or private Giant tech thinks it can side-step regulation and gets it wrong, their practices screw up public trust. It harms public interest research, and with it our future public good.

But will they care?

If we care, then across public and private sectors, we must cherish shared values and better collaboration. Embed ethical human values into development, design and policy. Ensure transparency of where, how, who and why my personal data has gone.

We must ensure that as the future becomes “smarter”, we educate ourselves and our children to stay intelligent about how we use data and AI.

We must start today, knowing how we are used by both machines, and man.

First published on Medium for a change.

care.data, change management, datasharing, engagement, ethics, HSCIC, human rights, NHS England, politics, privacy

A vanquished ghost returns as details of distress required in NHS opt out

It seems the ugly ghosts of care.data past were alive and well at NHS Digital this Christmas.

Old style thinking, the top-down patriarchal ‘no one who uses a public service should be allowed to opt out of sharing their records. Nor can people rely on their record being anonymised,‘ that you thought was vanquished, has returned with a vengeance.

The Secretary of State for Health, Jeremy Hunt, has reportedly  done a U-turn on opt out of the transfer of our medical records to third parties without consent.

That backtracks on what he said in Parliament on January 25th, 2014 on opt out of anonymous data transfers, despite the right to object in the NHS constitution [1].

So what’s the solution? If the new opt out methods aren’t working, then back to the old ones and making Section 10 requests? But it seems the Information Centre isn’t keen on making that work either.

All the data the HSCIC holds is sensitive and as such, its release risks patients’ significant harm or distress [2] so it shouldn’t be difficult to tell them to cease and desist, when it comes to data about you.

But how is NHS Digital responding to people who make the effort to write directly?

Someone who “got a very unhelpful reply” is being made to jump through hoops.

If anyone asks that their hospital data should not be used in any format and passed to third parties, that’s surely for them to decide.

Let’s take the case study of a woman who spoke to me during the whole care.data debacle who had been let down by the records system after rape. Her NHS records subsequently about her mental health care were inaccurate, and had led to her being denied the benefit of private health insurance at a new job.

Would she have to detail why selling her medical records would cause her distress? What level of detail is fair and who decides? The whole point is, you want to keep info confidential.

Should you have to state what you fear? “I have future distress, what you might do to me?” Once you lose control of data, it’s gone. Based on past planning secrecy and ideas for the future, like mashing up health data with retail loyalty cards as suggested at Strata in November 2013 [from 16:00] [2] no wonder people are sceptical. 

Given the long list of commercial companies,  charities, think tanks and others that passing out our sensitive data puts at risk and given the Information Centre’s past record, HSCIC might be grateful they have only opt out requests to deal with, and not millions of medical ethics court summonses. So far.

HSCIC / NHS Digital has extracted our identifiable records and has given them away, including for commercial product use, and continues give them away, without informing us. We’ve accepted Ministers’ statements and that a solution would be found. Two years on, patience wears thin.

“Without that external trust, we risk losing our public mandate and then cannot offer the vital insights that quality healthcare requires.”

— Sir Nick Partridge on publication of the audit report of 10% of 3,059 releases by the HSCIC between 2005-13

— Andy WIlliams said, “We want people to be certain their choices will be followed.”

Jeremy Hunt said everyone should be able to opt out of having their anonymised data used. David Cameron did too when the plan was  announced in 2012.

In 2014 the public was told there should be no more surprises. This latest response is not only a surprise but enormously disrespectful.

When you’re trying to rebuild trust, assuming that we accept that ‘is’ the aim, you can’t say one thing, and do another.  Perhaps the Department for Health doesn’t like the public answer to what the public wants from opt out, but that doesn’t make the DH view right.

Perhaps NHS Digital doesn’t want to deal with lots of individual opt out requests, that doesn’t make their refusal right.

Kingsley Manning recognised in July 2014, that the Information Centre “had made big mistakes over the last 10 years.” And there was “a once-in-a-generation chance to get it right.”

I didn’t think I’d have to move into the next one before they fix it.

The recent round of 2016 public feedback was the same as care.data 1.0. Respect nuanced opt outs and you will have all the identifiable public interest research data you want. Solutions must be better for other uses, opt out requests must be respected without distressing patients further in the process, and anonymous must mean  anonymous.

“Pseudonymised data requests that go through the DARS process so that a Data Sharing Framework Contract and Data Sharing Agreement are in place are considered to be compliant with the ICO code of practice“ – fine, but they are not anonymous. If DARS is still giving my family’s data to Experian, Harvey Walsh, and co, despite opt out, I’ll be furious.

The [Caldicott 2] Review Panel found “that commissioners do not need dispensation from confidentiality, human rights & data protection law.”

Neither do our politicians, their policies or ALBs.

[1] https://www.england.nhs.uk/ourwork/tsd/ig/ig-fair-process/further-info-gps/

“A patient can object to their confidential personal information from being disclosed out of the GP Practice and/or from being shared onwards by the HSCIC for non-direct care purposes (secondary purposes).”

[2] Minimum Mandatory Measures http://www.nationalarchives.gov.uk/documents/information-management/cross-govt-actions.pdf p7

#caredata, AI, care.data, change

DeepMind or DeepMined? NHS public data, engagement and regulation repackaged

A duty of confidentiality and the regulation of medical records are as old as the hills. Public engagement on attitudes in this in context of the NHS has been done and published by established social science and health organisations in the last three years. So why is Google DeepMind (GDM) talking about it as if it’s something new? What might assumed consent NHS-wide mean in this new context of engagement? Given the side effects for public health and medical ethics of a step-change towards assumed consent in a commercial product environment, is this ‘don’t be evil’ shift to ‘do no harm’ good enough?  Has Regulation failed patients?
My view from the GDM patient and public event, September 20.

Involving public and patients

Around a hundred participants joined the Google DeepMind public and patient event,  in September after which Paul Wicks gave his view in the BMJ afterwards, and rightly started with the fact the event was held in the aftermath of some difficult questions.

Surprisingly, none were addressed in the event presentations. No one mentioned data processing failings, the hospital Trust’s duty of confidentiality, or criticisms in the press earlier this year. No one talked about the 5 years of past data from across the whole hospital or monthly extracts that were being shared and had first been extracted for GDM use without consent.

I was truly taken aback by the sense of entitlement that came across. The decision by the Trust to give away confidential patient records without consent earlier in 2015/16 was either forgotten or ignored and until the opportunity for questions,  the future model was presented unquestioningly. The model for an NHS-wide hand held gateway to your records that the announcement this week embeds.

What matters on reflection is that the overall reaction to this ‘engagement’ is bigger than the one event, bigger than the concepts of tools they could hypothetically consider designing, or lack of consent for the data already used.

It’s a massive question of principle, a litmus test for future commercial users of big, even national population-wide public datasets.

Who gets a say in how our public data are used? Will the autonomy of the individual be ignored as standard, assumed unless you opt out, and asked for forgiveness with a post-haste opt out tacked on?

Should patients just expect any hospital can now hand over all our medical histories in a free-for-all to commercial companies and their product development without asking us first?

Public and patient questions

Where data may have been used in the algorithms of the DeepMind black box, there was a black hole in addressing patient consent.

Public engagement with those who are keen to be involved, is not a replacement for individual permission from those who don’t want to be, and who expected a duty of patient-clinician confidentiality.

Tellingly, the final part of the event tried to be a capture our opinions on how to involve the public. Right off the bat the first question was one of privacy. Most asked questions about issues raised to date, rather than looking to design the future. Ignoring those and retrofitting a one-size fits all model under the banner of ‘engagement’ won’t work until they address concerns of those people they have already used and the breach of trust that now jeopardises people’s future willingness to be involved, not only in this project, but potentially other research.

This event should have been a learning event for Google which is good at learning and uses people to do it both by man and machine.

But from their post-media reaction after  this week’s announcement it seems not all feedback or lessons learned are welcome.

Google DeepMind executives were keen to use patient case studies and had patients themselves do the most talking, saying how important data is to treat kidney and eyecare, which I respect greatly. But there was very little apparent link why their experience was related to Google DeepMind at all or products created to date.

Google DeepMind has the data from every patient in the hospital in recent years, not only patients affected by this condition and not data from the people who will be supported directly by this app.

Yet GoogleDeepMind say this is “direct care” not research. Hard to be for direct care when you are no longer under the hospital’s care. Implied consent for use of sensitive health data, needs to be used in alignment with the purposes for which it was given. It must be fair and lawful.

If data users don’t get that, or won’t accept it, they should get out of healthcare and our public data right now. Or heed advice of critical friends and get it right to be trustworthy in future. .

What’s the plan ahead?

Beneath the packaging, this came across as a pitch on why Google DeepMind should get access to paid-for-by-the-taxpayer NHS patient data. They have no clinical background or duty of care. They say they want people to be part of a rigorous process, including a public/patient panel, but it’s a process they clearly want to shape and control, and for a future commercial model. Can a public panel be truly independent, and ethical, if profit plays a role?

Of course it’s rightly exciting for healthcare to see innovation and drives towards better clinical care, but not only the intent but how it gets done matters. This matters because it’s not a one-off.

The anticipation in the room of ‘if only we could access the whole NHS data cohort’ was tangible in the room, and what a gift it would be to commercial companies and product makers. Wrapped in heart wrenching stories. Stories of real-patients, with real-lives who genuinely want improvement for all. Who doesn’t want that? But hanging on the coat tails of Mr Suleyman were a range of commmercial companies and third party orgs asking for the same.

In order to deliver those benefits and avoid its risks there is well-established framework of regulation and oversight of UK  practitioners and use of medical records and in medical devices and tools: the General Medical Council, the Health and Social Care Information Centre (Now called ‘NHS Digital’), Confidentiality Advisory Group (CAG)and more, all have roles to play.

Google DeepMind and the Trusts have stepped outwith that framework and been playing catch up not only with public involvement, but also with MHRA regulatory approval.

One of the major questions is around the invisibility of data science decisions that have direct interventions in people’s life and death.

The ethics of data sciences in which decisions are automated, requires us to “guard against dangerous assumptions that algorithms are near-perfect, or more perfect than human judgement.”  (The Opportunities and Ethics of Big Data. [1])

If Google DeepMind now plans to share their API widely who will proof their tech? Who else gets to develop something similar?

Don’t be evil 2.0

Google DeepMind appropriated ‘do no harm’ as the health event motto, echoing the once favored Google motto ‘don’t be evil’.

However, they really needed to address that the fragility of some patients’ trust in their clinicians has been harmed already, before DeepMind has even run an algorithm on the data, simply because patient data was given away with patients’ permission.

A former Royal Free patient spoke to me at the event and said they were shocked to have to have first read in the papers that their confidential medical records had been given to Google without their knowledge. Another said his mother had been part of the cohort and has concerns. Why weren’t they properly informed? The public engagement work they should to my mind be doing, is with the London hospital individual patients whose data they have already been using without their consent, explaining why they got their confidential medical records without telling them, and addressing their questions and real concerns. Not at a flash public event.

I often think in the name, they just left off the ‘e’. They are Google. We are the deep mined. That may sound flippant but it’s not the intent. It’s entirely serious. Past patient data was handed over to mine, in order to think about building a potential future tool.

There was a lot of if, future, ambition, and sweeping generalisations and ‘high-level sketches’ of what might be one day. You need moonshots to boost discovery, but losing patient trust even of a few people, cannot be a casualty we should casually accept. For the company there is no side effect. For patients, it could last a lifetime.

If you go back to the roots of health care, you could take the since misappropriated Hippocratic Oath and quote not only, as Suleyman did, “do no harm” , but the next part. “I will not play God.”

Patriarchal top down Care.data was a disastrous model of engagement that confused communication with ‘tell the public loudly and often what we want to happen, what we think best, and then disregard public opinion.’ A model that doesn’t work.

The recent public engagement event on the National Data Guardian work consent models certainly appear from the talks to be learning those lessons. To get it wrong in commercial use, will be disastrous.

The far greater risk from this misadventure is not company  reputation, which seems to be top among Google DeepMind’s greatest concern. The risk that Google DeepMind seems prepared to take is one that is not at its cost, but that of public trust in the hospitals and NHS brand, public health, and its research.

Commercial misappropriation of patient data without consent could set back restoration of public trust and work towards a better model that has been work-in-progress since care.data car crash of 2013.

You might be able to abdicate responsibility if you think you’re not the driver. But where does the buck stop for contributory failure?

All this, says Google DeepMind, is nothing new, but Google isn’t other companies and this is a massive pilot move by a corporate giant into first appropriating and then brokering access to NHS-wide data to make an as-yet opaque private profit.  And being paid by the hospital trust to do so. Creating a data-sharing access infrastructure for the Royal Free is product development and one that had no permission to use 5 years worth of patient records to do so.

The care.data catastrophe may have damaged public trust and data access for public interest research for some time, but it did so doing commercial interests a massive favour. An assumption of ‘opt out’ rather than ‘opt in’ has become the NHS model. If the boundaries are changing of what is assumed under that, do the public still have no say in whether that is satisfactory? Because it’s not.

This example should highlight why an opt out model of NHS patient data is entirely unsatisfactory and cannot continue for these uses.

Should boundaries be in place?

So should boundaries in place in the NHS before this spreads. Hell yes. If as Mustafa said, it’s not just about developing technology but the process, regulatory and governance landscapes, then we should be told why their existing use of patient data intended for the Streams app development steam-rollered through those existing legal and ethical landscapes we have today. Those frameworks exist to preserve patients from quacks and skullduggery.

This then becomes about the duty of the controller and rights of the patient. It comes back to what we release, not only how it is used.

Can a panel of highly respected individuals intervene to embed good ethics if plans conflict with the purpose of making money from patients? Where are the boundaries between private and public good? Where they quash consent, where are its limitations and who decides? What boundaries do hospital trusts think they have on the duty of confidentiality?

It is for the hospitals as the data controllers from information received through their clinicians that responsibility lies.

What is next for Trusts? Giving an entire hospital patient database to supermarket pharmacies, because they too might make a useful tool? Mash up your health data with your loyalty card? All under assumed consent because product development is “direct care” because it’s clearly not research? Ethically it must be opt in.

App development is not using data for direct care. It is in product development. Post-truth packaging won’t fly. Dressing up the donkey by simply calling it by another name, won’t transform it into a unicorn, no matter how much you want to believe in it.

“In some sense I recognise that we’re an exceptional company, in other senses I think it’s important to put that in the wider context and focus on the patient benefit that we’re obviously trying to deliver.” [TechCrunch, November 22]

We’ve heard the cry, to focus on the benefit before. Right before care.data  failed to communicate to 50m people what it was doing with their health records. Why does Google think they’re different? They don’t. They’re just another company normalising this they say.

The hospitals meanwhile, have been very quiet.

What do patients want?

This was what Google DeepMind wanted to hear in the final 30 minutes of the event, but didn’t get to hear as all the questions were about what have you done so far and why?

There is already plenty of evidence what the public wants on the use of their medical records, from public engagement work that has already been done around NHS health data use from workshops and surveys since 2013. Public opinion is pretty clear. Many say companies should not get NHS records for commercial exploitation without consent at all (in the ESRC public dialogues on data in 2013, the Royal Statistical Society’s data trust deficit with lessons for policy makers work with Ipsos MORI in 2014, and the Wellcome Trust one-way mirror work in 2016 as well of course as the NHS England care.data public engagement workshops in 2014).

mirror

All those surveys and workshops show the public have consistent levels of concern about having a lack of control over who has access to their NHS data for what purposes and unlimited scope or future, and commercial purposes of their data is a red-line for many people.

A red-line which this Royal Free Google DeepMind project appeared to want to wipe out as if it had never been drawn at all.

I am sceptical that Google DeepMind has not done their research into existing public opinion on health data uses and research.

Those studies in public engagement already done by leading health and social science bodies state clearly that commercial use is a red line for some.

So why did they cross it without consent? Tell me why I should trust the hospitals to get this right with this company but trust you not to get it wrong with others. Because Google’s the good guys?

If this event and thinking ‘let’s get patients to front our drive towards getting more data’ sought to legitimise what they and these London hospitals are already getting wrong, I’m not sure that just ‘because we’re Google’ being big, bold and famous for creative disruption, is enough. This is a different game afoot. It will be a game-changer for patient rights to privacy if this scale of commercial product exploitation of identifiable NHS data becomes the norm at a local level to decide at will. No matter how terrific the patient benefit should be, hospitals can’t override patient rights.

If this steamrollers over consent and regulations, what next?

Regulation revolutionised, reframed or overruled

The invited speaker from Patients4Data spoke in favour of commercial exploitation as a benefit for the NHS but as Paul Wicks noted, was ‘perplexed as to why “a doctor is worried about crossing the I’s and dotting the T’s for 12 months (of regulatory approval)”.’

Appropriating public engagement is one thing. Appropriating what is seen as acceptable governance and oversight is another. If a new accepted model of regulation comes from this, we can say goodbye to the old one.  Goodbye to guaranteed patient confidentiality. Goodbye to assuming your health data are not open to commercial use.  Hello to assuming opt out of that use is good enough instead.

Trusted public regulatory and oversight frameworks exist for a reason. But they lag behind the industry and what some are doing. And if big players can find no retribution in skipping around them and then being approved in hindsight there’s not much incentive to follow the rules from the start. As TechCrunch suggested after the event, this is all “pretty standard playbook for tech firms seeking to workaround business barriers created by regulation.”

Should patients just expect any hospital can now hand over all our medical histories in a free-for-all to commercial companies without asking us first? It is for the Information Commissioner to decide whether the purposes of product design were what patients expected their data to be used for, when treated 5 years ago.

The state needs to catch up fast. The next private appropriation of the regulation of  AI collaboration oversight, has just begun. Until then, I believe civil society will not be ‘pedalling’ anything, but I hope will challenge companies cheek by jowl in any race to exploit personal confidential data and universal rights to privacy [2] by redesigning regulation on company terms.

Let’s be clear. It’s not direct care. It’s not research. It’s product development. For a product on which the commercial model is ‘I don’t know‘. How many companies enter a 5 year plan like that?

Benefit is great. But if you ignore the harm you are doing in real terms to real lives and only don’t see it because they’ve not talked to you, ask yourself why that is, not why you don’t believe it matters.

There should be no competition in what is right for patient care and data science and product development. The goals should be the same. Safe uses of personal data in ways the public expect, with no surprises. That means consent comes first in commercial markets.

[1] Olivia Varley-Winter, Hetan Shah, ‘The opportunities and ethics of big data: practical priorities for a national Council of Data Ethics.’ Theme issue ‘The ethical impact of data science’ compiled and edited by Mariarosaria Taddeo and Luciano Floridi. [The Royal Society, Volume 374, issue 2083]

[2] Universal rights to privacy: Upcoming Data Protection legislation (GDPR) already in place and enforceable from May 25, 2018 requires additional attention to fair processing, consent, the right to revoke it, to access one’s own and seek redress for inaccurate data. “The term “child” is not defined by the GDPR. Controllers should therefore be prepared to address these requirements in notices directed at teenagers and young adults.”

The Rights of the Child: Data policy and practice about children’s confidential data will impinge on principles set out in the United Nations Convention on the Rights of the Child, Article 12, the right to express views and be heard in decisions about them and Article 16 a right to privacy and respect for a child’s family and home life if these data will be used without consent. Similar rights that are included in the common law of confidentiality.

Article 8 of the Human Rights Act 1998 incorporating the European Convention on Human Rights Article 8.1 and 8.2 that there shall be no interference by a  public authority on the respect of private and family life that is neither necessary or proportionate.

Judgment of the Court of Justice of the European Union in the Bara case (C‑201/14) (October 2015) reiterated the need for public bodies to legally and fairly process personal data before transferring it between themselves. Trusts need to respect this also with contractors.

The EU Charter of Fundamental Rights, Article 52 also protects the rights of individuals about data and privacy and Article 52 protects the essence of these freedoms.

#caredata, care.data, change management, consent, datasharing, engagement, HSCIC, NHS, NHS England, privacy, trust

care.data listening events and consultation: The same notes again?

If lots of things get said in a programme of events, and nothing is left around to read about it, did they happen?

The care.data programme 2014-15 listening exercise and action plan has become impossible to find online. That’s OK, you might think, the programme has been scrapped. Not quite.

You can give your views online until September 7th on the new consultation, “New data security standards and opt-out models for health and social care”  and/or attend the new listening events, September 26th in London, October 3rd in Southampton and October 10th in Leeds.

The Ministerial statement on July 6, announced that NHS England had taken the decision to close the care.data programme after the review of data security and consent by Dame Fiona Caldicott, the National Data Guardian for Health and Care.

But the same questions are being asked again around consent and use of your medical data, from primary and secondary care. What a very long questionnaire asks is in effect,  do you want to keep your medical history private? You can answer only Q 15 if you want.

Ambiguity again surrounds what constitutes “de-identified” patient information.

What is clear is that public voice seems to have been deleted or lost from the care.data programme along with the feedback and brand.

People spoke up in 2014, and acted. The opt out that 1 in 45 people chose between January and March 2014 was put into effect by the HSCIC in April 2016. Now it seems, that might be revoked.

We’ve been here before.  There is no way that primary care data can be extracted without consent without it causing further disruption and damage to public trust and public interest research.  The future plans for linkage between all primary care data and secondary data and genomics for secondary uses, is untenable without consent.

Upcoming events cost time and money and will almost certainly go over the same ground that hours and hours were spent on in 2014. However if they do achieve a meaningful response rate, then I hope the results will not be lost and will be combined with those already captured under the ‘care.data listening events’ responses.  Will they have any impact on what consent model there may be in future?

So what we gonna do? I don’t know, whatcha wanna do? Let’s do something.

Let’s have accredited access and security fixed. While there may now be a higher transparency and process around release, there are still problems about who gets data and what they do with it.

Let’s have clear future scope and control. There is still no plan to give the public rights to control or delete data if we change our minds who can have it or for what purposes. And that is very uncertain. After all, they might decide to privatise or outsource the whole thing as was planned for the CSUs. 

Let’s have answers to everything already asked but unknown. The questions in the previous Caldicott review have still to be answered.

We have the possibility to  see health data used wisely, safely, and with public trust. But we seem stuck with the same notes again. And the public seem to be the last to be invited to participate and views once gathered, seem to be disregarded. I hope to be proved wrong.

Might, perhaps, the consultation deliver the nuanced consent model discussed at public listening exercises that many asked for?

Will the care.data listening events feedback summary be found, and will its 2014 conclusions and the enacted opt out be ignored? Will the new listening event view make more difference than in 2014?

Is public engagement, engagement, if nobody hears what was said?

#caredata, care.data, change, choice, confidentiality, datasharing, empowerment, ethics, HSCIC, National Pupil Database, NHS England, trust

Datasharing, lawmaking and ethics: power, practice and public policy

“Lawmaking is the Wire, not Schoolhouse Rock. It’s about blood and war and power, not evidence and argument and policy.”

"We can't trust the regulators," they say. "We need to be able to investigate the data for ourselves." Technology seems to provide the perfect solution. Just put it all online - people can go through the data while trusting no one.  There's just one problem. If you can't trust the regulators, what makes you think you can trust the data?"

Extracts from The Boy Who Could Change the World: The Writings of Aaron Swartz. Chapter: ‘When is Technology Useful? ‘ June 2009.

The question keeps getting asked, is the concept of ethics obsolete in Big Data?

I’ve come to some conclusions why ‘Big Data’ use keeps pushing the boundaries of what many people find acceptable, and yet the people doing the research, the regulators and lawmakers often express surprise at negative reactions. Some even express disdain for public opinion, dismissing it as ignorant, not ‘understanding the benefits’, yet to be convinced. I’ve decided why I think what is considered ‘ethical’ in data science does not meet public expectation.

It’s not about people.

Researchers using large datasets, often have a foundation in data science, applied computing, maths, and don’t see data as people. It’s only data. Creating patterns, correlations, and analysis of individual level data are not seen as research involving human subjects.

This is embodied in the nth number of research ethics reviews I have read in the last year in which the question is asked, does the research involve people? The answer given is invariably ‘no’.

And these data analysts using, let’s say health data, are not working in a subject that is founded on any ethical principle, contrasting with the medical world the data come from.

The public feels differently about the information that is about them, and may be known, only to them or select professionals. The values that we as the public attach to our data  and expectations of its handling may reflect the expectation we have of handling of us as people who are connected to it. We see our data as all about us.

The values that are therefore put on data, and on how it can and should be used, can be at odds with one another, the public perception is not reciprocated by the researchers. This may be especially true if researchers are using data which has been de-identified, although it may not be anonymous.

New legislation on the horizon, the Better Use of Data in Government,  intends to fill the [loop]hole between what was legal to share in the past and what some want to exploit today, and emphasises a gap in the uses of data by public interest, academic researchers, and uses by government actors. The first incorporate by-and-large privacy and anonymisation techniques by design, versus the second designed for applied use of identifiable data.

Government departments and public bodies want to identify and track people who are somehow misaligned with the values of the system; either through fraud, debt, Troubled Families, or owing Student Loans. All highly sensitive subjects. But their ethical data science framework will not treat them as individuals, but only as data subjects. Or as groups who share certain characteristics.

The system again intrinsically fails to see these uses of data as being about individuals, but sees them as categories of people – “fraud” “debt” “Troubled families.” It is designed to profile people.

Services that weren’t built for people, but for government processes, result in datasets used in research, that aren’t well designed for research. So we now see attempts to shoehorn historical practices into data use  by modern data science practitioners, with policy that is shortsighted.

We can’t afford for these things to be so off axis, if civil service thinking is exploring “potential game-changers such as virtual reality for citizens in the autism spectrum, biometrics to reduce fraud, and data science and machine-learning to automate decisions.”

In an organisation such as DWP this must be really well designed since “the scale at which we operate is unprecedented: with 800 locations and 85,000  colleagues, we’re larger than most retail operations.”

The power to affect individual lives through poor technology is vast and some impacts seem to be being badly ignored. The ‘‘real time earnings’ database improved accuracy of benefit payments was widely agreed to have been harmful to some individuals through the Universal Credit scheme, with delayed payments meaning families at foodbanks, and contributing to worse.

“We believe execution is the major job of every business leader,” perhaps not the best wording in on DWP data uses.

What accountability will be built-by design?

I’ve been thinking recently about drawing a social ecological model of personal data empowerment or control. Thinking about visualisation of wants, gaps and consent models, to show rather than tell policy makers where these gaps exist in public perception and expectations, policy and practice. If anyone knows of one on data, please shout. I think it might be helpful.

But the data *is* all about people

Regardless whether they are in front of you or numbers on a screen, big or small datasets using data about real lives are data about people. And that triggers a need to treat the data with an ethical approach as you would people involved face-to-face.

Researchers need to stop treating data about people as meaningless data because that’s not how people think about their own data being used. Not only that, but if the whole point of your big data research is to have impact, your data outcomes, will change lives.

Tosh, I know some say. But, I have argued, the reason being is that the applications of the data science/ research/ policy findings / impact of immigration in education review / [insert purposes of the data user’s choosing] are designed to have impact on people. Often the people about whom the research is done without their knowledge or consent. And while most people say that is OK, where it’s public interest research, the possibilities are outstripping what the public has expressed as acceptable, and few seem to care.

Evidence from public engagement and ethics all say, hidden pigeon-holing, profiling, is unacceptable. Data Protection law has special requirements for it, on autonomous decisions. ‘Profiling’ is now clearly defined under article 4 of the GDPR as ” any form of automated processing of personal data consisting of using those data to evaluate certain personal aspects relating to a natural person, in particular to analyse or predict aspects concerning that natural person’s performance at work, economic situation, health, personal preferences, interests, reliability, behaviour, location or movements.”

Using big datasets for research that ‘isn’t interested in individuals’ may still intend to create results profiling groups for applied policing, or discriminate, to make knowledge available by location. The data may have been deidentified, but in application becomes no longer anonymous.

Big Data research that results in profiling groups with the intent for applied health policy impacts for good, may by the very point of research, with the intent of improving a particular ethnic minority access to services, for example.

Then look at the voting process changes in North Carolina and see how that same data, the same research knowledge might be applied to exclude, to restrict rights, and to disempower.

Is it possible to have ethical oversight that can protect good data use and protect people’s rights if they conflict with the policy purposes?

The “clear legal basis”is not enough for public trust

Data use can be legal and can still be unethical, harmful and shortsighted in many ways, for both the impacts on research – in terms of withholding data and falsifying data and avoiding the system to avoid giving in data – and the lives it will touch.

What education has to learn from health is whether it will permit the uses by ‘others’ outside education to jeopardise the collection of school data intended in the best interests of children, not the system. In England it must start to analyse what is needed vs wanted. What is necessary and proportionate and justifies maintaining named data indefinitely, exposed to changing scope.

In health, the most recent Caldicott review suggests scope change by design – that is a red line for many: “For that reason the Review recommends that, in due course, the opt-out should not apply to all flows of information into the HSCIC. This requires careful consideration with the primary care community.”

The community spoke out already, and strongly in Spring and Summer 2014 that there must be an absolute right to confidentiality to protect patients’ trust in the system. Scope that ‘sounds’ like it might sneakily change in future, will be a death knell to public interest research, because repeated trust erosion will be fatal.

Laws change to allow scope change without informing people whose data are being used for different purposes

Regulators must be seen to be trusted, if the data they regulate is to be trustworthy. Laws and regulators that plan scope for the future watering down of public protection, water down public trust from today. Unethical policy and practice, will not be saved by pseudo-data-science ethics.

Will those decisions in private political rooms be worth the public cost to research, to policy, and to the lives it will ultimately affect?

What happens when the ethical black holes in policy, lawmaking and practice collide?

At the last UK HealthCamp towards the end of the day, when we discussed the hard things, the topic inevitably moved swiftly to consent, to building big databases, public perception, and why anyone would think there is potential for abuse, when clearly the intended use is good.

The answer came back from one of the participants, “OK now it’s the time to say. Because, Nazis.” Meaning, let’s learn from history.

Given the state of UK politics, Go Home van policies, restaurant raids, the possibility of Trump getting access to UK sensitive data of all sorts from across the Atlantic, given recent policy effects on the rights of the disabled and others, I wonder if we would hear the gentle laughter in the room in answer to the same question today.

With what is reported as Whitehall’s digital leadership sharp change today, the future of digital in government services and policy and lawmaking does indeed seem to be more “about blood and war and power,” than “evidence and argument and policy“.

The concept of ethics in datasharing using public data in the UK is far from becoming obsolete. It has yet to begin.

We have ethical black holes in big data research, in big data policy, and big data practices in England. The conflicts between public interest research and government uses of population wide datasets, how the public perceive the use of our data and how they are used, gaps and tensions in policy and practice are there.

We are simply waiting for the Big Bang. Whether it will be creative, or destructive we are yet to feel.

*****

image credit: LIGO – graphical visualisation of black holes on the discovery of gravitational waves

References:

Report: Caldicott review – National Data Guardian for Health and Care Review of Data Security, Consent and Opt-Outs 2016

Report: The One–Way Mirror: Public attitudes to commercial access to health data

Royal Statistical Society Survey carried out by Ipsos MORI: The Data Trust Deficit

care.data, change management, communications, engagement, ethics, genomics, health, human rights, politics, privacy, research, transparency, trust

OkCupid and Google DeepMind: Happily ever after? Purposes and ethics in datasharing

This blog post is also available as an audio file on soundcloud.

What constitutes the public interest must be set in a universally fair and transparent ethics framework if the benefits of research are to be realised – whether in social science, health, education and more – that framework will provide a strategy to getting the pre-requisite success factors right, ensuring research in the public interest is not only fit for the future, but thrives. There has been a climate change in consent. We need to stop talking about barriers that prevent datasharing  and start talking about the boundaries within which we can.

What is the purpose for which I provide my personal data?

‘We use math to get you dates’, says OkCupid’s tagline.

That’s the purpose of the site. It’s the reason people log in and create a profile, enter their personal data and post it online for others who are looking for dates to see. The purpose, is to get a date.

When over 68K OkCupid users registered for the site to find dates, they didn’t sign up to have their identifiable data used and published in ‘a very large dataset’ and onwardly re-used by anyone with unregistered access. The users data were extracted “without the express prior consent of the user […].”

Are the registration consent purposes compatible with the purposes to which the researcher put the data should be a simple enough question.  Are the research purposes what the person signed up to, or would they be surprised to find out their data were used like this?

Questions the “OkCupid data snatcher”, now self-confessed ‘non-academic’ researcher, thought unimportant to consider.

But it appears in the last month, he has been in good company.

Google DeepMind, and the Royal Free, big players who do know how to handle data and consent well, paid too little attention to the very same question of purposes.

The boundaries of how the users of OkCupid had chosen to reveal information and to whom, have not been respected in this project.

Nor were these boundaries respected by the Royal Free London trust that gave out patient data for use by Google DeepMind with changing explanations, without clear purposes or permission.

The legal boundaries in these recent stories appear unclear or to have been ignored. The privacy boundaries deemed irrelevant. Regulatory oversight lacking.

The respectful ethical boundaries of consent to purposes, disregarding autonomy, have indisputably broken down, whether by commercial org, public body, or lone ‘researcher’.

Research purposes

The crux of data access decisions is purposes. What question is the research to address – what is the purpose for which the data will be used? The intent by Kirkegaard was to test:

“the relationship of cognitive ability to religious beliefs and political interest/participation…”

In this case the question appears intended rather a test of the data, not the data opened up to answer the test. While methodological studies matter, given the care and attention [or self-stated lack thereof] given to its extraction and any attempt to be representative and fair, it would appear this is not the point of this study either.

The data doesn’t include profiles identified as heterosexual male, because ‘the scraper was’. It is also unknown how many users hide their profiles, “so the 99.7% figure [identifying as binary male or female] should be cautiously interpreted.”

“Furthermore, due to the way we sampled the data from the site, it is not even representative of the users on the site, because users who answered more questions are overrepresented.” [sic]

The paper goes on to say photos were not gathered because they would have taken up a lot of storage space and could be done in a future scraping, and

“other data were not collected because we forgot to include them in the scraper.”

The data are knowingly of poor quality, inaccurate and incomplete. The project cannot be repeated as ‘the scraping tool no longer works’. There is an unclear ethical or peer review process, and the research purpose is at best unclear. We can certainly give someone the benefit of the doubt and say intent appears to have been entirely benevolent. It’s not clear what the intent was. I think it is clearly misplaced and foolish, but not malevolent.

The trouble is, it’s not enough to say, “don’t be evil.” These actions have consequences.

When the researcher asserts in his paper that, “the lack of data sharing probably slows down the progress of science immensely because other researchers would use the data if they could,”  in part he is right.

Google and the Royal Free have tried more eloquently to say the same thing. It’s not research, it’s direct care, in effect, ignore that people are no longer our patients and we’re using historical data without re-consent. We know what we’re doing, we’re the good guys.

However the principles are the same, whether it’s a lone project or global giant. And they’re both wildly wrong as well. More people must take this on board. It’s the reason the public interest needs the Dame Fiona Caldicott review published sooner rather than later.

Just because there is a boundary to data sharing in place, does not mean it is a barrier to be ignored or overcome. Like the registration step to the OkCupid site, consent and the right to opt out of medical research in England and Wales is there for a reason.

We’re desperate to build public trust in UK research right now. So to assert that the lack of data sharing probably slows down the progress of science is misplaced, when it is getting ‘sharing’ wrong, that caused the lack of trust in the first place and harms research.

A climate change in consent

There has been a climate change in public attitude to consent since care.data, clouded by the smoke and mirrors of state surveillance. It cannot be ignored.  The EUGDPR supports it. Researchers may not like change, but there needs to be an according adjustment in expectations and practice.

Without change, there will be no change. Public trust is low. As technology advances and if we continue to see commercial companies get this wrong, we will continue to see public trust falter unless broken things get fixed. Change is possible for the better. But it has to come from companies, institutions, and people within them.

Like climate change, you may deny it if you choose to. But some things are inevitable and unavoidably true.

There is strong support for public interest research but that is not to be taken for granted. Public bodies should defend research from being sunk by commercial misappropriation if they want to future-proof public interest research.

The purpose for which the people gave consent are the boundaries within which you have permission to use data, that gives you freedom within its limits, to use the data.  Purposes and consent are not barriers to be overcome.

If research is to win back public trust developing a future proofed, robust ethical framework for data science must be a priority today.

Commercial companies must overcome the low levels of public trust they have generated in the public to date if they ask ‘trust us because we’re not evil‘. If you can’t rule out the use of data for other purposes, it’s not helping. If you delay independent oversight it’s not helping.

This case study and indeed the Google DeepMind recent episode by contrast demonstrate the urgency with which working out what common expectations and oversight of applied ethics in research, who gets to decide what is ‘in the public interest’ and data science public engagement must be made a priority, in the UK and beyond.

Boundaries in the best interest of the subject and the user

Society needs research in the public interest. We need good decisions made on what will be funded and what will not be. What will influence public policy and where needs attention for change.

To do this ethically, we all need to agree what is fair use of personal data, when is it closed and when is it open, what is direct and what are secondary uses, and how advances in technology are used when they present both opportunities for benefit or risks to harm to individuals, to society and to research as a whole.

The potential benefits of research are potentially being compromised for the sake of arrogance, greed, or misjudgement, no matter intent. Those benefits cannot come at any cost, or disregard public concern, or the price will be trust in all research itself.

In discussing this with social science and medical researchers, I realise not everyone agrees. For some, using deidentified data in trusted third party settings poses such a low privacy risk, that they feel the public should have no say in whether their data are used in research as long it’s ‘in the public interest’.

For the DeepMind researchers and Royal Free, they were confident even using identifiable data, this is the “right” thing to do, without consent.

For the Cabinet Office datasharing consultation, the parts that will open up national registries, share identifiable data more widely and with commercial companies, they are convinced it is all the “right” thing to do, without consent.

How can researchers, society and government understand what is good ethics of data science, as technology permits ever more invasive or covert data mining and the current approach is desperately outdated?

Who decides where those boundaries lie?

“It’s research Jim, but not as we know it.” This is one aspect of data use that ethical reviewers will need to deal with, as we advance the debate on data science in the UK. Whether independents or commercial organisations. Google said their work was not research. Is‘OkCupid’ research?

If this research and data publication proves anything at all, and can offer lessons to learn from, it is perhaps these three things:

Who is accredited as a researcher or ‘prescribed person’ matters. If we are considering new datasharing legislation, and for example, who the UK government is granting access to millions of children’s personal data today. Your idea of a ‘prescribed person’ may not be the same as the rest of the public’s.

Researchers and ethics committees need to adjust to the climate change of public consent. Purposes must be respected in research particularly when sharing sensitive, identifiable data, and there should be no assumptions made that differ from the original purposes when users give consent.

Data ethics and laws are desperately behind data science technology. Governments, institutions, civil, and all society needs to reach a common vision and leadership how to manage these challenges. Who defines these boundaries that matter?

How do we move forward towards better use of data?

Our data and technology are taking on a life of their own, in space which is another frontier, and in time, as data gathered in the past might be used for quite different purposes today.

The public are being left behind in the game-changing decisions made by those who deem they know best about the world we want to live in. We need a say in what shape society wants that to take, particularly for our children as it is their future we are deciding now.

How about an ethical framework for datasharing that supports a transparent public interest, which tries to build a little kinder, less discriminating, more just world, where hope is stronger than fear?

Working with people, with consent, with public support and transparent oversight shouldn’t be too much to ask. Perhaps it is naive, but I believe that with an independent ethical driver behind good decision-making, we could get closer to datasharing like that.

That would bring Better use of data in government.

Purposes and consent are not barriers to be overcome. Within these, shaped by a strong ethical framework, good data sharing practices can tackle some of the real challenges that hinder ‘good use of data’: training, understanding data protection law, communications, accountability and intra-organisational trust. More data sharing alone won’t fix these structural weaknesses in current UK datasharing which are our really tough barriers to good practice.

How our public data will be used in the public interest will not be a destination or have a well defined happy ending, but it is a long term  process which needs to be consensual and there needs to be a clear path to setting out together and achieving collaborative solutions.

While we are all different, I believe that society shares for the most part, commonalities in what we accept as good, and fair, and what we believe is important. The family sitting next to me have just counted out their money and bought an ice cream to share, and the staff gave them two. The little girl is beaming. It seems that even when things are difficult, there is always hope things can be better. And there is always love.

Even if some might give it a bad name.

********

img credit: flickr/sofi01/ Beauty and The Beast  under creative commons

care.data, change management, communications, consent, engagement, genomics, National Pupil Database, privacy, transparency

Can new datasharing laws win social legitimacy, public trust and support without public engagement?

I’ve been struck by stories I’ve heard on the datasharing consultation, on data science, and on data infrastructures as part of ‘government as a platform’ (#GaaPFuture) in recent weeks. The audio recorded by the Royal Statistical Society on March 17th is excellent, and there were some good questions asked.

There were even questions from insurance backed panels to open up more data for commercial users, and calls for journalists to be seen as accredited researchers, as well as to include health data sharing. Three things that some stakeholders, all users of data, feel are  missing from consultation, and possibly some of those with the most widespread public concern and lowest levels of public trust. [1]

What I feel is missing in consultation discussions are:

  1. a representative range of independent public voice
  2. a compelling story of needs – why tailored public services benefits citizens from whom data is taken, not only benefits data users
  3. the impacts we expect to see in local government
  4. any cost/risk/benefit assessment of those impacts, or for citizens
  5. how the changes will be independently evaluated – as some are to be reviewed

The Royal Statistical Society and ODI have good summaries here of their thoughts, more geared towards the statistical and research aspects of data,  infrastructure and the consultation.

I focus on the other strands that use identifiable data for targeted interventions. Tailored public services, Debt, Fraud, Energy Companies’ use. I think we talk too little of people, and real needs.

Why the State wants more datasharing is not yet a compelling story and public need and benefit seem weak.

So far the creation of new data intermediaries, giving copies of our personal data to other public bodies  – and let’s be clear that this often means through commercial representatives like G4S, Atos, Management consultancies and more –  is yet to convince me of true public needs for the people, versus wants from parts of the State.

What the consultation hopes to achieve, is new powers of law, to give increased data sharing increased legal authority. However this alone will not bring about the social legitimacy of datasharing that the consultation appears to seek through ‘open policy making’.

Legitimacy is badly needed if there is to be public and professional support for change and increased use of our personal data as held by the State, which is missing today,  as care.data starkly exposed. [2]

The gap between Social Legitimacy and the Law

Almost 8 months ago now, before I knew about the datasharing consultation work-in-progress, I suggested to BIS that there was an opportunity for the UK to drive excellence in public involvement in the use of public data by getting real engagement, through pro-active consent.

The carrot for this, is achieving the goal that government wants – greater legal clarity, the use of a significant number of consented people’s personal data for complex range of secondary uses as a secondary benefit.

It was ignored.

If some feel entitled to the right to infringe on citizens’ privacy through a new legal gateway because they believe the public benefit outweighs private rights, then they must also take on the increased balance of risk of doing so, and a responsibility to  do so safely. It is in principle a slippery slope. Any new safeguards and ethics for how this will be done are however unclear in those data strands which are for targeted individual interventions. Especially if predictive.

Upcoming discussions on codes of practice [which have still to be shared] should demonstrate how this is to happen in practice, but codes are not sufficient. Laws which enable will be pushed to their borderline of legal and beyond that of ethical.

In England who would have thought that the 2013 changes that permitted individual children’s data to be given to third parties [3] for educational purposes, would mean giving highly sensitive, identifiable data to journalists without pupils or parental consent? The wording allows it. It is legal. However it fails the DPA Act legal requirement of fair processing.  Above all, it lacks social legitimacy and common sense.

In Scotland, there is current anger over the intrusive ‘named person’ laws which lack both professional and public support and intrude on privacy. Concerns raised should be lessons to learn from in England.

Common sense says laws must take into account social legitimacy.

We have been told at the open policy meetings that this change will not remove the need for informed consent. To be informed, means creating the opportunity for proper communications, and also knowing how you can use the service without coercion, i.e. not having to consent to secondary data uses in order to get the service, and knowing to withdraw consent at any later date. How will that be offered with ways of achieving the removal of data after sharing?

The stick for change, is the legal duty that the recent 2015 CJEU ruling reiterating the legal duty to fair processing [4] waved about. Not just a nice to have, but State bodies’ responsibility to inform citizens when their personal data are used for purposes other than those for which those data had initially been consented and given. New legislation will not  remove this legal duty.

How will it be achieved without public engagement?

Engagement is not PR

Failure to act on what you hear from listening to the public is costly.

Engagement is not done *to* people, don’t think ‘explain why we need the data and its public benefit’ will work. Policy makers must engage with fears and not seek to dismiss or diminish them, but acknowledge and mitigate them by designing technically acceptable solutions. Solutions that enable data sharing in a strong framework of privacy and ethics, not that sees these concepts as barriers. Solutions that have social legitimacy because people support them.

Mr Hunt’s promised February 2014 opt out of anonymised data being used in health research, has yet to be put in place and has had immeasurable costs for delayed public research, and public trust.

How long before people consider suing the DH as data controller for misuse? From where does the arrogance stem that decides to ignore legal rights, moral rights and public opinion of more people than those who voted for the Minister responsible for its delay?

 

This attitude is what fails care.data and the harm is ongoing to public trust and to confidence for researchers’ continued access to data.

The same failure was pointed out by the public members of the tiny Genomics England public engagement meeting two years ago in March 2014, called to respond to concerns over the lack of engagement and potential harm for existing research. The comms lead made a suggestion that the new model of the commercialisation of the human genome in England, to be embedded in the NHS by 2017 as standard clinical practice, was like steam trains in Victorian England opening up the country to new commercial markets. The analogy was felt by the lay attendees to be, and I quote, ‘ridiculous.’

Exploiting confidential personal data for public good must have support and good two-way engagement if it is to get that support, and what is said and agreed must be acted on to be trustworthy.

Policy makers must take into account broad public opinion, and that is unlikely to be submitted to a Parliamentary consultation. (Personally, I first knew such  processes existed only when care.data was brought before the Select Committee in 2014.) We already know what many in the public think about sharing their confidential data from the work with care.data and objections to third party access, to lack of consent. Just because some policy makers don’t like what was said, doesn’t make that public opinion any less valid.

We must bring to the table the public voice from past but recent public engagement work on administrative datasharing [5], the voice of the non-research community, and from those who are not stakeholders who will use the data but the ‘data subjects’, the public  whose data are to be used.

Policy Making must be built on Public Trust

Open policy making is not open just because it says it is. Who has been invited, participated, and how their views actually make a difference on content and implementation is what matters.

Adding controversial ideas at the last minute is terrible engagement, its makes the process less trustworthy and diminishes its legitimacy.

This last minute change suggests some datasharing will be dictated despite critical views in the policy making and without any public engagement. If so, we should ask policy makers on what mandate?

Democracy depends on social legitimacy. Once you lose public trust, it is not easy to restore.

Can new datasharing laws win social legitimacy, public trust and support without public engagement?

In my next post I’ll post look at some of the public engagement work done on datasharing to date, and think about ethics in how data are applied.

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References:

[1] The Royal Statistical Society data trust deficit

[2] “The social licence for research: why care.data ran into trouble,” by Carter et al.

[3] FAQs: Campaign for safe and ethical National Pupil Data

[4] CJEU Bara 2015 Ruling – fair processing between public bodies

[5] Public Dialogues using Administrative data (ESRC / ADRN)

img credit: flickr.com/photos/internetarchivebookimages/

care.data, change management, commercial, engagement, human rights, scope, Tech, transparency

A data sharing fairytale (3): transformation and impact

Part three: It is vital that the data sharing consultation is not seen in a silo, or even a set of silos each particular to its own stakeholder. To do it justice and ensure the questions that should be asked are answered, we must look instead at the whole story and the background setting. And we must ask each stakeholder, what does your happy ending look like?

Parts one and two to follow address public engagement and ethics, this focuses on current national data practice, tailored public services, and local impact of the change and transformation that will result.

What is your happy ending?

This data sharing consultation is gradually revealing to me how disjoined government appears in practice and strategy. Our digital future, a society that is more inclusive and more just, supported by better uses of technology and data in ‘dot everyone’ will not happen if they cannot first join the dots across all of Cabinet thinking and good practice, and align policies that are out of step with each other.

Last Thursday night’s “Government as a Platform Future” panel discussion (#GaaPFuture) took me back to memories of my old job, working in business implementations of process and cutting edge systems. Our finest hour was showing leadership why success would depend on neither. Success was down to local change management and communications, because change is about people, not the tech.

People in this data sharing consultation, means the public, means the staff of local government public bodies, as well as the people working at national stakeholders of the UKSA (statistics strand), ADRN (de-identified research strand), Home Office (GRO strand), DWP (Fraud and Debt strands), and DECC (energy) and staff at the national driver, the Cabinet Office.

I’ve attended two of the 2016 datasharing meetings,  and am most interested from three points of view  – because I am directly involved in the de-identified data strand,  campaign for privacy, and believe in public engagement.

Engagement with civil society, after almost 2 years of involvement on three projects, and an almost ten month pause in between, the projects had suddenly become six in 2016, so the most sensitive strands of the datasharing legislation have been the least openly discussed.

At the end of the first 2016 meeting, I asked one question.

How will local change management be handled and the consultation tailored to local organisations’ understanding and expectations of its outcome?

Why? Because a top down data extraction programme from all public services opens up the extraction of personal data as business intelligence to national level, of all local services interactions with citizens’ data.  Or at least, those parts they have collected or may collect in future.

That means a change in how the process works today. Global business intelligence/data extractions are designed to make processes more efficient, through reductions in current delivery, yet concrete public benefits for citizens are hard to see that would be different from today, so why make this change in practice?

What it might mean for example, would be to enable collection of all citizens’ debt information into one place, and that would allow the service to centralise chasing debt and enforce its collection, outsourced to a single national commercial provider.

So what does the future look like from the top? What is the happy ending for each strand, that will be achieved should this legislation be passed?  What will success for each set of plans look like?

What will we stop doing, what will we start doing differently and how will services concretely change from today, the current state, to the future?

Most importantly to understand its implications for citizens and staff, we should ask how will this transformation be managed well to see the benefits we are told it will deliver?

Can we avoid being left holding a pumpkin, after the glitter of ‘use more shiny tech’ and government love affair with the promises of Big Data wear off?

Look into the local future

Those with the vision of the future on a panel at the GDS meeting this week, the new local government model enabled by GaaP, also identified, there are implications for potential loss of local jobs, and “turkeys won’t vote for Christmas”. So who is packaging this change to make it successfully deliverable?

If we can’t be told easily in consultation, then it is not a clear enough policy to deliver. If there is a clear end-state, then we should ask what the applied implications in practice are going to be?

It is vital that the data sharing consultation is not seen in a silo, or even a set of silos each particular to its own stakeholder, about copying datasets to share them more widely, but that we look instead at the whole story and the background setting.

The Tailored Reviews: public bodies guidance suggests massive reform of local government, looking for additional savings, looking to cut back office functions and commercial plans. It asks “What workforce reductions have already been agreed for the body? Is there potential to go further? Are these linked to digital savings referenced earlier?”

Options include ‘abolish, move out of central government, commercial model, bring in-house, merge with another body.’

So where is the local government public bodies engagement with change management plans in the datasharing consultation as a change process? Does it not exist?

I asked at the end of the first datasharing meeting in January and everyone looked a bit blank. A question ‘to take away’ turned into nothing.

Yet to make this work, the buy-in of local public bodies is vital. So why skirt round this issue in local government, if there are plans to address it properly?

If there are none, then with all the data in the world, public services delivery will not be improved, because the issues are friction not of interference by consent, or privacy issues, but working practices.

If the idea is to avoid this ‘friction’ by removing it, then where is the change management plan for public services and our public staff?

Trust depends on transparency

John Pullinger, our National Statistician, this week also said on datasharing we need a social charter on data to develop trust.

Trust can only be built between public and state if the organisations, and all the people in them, are trustworthy.

To implement process change successfully, the people involved in these affected organisations, the staff, must trust that change will mean positive improvement and risks explained.

For the public, what defined levels of data access, privacy protection, and scope limitation that this new consultation will permit in practice, are clearly going to be vital to define if the public will trust its purposes.

The consultation does not do this, and there is no draft code of conduct yet, and no one is willing to define ‘research’ or ‘public interest’.

Public interest models or ‘charter’ for collection and use of research data in health, concluded that ofr ethical purposes, time also mattered. Benefits must be specific, measurable, attainable, relevant and time-bound. So let’s talk about the intended end state that is to be achieved from these changes, and identify how its benefits are to meet those objectives – change without an intended end state will almost never be successful, if you don’t know start knowing what it looks like.

For public trust, that means scope boundaries. Sharing now, with today’s laws and ethics is only fully meaningful if we trust that today’s governance, ethics and safeguards will be changeable in future to the benefit of the citizen, not ever greater powers to the state at the expense of the individual. Where is scope defined?

There is very little information about where limits would be on what data could not be shared, or when it would not be possible to do so without explicit consent. Permissive powers put the onus onto the data controller to share, and given ‘a new law says you should share’ would become the mantra, it is likely to mean less individual accountability. Where are those lines to be drawn to support the staff and public, the data user and the data subject?

So to summarise, so far I have six key questions:

  • What does your happy ending look like for each data strand?
  • How will bad practices which conflict with the current consultation proposals be stopped?
  • How will the ongoing balance of use of data for government purposes, privacy and information rights be decided and by whom?
  • In what context will the ethical principles be shaped today?
  • How will the transformation from the current to that future end state be supported, paid for and delivered?
  • Who will oversee new policies and ensure good data science practices, protection and ethics are applied in practice?

This datasharing consultation is not entirely for something new, but expansion of what is done already. And in some places is done very badly.

How will the old stories and new be reconciled?

Wearing my privacy and public engagement hats, here’s an idea.

Perhaps before the central State starts collecting more, sharing more, and using more of our personal data for ‘tailored public services’ and more, the government should ask for a data amnesty?

It’s time to draw a line under bad practice.  Clear out the ethics drawers of bad historical practice, and start again, with a fresh chapter. Because current practices are not future-proofed and covering them up in the language of ‘better data ethics’ will fail.

The consultation assures us that: “These proposals are not about selling public or personal data, collecting new data from citizens or weakening the Data Protection Act 1998.”

However it does already sell out personal data from at least BIS. How will these contradictory positions across all Departments be resolved?

The left hand gives out de-identified data in safe settings for public benefit research while the right hands out over 10 million records to the Telegraph and The Times without parental or schools’ consent. Only in la-la land are these both considered ethical.

Will somebody at the data sharing meeting please ask, “when will this stop?” It is wrong. These are our individual children’s identifiable personal data. Stop giving them away to press and charities and commercial users without informed consent. It’s ludicrous. Yet it is real.

Policy makers should provide an assurance there are plans for this to change as part of this consultation.

Without it, the consultation line about commercial use, is at best disingenuous, at worst a bare cheeked lie.

“These powers will also ensure we can improve the safe handling of citizen data by bringing consistency and improved safeguards to the way it is handled.”

Will it? Show me how and I might believe it.

Privacy, it was said at the RSS event, is the biggest concern in this consultation:

“includes proposals to expand the use of appropriate and ethical data science techniques to help tailor interventions to the public”

“also to start fixing government’s data infrastructure to better support public services.”

The techniques need outlined what they mean, and practices fixed now, because many stand on shaky legal ground. These privacy issues have come about over cumulative governments of different parties in the last ten years, so the problems are non-partisan, but need practical fixes.

Today, less than transparent international agreements push ‘very far-reaching chapters on the liberalisation of data trading’ while according to the European Court of Justice these practices lack a solid legal basis.

Today our government already gives our children’s personal data to commercial third parties and sells our higher education data without informed consent, while the DfE and BIS both know they fail processing and its potential consequences: the European Court reaffirmed in 2015 “persons whose personal data are subject to transfer and processing between two public administrative bodies must be informed in advance” in Judgment in Case C-201/14.

In a time that actively cultivates universal public fear,  it is time for individuals to be brave and ask the awkward questions because you either solve them up front, or hit the problems later. The child who stood up and said The Emperor has on no clothes, was right.

What’s missing?

The consultation conversation will only be genuine, once the policy makers acknowledge and address solutions regards:

  1. those data practices that are currently unethical and must change
  2. how the tailored public services datasharing legislation will shape the delivery of government services’ infrastructure and staff, as well as the service to the individual in the public.

If we start by understanding what the happy ending looks like, we are much more likely to arrive there, and how to measure success.

The datasharing consultation engagement, the ethics of data science, and impact on data infrastructures as part of ‘government as a platform’ need seen as a whole joined up story if we are each to consider what success for us as stakeholders, looks like.

We need to call out current data failings and things that are missing, to get them fixed.

Without a strong, consistent ethical framework you risk 3 things:

  1. data misuse and loss of public trust
  2. data non-use because your staff don’t trust they’re doing it right
  3. data is becoming a toxic asset

The upcoming meetings should address this and ask practically:

  1. How the codes of conduct, and ethics, are to be shaped, and by whom, if outwith the consultation?
  2. What is planned to manage and pay for the future changes in our data infrastructures;  ie the models of local government delivery?
  3. What is the happy ending that each data strand wants to achieve through this and how will the success criteria be measured?

Public benefit is supposed to be at the heart of this change. For UK statistics, for academic public benefit research, they are clear.

For some of the other strands, local public benefits that outweigh the privacy risks and do not jeopardise public trust seem like magical unicorns dancing in the land far, far away of centralised government; hard to imagine, and even harder to capture.

*****

Part one: A data sharing fairytale: Engagement
Part two: A data sharing fairytale: Ethics
Part three: A data sharing fairytale: Impact (this post)

Tailored public bodies review: Feb 2016

img credit: Hermann Vogel illustration ‘Cinderella’

care.data, change management, confidentiality, consent, politics, privacy

Destination smart-cities: design, desire and democracy (Part three)

Smart Technology we have now: A UK Case Study

In places today, where climate surveillance sensors are used to predict and decide which smog-days cars should be banned from cities, automatic number-plate recognition (ANPR) can identify cars driving on the wrong days and send automatic penalties.

Similarly ANPR technology is used in our UK tunnels and congestion charging systems. One British company encouraging installation of ANPR in India is the same provider of a most significant part of our British public administrative data and surveillance softwares in a range of sectors.

About themselves that company says:

“Northgate Public Services has a unique experience of delivering ANPR software to all Home Office police forces. We developed and managed the NADC, the mission critical solution providing continuous surveillance of the UK’s road network.  The NADC is integrated with other databases, including the Police National Computer, and supports more than 30 million reads a day across the country.”

30 million snapshots from ‘continuous surveillance of the UK’s road network‘. That’s surprised me. That’s half the population in England, not all of whom drive. 30 million every day. It’s massive, unreasonable, and risks backlash.

Northgate Public Services’ clients also include 80% of UK water companies, as well as many other energy and utility suppliers.

And in the social housing market they stretch to debt collection, or ‘income management’.

So who I wondered, who is this company that owns all this data-driven access to our homes, our roads, our utilities, life insurance, hospital records and registeries, half of all UK calls to emergency services?

Northgate Information Solutions announced the sale of its Public Services division in December 2014 to venture capital firm Cinven. Cinven that also owns a 62% shareholding in the UK private healthcare provider Spire with all sorts of influence given their active share of services and markets. 

Not only does this private equity firm hold these vast range of data systems across a wide range of sectors, but it’s making decisions about how our public policies and money are being driven.

Using health screening data they’re even making decisions that affect our future and our behaviour and affect our private lives: “software provides the information and tools that housing officers need to proactively support residents, such as sending emails, letters or rent reminders by SMS and freeing up time for face-to-face support.”

Of their ANPR systems, Northgate says the data should be even more widely used “to turn CONNECT: ANPR into a critical source of intelligence for proactive policing.”

If the company were to start to ‘proactively’ use all the data it owns across the sectors we should be asking, is ‘smart’ sensible and safe?

Where is the boundary between proactive and predictive? Or public and private?

Where do companies draw the line between public and personal space?

The public services provided by the company seem to encroach into our private lives in many ways, In Northgate’s own words, “It’s also deeply personal.”

Who’s driving decision making is clear. The source of their decision making is data. And it’s data about us.

Today already whether collected by companies proactively like ANPR or through managing data we give them with consent for direct administrative purpose, private companies are the guardians of massive amounts of our personal and public data.

What is shocking to me, is how collected data in one area of public services are also used for entirely different secondary purposes without informed consent or an FYI, for example in schools.

If we don’t know which companies manage our data, how can we trust that it is looked after well and that we are told if things go wrong?

Steps must be taken in administrative personal data security, transparency and public engagement to shore up public trust as the foundation for future datasharing as part of the critical infrastructure for any future strategy, for public or commercial application. Strategy must include more transparency of the processing of our data and public involvement, not the minimum, if ‘digital citizenship’ is to be meaningful.

How would our understanding of data improve if anyone using personal data were required to put in place clear public statements about their collection, use and analysis of data?  If the principles of data protection were actually upheld, in particular that individuals should be informed? How would our understanding of data improve especially regards automated decision making and monitoring technology? Not ninety page privacy policies. Plain English. If you need ninety pages, you’re doing too much with my data.

Independent privacy impact assessments should be mandatory and published before data are collected and shared with any party other than that to which it was given for a specific purpose. Extensions broadening that purpose should require consultation and consent. If that’s a street, then make it public in plain sight.

Above all, planning committees in local government, in policy making and practical application, need to think of data in every public decision they make and its ethical implications. We need some more robust decision-making in the face of corporate data grabs, to defend data collected in public space safe, and to keep some private.

How much less fun is a summer’s picnic spent smooching, if you feel watched? How much more anxious will we make our children if they’re not allowed to ever have their own time to themselves, and every word they type in a school computer is monitored?

How much individual creativity and innovation does that stifle? We are effectively censoring children before they have written a word.

Large corporations have played historically significant and often shadowy roles in surveillance that retrospectively were seen as unethical.

We should consider sooner rather than later, if corporations such as BAE systems, Siemens and the IMSs of the world act in ways worthy of our trust in such massive reach into our lives, with little transparency and oversight.

“Big data is big opportunity but Government should tackle misuse”

The Select Committee warned in its recent report on Big Data that distrust arising from concerns about privacy and security is often well-founded and must be resolved by industry and Government.

If ‘digital’ means smart technology in the future is used in “every part of government” as announced at #Sprint16, what will its effects be on the involvement and influence these massive corporations on democracy itself?

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I thought about this more in depth on Part one here,  “Smart systems and Public Services” here (part two), and continue after this by looking at “The Best Use of Data” used in predictions and the Future (part four).