That contract value is ridiculous - how many full time staff do they have on this project and what rates are they charging? How can some say ‘operational data collection’ is worth a third of a billion to NHS over the alternatives of using a third of a billion on patient healthcare and actual medical research? This needs an investigation around how this contract was ever approved.

https://www.england.nhs.uk/wp-content/uploads/2020/02/removi...

nhs is famous dumb and has spent years trying to stop using fax machine. £330 million is nothing over a few years.. NHS budget for 2024/25 is circa £242 billion.

the entire annual intake from capital gains tax is £20 million or so

Thus only the wealthiest are outside these boundaries, and they often will not liquidate holdings until their death to pay inhertiance tax, or in trusts which will liqudiate over decades as they can pay inheritance tax over a very long period.

This is not to mention the large amounts of off-shore holdings.

In 2025-26 there are an estimated 39.1 million people paying income tax - 56.0% of the population [1]. Of course, in the last census, 20.7% of the population were children [2]. About 3.1% of the population are UK students in University education [3], and about 18.6% of the population are retired [4]. I've also missed all the 18-year-olds in their final year of school, which is roughly 1.1 million or 1.6% of the population [5]. About 8.8 million, or 12.6%, are pensioners who pay income tax that I have double counted, usually due to private pensions and other sources of income [6].

Totally these numbers gives a rough estimate that suggest only about 12.6% of working age people do not pay income tax. This is in line with the government's own statistics putting those claiming Universal Credit at 10.6% of the population [7], or those economically inactive at 12.9% [8]. This is wildly different to your implication that 61% of people are too lazy to work.

Unemployment, which is roughly defined as those out of work who are actively looking for work, is at 5.2% [9], which it is worth noting is slightly below the EU and Euro area average of 5.9% and 6.2% respectively [10]. Direct comparisons are difficult to make, but it is certainly indicative of the UK falling within what is considered a healthy range.

Furthermore, take-home pay on a £100,000 salary is £68,561 [11], giving an effective income tax of 31.4% - far below your claim of 71%. True, there is the so-called "£100k tax trap" which gradually reduces your tax-free allowance above this salary. But this still gives just a 37.6% tax on £125,000, or 41.1% on £200,000. You may consider these to be high, but they are far, far below your claim of 71% income tax.

[1] https://www.gov.uk/government/statistics/income-tax-liabilit...

[2] https://www.ethnicity-facts-figures.service.gov.uk/uk-popula...

[3] https://www.universitiesuk.ac.uk/latest/insights-and-analysi...

[4] https://www.gov.uk/government/statistics/dwp-benefits-statis...

[5] https://www.gov.uk/government/publications/infographics-leve...

[6] https://www.ftadviser.com/content/291a4ce0-9287-4118-849b-ff...

[7] https://www.gov.uk/government/statistics/dwp-benefits-statis...

[8] https://www.ons.gov.uk/employmentandlabourmarket/peoplenotin...

[9] https://www.ons.gov.uk/employmentandlabourmarket/peoplenotin...

[10] https://ec.europa.eu/eurostat/statistics-explained/index.php...

[11] https://www.gov.uk/estimate-income-tax

So they want LLMs to look at all the files, and essentially kick a lot such people off the NHS. That's what they're paying for.

In other words they want to "Elon Musk the NHS, DOGE-style".

This is, of course, highly illegal to do. There is no way giving medical data to a US consultancy does not violate UK and EU law something awful. The government knows this, does it anyway. Which is one reason you won't be able to do anything about this: the government has zero intention to respect the law in this case. You will, of course, be expected to pay your taxes correctly.

Do you have a citation for this? I'm interested in how this figure was extracted from where it came.

There's a segment of a few thousand pounds where your marginal tax rate skyrockets because you lose your tax free allowance at that income level.

It's stupid, annoying and has some minor economic effects, but it's very different from a 71% income tax rate.

(source: a UK voter)

I checked, and you can of course donate to Led By Donkeys either as a one-off or monthly via their web page https://donate.ledbydonkeys.org/ but they don't have a way to contribute to specific campaigns.

Thanks for mentioning them though.

The fact I can't even see a GP I'm not registered with (not even an option to pay extra) is ridiculous. You have absolutely no control over your health at all.

With private, you get exactly what you want, whenever you want it.

In the US this isn't how it works. You can't see whoever you want unless you have a really, really good plan. Otherwise, you need referrals. And lots of specialists won't see you without a referral anyway.

And, the wait is often on the order of months. I know that's something people complain about in the UK but I assure you, it happens that way in the US too even though we're paying 10x as much.

I know private in the UK is quite good. What you need to understand is that the only reason it's any good at all is because of the NHS. It has to remain competitive. If you go full private, then it very quickly decays.

That's why in practice we have all these (private) services to get easy GP appointments via phone, video or even online forms. While everyone knows those appointments can't realistically do any real medical work, they serve to give you prescriptions and referrals.

It's just a gatekeeping mechanism, that you can more easily bypass if you have money. The more you pay, the more they care about your user experience and how streamlined it is.

I pay $500 per month for the privilege (and a $50 copay)

So I’m paying $1000 in the time period where I’m getting no service.

I also had cancer in the past and you might think that that would mean I get faster appointments. I do not.

And I have a very, very, very good PPO plan.

My SO is on state Medicaid (cancer) and does experience the kinds of waits mentioned above... so I guess it does follow similarly for government/state backed healthcare, where I'm mostly out of pocket.

But even when I had relatively typical coverage, I didn't have issues getting into a doctor more often than not. I think getting my sleep study was the longest wait I had for anything, they were months backed up with appointments... but my kidney and retina specialists were somewhat easy to get started with.

Pharmacy was useless, no medical skills or knowledge of their own products. Asked me to figure out myself what I needed and put it on my son myself.

Local GP surgery sent us away: no registration, no visit. Me saying this was an emergency just made them suggest A&E.

A&E is where we ended up, and while that definitely works, going to the emergency services of a large hospital for every little thing is not only a waste of my time but also of resources. It seems however to be the NHS way: whenever the littlest of troubles arise, just go to the hospital, or even call an ambulance.

The projects I worked on were genuinely absurd... My team alone spent millions on things that literally wouldn't have made any difference to the quality of healthcare in the UK.

Apparently we were given a budget and we had to find a way to spend it otherwise it would be cut. At any normal company we should have all immediately have been made redundant.

The UK healthcare system is uniquely incompetent, administratively bloated and drives very suboptimal value for money.

UK citizens appear to be in a collective delusion about the NHS that allows them to continue ineptly bumbling through mediocrity while perpetually fleecing more tax money to line the pockets of administrators.

Meanwhile actual frontline workers in the NHS are completely ripped off in salary. Nurses get paid peanuts, while even neurosurgeons earn less than 1/6th of their American counterparts.

To plug the gap by skilled healthcare workers bailing over these horrific conditions, the UK has been importing people to fill these gaps, often with severely lower competence (usually because of completely faked qualifications or outright fraud [1]).

[1] https://www.hrmagazine.co.uk/content/news/hundreds-of-nhs-nu...

https://www.contractsfinder.service.gov.uk/Notice/0f8a65b5-2...

AND they're putting private information at risk by working with Panantir

this isn't a "delivery" product, it should be an institutional pillar of the system

It was incredibly expensive to run East Berlin as a panopticon state, with a large fraction of the population on the payroll as informers to the 100,000 Stasi agents. Obvious conclusions were missed all the time because of the sheer difficulty of keeping track of facts cross-referenced on paper in filing cabinets in a large office building. This volume of classified siloed information is toxic for the occupation, operationally unusable. People were disappeared or even executed on mere suspicion because it would have been too difficult to rustle up proof.

Thiel looked at our prospects for effectively running an authoritarian surveillance state in Afghanistan and Iraq, looked at how many American contractors we would have had to devote to that, how many people we would have had to torture on a routine basis, how fast we might learn the language, and said "I think I can do better. A softer touch, a smarter system for controlling people. This is what AI is for, running society after this liberal democracy fiction falls away"

The rest of your comment is, unfortunately, spot on.

I suppose it's just the Don't make the Torment Nexus effect with a different motif.

https://en.wikipedia.org/wiki/Constitution_of_the_United_Kin...

More importantly, the UK is a Constitutional Monarchy, with ultimate legislative power vested in Parliament rather than the Monarch.

It doesn't look like a duck, it doesn't quack like a duck, yet you insist that this goose-shaped creature is a duck.

Some special amendment procedure is not the only or even defining feature of constitutional law. There is non-constitutional law that has this property and there is constitutional law that does not.

The oddities of this "duck" go far beyond its lack of entrenchment. It also lacks form and definition in the way that a puff of smoke lacks form and definition. It includes such nebulous elements as common law, unwritten convention, and even legal commentary of various law scholars. It's also said to be in constant flux as it evolves over time.

It may be a useful abstraction within the context of UK law to refer to this amorphous blob as the "constitution," but for anyone unfamiliar with the UK's system of government, to say the UK has a constitution is grossly misleading in as much as all of the conclusions the listener will draw from that assertion will be false. It's like characterizing a chicken eating grain out of your hand as being "attacked by a dinosaur." The chicken may belong to the clade "Dinosauria" and may have inadvertently pecked your palm in its feeding frenzy, but in as much as it communicates information contrary to fact, it is a confabulation. At best, it's a lawyer's lie, to coin a phrase.

That's got to be the understatement of (many) centuries. AFAIK the UK constitution isn't even even codified into millions of documents, let alone a "single" one. Saying it's not in a "single" document is like saying my trillions of dollars aren't in a "single" bank account. The number of partitions really isn't the problem with that statement here.

Is there a single human (or even computer program) that could even definitively list all the sentences in this "constitution", let alone an arbitrary citizen who needs to be able to become aware of them to be able to follow them? (Note I'm not asking for interpretation, but literally just listing the sentences.) Could they even do this with infinite time? Is it even possible to have an oracle that, given an arbitrary sentence, could indisputably tell you if it is in the constitution?

Maybe that's asking too much. Forget enumerating the laws. Per your own link: "...this enables the constitution to be easily changed as no provisions are formally entrenched."

If this doesn't itself sound silly, hopefully you can at least forgive people for getting irritated at the proposition that there totally exists a "constitution"... that nobody can point to... and that doesn't actually do the one thing many people want from a constitution: being more entrenched than statutes.

> Also of note; even countries with a codified constitution have parts that are uncodified.

Not sure what countries you're referring to, but at least in the US, this is not the case. There is a single document that is the constitution, and (thankfully, so far) nobody is disputing what words are in fact written on that document. And that document absolutely is supreme to statutes.

Interpretation of the words is obviously left to courts in the US, and courts can interpret it differently changing the effective law, but "constitution" is not a synonym for "effective law", and nobody argues over what the words to be interpreted are. And even those interpretations are still written down!

You can't just brush it aside as some quibble about definitions. It's a fundamentally substantive difference in the two structures: one of these has an indisputable source of truth (a foundation everyone can witness) that everything else is built on top of -- however shakily! -- and the other does not. Regardless of whether you include the upper parts of this metaphorical building in your definitions or not, the foundations are not the same.

Yes, it is a substantive difference but it does not follow that this difference provides the 'constitution' property.

> one of these has an indisputable source of truth... the foundations are not the same

They are so similar as to be almost the same and if an 'indisputable source of truth' exists anywhere, it is not in the written documents or their structure but unwritten norms and rituals sit beneath both.

What stops a President from simply choosing to ignore a Supreme Court ruling and what prevents the King from returning to personal rule?

The lack of arbitrary rule is a defining feature of both and relies on something that emerged rather than something imposed from without by written words.

Legally? The fact that everybody under the president -- including those in the military -- understand they are swearing their oath to the constitution -- not the King, not the Crown, not God, not the Supreme Court, not anything else. And that the Supreme Court says what the constitution means. And that if there is a clear and direct contradiction between the Supreme Court and the president, the former trumps (no pun intended) the latter.

Physically? "Nothing", yeah. Same goes for non-presidents. If you can get enough people to follow you (or maybe at least enough of the people with guns) everything else becomes irrelevant, including whether your title was president or King or God or Constitution or whatever.

> The lack of arbitrary rule is a defining feature of both

It is emphatically not. There are lots of countries with constitutions that nevertheless have arbitrary rule. As there are countries without constitutions or arbitrary rule.

> They are so similar as to be almost the same and if an 'indisputable source of truth' exists anywhere, it is not in the written documents or their structure but unwritten norms and rituals sit beneath both.

No, that's exactly what those are not. Unwritten stories, traditions, and rituals are very much disputable. That's kind of the entire point of writing things down, and the point of the game we call Telephone. The indisputable bits are physical artifacts everyone can see with their own eyes.

> No, it's a living thing. Why is this your sticking point on the existence of a constitution or not?

Do you never write down or sign contracts? Are verbal promises adequate for you in all transactions?

If you don't see the value of laws being written down - especially the most important ones! - I can't really convince you of it here on HN.

But what I can tell is that most people who care about the legitimacy of government believe it is fundamental to fairness that there be a single source of truth that can tell them the laws under which they would be rewarded or punished, before those happen.

https://en.wikipedia.org/wiki/Uncodified_constitution

https://en.wikipedia.org/wiki/Convention_(political_norm)#Un...

Note the second one applies to the US - a country with a mostly but not completely codified constitution.

I don't think this is helping much in the US right now. The orangefuhrer has shown he is willing to ignore clauses that are inconvenient.

"I do too, but the way Trump is behaving, pretty soon it will be illegal to ..."

You are technically incorrect about the UK not having a constitution. It's just not all compiled into a single written document.

I have no doubt that it's an extremely complicated mixture of 100s of systems, but anyone who has lived here knows how terrible it is. GP surgery's have for years had to send paper files across to new practices when a patient moves. The new NHS app is great, but I can see from my history that > 90% is missing.

Another great example of how good the NHS is at this, is the fact that nurses & doctors would have to scroll down a combo list without any typeahead to pick a medication, which would be in an A-Z list of every medication ever.

So, closing the circle, is there a reason to bring in a company that hires people at and above our level of competence, who have the expertise to implement a system to bring the NHS out of the dark ages of IT? Yes. There are many.

There will always be concerns about data, about security, but I'd much rather data be in the hands of a corporation that doesn't leak it than an unknown company getting billions in contracts, building software worse than someone with a $20 Claude extension, and then leaking it to hackers.

Just my 2p

Yep, as someone who's worked at a couple of small startups trying to sell into the NHS, it's terrible. A big part of the problem seems to be that there's no centralised procurement: each trust (of which there are ~200) does their own precurement. And a lot of the companies (the big established players are the worst) at most pay lip service interoperability. So you end with a big mess of system that don't talk to each other.

And they're not setup to pay "market rates" that are competitive with private employers to their in-house developers. So it's hard for them to attract and retain good in-house developers where they have them (although there are still some great people working there).

But it looks like lobbying by US corporations has resulted in the NHS quietly deleting it's open source policy https://www.digitalhealth.net/2025/12/nhs-england-quietly-re...

Is there no one in the UK with any competence?

> who have the expertise to implement a system to bring the NHS out of the dark ages of IT?

Why on earth do you think that's Palantir?

> but I'd much rather data be in the hands of a corporation that doesn't leak it

Until the US government wants it, at least.

So would I and I think Palantir will leak it.

They work with many international governments and companies, and I would imagine any sort of unapproved leak would be disastrous for their brand.

I'm not 100% convinced that the consultancy/implementation being the same as the software vendor is a bad thing.

Depending on the contract it can give you better exit clauses, implementation costs can be subsidised by SaaS revenue, you might have novel clauses for PS overspends, you get rid of the 'implementation vendor blames software vendor' thing, if you need modifications/enhancements to the base product then it sits with the same person, plus we don't know if Palantir's system is easily made for an independent implementation consultant to pick it up and be able to do everything without having to do some backend magic.

this is EXACTLY why it is of outmost importance to own those critical systems, and not delegate them to foreign companies, especially if from a country explicitly hostile towards Europe

As things are Europe (except Russia and a few others) is utterly reliant on Americas. Read up on how difficult things became for the ICJ judge the US sanctioned. If the US ever blocked almost any European countries access to online services they economy would collapse.

> Our mission for the NHS Federated Data Platform is to provide a secure, flexible system that connects data across NHS organisations to improve patient care, streamline services, and support informed decision-making.[1]

[1] : https://www.england.nhs.uk/digitaltechnology/nhs-federated-d...

If staff don't want to work with it then they're not fulfilling their roles.

What if any of us took a job and then refused to work with Microsoft or [Insert company] due to personal reasons? We'd be jobless.

Modern HR culture is working hard to address this terrible failing. </s>

Could you be a bit more specific? No IT initiative at all? No attempt to create a national data spine?

Either they are completely ignorant about what palantir is and who it's owned by (would be very concerning) or they are corrupt and were bribed.

no british person would down vote this - at least not one with any integrity

Definitely not a conflict of interest...

But they had no issue with any other db?

"We send the EU 350 million pounds a week. Why not send it to Palantir instead?"

(Not that the comparison would make much more sense if it were, apples and doorframes.)

Even if I assume that you meant 0.02%, which is equal to 0.0002, that would put their budget at £1.8e12, which I am also strongly inclined to doubt.

100 × ((182/5)/196000) = 0.019%

Which, to me, still seems too high a number for a data management function: I make it about 1000 persons-worth of per-capita GDP.

[1] https://www.england.nhs.uk/long-read/financial-performance-u...