Did Matt Hancock get the Online Harms memo?

Alexa, make Amazon pay its taxes so we can fund frontline healthcare services

Yesterday I launched this whole thing with a piece that was just a little too optimistic for a newsletter that’s supposed to be about the dark side of technology (fuck you, Instagram).

Luckily, wide-eyed techno-optimist Matt Hancock has played right into my hands by announcing that the NHS is partnering with Amazon. It’s all part of an initiative that will allow people to get medical advice simply by talking to their Alexa.

As you’d expect, Health Secretary Hancock hailed the news. “We want to empower every patient to take better control of their healthcare,” he said.

Empower is a word we should have all learned to distrust. In this scenario, it’s all too easy to see how ‘empowering’ people extends the pretext for privatization. It subtly continues that rhetorical shift from the social dimension of the health service, one which we support and use as citizens, to one in which we are simply customers able to make our own (atomized and disinterested) decisions.

The privacy issue

But there are other issues at stake. The most obvious is one of privacy. And while an Amazon spokesperson has told The Times that “all data was encrypted and kept confidential” and that “customers are in control of their voice history and can review or delete recordings,” the idea that we should take Amazon at its word is plainly absurd.

Even if that is indeed true, it doesn’t take Nostradamus to see how an innovation like this can spiral and evolve in a way that will render the current discussion and thinking around privacy obsolete in a matter of years.

Alexa is helping to define our political future

Clearly, this proposal is awful. Whatever benefits it might have are far outweighed by the dangerous precedent it sets for the way we fund and even understand healthcare (ie. as something we can all access, as something run by humans for humans).

But the government is blind to this. Absurdly, Hancock suggested this was a way to relieve pressure on front line staff (as opposed to, I don’t know, actually funding them).

(Of course, I’m well aware that calling the government blind is too charitable - there’s a clear agenda here informing the deployment of technology.)

The Online Harms White Paper

The ironic footnote to all this is the government’s recent Online Harms White Paper. In it, the government (Sajid Javid and Jeffrey Wright) argued for a regulatory framework that would force tech companies to take action when their platforms are used for harm (eg. to post revenge porn, to bully or harass people).

The proposals are fairly well-intentioned, but its drawbacks highlight the government’s complete lack of thinking around digital safety.

Indeed, the fact that the proposals would do little to curtail any of the negative consequences of the Amazon partnership is significant. It shows that the whole debate around what we want our digital lives to be like, and how we want technology to be used is completely skewed by a pernicious or perhaps plain stupid political agenda.

Tech charity/think tank Doteveryone contributed a detailed and powerful response to the white paper. I won’t detail it here, but it’s worth reading Director of Policy Catherine Miller’s summary published on Medium. Miller blasts the white paper as “a hodge-podge of Codes of Practice and initiatives with neither a clear articulation of what problem the proposals are supposed to solve, nor a clear vision for what alternative future they’re intended to promote.”

Did Matt Hancock get the Online Harms memo?

If we follow two of the key points raised by Doteveryone in relation to the Alexa/NHS initiative - one about a systemic approach to responsibility in design, and the other about building on a human rights framework, not an abstract notion of ‘harm’, it’s clear that everything falls apart.

  1. Thinking even beyond the design of Alexa itself is bringing in the device as a small but important component within your healthcare strategy responsible? Does it do anything to substantially address systemic issues around healthcare that are impacting huge sections of the population?

  2. Does using technology to as a sticking plaster over the ever-painful wound that is the NHS funding crisis actually do anything to respect the human rights of citizens failing to receive adequate healthcare? Absolutely not.

Whether it’s naivety or opportunism… this is bad

There’s much more to this partnership that’s worrying. At a fundamental level it exposes how dangerous it can be to think about technology purely instrumental sense, focusing only on a narrow end-goal.

If you were being generous I suppose you could say that in the eyes of senior Tories, technology is either a tool for getting information quickly (good) or sending mean messages (bad).

But sadly it’s more likely that the subtle and slippery manner in which technology can twist and change social relations, looks, to certain ideologues, like a very tasty opportunity for reshaping society as the dark and depressing one of their political fantasies.