Building infrastructure is key to unifying UK health data

Reforming the NHS by shifting from analogue to digital, from treating sickness to prevention of disease, and from hospital to community care is a priority for the UK government.

The UK’s health data infrastructure is outdated and fragmented, with datasets siloed across multiple locations and controlled by different entities that make inconsistent decisions about access. This slows down research and undermines public trust.

In our editorial for BMJ, we argue that the Sudlow review’s vision for unifying the UK’s health data is compelling, but its implementation strategy is misguided. It assumes that the current limitations to the scale and capability of privacy preserving, high utility infrastructure are permanent, rather than asking why these limitations exist. It could be underinvestment, lack of technical skills, or other systemic barriers. Understanding these root causes is essential for developing evidence based solutions that enable the system to “lower barriers to data sharing for public benefit whilst keeping it secure.”

Adding bureaucratic requirements to an already burdened system, while perpetuating ideas about NHS technical limitations and false dichotomies will slow progress. This risks leaving the NHS vulnerable to exploitation by private technology companies whose offers to “assist” with infrastructure development could result in loss of control over valuable public assets. Instead, the NHS needs strategic investment in teams capable of developing privacy preserving platforms at scale with robust security measures that go beyond criminalising re-identification. This technical innovation, supported by proper evaluation frameworks to verify security claims and ensure research integrity, can deliver the “critical national infrastructure” the review supports.