Healios raises $10M to scale its mental health platform for children scarred by the COVID-19 pandemic

Heaven knows what will happen to the mental health of children who’ve gone through this past year but if there’s one thing we need right now it’s mental health provision for young people that can scale. And as much as some of us can’t bear the thought of another video call, a UK startup reckons it’s come up with the magic formula for online therapy for children.

Now, Healios has raised a £7 million ($10M) Series A round to expand its platform across the UK. If the roll-out is successful, the startup is looking at expanding internationally. The round was led by InHealth Ventures with participation from existing investors AlbionVC.

Healios will use the funding to expand its AI, machine learning, and data science expertise, as well as add to the team. Healios says its platform digitises the clinical pathway, enabling children, adults, and their family members to use clinical services at home.

According to UK government statistics, one in eight (12.8%) five to 19-year-olds in the UK have a mental health disorder but two-thirds are unable to access NHS care because of soaring demands. And the Covid-19 pandemic has made things worse.

Launched in 2013, Healios says it has now worked with 65% of NHS Mental Health Trusts, with 70,000 specialized clinical sessions delivered, which is a high success rate for a startup, considering how hard it is to get NHS approval.

The online, family-focused therapy program for young people zeros in on psychosis and schizophrenia. Healios says that studies have shown involving family members from the start can reduce suicide by as much as 90%. It also covers anxiety, low mood, autism and ADHD, as well as support to their families.

Unlike some startups in the area of mental health, Healios is not a marketplace of advisers but is an end-to-end provider of these services.

InHealth Ventures and InHealth Group Chair, Richard Bradford, will be joining the Healios board, alongside Cat McDonald of AlbionVC.

Rich Andrews, Founder, and CEO of Healios, said: “This funding will help us reach more families in need and enable us to develop further sector-leading interventions and therapies. By bringing together clinical experts and giving them the tools to reach their patients regardless of where they are, we are closing the access gap which has plagued mental health provision for far too long.”

Andrews also told me: “A young person will have an initial mental health assessment with us. If needed, we’ll make a diagnosis and then they’ll move on to other interventions with us, so this is a seamless experience.”

Dr Ben Evans, Managing Director of InHealth Ventures, said: “Healios is a standard-bearer for healthcare innovation. They bring together clinical excellence with digital expertise, working in partnership with the NHS to address a critical, but complex area of care delivery. Healios’ work to date speaks for itself; their holistic approach to diagnosis and treatment has had a substantive impact on clinical outcomes and patient experience.”

Cat McDonald, Investor at AlbionVC, added: “Covid has engendered a pace of innovation previously unseen in healthcare. In particular, we have seen that remote care not only works, but often works much better than traditional alternatives. The option to receive care remotely, at home and in a family-centric setting is the strong preference of most kids suffering from poor mental health.”

#artificial-intelligence, #autism, #ceo, #chair, #europe, #health, #health-care, #healthcare, #machine-learning, #mental-health, #national-health-service, #nhs, #online-therapy, #schizophrenia, #services, #tc, #uk-government, #united-kingdom


‘Every Time I’m Calling, Someone Has Died’: The Anguish of India’s Diaspora

In WhatsApp chats, video calls, Facebook groups and forums, a global community has scrambled to save, and sometimes mourn, Covid-stricken loved ones.

#ahmedabad-india, #bihar-india, #coronavirus-2019-ncov, #england, #families-and-family-life, #grief-emotion, #india, #indian-americans, #london-england, #national-health-service, #politics-and-government


Kry closes $312M Series D after use of its telehealth tools grows 100% yoy

Swedish digital health startup Kry, which offers a telehealth service (and software tools) to connect clinicians with patients for remote consultations, last raised just before the pandemic hit in Western Europe, netting a €140M Series C in January 2020.

Today it’s announcing an oversubscribed sequel: The Series D raise clocks in at $312M (€262M) and will be used to keep stepping on the growth gas in the region.

Investors in this latest round for the 2015-founded startup are a mix of old and new backers: The Series D is led by CPP Investments (aka, the Canadian Pension Plan Investment Board) and Fidelity Management & Research LLC, with participation from existing investors including The Ontario Teachers’ Pension Plan, as well as European-based VC firms Index Ventures, Accel, Creandum and Project A.

The need for people to socially distance during the coronavirus pandemic has given obvious uplift to the telehealth category, accelerating the rate of adoption of digital health tools that enable remote consultations by both patients and clinicians. Kry quickly stepped in to offer a free service for doctors to conduct web-based consultations last year, saying at the time that it felt a huge responsibility to help.

That agility in a time of public health crisis has clearly paid off. Kry’s year-over-year growth in 2020 was 100% — meaning that the ~1.6M digital doctors appointments it had served up a year ago now exceed 3M. Some 6,000 clinicians are also now using its telehealth platform and software tools. (It doesn’t break out registered patient numbers).

Yet co-founder and CEO, Johannes Schildt, says that, in some ways, it’s been a rather quiet 12 months for healthcare demand.

Sure the pandemic has driven specific demand, related to COVID-19 — including around testing for the disease (a service Kry offers in some of its markets) — but he says national lockdowns and coronavirus concerns have also dampened some of the usual demand for healthcare. So he’s confident that the 100% growth rate Kry has seen amid the COVID-19 public health crisis is just a taster of what’s to come — as healthcare provision shifts toward more digital delivery.

“Obviously we have been on the right side of a global pandemic. And if you look back the mega trend was obviously there long before the pandemic but the pandemic has accelerated the trend and it has served us and the industry well in terms of anchoring what we do. It’s now very well anchored across the globe — that telemedicine and digital healthcare is a crucial part of the healthcare systems moving forward,” Schildt tells TechCrunch.

“Demand has been increasing during the year, most obviously, but if you look at the broader picture of healthcare delivery — in most European markets — you actually have healthcare usage at an all time low. Because a lot of people are not as sick anymore given that you have tight restrictions. So it’s this rather strange dynamic. If you look at healthcare usage in general it’s actually at an all time low. But telemedicine is on an upward trend and we are operating on higher volumes… than we did before. And that is great, and we have been hiring a lot of great clinicians and been shipping a lot of great tools for clinicians to make the shift to digital.”

The free version of Kry’s tools for clinicians generated “big uplift” for the business, per Schildt, but he’s more excited about the wider service delivery shifts that are happening as the pandemic has accelerated uptake of digital health tools.

“For me the biggest thing has been that [telemedicine is] now very well established, it’s well anchored… There is still a different level of maturity between different European markets. Even [at the time of Kry’s Series C round last year] telemedicine was maybe not something that was a given — for us it’s always been of course; for me it’s always been crystal clear that this is the way of the future; it’s a necessity, you need to shift a lot of the healthcare delivery to digital. We just need to get there.”

The shift to digital is a necessary one, Schildt argues, in order to widen access to (inevitably) limited healthcare resources vs ever growing demand (current pandemic lockdown dampeners excepted). This is why Kry’s focus has always been on solving inefficiencies in healthcare delivery.

It seeks to do that in a variety of ways — including by offering support tools for clinicians working in public healthcare systems (for example, more than 60% of all the GPs in the UK market, where most healthcare is delivered via the taxpayer-funded NHS, is using Kry’s tools, per Schildt); as well as (in a few markets) running a full healthcare service itself where it combines telemedicine with a network of physical clinics where users can go when they need to be examined in person by a clinician. It also has partnerships with private healthcare providers in Europe.

In short, Kry is agnostic about how it helps deliver healthcare. That philosophy extends to the tech side — meaning video consultations are just one component of its telemedicine business which offers remote consultations for a range of medical issues, including infections, skin conditions, stomach problems and psychological disorders. (Obviously not every issue can be treated remotely but at the primary care level there are plenty of doctor-patient visits that don’t need to take place in person.)

Kry’s product roadmap — which is getting an investment boost with this new funding — involves expanding its patient-facing app to offer more digitally delivered treatments, such as Internet Cognitive Based Therapy (ICBT) and mental health self-assessment tools. It also plans to invest in digital healthcare tools to support chronic healthcare conditions — whether by developing more digital treatments itself (either by digitizing existing, proven treatments or coming up with novel approaches), and/or expanding its capabilities via acquisitions and strategic partnerships, according to Schildt.

Over the past five+ years, a growing number of startups have been digitizing proven treatment programs, such as for disorders like insomnia and anxiety, or musculoskeletal and chronic conditions that might otherwise require accessing a physiotherapist in person. Options for partners for Kry to work with on expanding its platform are certainly plentiful — although it’s developed the ICBT programs in house so isn’t afraid to tackle the digital treatment side itself.

“Given that we are in the fourth round of this massive change and transition in healthcare it makes a lot of sense for us to continue to invest in great tools for clinicians to deliver high quality care at great efficiency and deepening the experience from the patient side so we can continue to help even more people,” says Schildt.

“A lot of what we do we do is through video and text but that’s just one part of it. Now we’re investing a lot in our mental health plans and doing ICBT treatment plans. We’re going deeper into chronic treatments. We have great tools for clinicians to deliver high quality care at scale. Both digitally and physically because our platform supports both of it. And we have put a lot of effort during this year to link together our digital healthcare delivery with our physical healthcare delivery that we sometimes run ourselves and we sometimes do in partnerships. So the video itself is just one piece of the puzzle. And for us it’s always been about making sure we saw this from the end consumer’s perspective, from the patient’s perspective.”

“I’m a patient myself and still a lot of what we do is driven by my own frustration on how inefficient the system is structured in some areas,” he adds. “You do have a lot of great clinicians out there but there’s truly a lack of patient focus and in a lot of European markets there’s a clear access problem. And that has always been our starting point — how can we make sure that we solve this in a better way for the patients? And then obviously that involves us both building strong tools and front ends for patients so they can easily access care and manage their health, be pro-active about their health. It also involves us building great tools for clinicians that they can operate and work within — and there we’re putting way more effort as well.

“A lot of clinicians are using our tools to deliver digital care — not only clinicians that we run ourselves but ones we’re partnering with. So we do a lot of it in partnerships. And then also, given that we are a European provider, it involves us partnering with both public and private payers to make sure that the end consumer can actually access care.”

Another batch of startups in the digital healthcare delivery space talk a big game about ‘democratizing’ access to healthcare with the help of AI-fuelled triage or even diagnosis chatbots — with the idea that these tools can replace at least some of the work done by human doctors. The loudest on that front is probably Babylon Health.

Kry, by contrast, has avoided flashy AI hype, even though its tools do frequently incorporate machine learning technology, per Schildt. It also doesn’t offer a diagnosis chatbot. The reason for its different emphasis comes back to the choice of problem to focus on: Inefficiencies in healthcare delivery — with Schildt arguing that decision-making by doctors isn’t anywhere near the top of the list of service pain-points in the sector.

“We’re obviously using what would be considered AI or machine learning tools in all products that we’re building. I think sometimes personally I’m a bit annoyed at companies screaming and shouting about the technology itself and less about what problem you are solving with it,” he tells us. “On the decision-support [front], we don’t have the same sort of chatbot system that some other companies do, no. It’s obviously something that we could build really effortlessly. But I think — for me — it’s always about asking yourself what is the problem that you’re solving for? For the patient. And to be honest I don’t find it very useful.

“In many cases, especially in primary care, you have two categories. You have patients that already know why they need help, because you have a urinary tract infection; you had it before. You have an eye infection. You have a rash —  you know that it’s a rash, you need to see someone, you need to get help. Or you’re worried about your symptoms and you’re not really sure what it is — and you need comfort. And I think we’re not there yet where a chatbot would give you that sort of comfort, if this is something severe or not. You still want to talk to a human being. So I think it’s of limited use.

“Then on the decision side of it — sort of making sure that clinicians are making better decisions — we are obviously doing decision support for our clinicians. But if it’s one thing clinicians are really good at it’s actually making decisions. And if you look into the inefficiencies in healthcare the decision-making process is not the inefficiency. The matching side is an inefficiency side.”

He gives the example of how much the Swedish healthcare system spends on translators (circa €200M) as a “huge inefficiency” that could be reduced simply — by smarter matching of multilingual clinicians to patients.

“Most of our doctors are bilingual but they’re not there at the same time as the patient. So on the matching side you have a lot of inefficiency — and that’s where we have spent time on, for example. How can we sort that, how can we make sure that a patient that is seeking help with us ends up with the right level of care? If that is someone that speaks your native language so you can actually understand each other. Is this something that could be fully treated by a nurse? Or should it be directly to a psychologist?”

“With all technology it’s always about how do we use technology to solve a real problem, it’s less about the technology itself,” he adds.

Another ‘inefficiency’ that can affect healthcare provision in Europe relates to a problematic incentive to try to shrink costs (and, if it’s private healthcare, maximize an insurer’s profits) by making it harder for patients to access primary medical care — whether through complicated claims processes or by offering a bare minimum of information and support to access services (or indeed limiting appointment availability), making patients do the legwork of tracking down a relevant professional for their particular complaint and obtaining a coveted slot to see them.

It’s a maddening dynamic in a sector that should be focused on making as many people as healthy as they possibly can be in order that they avoid as much disease as possible — obviously as that outcome is better for the patients themselves. But also given the costs involved in treating really sick people (medical and societal). A wide range of chronic conditions, from type 2 diabetes to lower back pain, can be particularly costly to treat and yet may be entirely preventable with the right interventions.

Schildt sees a key role for digital healthcare tools to drive a much needed shift toward the kind of preventative healthcare that would be better all round, for both patients and for healthcare costs.

“That annoys me a lot,” he says. “That’s sometimes how healthcare systems are structured because it’s just costly for them to deliver healthcare so they try to make it as hard as possible for people to access healthcare — which is an absurdity and also one of the reasons why you now have increasing costs in healthcare systems in general, it’s exactly that. Because you have a lack of access in the first point of contact, with primary care. And what happens is you do have a spillover effect to secondary care.

“We see that in the data in all European markets. You have people ending up in emergency rooms that should have been treated in primary care but they can’t access primary care because there’s no access — you don’t know how to get in there, it’s long waiting times, it’s just triaged to different levels without getting any help and you have people with urinary tract infections ending up in emergency rooms. It’s super costly… when you have healthcare systems trying to fend people off. That’s not the right way doing it. You have to — and I think we will be able to play a crucial role in that in the coming ten years — push the whole system into being more preventative and proactive and access is a key part of that.

“We want to make it very, very simple for the patients — that they should be able to reach out to us and we will direct you to the right level of care.”

With so much still to do tackling the challenges of healthcare delivery in Europe, Kry isn’t in a hurry to expand its services geographically. Its main markets are Sweden, Norway, France, Germany and the UK, where it operates a healthcare service itself (not necessarily nationwide), though it notes that it offers a video consultation service to 30 regional markets.

“Right now we are very European focused,” says Schildt, when asked whether it has any plans for a U.S. launch. “I would never say that we would never go outside of Europe but for here and now we are extremely focused on Europe, we know those markets very, very well. We know how to manoeuvre in the European systems.

“It’s a very different payer infrastructure in Europe vs the US and then it’s also so that focus is always king and Europe is the mega market. Healthcare is 10% of the GDP in all European markets, we don’t have to go outside of Europe to build a very big business. But for the time being I think it makes a lot of sense for us to stay focused.”


#accel, #artificial-intelligence, #canadian-pension-plan-investment-board, #covid-19, #digital-health, #digital-healthcare, #europe, #fundings-exits, #germany, #health, #healthcare, #johannes-schildt, #kry, #machine-learning, #machine-learning-technology, #national-health-service, #nhs, #sweden, #tc, #telehealth, #telemedicine


150,000 Painted Hearts, Each for a Life Lost to Covid-19 in Britain

The National Covid Memorial Wall in London aims to remember those who die during the pandemic. “It’s therapeutic,” said a volunteering painter who lost her grandmother to the disease.

#coronavirus-2019-ncov, #deaths-fatalities, #great-britain, #johnson-boris, #london-england, #national-health-service, #river-thames-england


Entitled to Vaccines, Undocumented Immigrants in U.K. Struggle for Access

The government has said inoculation centers won’t check immigration status, but many people remain fearful and confused about health care services.

#coronavirus-2019-ncov, #great-britain, #illegal-immigration, #national-health-service, #politics-and-government, #vaccination-and-immunization


Some Covid-19 Patients Say They’re Left With Ringing Ears

Scientists are examining a possible link to tinnitus. A businessman’s suicide has lent urgency to the research.

#coronavirus-2019-ncov, #depression-mental, #ears-and-hearing, #great-britain, #national-health-service, #quarantine-life-and-culture, #taylor-kent-1955, #texas-roadhouse-inc, #tinnitus, #united-states


Opera Singers Help Covid-19 Patients Learn to Breathe Again

A six-week program developed by the English National Opera and a London hospital offers customized vocal lessons to aid coronavirus recovery.

#chronic-condition-health, #coronavirus-2019-ncov, #english-national-opera, #national-health-service, #opera, #voice-and-speech


‘I Did Something Useful’: Unemployed Workers Take On the Virus in Temp Jobs

Some workers in devastated industries in Britain are finding solace and using their old skills as coronavirus testers, contact-tracing callers and hospital housekeeping workers.

#coronavirus-2019-ncov, #great-britain, #labor-and-jobs, #layoffs-and-job-reductions, #national-health-service


Captain Tom, Who Raised Millions for U.K. Health Workers, Is Hospitalized

Tom Moore, 100, raised $40 million in the spring by walking laps in his garden. He was admitted to a hospital on Sunday with the coronavirus, his daughter said.

#coronavirus-2019-ncov, #great-britain, #longevity, #moore-tom-1920, #national-health-service, #philanthropy


Vaccine Rollout Gives U.K. a Rare Win in Pandemic

“Vaccination is the one thing we’ve gotten right”: How a country that botched so much of its pandemic response has managed one of the fastest distributions in the world.

#astrazeneca-plc, #clinical-trials, #coronavirus-2019-ncov, #great-britain, #johnson-boris, #national-health-service, #oxford-university, #politics-and-government, #vaccination-and-immunization


U.K. Hospitals Struggle to Cope With a New Coronavirus Variant

Hospitals are straining to cope with a new coronavirus variant, despite warnings last year that more preparations were needed for an expected surge of cases in the winter.

#coronavirus-2019-ncov, #great-britain, #hospitals, #national-health-service, #nursing-and-nurses


In U.K. Hospitals, a Desperate Battle Against a Threat Many Saw Coming

Hospitals are straining to cope with a new coronavirus variant, despite warnings last year that more preparations were needed for an expected surge of cases in the winter.

#coronavirus-2019-ncov, #great-britain, #hospitals, #national-health-service, #nursing-and-nurses


As Crisis Grows in Britain Over Coronavirus Variant, a Reprieve for Johnson

The public health threat of the new coronavirus variant has stilled the British prime minister’s critics and offered a chance to redeem past failures.

#coronavirus-2019-ncov, #great-britain, #johnson-boris, #national-health-service, #starmer-keir


U.K. to Ease Rules on Blood Donations by Gay and Bisexual Men

The new policy, which will take effect next summer, was described by Britain’s health secretary as a landmark and by an activist as “a fundamental shift toward recognizing people are individuals.”

#blood-donation, #discrimination, #great-britain, #homosexuality-and-bisexuality, #men-and-boys, #national-health-service


How the US, UK and Canada Will Roll Out the Covid Vaccine

Within days, all three countries could be giving the Pfizer-BioNTech vaccine, but they have varying strategies and challenges. The U.S. plan, working through the states, is the least centralized.

#astrazeneca-plc, #coronavirus-2019-ncov, #european-union, #great-britain, #moderna-inc, #national-health-service, #national-institutes-of-health, #oxford-university, #pfizer-inc, #united-states, #vaccination-and-immunization


U.K. Tackles Giant Vaccine Rollout After Botched Covid Response

Britain left hospitals short of masks and gowns, and stumbled on testing and tracing, so can it vaccinate tens of millions of people in a matter of months? Experts think it can.

#astrazeneca-plc, #biontech-se, #coronavirus-2019-ncov, #cyberattacks-and-hackers, #great-britain, #interpol-international-criminal-police-organization, #moderna-inc, #national-health-service, #pfizer-inc, #vaccination-and-immunization


I’m Autistic. I Didn’t Know Until I Was 27.

Autism spectrum disorder is inseparable from who I am. I wish only that it hadn’t taken so long to find out.

#attention-deficit-hyperactivity-disorder, #autism, #great-britain, #medicine-and-health, #national-health-service, #women-and-girls


For Boris Johnson, Vaccine Rollout Offers Last Chance to Show Competence

With the vaccine rollout and a potential Brexit deal looming, his government has a chance to wash away its reputation for chaos and mismanagement.

#biontech-se, #coronavirus-2019-ncov, #great-britain, #great-britain-withdrawal-from-eu-brexit, #johnson-boris, #national-health-service, #pfizer-inc, #vaccination-and-immunization


Why the U.K. Approved the Pfizer Covid Vaccine First

When early results from the final trials began to roll in, scientists were well prepared. Now, they face the logistical challenge of putting the vaccine to work.

#belgium, #biontech-se, #coronavirus-2019-ncov, #european-medicines-agency, #great-britain, #national-health-service, #nursing-homes, #pfizer-inc, #vaccination-and-immunization


U.K. Approves Pfizer Coronavirus Vaccine, a First in the West

Emergency approval of the vaccine, ahead of the United States and the European Union, clears the way for Britain to begin mass inoculations.

#coronavirus-2019-ncov, #european-medicines-agency, #great-britain, #medicines-and-healthcare-products-regulatory-agency-uk, #national-health-service, #pfizer-inc, #politics-and-government, #regulation-and-deregulation-of-industry, #rumors-and-misinformation, #vaccination-and-immunization


English Gyms Find Themselves on the Front Lines of Lockdown Revolt

Despite police raids and the threat of heavy fines, some health clubs have stayed open in an act of defiance against a coronavirus lockdown.

#anxiety-and-stress, #coronavirus-2019-ncov, #health-clubs, #johnson-boris, #london-england, #martial-arts, #national-health-service


England Weighs Another Nationwide Virus Lockdown

Prime Minister Boris Johnson’s cabinet met on Saturday as medical experts warned that the virus would soon overwhelm hospitals if the government did not take draconian action.

#conservative-party-great-britain, #coronavirus-2019-ncov, #great-britain, #johnson-boris, #labour-party-great-britain, #national-health-service, #shutdowns-institutional, #starmer-keir


Britain’s Health Workers Face 2nd Virus Wave, but This Time With Less Support

Public backing for the efforts of the country’s health service is eroding amid a lack of a clear government policy to deal with the pandemic, many medical workers say.

#coronavirus-2019-ncov, #great-britain, #johnson-boris, #national-health-service


Replace legacy healthcare staffing with a vertical marketplace for workers

Over the last several months, we’ve seen dramatic swings in the demand for healthcare across the country. While hospitals in some cities were overwhelmed by an influx of COVID-19 patients, others sat empty — and in many cases experienced financial distress — as patients postponed elective surgeries and care for non-life-threatening matters. Cities went from relative safe zones to dangerous hotspots and back again within a matter of a few months.

This “COVID-19 whipsaw” has brought into focus a problem that has long been simmering in healthcare: The movement of labor is highly inefficient. We need a new paradigm in healthcare labor markets.

The pandemic has exposed systemic vulnerabilities

Early in the pandemic, many clinicians moved across state lines to answer Governor Andrew Cuomo’s calls for help in New York, only to be told upon arrival that their contracts had been canceled because the hospitals had overestimated their need. The imbalance of nurse and physician labor across states, which existed well before the pandemic, reached a terrifying apex during the height of the pandemic. In some parts of the country, clinicians were being furloughed or laid off, while in others they were stretched to their full capacity working around the clock to save lives. With each month came new hotspots — New York, Detroit, Miami, Phoenix, Los Angeles — and with each new hotspot a near disaster caused by a shortage of healthcare workers.

The marathon of addressing COVID-19 has imposed severe stress, depression and anxiety on our nation as a whole, with our healthcare providers at the epicenter. Clinician burnout was a serious issue even before COVID-19, but it has only gotten worse in recent months, especially for those working in geographic hotspots.

Healthcare workers across the country have found themselves delivering care for a high volume of acutely ill patients, often with severely limited supplies of personal protective equipment (PPE), magnifying their own risk. Many have watched colleagues fall sick and even die, while others have been asked to ration patient care. Multiple studies have highlighted increased instances of depression, anxiety, insomnia and psychological distress amongst frontline workers, and some clinicians have even taken their own lives.

Challenges with the legacy staffing model

Prior to the pandemic, our healthcare system had long dealt with seasonal and geographic differences in healthcare demand. Flu season, for example, causes more demand for healthcare in December than July. Florida experiences more demand for care in February than June because snowbirds migrate from the northeast in the winter and bring their healthcare needs with them.

In the past, temporary or contingent workers — travel nurses, per diem nurses and locum tenens doctors — helped to balance supply of labor with the seasonal and geographic peaks and troughs in demand. Staffing agencies worked with these temporary clinicians to match them with opportunities at hospitals, ambulatory surgical centers, long-term care facilities and other providers. Many people don’t realize that temporary clinicians are an important part of the healthcare workforce. Estimates are that supplemental staffing accounts for more than 30% of total nursing hours in the U.S.

Staffing agencies, however, cannot scale for pandemic scale events because they are using outdated tools and processes. Recruiters at staffing agencies make phone calls and send emails to communicate with the clinicians who are frequently annoyed by inconvenient and unwanted solicitations. More importantly, these tools are not fast enough when we experience sudden unpredicted spikes in different geographic areas like those in the past six months.

Outdated regulations are partly to blame. Licensure for nurses is handled state-by-state, which creates obstacles that prohibit nurses from working in states where they are not licensed. There are approximately 35 states that are part of a licensing compact that offers mutual recognition, but many of the largest states and those hit hardest by the early days of the pandemic — like California, New York and Washington — are not part of the compact. In California, it takes six weeks on average to get a license for an out-of-state nurse, a number that has not budged even as the state’s COVID-19 cases have skyrocketed.

Some states that are not part of the compact have used executive actions or emergency declarations to allow nurses to cross state lines, but many of those are now expiring and were never meant to be a long-term solution. The pandemic has highlighted the need for new regulations as part of the solution described below that allow for a more fluid movement of clinicians across state lines. Are patients and diseases in California really that different from the patients and diseases in Texas such that we need different regulatory standards and license requirements in each state?

The solution: A vertical marketplace for healthcare workers

We need to move beyond the antiquated staffing agency model to facilitate a more rapid response, a better clinician experience and more efficient matching. The good news is that we are starting to see companies addressing this problem with a software-centric model: the vertical labor marketplace. Some examples of these marketplaces include Trusted Health and Nomad Health.

Like StubHub, the company I started 20 years ago, these marketplaces use the power of the internet to connect supply with demand. In the case of these healthcare labor marketplaces, the clinicians make up the supply while the hospitals and other care facilities make up the demand. Rather than scouring the job boards for individual hospitals or fielding calls from recruiters, clinicians can see all available positions that meet their skills and experience, along with compensation and other job details. They can check the marketplace when it is convenient without getting inundated by phone calls or emails.

Clinicians can use the marketplaces to come in and out of the labor pool as they wish. This helps to reduce stress and increase work-life balance before burnout sets in. Some nurses might choose to leverage the marketplace to move to Florida in the winter to serve the snowbirds while others may choose to take the summer off and work during flu season. The marketplace also creates financial opportunities for underutilized clinicians by better allocating their labor to geographies and hospitals that need them. Hospitals and other providers benefit from these simple-to-use cloud-based marketplaces that allow them to quickly ramp up capacity when they need it most.

The system needs more contingent workers

In the staffing agency paradigm, when an independent hospital experiences a spike in demand it must work with a staffing agency to bring in temporary clinicians quickly. A multihospital health system has the advantage of being able to move clinicians from lower demand hospitals to a sister-hospital that is experiencing an unexpected peak. A widely adopted national marketplace would theoretically have an even greater advantage because its broader visibility across more hospitals would allow it to move resources from hospitals with excess capacity to those with the highest demand, even if the two hospitals are unaffiliated.

There have been heroic doctors and nurses who have volunteered to move to areas with the highest demand. However, hospitals and health systems are not incentivized to lend out their doctors and nurses to nonaffiliated hospitals. Therefore, the solution requires more clinicians to be in the contingent workforce (like travel and per diem nurses). If the mix between contingent nurses and permanent nurses were 70/30 instead of 30/70, peaks and troughs would be more easily handled since a larger percentage of the resources would be shared across a larger network of hospitals. The marketplaces would have an even greater impact on our society because they would be able to allocate even more resources to the hospitals with the most acute needs.

There are two possible sources of additional contingent workers. First, permanent healthcare workers may decide to terminate their affiliation with a single hospital or health system in favor of contingent work because they are attracted to the flexibility. Second, workers in other industries may choose to enter the healthcare industry because it provides more options for contingent work. Regardless of the path, an expansion of the supply of contingent healthcare workers is a necessary part of the solution.

A side benefit: Stronger financial health for our hospitals

During the pandemic, patients across the country chose to postpone many elective surgeries and non-life-threatening procedures because they were scared of contracting the virus at the hospital. As a result, hospitals lost revenue from profitable elective procedures. Because hospitals have huge fixed costs (salaries are a big component), the government has provided tens of billions of stimulus money for hospitals in financial distress.

In addition to all the other benefits described above, a more widely adopted vertical labor marketplace for healthcare workers would provide relief to hospitals by shifting a larger portion of clinician labor from a fixed cost to a variable cost. Hospitals would have a smaller number of permanent employees and a larger number of temporary contingent workers. When demand drops, hospitals would use fewer contingent clinicians. When demand rises, they could tap into the marketplace to bring on more capacity.

A marketplace approach to America’s healthcare and its clinicians is long overdue. While the pandemic magnified our current system’s vulnerabilities, they have been there all along. By leveraging the technology and marketplace paradigm that has made so many other industries efficient, we can improve not only our healthcare system and clinician quality of life, but also our hospitals’ bottom line. Let’s galvanize the collective distress COVID-19 has created and use it to pioneer a more efficient model for all.

* Craft is an investor in Trusted.

#column, #covid-19, #flu, #health, #health-care, #health-systems, #healthcare, #national-health-service, #novel-coronavirus, #nursing, #opinion, #policy, #tc


American Clinical Research Needs to Step Up Its Game Against Covid-19

Here’s how: Follow Britain’s example.

#clinical-trials, #coronavirus-2019-ncov, #food-and-drug-administration, #great-britain, #national-health-service, #national-institutes-of-health, #research, #united-states


England’s Flawed Virus Contact Tracing Will Be Revamped

After months of complaints about its centralized, privatized system, Prime Minister Boris Johnson’s government says resources will be diverted to local public health authorities.

#contact-tracing-public-health, #coronavirus-2019-ncov, #england, #great-britain, #johnson-boris, #layoffs-and-job-reductions, #national-health-service, #serco-group-plc


U.K.’s New Coronavirus Tactic: Urge Britons to Lose Weight

The prime minister, who cited his own problems with obesity, said his hospitalization with Covid-19 had prompted his push to tighten regulations on junk food.

#advertising-and-marketing, #coronavirus-2019-ncov, #diet-and-nutrition, #great-britain, #johnson-boris, #labeling-and-labels-product, #national-health-service, #obesity


Europe Said It Was Pandemic-Ready. Pride Was Its Downfall.

The coronavirus exposed European countries’ misplaced confidence in faulty models, bureaucratic busywork and their own wealth.

#belgium, #china, #coronavirus-2019-ncov, #disease-rates, #england, #epidemics, #europe, #european-union, #ferguson-neil-m, #france, #great-britain, #imperial-college-london, #johnson-boris, #macron-emmanuel-1977, #national-health-service, #politics-and-government, #protective-clothing-and-gear, #scientific-advisory-group-for-emergencies-great-britain, #south-korea, #swine-influenza, #united-states


Long Waits for U.K. Hospital Treatment as N.H.S. Fights Coronavirus

With routine operations in England curtailed, some patients have experienced a significant deterioration.

#coronavirus-2019-ncov, #england, #hospitals, #national-health-service, #surgery-and-surgeons, #tests-medical


England’s ‘World Beating’ System to Track Coronavirus Is Anything But

Like a lot of the country’s pandemic response, contact tracing has been hampered by inconsistency, with much promised but little delivered.

#contact-tracing-public-health, #coronavirus-2019-ncov, #coronavirus-reopenings, #england, #government-contracts-and-procurement, #great-britain, #johnson-boris, #london-england, #national-health-service, #politics-and-government, #serco-group-plc


UK’s COVID-19 health data contracts with Google and Palantir finally emerge

Contracts for a number of coronavirus data deals that the U.K. government inked in haste with U.S. tech giants, including Google and Palantir, plus a U.K.-based AI firm called Faculty, have been published today by openDemocracy and law firm Foxglove — which had threatened legal action for withholding the information.

Concerns had been raised about what is an unprecedented transfer of health data on millions of U.K. citizens to private tech companies, including those with a commercial interest in acquiring data to train and build AI models. Freedom of Information requests for the contracts had been deferred up to now.

In a blog post today, openDemocracy and Foxglove write that the data store contracts show tech companies were “originally granted intellectual property rights (including the creation of databases), and were allowed to train their models and profit off their unprecedented access to NHS data.”

“Government lawyers have now claimed that a subsequent (undisclosed) amendment to the contract with Faculty has cured this problem, however they have not released the further contract. openDemocracy and Foxglove are demanding its immediate release,” they add.

They also say the contracts show that the terms of at least one of the deals — with Faculty — were changed “after initial demands for transparency under the Freedom of Information Act.”

They have published PDFs of the original contracts for Faculty, Google, Microsoft and Palantir. Amazon Web Services was also contracted by the NHS to provide cloud hosting services for the data store.

An excerpt from the Faculty contract regarding IP rights

Back in March, as concern about the looming impact of COVID-19 on the UK’s National Health Service (NHS) took hold, the government revealed plans for the health service to work with the aforementioned tech companies to develop a “data platform” — to help coordinate its response, touting the “power” of “secure, reliable and timely data” to inform “effective” pandemic decisions.

However the government’s lack of transparency around such massive health data deals with commercial tech giants — including the controversial firm Palantir, which has a track record of working with intelligence and law enforcement agencies to track individuals, such as supplying tech to ICE to aid deportations — raises major flags.

As does the ongoing failure by the government to publish the amended contracts — with the claimed tightened IP clauses.

The (now published, original) Google contract — to provide “technical, advisory and other support” to NHSX to tackle COVID-19 — is dated March 1, and specifies that services will be provided by Google to the NHS for zero charge. 

The Palantir contract, for provision of its Foundry data management platform services, is dated as beginning March 12 and expiring June 11 — with the company charging a mere £1 ($1.27) for services provided.

While the Faculty contract — providing “strategic support to the NHSX AI Lab” — has a value in excess of £1M (including VAT), and an earlier commencement date (February 3), with an expiry date of August 3.

The government announced its plan to launch an AI Lab within NHSX, the digital transformation branch of the health service, just under a year ago — saying then that it would plough in £250 million to apply AI to healthcare related challenges, and touting the potential for “earlier cancer detection, discovering new treatments and relieving the workload on our NHS workforce.”

The lab had been slated to start spending on AI in 2021. Yet the Faculty contract, in which the AI firm is providing “strategic support to the NHSX AI Lab,” and described as an “AI Lab Strategic Partner,” suggests the pandemic nudged the government to accelerate its plan.

We’ve reached out to the Department of Health with questions.

Last month, NHS England and NHS Improvement responded to an FOI request that TechCrunch filed in early April asking for the contracts — but only to say a response was delayed, already around a month after our original request. (The normal response time for U.K. FOIs is within 20 working days, although the law allows for “a reasonable extension of time to consider the public interest test.”)

Earlier this month, The Telegraph reported that Google-owned DeepMind co-founder Mustafa Suleyman — who has since moved over to work for Google in a policy role — was temporarily taken on by the NHS in March, in a pro bono advisory capacity that reportedly included discussing how to collect patient data.

An NHSX spokesperson told Digital Health that Suleyman had “volunteered his time and expertise for free to help the NHS during the greatest public health threat in a century,” and denied there had been any conflict of interest.

The latter refers to the fact that when Suleyman was still leading DeepMind the company inked a number of data-sharing agreements with NHS Trusts — gaining access to patient health data as part of an app development project. One of these contracts, with the Royal Free NHS Trust, was subsequently found to have breached U.K. data protection law. Regulators said patients could not have “reasonably expected” their information to be shared for this purpose. The Trust was also reprimanded over a lack of transparency.

Google has since taken over DeepMind’s health division and taken on most of the contracts it had inked with the NHS — despite Suleyman’s prior insistence that NHS patient data would not be shared with Google.


#amazon-web-services, #artificial-intelligence, #coronavirus, #covid-19, #data-protection-law, #deepmind, #europe, #google, #health, #microsoft, #mustafa-suleyman, #national-health-service, #nhs, #nhsx, #palantir, #tc, #uk-government, #united-kingdom


Britain’s Minorities Are Facing the Coronavirus Alone

The government could have predicted, and perhaps prevented, many deaths. It did not.

#coronavirus-2019-ncov, #deaths-fatalities, #discrimination, #great-britain, #johnson-boris, #national-health-service, #race-and-ethnicity


U.K. Coronavirus Testers Pay Price for a Day of Triumph

The British government promised 100,000 daily tests by April 30. It delivered. But the frantic push to hit that deadline has left labs scrabbling for supplies just when they need to expand further.

#conservative-party-great-britain, #coronavirus-2019-ncov, #england, #great-britain, #hancock-matt-1978, #hospitals, #imperial-college-london, #laboratories-and-scientific-equipment, #london-england, #national-health-service, #shortages, #tests-medical, #united-states


Tom Moore, a.k.a. Captain Tom, Gives Britain Hope During Coronavirus

In the space of six weeks, 100-year-old Tom Moore — better known as Captain Tom — raised $40 million for the British health service and became a national hero.

#awards-decorations-and-honors, #captain-tom, #coronavirus-2019-ncov, #defense-and-military-forces, #elizabeth-ii-queen-of-great-britain, #england, #moore-tom-1920, #myanmar, #national-health-service, #philanthropy, #world-war-ii-1939-45


‘The New Church of England’: Coronavirus Renews Pride in U.K.’s Health Service

It was looking run-down after 10 years of austerity. But the British health service’s performance in the pandemic has restored its mythic status to the nation.

#coronavirus-2019-ncov, #great-britain, #hospitals, #labour-party-great-britain, #national-health-service


Coronavirus Killing Black Britons at Twice the Rate as Whites

That gap grows to four times when class and health differences aren’t considered. South Asians have also been dying disproportionately.

#black-people, #conservative-party-great-britain, #coronavirus-2019-ncov, #deaths-fatalities, #hancock-matt-1978, #johnson-boris, #labour-party-great-britain, #national-health-service, #race-and-ethnicity


Eager to Corral the Coronavirus, U.K. Tests a Disputed Tracing App

The British government’s tool to track infected people puts it at odds with Apple and Google on privacy.

#apple-inc, #coronavirus-2019-ncov, #epidemics, #google-inc, #mobile-applications, #national-health-service, #privacy, #smartphones, #surveillance-of-citizens-by-government


UK’s NHS COVID-19 app lacks robust legal safeguards against data misuse, warns committee

A UK parliamentary committee that focuses on human rights issues has called for primary legislation to be put in place to ensure that legal protections wrap around the national coronavirus contact tracing app.

The app, called NHS COVID-19, is being fast tracked for public use — with a test ongoing this week in the Isle of Wight. It’s set to use Bluetooth Low Energy signals to log social interactions between users to try to automate some contacts tracing based on an algorithmic assessment of users’ infection risk.

The NHSX has said the app could be ready for launch within a matter of weeks but the committee says key choices related to the system architecture create huge risks for people’s rights that demand the safeguard of primary legislation.

“Assurances from Ministers about privacy are not enough. The Government has given assurances about protection of privacy so they should have no objection to those assurances being enshrined in law,” said committee chair, Harriet Harman MP, in a statement.

“The contact tracing app involves unprecedented data gathering. There must be robust legal protection for individuals about what that data will be used for, who will have access to it and how it will be safeguarded from hacking.

“Parliament was able quickly to agree to give the Government sweeping powers. It is perfectly possible for parliament to do the same for legislation to protect privacy.”

The NHSX, a digital arm of the country’s National Health Service, is in the process of testing the app — which it’s said could be launched nationally within a few weeks.

The government has opted for a system design that will centralize large amounts of social graph data when users experiencing COVID-19 symptoms (or who have had a formal diagnosis) choose to upload their proximity logs.

Earlier this week we reported on one of the committee hearings — when it took testimony from NHSX CEO Matthew Gould and the UK’s information commissioner, Elizabeth Denham, among other witnesses.

Warning now over a lack of parliamentary scrutiny — around what it describes as an unprecedented expansion of state surveillance — the committee report calls for primary legislation to ensure “necessary legal clarity and certainty as to how data gathered could be used, stored and disposed of”.

The committee also wants to see an independent body set up to carry out oversight monitoring and guard against ‘mission creep’ — a concern that’s also been raised by a number of UK privacy and security experts in an open letter late last month.

“A Digital Contact Tracing Human Rights Commissioner should be responsible for oversight and they should be able to deal with complaints from the Public and report to Parliament,” the committee suggests.

Prior to publishing its report, the committee wrote to health minister Matt Hancock, raising a full spectrum of concerns — receiving a letter in response.

In this letter, dated May 4, Hancock told it: “We do not consider that legislation is necessary in order to build and deliver the contact tracing app. It is consistent with the powers of, and duties imposed on, the Secretary of State at a time of national crisis in the interests of protecting public health.”

The committee’s view is Hancock’s ‘letter of assurance’ is not enough given the huge risks attached to the state tracking citizens’ social graph data.

“The current data protection framework is contained in a number of different documents and it is nearly impossible for the public to understand what it means for their data which may be collected by the digital contact tracing system. Government’s assurances around data protection and privacy standards will not carry any weight unless the Government is prepared to enshrine these assurances in legislation,” it writes in the report, calling for a bill that it says myst include include a number of “provisions and protections”.

Among the protections the committee is calling for are limits on who has access to data and for what purpose.

“Data held centrally may not be accessed or processed without specific statutory authorisation, for the purpose of combatting Covid-19 and provided adequate security protections are in place for any systems on which this data may be processed,” it urges.

It also wants legal protections against data reconstruction — by different pieces of data being combined “to reconstruct information about an individual”.

The report takes a very strong line — warning that no app should be released without “strong protections and guarantees” on “efficacy and proportionality”.

“Without clear efficacy and benefits of the app, the level of data being collected will be not be justifiable and it will therefore fall foul of data protection law and human rights protections,” says the committee.

The report also calls for regular reviews of the app — looking at efficacy; data safety; and “how privacy is being protected in the use of any such data”.

It also makes a blanket call for transparency, with the committee writing that the government and health authorities “must at all times be transparent about how the app, and data collected through it, is being used”.

A lack of transparency around the project was another of the concerns raised by the 177 academics who signed the open letter last month.

The government has committed to publishing data protection impact assessments for the app. But the ICO’s Denham still hadn’t had sight of this document as of this Monday.

Another call by the committee is for a time-limit to be attached to any data gathered by or generated via the app. “Any digital contact tracing (and data associated with it) must be permanently deleted when no longer required and in any event may not be kept beyond the duration of the public health emergency,” it writes.

We’ve reached out to the Department of Health and NHSX for comment on the human rights committee’s report.

There’s another element to this fast moving story: Yesterday the Financial Times reported that the NHSX has inked a new contract with an IT supplier which suggests it might be looking to change the app architecture — moving away from a centralized database to a decentralized system for contacts tracing. Although NHSX has not confirmed any such switch at this point.

Some other countries have reversed course in their choice of app architecture after running into technical challenges related to Bluetooth. The need to ensure public trust in the system was also cited by Germany for switching to a decentralized model.

The human rights committee report highlights a specific app efficacy issue of relevance to the UK, which it points out is also linked to these system architecture choices, noting that: “The Republic of Ireland has elected to use a decentralised app and if a centralised app is in use in Northern Ireland, there are risks that the two systems will not be interoperable which would be most unfortunate.”

#apps, #bluetooth, #data-protection-law, #digital-rights, #elizabeth-denham, #europe, #germany, #health, #human-rights, #identity-management, #ireland, #law, #matt-hancock, #mobile, #national-health-service, #nhs, #nhs-covid-19, #nhsx, #northern-ireland, #privacy, #privacy-policy, #terms-of-service, #united-kingdom


UK eyeing switch to Apple-Google API for coronavirus contacts tracing — report

The UK may be rethinking its decision to shun Apple and Google’s API for its national coronavirus contacts tracing app, according to the Financial Times, which reported yesterday that the government is paying an IT supplier to investigate whether it can integrate the tech giants’ approach after all.

As we’ve reported before coronavirus contacts tracing apps are a new technology which aims to repurpose smartphones’ Bluetooth signals and device proximity to try to estimate individuals’ infection risk.

The UK’s forthcoming app, called NHS COVID-19, has faced controversy because it’s being designed to use a centralized app architecture. This means developers are having to come up with workarounds for platform limitations on background access to Bluetooth as the Apple-Google cross-platform API only works with decentralized systems.

The choice of a centralized app architecture has also raised concerns about the impact of such an unprecedented state data grab on citizens’ privacy and human rights, and the risk of state ‘mission creep‘.

The UK also looks increasingly isolated in its choice in Europe after the German government opted to switch to a decentralized model, joining several other European countries that have said they will opt for a p2p approach, including Estonia, Ireland and Switzerland.

In the region, France remains the other major backer of a centralized system for its forthcoming coronavirus contacts tracing app, StopCovid.

Apple and Google, meanwhile, are collaborating on a so-called “exposure notification” API for national coronavirus contacts tracing apps. The API is slated to launch this month and is designed to remove restrictions that could interfere with how contact events are logged. However it’s only available for apps that don’t hold users’ personal data on central servers and prohibits location tracking, with the pair emphasizing that their system is designed to put privacy at the core.

Yesterday the FT reported that NHSX, the digital transformation branch of UK’s National Health Service, has awarded a £3.8M contract to the London office of Zuhlke Engineering, a Switzerland-based IT development firm which was involved in developing the initial version of the NHS COVID-19 app.

The contract includes a requirement to “investigate the complexity, performance and feasibility of implementing native Apple and Google contact tracing APIs within the existing proximity mobile application and platform”, per the newspaper’s report.

The work is also described as a “two week timeboxed technical spike”, which the FT suggests means it’s still at a preliminary phase — thought it also notes the contract includes a deadline of mid-May.

The contracted work was due to begin yesterday, per the report.

We’ve reached out to Zuhlke for comment. Its website describes the company as “a strong solutions partner” that’s focused on projects related to digital product delivery; cloud migration; scaling digital platforms; and the Internet of Things.

We also put questions arising from the FT report to NHSX.

At the time of writing the unit had not responded but yesterday a spokesperson told the newspaper: “We’ve been working with Apple and Google throughout the app’s development and it’s quite right and normal to continue to refine the app.”

The specific technical issue that appears to be causing concern relates to a workaround the developers have devised to try to circumvent platform limitations on Bluetooth that’s intended to wake up phones when the app itself is not being actively used in order that the proximity handshakes can still be carried out (and contacts events properly logged).

Thing is, if any of the devices fail to wake up and emit their identifiers so other nearby devices can log their presence there will be gaps in the data. Which, in plainer language, means the app might miss some close encounters between users — and therefore fail to notify some people of potential infection risk.

Recent reports have suggested the NHSX workaround has a particular problem with iPhones not being able to wake up other iPhones. And while Google’s Android OS is the more dominant platform in the UK (running on circa ~60% of smartphones, per Kantar) there will still be plenty of instances of two or more iPhone users passing near each other. So if their apps fail to wake up they won’t exchange data and those encounters won’t be logged.

On this, the FT quotes one person familiar with the NHS testing process who told it the app was able to work in the background in most cases, except when two iPhones were locked and left unused for around 30 minutes, and without any Android devices coming within 60m of the devices. The source also told it that bringing an Android device running the app close to the iPhone would “wake up” its Bluetooth connection.

Clearly, the government having to tell everyone in the UK to use an Android smartphone not an iPhone wouldn’t be a particularly palatable political message.

One source with information about the NHSX testing process told us the unit has this week been asking IT suppliers for facilities or input on testing environments with “50-100 Bluetooth devices of mixed origin”, to help with challenges in testing the Bluetooth exchanges — which raises questions about how extensively this core functionality has been tested up to now. (Again, we’ve put questions to the NHSX about testing and will update this report with any response.)

Work on planning and developing the NHS COVID-19 app began March 7, according to evidence given to a UK parliamentary committee by the NHSX CEO’s, Matthew Gould, last month.

Gould has also previously suggested that the app could be “technically” ready to launch in as little as two or three weeks time from now. While a limited geographical trial of the app kicked off this week in the Isle of Wight. Prior to that, an alpha version of the app was tested at an RAF base involving staff carrying out simulations of people going shopping, per a BBC report last month.

Gould faced questions over the choice of centralized vs decentralized app architecture from the human rights committee earlier this week. He suggested then that the government is not “locked” to the choice — telling the committee: “We are constantly reassessing which approach is the right one — and if it becomes clear that the balance of advantage lies in a different approach then we will take that different approach. We’re not irredeemably wedded to one approach; if we need to shift then we will… It’s a very pragmatic decision about what approach is likely to get the results that we need to get.”

However it’s unclear how quickly such a major change to app architecture could be implemented, given centralized vs decentralized systems work in very different ways.

Additionally, such a big shift — more than two months into the NHSX’s project — seems, at such a late stage, as if it would be more closely characterized as a rebuild, rather than a little finessing (as suggested by the NHSX spokesperson’s remark to the FT vis-a-vis ‘refining’ the app).

In related news today, Reuters reports that Colombia has pulled its own coronavirus contacts tracing app after experiencing glitches and inaccuracies. The app had used alternative technology to power contacts logging via Bluetooth and wi-fi. A government official told the news agency it aims to rebuild the system and may now use the Apple-Google API.

Australia has also reported Bluetooth related problems with its national coronavirus app. And has also been reported to be moving towards adopting the Apple-Google API.

While, Singapore, the first country to launch a Bluetooth app for coronavirus contacts tracing, was also the first to run into technical hitches related to platform limits on background access — likely contributing to low download rates for the app (reportedly below 20%).

#alpha, #android, #api, #apple, #apple-inc, #apps, #australia, #bbc, #bluetooth, #ceo, #colombia, #computing, #estonia, #europe, #google, #health, #instagram, #ios-11, #iphone, #ireland, #mobile, #mobile-app, #national-health-service, #nhs, #nhsx, #operating-systems, #privacy, #singapore, #smartphone, #smartphones, #spokesperson, #switzerland, #the-financial-times, #united-kingdom, #wi-fi


NHS COVID-19: The UK’s coronavirus contacts-tracing app explained

The UK has this week started testing a coronavirus contacts-tracing app which NHSX, a digital arm of the country’s National Health Service, has been planning and developing since early March. The test is taking place in the Isle of Wight, a 380km2 island off the south coast of England, with a population of around 140,000.

The NHS COVID-19 app uses Bluetooth Low Energy handshakes to register proximity events (aka ‘contacts’) between smartphone users, with factors such as the duration of the ‘contact event’ and the distance between the devices feeding an NHS clinical algorithm that’s being designed to estimate infection risk and trigger notifications if a user subsequently experiences COVID-19 symptoms.

The government is promoting the app as an essential component of its response to fighting the coronavirus — the health minister’s new mantra being: ‘Protect the NHS, stay home, download the app’ — and the NHSX has said it expects the app to be “technically” ready to deploy two to three weeks after this week’s trial.

However there are major questions over how effective the tool will prove to be, especially given the government’s decision to ‘go it alone’ on the design of its digital contacts-tracing system — which raises some specific technical challenges linked to how modern smartphone platforms operate, as well as around international interoperability with other national apps targeting the same purpose.

In addition, the UK app allows users to self report symptoms of COVID-19 — which could lead to many false alerts being generated. That in turn might trigger notification fatigue and/or encourage users to ignore alerts if the ratio of false alarms exceeds genuine alerts.

Keep calm and download the app?

How users will generally respond to this technology is a major unknown. Yet mainstream adoption will be needed to maximize utility; not just one-time downloads. Dealing with the coronavirus will be a marathon not a sprint — which means sustaining usage will be vital to the app functioning as intended. And that will require users to trust that the app is both useful for the claimed public health purpose, by being effective at shrinking infection risk, and also that using it will not create any kind of disadvantages for them personally or for their friends and family.

The NHSX has said it will publish the code for the app, the DPIA (data protection impact assessment) and the privacy and security models — all of which sounds great, though we’re still waiting to see those key details. Publishing all that before the app launches would clearly be a boon to user trust.

A separate consideration is whether there should be a dedicated legislation wrapper put around the app to ensure clear and firm legal bounds on its use (and to prevent abuse and data misuse).

As it stands the NHS COVID-19 app is being accelerated towards release without this — relying on existing legislative frameworks (with some potential conflicts); and with no specific oversight body to handle any complaints. That too could impact user trust.

The overarching idea behind digital contacts tracing is to leverage uptake of smartphone technology to automate some contacts tracing, with the advantage that such a tool might be able to register fleeting contacts, such as between strangers on the street or public transport, that may more difficult for manual contacts-tracing methods to identify. Though whether these sorts of fleeting contacts create a significant risk of infection with the SARS-CoV-2 virus has not yet been quantified.

All experts are crystal clear on one thing: Digital contacts tracing is only going to be — at very best — a supplement to manual contact tracing. People who do not own or carry smartphones or who do not or cannot use the app obviously won’t register in any captured data. Technical issues may also create barriers and data gaps. It’s certainly not a magic bullet — and may, in the end, turn out to be ill-suited for this use case (we’ve written a general primer on digital contacts tracing here).

One major component of the UK approach is that it’s opted to create a so-called ‘centralized’ system for coronavirus contacts tracing — which leads to a number of specific challenges.

While the NHS COVID-19 app stores contacts events on the user’s device initially, at the point when (or if) a user chooses to report themselves having coronavirus symptoms then all their contacts events data is uploaded to a central server. This means it’s not just a user’s own identifier but a list of any identifiers they have encountered over the past 28 days — so, essentially, a graph of their recent social interactions.

This data cannot be deleted after the fact, according to the NHSX, which has also said it may be used for “research” purposes related to public health — raising further questions around privacy and trust.

Questions around the legal bases for this centralized approach also remain to be answered in detail by the government. UK and EU data protection law emphasize data minimization as a key principle; and while there’s flexibility built into these frameworks for a public health emergency there is still a requirement on the government to detail and justify key data processing decisions.

The UK’s decision to centralize contacts data has another obvious and immediate consequence: It means the NHS COVID-19 app will not be able to plug into an API that’s being jointly developed by Apple and Google to provide technical support for Bluetooth-based national contacts-tracing apps — and due to be release this month.

The tech giants have elected to support decentralized app architectures for these apps — which, conversely, do not centralize social graph data. Instead, infection risk calculations are performed locally on the device.

By design, these approaches avoid providing a central authority with information on who infected whom.

In the decentralized scenario, an infected user consents to their ephemeral identifier being shared with other users so apps can do matching locally, on the end-user device — meaning exposure notifications are generated without a central authority needing to be in the loop. (It’s also worth noting there are ways for decentralized protocols to feed aggregated contact data back to a central authority for epidemiological research, though the design is intended to prevent users’ social graph being exposed. A system of ‘exposure notification’, as Apple and Google are now branding it, has no need for such data, is their key argument. The NHSX counters that by suggesting social graph data could provide useful epidemiological insights — such as around how the virus is being spread.)

At the point a user of the NHS COVID-19 app experiences symptoms or gets a formal coronavirus diagnosis — and chooses to inform the authorities — the app will upload their recent contacts to a central server where infection risk calculations are performed.

The system will then send exposure notifications to other devices — in instances where the software deems there may be at risk of infection. Users might, for example, be asked to self isolate to see if they develop symptoms after coming into contact with an infected person, or told to seek a test to determine if they have COVID-19 or not.

A key detail here is that users of the NHS COVID-19 app are assigned a fixed identifier — basically a large, random number — which the government calls an “installation ID”. It claims this identifier is ‘anonymous’. However this is where political spin in service of encouraging public uptake of the app is being allowed to obscure a very different legal reality: A fixed identifier linked to a device is in fact pseudonymous data, which remains personal data under UK and EU law. Because, while the user’s identity has been ‘obscured’, there’s still a clear risk of re-identification.

Truly ‘anonymous’ data is a very high bar to achieve when you’re dealing with large data-sets. In the NHS COVID-19 app case there’s no reason beyond spin for the government to claim the data is “anonymous”; given the system design involves a device-linked fixed identifier that’s uploaded to a central authority alongside at least some geographical data (a partial postcode: which the app also asks users to input — so “the NHS can plan your local NHS response”, per the official explainer).

The NHSX has also said future versions of the app may ask users to share even more personal data, including their location. (And location data-sets are notoriously difficult to defend against re-identification.)

Nonetheless the government has maintained that individual users of the app will not be identified. But under such a system architecture this assertion sums to ‘trust us with your data’; the technology itself has not been designed to remove the need for individual users to trust a central authority, as is the case with bona fide decentralized protocols.

This is why Apple and Google are opting to support the latter approach — it cuts the internationally thorny issue of ‘government trust’ out of their equation.

However it also means governments that do want to centralize data face a technical headache to get their apps to function smoothly on the only two smartphone platforms that matter.

Technical and geopolitical headaches

The specific technical issue here relates to how these mainstream platforms manage background access to Bluetooth.

Using Bluetooth as a proxy for measuring coronavirus infection risk is of course a very new and novel technology. Singapore was reported to be the first country to attempt this. Its TraceTogether app, which launched in March, reportedly gained only limited (<20%) uptake — with technical issues on iOS being at least partly blamed for the low uptake.

The problem that the TraceTogether app faced initially is the software needed to be actively running and the iPhone open (not locked) for the tracing function to work. That obviously interferes with the normal multitasking of the average iPhone user — discouraging usage of the app.

It’s worth emphasizing that the UK is doing things a bit differently vs Singapore, though, in that it’s using Bluetooth handshakes rather than a Bluetooth advertising channel to power the contacts logging.

The NHS COVID-19 app has been designed to listen passively for other Bluetooth devices and then wake up in order to perform the handshake. This is intended as a workaround for these platform limits on background Bluetooth access. However it is still a workaround — and there are ongoing questions over how robustly it will perform in practice. 

An analysis by The Register suggests the app will face a fresh set of issues in that iPhones specifically will fail to wake each other up to perform the handshakes — unless there’s also an Android device in the vicinity. If correct, it could result in big gaps in the tracing data (around 40% of UK smartphones run iOS vs 60% running Android).

Battery drain may also resurface as an issue with the UK system, though the NHSX has claimed its workaround solves this. (Though it’s not clear if they’ve tested what happens if an iPhone user switches on a battery saving mode which limits background app activity, for example.)

Other Bluetooth-based contract-tracing apps that have tried to workaround platforms limits have also faced issues with interference related to other Bluetooth devices — such as Australia’s recently launched app. So there are a number of potential issues that could trouble performance.

Being outside the Apple-Google API also certainly means the UK app is at the mercy of future platform updates which could derail the specific workaround. Best laid plans that don’t involve using an official interface as your plug are inevitably operating on shaky ground.

Finally, there’s a huge and complex issue that’s essentially being glossed over by government right now: Interoperability with other national apps.

How will the UK app work across borders? What happens when Brits start travelling again? With no obvious route for centralized vs decentralized systems to interface and play nice with each other there’s a major question mark over what happens when UK citizens want to travel to countries with decentralized systems (or indeed vice versa). Mandatory quarantines because the government picked a less interoperable app architecture? Let’s hope not.

Notably, the Republic of Ireland has opted for a decentralized approach for its national app, whereas Northern Ireland, which is part of the UK but shares a land border with the Republic, will — baring any NHSX flip — be saddled with a centralized and thus opposing choice. It’s the Brexit schism all over again in app form.

Earlier this week the NHSX was asked about this cross-border issue by a UK parliamentary committee — and admitted it creates a challenge “we’ll have to work through”, though it did not suggest how it proposes to do that.

And while that’s a very pressing backyard challenge, the same interoperability gremlins arise across the English Channel — where a number of European countries are opting for decentralized apps, including Estonia, Germany and Switzerland. While Apple and Google’s choice at the platform level means future US apps may also be encouraged down a decentralized route. (The two US tech giants are demonstrably flexing their market power to press on and influence governments’ app design choices internationally.)

So countries that fix on a ‘DIY’ approach for the digital component of their domestic pandemic response may find it leads to some unwelcome isolation for their citizens at the international level.

#android, #api, #app-store, #apple, #apps, #australia, #bluetooth, #contacts-tracing-apps, #coronavirus, #covid-19, #data-protection-law, #estonia, #europe, #european-union, #germany, #google, #health, #ios, #iphone, #ireland, #mobile-app, #national-health-service, #nhs-covid-19, #northern-ireland, #operating-systems, #privacy, #security, #singapore, #smartphone, #smartphones, #switzerland, #tc, #united-kingdom


UK’s coronavirus tracing app strategy faces fresh questions over transparency and interoperability

The UK’s data protection watchdog confirmed today the government still hasn’t given it sight of a key legal document attached to the coronavirus contacts tracing app which is being developed by the NHSX, the digital transformation branch of the country’s National Health Service .

Under UK and EU law, a Data Protection Impact Assessment (DPIA) can be a legal requirement in instances where there are high rights risks related to the processing of people’s information.

Last month the European Data Protection Board strongly recommended publication of DPIAs in the context of coronavirus contacts tracing apps. “The EDPB considers that a data protection impact assessment (DPIA) must be carried out before implementing such tool as the processing is considered likely high risk (health data anticipated large-scale adoption, systematic monitoring, use of new technological solution). The EDPB strongly recommends the publication of DPIAs,” the pan-EU data protection steerage body wrote in the guidance.

Giving evidence to the human rights committee today, UK information commissioner Elizabeth Denham confirmed that her department, the ICO, is involved in advising the government on the data protection elements of the app’s design. She said the agency has been provided with some technical documents for review thus far. But, under committee questioning, she reserved any firmer assessment of the rights impacts’ of the government’s choice of app design and architecture — saying the ICO still hasn’t seen the DPIA.

“I think that is on the verge of happening,” she said when asked if she had any idea when the document would be published or provided to the ICO for review.

“Having that key document — and the requirement for the NHXS to do that, and provide that to me and to the public — is a really important protection,” Denham added. “Especially when everything’s happening at pace and we want the public to take up such an app, to help with proximity and notification.

“The privacy notice and the DPIA will both need to be shared with us and I do know that NHSX plans to also publish that so that they can show the public — be transparent and accountable for what they’re doing.”

The NHSX has given a green light for the ICO to audit the app in future, she also told the committee.

Coronavirus contacts tracing applications are a new technology which, in the UK case, entail repurposing the Bluetooth signals emitted by smartphones to measure device proximity as a proxy for calculating infection risk. The digital tracing process opens a veritable pandora’s box of rights risks, with health data, social graph and potentially location information all in the mix — alongside overarching questions about how effective such a tech will prove in battling the coronavirus.

Yesterday the BBC reported that the NHSX will trial the tracing app in the Isle of Wight this week.

“As we see the trial in the Isle of Wight we’ll all be very interested to see the results of that trial and see if it’s working the way that the developers have intended,” added Denham.

At a separate parliamentary committee hearing last week NHSX CEO, Matthew Gould, told MPs that the app could be “technically” ready to deploy nationally within two to three weeks, following the limited geographical trial.

He also said the app will iterate — with future versions potentially asking users to share location data. So while the NHSX has maintained that only pseudonymized data will be collected and held centrally — where it could be used for public health “research” purposes — there remains a possibility that data could be linked to individual identities, such as if different pieces of data are combined by state agencies and/or if the centralized store of data is hacked and/or improperly accessed.

Privacy experts have also warned of the risk of ‘mission creep’ down the tracing line.

Today the Guardian reported that the government is in talks with digital identity startups about building technology to power so called ‘immunity passports’, as another plank of its digital response to the coronavirus. Per the report, such a system could combine facial recognition technology with individual coronavirus test results so a worker could verify their COVID-19 status prior to entrance to a workplace, for example. (A spokeswomen for Onfido confirmed to TechCrunch that it’s in discussions with the government but added: “As you’d expect these are confidential until publicly shared.”)

Returning to the coronavirus tracing app, the key point is that the government has opted for a system design that centralizes proximity events on an NHSX-controlled server — when or if a user elects to self-report themselves suffering from COVID-19 symptoms (or does so after getting a confirmed diagnosis).

This choice to centralize proximity event processing elevates not just privacy and security questions but also wider human rights risks, as the committee highlighted in a series of questions to Denham and Gould today — pointing out, for example, that Denham and the ICO have previously suggested that decentralized architectures would be preferable for such high rights risk technology.

On that Denham said: “Because I’m the information commissioner, if I were to start with a blank sheet of paper [it] would start with a decentralized system — and you can understand, from a privacy and security perspective, why that would be so. But that does not, in any way, mean that a centralized system can’t have the same kind of privacy and security protections. And it’s up to the government — it’s up to NHSX — to determine what kind of design specifications the system needs.

“It’s up to government to identify what those functions and needs are and if those lead to a centralized system then the question that the DPIA has to answer is why centralized? And my next question would be how are the privacy and security concerns addressed?  That’s what a DPIA is. It’s about the mitigation of concerns.”

Apple and Google are also collaborating on a cross-platform API that will support the technical functioning of decentralized national tracing apps, as well as baking a decentralized and opt-in system-wide contacts tracing into their own platforms.

The tech giants’ backing for decentralized tracing apps raises interoperability questions and technical concerns for governments that choose to go the other way and pool data.

In additional details for the forthcoming Exposure Notification API, released today, the tech giants stipulate that apps must gain user consent to get access to the API; should only gather the minimum info necessary for the purposes of exposure notification, and only use it for a COVID-19 response; and can’t access or even seek permission to access a device’s Location Services — meaning no uploading location data (something the NHSX app may ask users to do in future, per Gould’s testimony to a different parliamentary committee last week. He also confirmed today that users will be asked to input the first three letters of their postcode).

A number of European governments have now said they will use decentralized systems for digital contacts tracing — including Germany, Switzerland and the Republic of Ireland.

The European Commission has also urged the use of privacy preserving technologies — such as decentralization — in a COVID-19 contacts tracing context.

Currently, France and the UK remain the highest profile backers of centralized systems in Europe.

But, interestingly, Gould gave the first sign today of a UK government ‘wobble’ — saying it’s not “locked” to a centralization app architecture and could change its mind if evidence emerged that a different choice would make more sense.

Though he also made a point of laying out a number of reasons that he said explained the design choice, and — in response to a question from the committee — denied the decision had been influenced by the involvement of a cyber security arm of the UK’s domestic intelligence agency, GCHQ .

“We are working phenomenally closely with both [Apple and Google],” he said. “We are trying very hard in the context of a situation where we’re all dealing with a new technology and a new situation to try and work out what the right approach is — so we’re not in competition, we’re all trying to get this right. We are constantly reassessing which approach is the right one — and if it becomes clear that the balance of advantage lies in a different approach then we will take that different approach. We’re not irredeemably wedded to one approach; if we need to shift then we will… It’s a very pragmatic decision about what approach is likely to get the results that we need to get.”

Gould claimed the (current) choice of a centralized architecture was taken because the NHSX is balancing privacy needs against the need for public health authorities to “get insight” — such as about which symptoms subsequently lead to people subsequently testing positive; or what contacts are more risky (“what the changes are between a contact, for example, three days before symptoms develop and one day before symptoms develop”).

“It was our view that a centralized approach gave us… even on the basis of the system I explained where you’re not giving personal data over — to collect some very important data that gives serious insight into the virus that will help us,” he said. “So we thought that in that context, having a system that both provided that potential for insight but which also, we believe provided serious protections on the privacy front… was an appropriate balance. And as the information commissioner has said that’s really a question for us to work out where that balance is but be able to demonstrate that we have mitigations in place and we’ve really thought about the privacy side as well, which I genuinely believe we have.”

“We won’t lock ourselves in. It may be that if we want to take a different approach we have to do some heavy duty engineering work to take the different approach but what I wanted to do was provide some reassurance that just because we’ve started down one route doesn’t mean we’re locked into it,” Gould added, in response to concern from committee chair, Harriet Harman, that there might only be a small window of time for any change of architecture to be executed.

In recent days the UK has faced criticism from academic experts related to the choice of app architecture, and the government risks looking increasingly isolated in choosing such a bespoke system — which includes allowing users to self report having COVID-19 symptoms; something the French system will not allow, per a blog post by the digital minister.

Concerns have also been raised about how well the UK app will function technically, as it will be unable to plug directly into the Apple-Google API.

While international interoperability is emerging as a priority issue for the UK — in light of the Republic of Ireland’s choice to go for a decentralized system. 

Committee MP Joanna Cherry pressed Gould on that latter point today. “It is going to be a particular problem on the island of Ireland, isn’t it?” she said.

“It raises a further question of interoperability that we’ll have to work through,” admitted Gould.

Cherry also pressed Denham on whether there should be specific legislation and a dedicated oversight body and commissioner, to focus on digital coronavirus contacts tracing — to put in place clear legal bounds and safeguards and ensure wider human rights impacts are considered alongside privacy and security issues.

Denham said: “That’s one for parliamentarians and one for government to look at. My focus right now is making sure that I do a fulsome job when it comes to data protection and security of the data.”

Returning to the DPIA point, the government may not have a legal requirement to provide the document to the ICO in advance of launching the app, according to one UK-based data protection expert we spoke to. Although he agreed there’s a risk of ministers looking hypocritical if, on the one hand, they’re claiming to be very ‘open and transparent’ in the development of the app — a claim Gould repeated in his evidence to the committee today — yet, at the same time, aren’t fully involving the ICO (given it hasn’t had access to the DPIA); and also given what he called the government’s wider “dismal” record on transparency.

Asked whether he’d expect a DPIA to have been shared with the ICO in this context and at this point, Tim Turner, a UK based data protection trainer and consultant, told us: “It’s a tricky one. NHSX have no obligation to share the DPIA with the ICO unless it’s under prior consultation where they have identified a high risk and cannot properly manage or prevent it. If NHSX are confident that they’ve assessed and managed the risks effectively, even though that’s a subjective judgement, ICO has no right to demand it. There’s also no obligation to publish DPIAs in any circumstances. So it comes down to issues of right and wrong rather than legality.

“Honestly, I wouldn’t expect NHSX to publish it because they don’t have to,” he added. “If they think they’ve done it properly, they’ve done what’s required. That’s not to say they haven’t done it properly, I have no idea. I think it’s an example of where the concept of data ethics bumps into reality — it would be a breach of the GDPR [General Data Protection Regulation] not to do a DPIA, but as long as that’s happened and we don’t have an obvious personal data breach, ICO has nothing to complain about. Denham might expect organisations to behave in a certain way or give her information that she wants to see, but if an organisation’s leadership wants to stick rigidly to what the law says, her expectations don’t have any powers to back them up.”

On the government’s claim to openness and transparency, Turner added: “This isn’t a transparent government. Their record on FOI [Freedom of Information] is dismal (and ICO’s record on enforcing to do something about that is also dismal). It’s definitely hypocritical of them to claim to be transparent on this or indeed other important issues. I’m just saying that NHSX can fall back on not having an obligation to do it. They should be more honest about the fact that ICO isn’t involved and not use them as a shield.”

#api, #apple, #apps, #contacts-tracing-apps, #coronavirus, #covid-19, #data-management, #data-protection, #data-security, #elizabeth-denham, #europe, #european-commission, #european-data-protection-board, #european-union, #france, #gchq, #general-data-protection-regulation, #germany, #google, #health, #ireland, #national-health-service, #nhsx, #privacy, #switzerland, #uk-government, #united-kingdom


Oxwash bags $1.7M for a cleaner spin on laundry

Oxwash, a UK-based laundry startup that’s aiming to disrupt traditional but environmentally costly washing and dry-cleaning processes by using ozone to sterilize fabrics at lower temperatures, along with electric cargo bikes for hyper local pick ups and deliveries, has bagged a £1.4 million (~$1.7M) seed.

Backers in the funding round include TrueSight Ventures, Biz Stone (co-founder of Twitter), Paul Forster (founder of Indeed.com), Founders Factory and other unnamed angel investors.

Prior to this, Oxwash was working with a £300k pre-seed round — which it used to fund building its first washing hubs (which it calls “Lagoons”) and to test its reengineered washing process.

The startup’s pitch is that its applying “space age” technology to clean dirty laundry, burnished by the claim that its co-founder and CEO, Kyle Grant, is a former NASA engineer — having spent two years as a systems engineer where he researched the use and effect of microorganisms for extended space travel.

That said, it’s packing its reengineered cleaning system into standard (but “massively” modified) industrial washing machines. Just add coronavirus-safe ‘space suits’ (er, PPE)….

“Washing still has crazy carbon emissions, pollution and collection/delivery services cause large amounts of congestion. We saw a way to re-engineer the laundry process from the ground up and to be the first truly sustainable, space-age laundry company in the world,” says Grant, discussing the opportunity he and his co-founder spied to rethink laundry.

“We’re developing processes to have zero net carbon emissions for the whole laundry process — from collection to washing and back to delivery.”

The team is developing “chemistry that works at 20˚C better than at 40˚C or higher, integrating ozone disinfection to remove microorganisms by oxidation rather than using heat and developing water recycling and filtration systems to reduce water consumption and remove microfibre pollution at the same time”, per Grant.

It’s also structuring business operations to locate washing hubs in city centres, where its customers are based, so it can make use of electric bikes for moving the laundry around — allowing for a next day service with 30 minute collection and delivery windows.

“Traditional washing processes use huge amounts of water, energy to heat said water, harsh chemicals and normal petrol/diesel vans for the collections and deliveries. These process warehouses are usually located outside of cities and there are large lags in when items are returned to the customers (up to two weeks),” he further claims.

While ozone itself is a pollutant that degrades air quality, and can even be dangerous if released, Grant says the ozone used in its cleaning machines — which is produced from oxygen in the atmosphere — degrades back to oxygen “within minutes and is therefore inert and safe”.

“After extensive analysis ozone is far safer to use in commercial laundry processes than heat and harsh chemicals such as peroxides (bleach),” he suggests.

On safety, he also says their washing machines are modified to be sealed whilst “washing and disinfecting”, and can only be opened after the ozone has degraded. “Our lagoons are also fitted with ozone sensors that will cut off our generators if the ozone concentration in the air ever goes over the safe limit,” he adds. “Thankfully this has never occurred. The risks to our staff are far lower than when working with boiling water tanks, harsh chemicals and manual handling, the usual work flow in commercial laundries.”

Oxwash launched in the UK in early 2018 and now has more than 4,000 individual customers, per Grant, along with “several hundred” business customers — including the Marriott Hotel Chain, NHS GP practices, London Marathon and Universities of Oxford and Cambridge.

It’s executed a slight pivot of focus over the past two months — spying an opportunity to target risks related to the coronavirus. “We’ve developed a service in the last 2 months that is available to provide coronavirus disinfection,” he says in a statement. “We are working closely with [the UK’s National Health Service] NHS and vulnerable groups to provide support when needed.”

“We have adopted laboratory-grade PPE [personal protective equipment] processes, heavily inspired and adapted from my time working at NASA but also from guidelines from the NHS and HSE England,” Grant adds. “For example, we now perform contactless collections and deliveries whereby the customers pre-bag their items in supplied dissolvable bags. Our rider then has gloves, goggles and a respirator to perform the transfer back to the lagoon where a member of our team in full hazmat gear will load and unload the machines where disinfection is performed.”

Before the COVID-19 pandemic, he says the startup was getting traction from customers wanting to remove allergens that caused them allergic reactions.

“We were confident of moving into the healthcare market in the years to come but usually the tender process for such contracts is not conducive to a startup,” says Grant. “However since the advent of COVID-19 and our ongoing healthcare certification, we have seen a huge increase in the value of proper hygiene to both the individuals and businesses we serve. The Marriott Hotel chain and Airbnb have both expressed serious intent to work on a non-healthcare hygiene rating much like that of the Food Standards Authority. We are working with CINET (the international textile committee) to bring this to market with our technology and processes.”

The seed funding will be used to expand to more cities within the UK and Europe — with London and other European hubs, such as Paris and Amsterdam, in its sights. Its initial two locations are Oxford and Cambridge.

It’s also going to spin up on the hiring front, planning to add a head of growth and head of tech, as well as new operational roles in London.

Ploughing more resource into software dev is another focus, with funding going to expand the tech stack and the software systems which run its logistics and integrate with its digitised washing process. More work on its app is also planned. 

Asked what makes Oxwash a scalable business, Grant points to the development of this proprietary software alongside the reengineered washing service. “This iteration of technology and service allows us to develop our washing technology rapidly and get real-time feedback on the end-product and service from our customers,” he says. “The scalable technology element is the proprietary washing process driven by our bespoke software stack and process algorithms.”

On the labor side, Grant says Oxwash is “working towards a B Corp accreditation”.

“[We] have long held that our team should be properly reimbursed for their work but also as ambassadors for our brand out on our bikes. To that end all of our riders (couriers) are fully employed and like the rest of the team they are paid in excess of the national living wage,” he adds.

#biz-stone, #europe, #founders-factory, #fundings-exits, #greentech, #laundry, #nasa, #national-health-service, #oxford, #oxwash, #ozone, #recent-funding, #startups, #truesight-ventures, #twitter, #united-kingdom


The Lucrative Trade in Human Blood Samples

In short supply, the samples are vital for the creation of coronavirus antibody tests that can help end lockdowns. Several companies are racing to capitalize on that.

#antibodies, #blood-donation, #coronavirus-2019-ncov, #great-britain, #laboratories-and-scientific-equipment, #national-health-service, #tests-medical


Can Street Artists Survive a City in Lockdown?

Buskers, musicians and muralists have been entertaining London for centuries. But now the capital has gone quiet and the future of their activities looks uncertain.

#art, #banksy, #graffiti, #london-england, #music, #national-health-service, #street-performers


UK privacy and security experts warn over coronavirus app mission creep

A number of UK computer security and privacy experts have signed an open letter raising transparency and mission creep concerns about the national approach to develop a coronavirus contacts tracing app.

The letter, signed by 177 academics, follows a similar letter earlier this month signed by around 300 academics from across the world, who urged caution over the use of such tech tools and called for governments that choose to deploy digital contacts tracing to use privacy-preserving techniques and systems.

We urge that the health benefits of a digital solution be analysed in depth by specialists from all relevant academic disciplines, and sufficiently proven to be of value to justify the dangers involved,” the UK academics write now, directing their attention at NHSX, the digital arm of the National Health Service which has been working on building a digital contacts tracing app since early March. 

It has been reported that NHSX is discussing an approach which records centrally the de-anonymised ID of someone who is infected and also the IDs of all those with whom the infected person has been in contact. This facility would enable (via mission creep) a form of surveillance.”

Yesterday the NHSX’s CEO, Matthew Gould, was giving evidence to the UK parliament’s Science and Technology committee. He defended the approach it’s taking — claiming the forthcoming app uses only “a measure of centralization”, and arguing that it’s a “false dichotomy” to say decentralized is privacy secure and centralized isn’t.

He went on to describe a couple of scenarios he suggested show why centralizing the data is necessary in the NHSX’s view. But in the letter the UK academics cast doubt on the validity of the central claim, writing that “we have seen conflicting advice from different groups about how much data the public health teams need“.

We hold that the usual data protection principles should apply: collect the minimum data necessary to achieve the objective of the application,” they continue. “We hold it is vital that if you are to build the necessary trust in the application the level of data being collected is justified publicly by the public health teams demonstrating why this is truly necessary rather than simply the easiest way, or a ‘nice to have’, given the dangers involved and invasive nature of the technology.”

Europe has seen fierce debate in recent weeks over the choice of app architecture for government-backed coronavirus contacts tracing apps — with different coalitions forming to back decentralized and centralized approaches and some governments pressuring Apple over backing the opposing horse with a cross-platform API for national coronavirus contacts tracing apps it’s developing with Android-maker Google.

Most of the national apps in the works in the region are being designed to use Bluetooth proximity as a proxy for calculating infection risk — with smartphone users’ devices swapping pseudonymized identifiers when near each other. However privacy experts are concerned that centralized stores of IDs risk creating systems of state surveillance as the data could be re-identified by the authority controlling the server.

Alternative decentralized systems have been proposed, using a p2p system with IDs stored locally. Infection risk is also calculated on device, with a relay server used only to push notifications out to devices — meaning social graph data is not systematically exposed.

Although this structure does require the IDs of people who have been confirmed infected to be broadcast to other devices — meaning there’s a potential for interception and re-identification attacks at a local level.

At this stage it’s fair to say that the momentum in Europe is behind decentralized approaches for the national contacts tracing apps. Notably Germany’s government switched from previously backing a centralized approach to decentralized earlier this week, joining a number of others (including Estonia, Spain and Switzerland) — which leaves France and the UK the highest profile backers of centralized systems for now.

France is also seeing expert debate over the issue. Earlier this week a number of French academics signed a letter raising concerns about both centralized and decentralized architectures — arguing that “there should be important evidence in order to justify the risks incurred” of using any such tracking tools.

In the UK, key concerns being attached to the NHSX app are not only the risk of social graph data being centralized and reidentified by the state — but also scope/function creep.

Gould said yesterday that the app will iterate, adding that future versions could ask people to voluntarily give up more data such as their location. And while the NHSX has said use of the app will be voluntary, if multiple functions get baked in that could raise questions over the quality of the consent and whether mission creep is being used as a lever to enforce public uptake.

Another concern is that a public facing branch of the domestic spy agency, GCHQ, has also been involved in advising on the app architecture. And yesterday Gould dodged the committee’s direct questions on whether the National Cyber Security Centre (NCSC) had been involved in the decision to select a centralized architecture.

There may be more concerns on that front, too. Today the HSJ reports that health secretary Matt Hancock recently granted new powers to the UK’s intelligence agencies which mean they can require the NHS to disclose any information that relates to “the security” of the health service’s networks and information systems during the pandemic.

Such links to database-loving spooks are unlikely to quell privacy fears.

There is also concern about how involved the UK’s data watchdog has been in the detail of the app’s design process. Last week the ICO’s executive director, Simon McDougall, was reported to have told a public forum he had not seen plans for the app, although the agency put out a statement on April 24 saying it was working with NHSX “to help them ensure a high level of transparency and governance”.

Yesterday Gould also told the committee the NHSX would publish data protection impact assessments (DPIAs) for each iteration of the app, though none has yet been published.

He also said the software would be “technically” ready to launch in a few weeks’ time — but could not confirm when the code would be published for external review.

In their letter, the UK academics call on NHSX to publish a DPIA for the app “immediately”, rather than dropping it right before deployment, to allow for public debate about the implications of its use and in order that that public scrutiny can take place of the claimed security and privacy safeguards.

The academics are also calling for the unit to publicly commit to no database or databases being created that would allow de-anonymization of users of the system (other than those self reporting as infected), and which could therefore allow the data to be used for constructing users’ social graphs.

They also urge the NHSX to set out details on how the app will be phased out after the pandemic has passed — in order “to prevent mission creep”.

Asked for a commitment on the database point, an NHSX spokesman told us that’s a question for the UK’s Department of Health and Social Care and/or the NCSC — which won’t salve any privacy concerns around the governments’ wider plans for app users’ data.

We also asked when the NHSX will be publishing a DPIA for the app. At the time of writing we were still waiting for a response.

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