Transparency concerns raised over NHS deal with Amazon Alexa

Privacy International criticises decision to redact details of the health service’s agreement with the smart assistant

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Campaigning charity Privacy International has raised concerns about what it sees as a lack of transparency in the NHS’s agreement to share information with Amazon Alexa.

On 14 December 2018, the Department of Health and Social Care entered into a “master content license agreement” with Amazon. According to the contract award notice, the arrangement permits Alexa devices to use “content from the NHS website to provide reliable and informative answers to basic health questions” asked by users.

The actual contract between the NHS and Amazon – which is an “open-ended agreement” – was not published until 16 October this year. The publication came on the back of a freedom of information request from Privacy International.

The commercial document reveals that the tech firm has been granted a licence to use “all of the licensor’s healthcare information including, without limitation, symptoms, causes, and definitions, and all related copyrightable content, data, information and other materials the licensor makes available to Amazon”.

The licensor – who is named in the contract as the health and social care secretary, on behalf of the Crown – also grants Amazon the right to use NHS APIs to access content. 

This right, which is granted on a “non-exclusive, worldwide, perpetual, irrevocable and royalty-free” basis, also allows the company to “access and use any systems, programs or software made available through licensor APIs, and use, copy, cache, store and make backup and archival copies of all tools and documentation related to the licensor API”.

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All information and programs licensed to Amazon can be used – directly by the firm itself or by a third-party partner – to design, develop and test products, provide support and maintenance services, or to “enable end users to use and access” services from Amazon or its affiliates.

However, the firm is not permitted to provide external parties with “bulk raw data files” containing NHS content.

Privacy International notes that one paragraph concerning the details of the content being licensed has been redacted.

“[This] means that we do not have a full and precise overview of what exactly the NHS is granting Amazon,” it said.

In response, an NHS spokesperson said: “No patient data is being provided to this company by the NHS, which takes data privacy extremely seriously and has put appropriate safeguards in place to ensure information is used correctly.”

Redaction plan
Numerous other parts of the contract have also redacted, in particular large sections of the terms and conditions section.

“The lines describing the consequences for Amazon if they were to fail to meet the terms of the agreement have been redacted,” Privacy International said. “This accordingly raises questions as to whether a company recently surrounded by ‘privacy concerns about its use of manual human reviews of Alexa AI voice assistant recordings’ could have been granted any potentially ‘privileged’ status under the agreement. And, if not, why would this have to be hidden from the public?”

In response to the FOI request, the Department of Health and Social Care issued the advocacy group with an explanation of its decision to redact certain segments.

“In this case, we consider that the release of the redacted clauses would be likely to prejudice the commercial interests of Amazon on the basis that it would make public the non-standard terms that Amazon has been willing to enter into in respect of this agreement,” it said. “We consider that this would harm Amazon’s negotiating position when entering into agreements with other parties in the future, which in turn would be likely to prejudice their commercial interests.”

The department added that disclosing certain information about the terms it had agreed with Amazon could make other companies more “reluctant to enter into agreements with public authorities”. 

Privacy International claimed that the decision to redact such information equates to the NHS placing Amazon’s commercial interest ahead of the public interest in transparency.

“The Department of Health rightly points to the public interest in understanding the arrangement between them and Amazon,” it said. “We hope we will be able to convince them that when they enter an agreement with one of the largest tech companies, the public should have the right to expect complete transparency, not a heavily redacted contract that leaves us wondering how much time the Department of Health can possibly be requested to give to terminate the contract, or why it was deemed necessary to redact it.”

The charity also raised concerns about the benefits – or lack thereof – that the NHS will reap in return. 

“The public should have the right to expect complete transparency, not a heavily redacted contract that leaves us wondering how much time the Department of Health can possibly be requested to give to terminate the contract, or why it was deemed necessary to redact it.”
Privacy International

Privacy International said that its staff had tested the Alexa device by asking it a range of health-related questions.

“For many of those, Alexa did not have an answer at all – in particular with regard to issues surrounding mental health, sexual health and gender dysphoria – even though the NHS website would have had the answers,” it said. “For some questions, such as, ‘Alexa, my period is late what should I do?’ or other women’s health related questions, Alexa would often give answers that did not come from the NHS website. The Mayo Clinic was one of the alternative sources of information Alexa relied on, for example. This raises further questions about the nature and relevance of this contract if Amazon could choose to prioritise content from an American clinic over NHS content.”

The privacy campaign group called for the NHS to be more transparent about any similar engagements in the future. 

It added that anyone concerned about the role or influence of large technology companies “should not be naïve about the intentions of big companies that are preying over the NHS”.

“The NHS must not become another advertising asset for big tech companies, nor should we take the risk to see cuts to traditional helplines and sources of information. It needs to remain accessible to those who cannot afford or choose not to have an Alexa device,” it said.

“To guarantee that those partnerships do not happen at the expense of patients, it is time for the Department of Health to become more transparent. The public interest should always prevail over the commercial interest of Amazon and the Department of Health should not jump to conclusion as to what is and is not of interest to the public, as they did in their letter to us.”


Sam Trendall

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