Forum Topic

US firm gets green light for £1.2bn takeover of UK GP tech giant

American health giant UnitedHealth has provisionally been given the go-ahead to buy UK-based firm EMIS – the leading supplier of GP IT systems – by the Competition and Markets Authority in a deal worth £1.2bn.https://www.hsj.co.uk/technology-and-innovation/us-firm-gets-green-light-for-12bn-takeover-of-uk-gp-tech-giant/7035366.article#:~:text=American%20health%20giant%20UnitedHealth%20has,deal%20worth%20%C2%A31.2bn.This is subscription only article, but the one below has no restrictions.https://www.digitalhealth.net/2023/08/unitedhealth-group-acquisition-of-emis-close-after-provisional-clearance/Not good news, in my view!

Ivonne Holliday ● 1181d30 Comments

I suppose the CMA is considering economies of scale versus competition reducing prices not where patients' data will be held and who will have access to exploit it, and for what purpose?

Michael Ixer ● 1181d

Everyones a bogey man.

Andy Pike ● 1180d

Really?Who is the bogey man?

Ivonne Holliday ● 1180d

"Really?Who is the bogey man?"Silly! For Mr Pike the bogey mens is the "illegals".

David Ainsworth ● 1180d

Wrong again Mr Ainsworth.Yvonne seems to have a thing about US companies as sees bogeymen at every turn.

Andy Pike ● 1180d

Incorrect, Mr Pike!By the way, my name is spelt with an I, not a Y.I do not see US companies a bogey men at all.What I find utterly unacceptable and despicable is the NHS data is being sold to the US (or biggest bidder)!Patients' data should remain in the UK!!

Ivonne Holliday ● 1180d

Predictive text is a nuisance.

Andy Pike ● 1180d

Is that all you have to say?

Ivonne Holliday ● 1180d

Nothing else to add. I have no issues with the company as no evidence of any wrongdoing. 

Andy Pike ● 1180d

Andy, I don't see it's anything about individual companies but the effect on the overall software market in the UK. We're obviously not privy to the details of this deal but it's most likely to do with the acquisition of the UK customer base, intellectual property of UK software and patients' (our) data and what value can be derived from analysing the. Some would say it's our data so we should be the beneficiaries of that nor tge shareholders in a US corporation. The ECHR protocol on data protection and the GDPR may support that view but I'm sure the company involved is banking on the UK government diluting data privacy rights.There is also the danger of concentration of solutions based on a single or restricted number of suppliers. I've nothing against Microsoft - as an IT manager I've selected their software in preference to their competitors' and purchased lots of Windows, Office, SQL Server, Exchange, etc licences over the years. However, that concentration in one primry supplier makes us all vulnerable to weaknesses in their software (and to be fair all software has "bugs") that can be exploited by criminals writing malware. So if you reduce the number of health service software suppliers and products you're essentially making it easier for criminals engineer attacks.

Michael Ixer ● 1180d

"patients' (our) data and what value can be derived from analysing"Perhaps I've missed something, what has this got to do with patient data?Another acquisition, one of many more to come. Successful UK companies are fair game if listed on the International London stock exchange. Quite right that the CMA looked at it if there were competition concerns.The whole point about the LSE is to trade which will include international investment, acquisitions etc. Apart from competition which I assume the CMA has already addressed, I'm not sure what the issue is on this one.

Ed Robinson ● 1179d

Ed. I might be wrong but I believe these products are often sold as software services. (or SaaS in the IT jargon) so the data is held on databases operated by the software service provider. Perhaps the GPs do ensure that the data can't be analysed by the software provider but my understanding is that some parts of the health service are doing trades with US companies to analyse patients' data? That isn't necessarily a bad thing, it's just who has access to and benefits from the results - the NHS, the software service provider (or their shareholders), all of them ... hopefully "us" (the patients) with better outcomes from more knowledge. As you always say, Ed, there must be transparency when these arrangements are made as, after all, we the taxpayers pay for the NHS so we must be able to see we're getting a good deal, mustn't we?

Michael Ixer ● 1179d

Michael as you are no doubt aware, lots of companies use SaaS products. The owner of the data and their responsibilities do not change. The same for the platform the data is held on.The CMA is a UK institution and the body for setting the recommendations for security of storage and access is also an UK institution. But that does not appear to be the concern/criticism here.Although some GP's work directly to health authorities or through some intermediate boby that is owned by them, GP's have always been private NHS contractors using partnerships and other structures. But again that does not seem to be the concern here.The company is not owned by the government as far as I'm away and is operating in an open but regulated market. If there are regulations issues then that is a separate matter and would apply to the who market.This all leaves me, perhaps wrongly, to assume some other non specified concerns which can not be discussed unless someone says what they are.There are good reasons for some services and monopoly utilities to be publicly owned. There doesn't seem to be a suggestion that this is one of them.There is less of an argument for private public companies to be UK owned.Still waiting for what the actual concern is here.

Ed Robinson ● 1179d

Andy, a friend of mine works in cyber security for the DoD in Colarado Springs, he told me that the US spies on everyone, including the UK, likewise the UK spies on the US. It's not much of a stretch to believe that US tech companies spy on their customers

Adam Tripp ● 1179d

Ed, I basically agree with what you're saying but I have a somewhat cynical view regarding the long term strategy of US companies buying into the NHS, whether they're software providers or owners of GP surgeries. If the data goes to the US will it ever be repatriated? It's a sensitive area - I'm sure you've been following Mr Max Schrems and his legal antics in the ECJ. I was involved several years ago with an HR SaaS solution decision where at the last minute we bounced from the preferred supplier in the US and went with the runner up in the EU because of the arrogant, unsatisfactory answers concerning data protection and the GDPR from the US company. It was felt some staff might be uncomfortable with personal data being held in the US without more robust guarantees. As Andy indicates in his post, once one's data is in the US the US government has complete access to it and often without your knowledge. That extends to the US government attempting to request Microsoft, because they're a US company, to release data from Irish servers to the US security services.Do I care about my own personal data being in the US? Not really, it's pretty boring; if the US secret service like cats they might want to browse some of my Flickr folders in their coffee breaks. Do I use Facebook yes, but that's a trade off of my data for a service that helps me keep in contact with friends round the world. (Not everyday I get to see a picture from a friend in Michigan with a recently crashed Mig-23 in her apartment block car park!)

Michael Ixer ● 1179d

I do not think I did indicate anything like that Michael.I simply said I had no problems.

Andy Pike ● 1179d

AdamStore loyalty cards know what we buy and when. TFK oyster kniw where we travel and how often.CCTV picks up our every movement.Our phones pinpoint exactly where we are and how we got there.Social media and its cookies know what we look at and what we buy etc etcSo I'll not lose any sleep over some firm knowing what ails me and what medication I use to ease it.

Andy Pike ● 1179d

Apologies,  Andy, I was referring to Adam's post but was multitasking and transposed the name. Yes, TfL Oyser does hold your data but I believe its policy say they delete it after something like eight weeks as, like other organisations operating in the UK, they are subject to the UK GDPR and the corresponding DPA so (at least in theory) one has the rights to see and correct your personal data. Once the US authorities have that data you lose those rights. It's not of concern to you, I'm not too bothered; the main risk is probably mistaken identity so I hope the other Michael Ixer doesn't do anything bad. However, some people aren't happy with it; perhaps why Mr Schrems spends so much time in the ECJ.

Michael Ixer ● 1178d

"Once the US authorities.."Better regulation I can agree with, however if there is nothing to stop the data being moved there post sale it means there is nothing to stop the data being hosted there at present.

Ed Robinson ● 1178d

True but then the question might be who controls the encryption keys to the database. Ideally it would be the NHS but from a practical perspective its likely to be the SaaS vendor. A US judge can request a US company divulged them, more difficult to order a UK company to release them.

Michael Ixer ● 1178d

Keys are normally held by clients, in my experience.If the data is stored or processed abroad a judge or federal body may request access. It's a good reason for not storing the data abroad irrespective of company ownership.The US can require extradition -  Natwest Three, Julian Assange springs to mind.The current US/UK laws favour the US- another thing we have Labour to thank for.

Ed Robinson ● 1178d

There are a few things I do mind about the data being sold to an American company. This is, of course, in addition to the sale of GP practices to an American health care provider.It is all these "small steps" (or not so small?) that are undermining the NHS completely.  Lack of adequate funding, maintenance of hospitals reduced to below the bare minimum, to name but a few.Just as Rupert Murdoch wants to take over the BBC, the American companies are more than willing to take over the NHS. The sad thing is that some people in power are very willing to let them have it all!Jeremy Hunt as Secretary of Health and Social Care did a lot of damage. Now as the Chancellor......On a different subject, there is an article in the Telegraph today entitled:  If you’re under 50, it’s time to jump ship – get out of Britain while you canSam Ashworth-Hayes.......

Ivonne Holliday ● 1178d

That's good if the market has matured. This article reflected my experience with people often taking the easy way out but in fairness it's over half a dozen years since I've participated in due diligence of a SaaS or PaaS solution. Yes, best to keep data close to hand if possible but difficult if all the CFO looks at is the bottom line ...

Michael Ixer ● 1178d

And the article I was referring to …https://www.cryptomathic.com/news-events/blog/key-management-challenges-to-saas-providers-in-the-cloud

Michael Ixer ● 1178d

"If you’re under 50, it’s time to jump ship – get out of Britain while you can"Yes I would agree. No hope for the UK under either party or perhaps the one party with different colours as the policies are almost identical.Another lost decade. As other countries advance the UK remain frozen in time. Compare wages with the US states over the last few decades. Technology, infrastructure, transport - all frozen by comparison with other nations. We will need to factor in increased defense spending, much more going forward.Emigration comes at a high cost. Generations split, sometimes families too. Identities fractured. Some become too pro the new or old.It's a tough decision made easier by the hostile environment the UK has forced on families or future families. Housing, utilities cost, crime, education, health. If only the UK weather was great, but it is not.The fact that so many haven't is testimony to their love of their country.(That and we are crap nationally at languages)Just so sad the people deserve better politicians than the current bunch!

Ed Robinson ● 1178d

"Just so sad the people deserve better politicians than the current bunch!"The people are the electorate. We need a better electorate.

David Ainsworth ● 1178d

Well we do deserve better politicians. Why do they stand when they are so rich, they don't even understand the ordinary person. Why are there not more of our own in our Country standing. Instead of Sadiq Khan turning our Country into a sh-t hole.

Barbara Stevens ● 1178d

That is true, David.It is also true that the electorate must choose between the parties as well as candidates available. Some people vote for a party because they have always done so.  Others vote for personalities.  Many choose the least bad candidate.I think the electorate should be better educated and the prospective candidates too.

Ivonne Holliday ● 1178d

Interesting, was having a discussion with a younger friend and ex-colleague when I went to watch him play in a gig over at Clapham. He's a decade or more under 50 and I was wondering if I'd misjudged Brexit: it was obviously a disaster at the moment with no short term benefits but perhaps in the future it created opportunities for people like him?His response was; "No, Mike, Brexit was stupid but I'm ok with the future. People of my generation will fix it once all the dinosaurs of your generation who voted for Brexit, Truss and other regressive things have died off". Brexit, of course, makes it more difficult for youngsters to relocate anyways - although I do know someone who has recently moved to Spain - and if my friend wanted a job in IT/CyberSecurity abroad then I'm sure he could find one but I think he would take the view why should he when he felt people of his generation could fix the mistakes of people of my generation?

Michael Ixer ● 1178d

A recent paper in the BMJ found that "private equity takeovers are harming patients" and that it was often more expensive and had “mixed to harmful impacts on quality." The profits taken out by the owners are often excessive: Joseph Bruch, an assistant professor at the University of Chicago and co-author of the paper, is quoted in an FT article as saying that “A higher proportion of profits are being taken out of healthcare into the financial sector.” And private equity has a disgraceful tendency to acquire companies by loading then up with massive debt (cf. Manchester United and the private water companies, for example).Not encouraging.The paper can be accessed here (https://www.bmj.com/content/382/bmj.p1396.full) but it's free for BMA members only, or for the day at a cost of £38.

Richard Carter ● 1178d