Politics rarely damages delivery through policy mistakes. It damages delivery through trust mistakes. When leaders appear too close to major contractors, especially those embedded in national infrastructure, confidence erodes long before any facts are established. That erosion is subtle but lethal. Meetings start slowing. Decisions become cautious. Programmes lose momentum. What looks like a small optics issue in Westminster often becomes a large operational issue everywhere else.
When Keir Starmer visited the Washington offices of Palantir Technologies alongside Peter Mandelson, it was likely intended as a routine engagement with a global technology partner. Governments meet suppliers constantly. Yet the timing matters. The visit preceded significant UK public sector work for Palantir, including a £240m Ministry of Defence deal awarded without open competition. That sequence, even if procedurally sound, inevitably creates questions. Were relationships influencing access. Were decisions entirely arm’s length. Were other suppliers equally considered. These questions are not accusations. They are perception tests. And in public service procurement, perception is often as powerful as proof. Once the narrative forms that proximity equals advantage, it spreads quickly across civil servants, boards and markets. From there, trust weakens, and once trust weakens, delivery slows.
For healthcare leaders, this is where the story stops being political and starts being operational. Palantir is not just another vendor pitching dashboards. Its platforms sit deep inside the working machinery of the National Health Service. They inform patient flow, elective recovery modelling, waiting list prioritisation and command centre oversight. In many trusts, those tools influence daily decisions that affect thousands of patients. That makes Palantir infrastructure, not innovation. Infrastructure demands legitimacy. If clinicians or boards begin to suspect that suppliers are politically favoured rather than competitively selected, adoption becomes cautious. Cautious adoption means more scrutiny cycles, longer governance, additional procurement checks and delayed deployments. Those delays compound across the system. A week becomes a month. A month becomes a quarter. The result is slower improvement in performance metrics that the NHS can ill afford to miss. This is how optics quietly become waiting lists.
The deeper risk is structural. The NHS is currently trying to modernise at scale while under pressure to reduce backlogs and control cost. That requires confidence in national platforms. Executives need to believe that supplier selection is fair and replicable. SMEs need to believe they have a genuine chance to compete. Clinicians need to believe tools exist to support care rather than politics. If any of those groups start to doubt the integrity of the system, behaviour changes. Procurement participation falls. Legal challenges increase. Digital projects attract resistance. Transformation becomes negotiation rather than execution. Leaders then spend more time explaining processes than improving outcomes. This is not theoretical. It is how every large public system behaves under uncertainty. Transparency is not moral positioning. It is performance management. When transparency is high, decisions accelerate. When it is low, friction multiplies. The NHS is already short on capacity. It cannot afford extra friction.
There is also a market consequence. Health tech ecosystems thrive on competition. If smaller firms believe the biggest contracts flow through relationships, they stop investing in bids. Innovation narrows to a handful of incumbents. Costs rise and flexibility falls. Over time, the system becomes dependent on fewer suppliers with greater leverage. That reduces negotiating power and slows progress. In other words, even the perception of preferential access can distort the market for years.
The irony is that governments often meet large suppliers precisely to accelerate transformation. Yet without visible guardrails, those meetings create the opposite effect. Leaders then spend months defending optics rather than driving delivery. For CEOs and COOs inside the NHS, this creates a secondary burden. They must justify technology choices not just on merit, but on politics. Every board pack grows longer. Every approval becomes heavier. Decision cycles stretch.
The solution is not dramatic. It is dull. Publish meetings. Separate political engagement from procurement. Run open competitions where possible. Communicate criteria clearly. Treat visibility as part of delivery, not a compliance afterthought. Boring governance moves faster than exciting shortcuts.
Because when digital infrastructure underpins patient care, legitimacy is as critical as uptime.
Distilled takeaway
For NHS leaders, supplier trust is operational currency. Lose it, and transformation slows regardless of how good the technology is.
Image adapted from original portrait I Keir Starmer ©House of Commons
