The Royal Free London NHS Foundation Trust (RFL) has today published an audit into its use of Streams, an app which is helping to deliver improved care to patients with acute kidney injury (AKI).

The audit was completed to comply with undertakings following an investigation into the use of the app by the Information Commissioner in July 2017.

The audit was carried out by Linklaters LLP. Their conclusion is that RFL’s use of Streams is lawful and complies with data protection laws. While the audit identified areas in which further improvement could be made, it contains the following important conclusions:

  • DeepMind only uses patient information for the purpose of providing Streams. It does so under the direction of RFL and in strictly controlled conditions. DeepMind is not permitted to use patient information for any other purpose
  • Streams does not use artificial intelligence. Instead, it implements a simple decision tree used across the whole of the NHS.
  • The audit revealed nothing that casts doubt on the safety and security of the patient information used in Streams. The audit confirmed appropriate systems and controls are in place to protect patient information.

Streams is a secure instant alert app which delivers improved care for patients by getting the right data to the right clinician at the right time. Similar to a breaking news alert on a mobile phone, the technology notifies nurses and doctors immediately when test results show a patient is at risk of becoming seriously ill, and provides all the clinical information they need to take action.

Each year, many thousands of people in UK hospitals die preventably from conditions like AKI, because the warning signs are not picked up and acted on in time. AKI is estimated to cause 40,000 deaths and cost the NHS over £1 billion every year.

Streams integrates different types of data and test results from a range of existing IT systems used by the Royal Free Hospital. Because patient information is displayed in one place – on a mobile application – it reduces the administrative burden on staff and means they can dedicate more time to delivering direct patient care.

The Streams app was built in close collaboration between experts at DeepMind and clinicians at the Royal Free London. It was introduced in January 2017 and is already helping to provide better, safer and faster care to our patients. Nurses report it is saving them around two hours each day – time which would previously have been spent looking through paper patient notes.

Dr Chris Streather, RFL group chief medical officer, said:  

“The Information Commissioner’s investigation last year identified a number of areas of improvement. We accepted those findings and took a number of remedial steps to address them. We welcome the outcome of the audit which confirms our use of Streams complies with data protection laws and would like to thank the Information Commissioner’s Office for their assistance throughout this process.

“We passionately believe in the power of technology to improve care for patients and that has always been the motivation for our Streams app.

“This project is one of the first of its kind in the UK and we have learnt important lessons which will be applicable to the whole of the NHS. We are pleased that the audit concludes we are getting it right and hope that will reassure our patients.

“We are proud of our partnership with DeepMind and look forward to continuing to work closely with them in the future to ensure that the NHS has the opportunity to benefit from the technology we all use in our everyday lives.”

You can download the audit report here.

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Update September 2019: In November 2016, the Royal Free London entered into a five-year partnership with the British technology company DeepMind. In November 2018, it was announced that Streams, and the team behind it, would move to Google Health UK so that the app can grow and support more doctors to deliver faster, better care to patients. In September 2019, after careful consideration, we have now replaced our partnership agreements to continue our work with Google Health UK.

In July 2019, The Information Commissioner’s Office recognised that the Royal Free had completed all actions required in the undertaking and that there were “no further outstanding concerns regarding the current processing of personal data within Streams”.


About the Royal Free London NHS Foundation Trust

The Royal Free London’s mission is to provide world class expertise and local care.

We attract patients from across the country and beyond to our specialist services in liver and kidney transplantation, haemophilia, HIV, infectious diseases, plastic surgery, immunology, neurology, Parkinson’s disease, vascular surgery, cardiology, amyloidosis and scleroderma. We are a member of the academic health science partnership UCL Partners, which brings people and organisations together to transform the health and wellbeing of the population.

The Royal Free London is one of four trusts across the NHS to be chosen to develop a group model enabling us to share services and resources more effectively across hospitals to improve the experience of patients and staff. More information is available here.

Barnet Hospital, Chase Farm Hospital and the Royal Free Hospital are part of the Royal Free London group, and North Middlesex University Hospital NHS Trust became its first clinical partner in September 2017.

For more information about our group structure visit The Royal Free London group model  and for general information about the trust visit