Deceptive stories about scale: digital technology, public services, and the promise of efficiency

“Blitzscaling”—the language and practice of rapidly scaling technology companies—can have significant consequences when pursued in public service delivery. From 2016 until it went bankrupt in 2023, health-tech start-up Babylon Health introduced discourses and practices of scaling to the United Kingdom’s National Health Service (NHS). While the company promised that its software and Artificial Intelligence (AI) would create efficiency, automated diagnosis, and faster access to service for increasing numbers of people, its integration into the service undermined central organizing features of the NHS, including equity of care and the epistemic authority of clinicians. A focus on working at speed also led to obfuscation of the nature of the company’s AI and software products to evade regulatory responsibility and to Babylon accessing and enclosing public data. Recommendations for continued commitments to principles of public service, including attention to relationships and multiple forms of knowledge, could benefit other public services contending with promised technological transformations.