However, I believe that the market for healthcare software in the UK is severely flawed, and there is little commercial incentive for companies to produce high quality products. Specifically,
1. As identified elsewhere on this thread, the procurement process generally does not reward quality or functionality above accountability / company financials.
2. The cost of sales is very high, and hospital trusts have no money. Therefore, suppliers will generally sell at a loss and require significant revenue through support contracts to make the contract viable. The business is all about lock-in, and there is very little customer demand for real interoperability between systems. Startups are unlikely to become profitable for a long time. It also means that customers resent suppliers for charging through the nose for an apparently trivial change to the software.
3. For any non-trivial IT solution, there are significant interoperability and business process differences between hospitals. You end up implementing a custom solution for each trust and have to absorb the operational costs associated with this. As a supplier, we spend a lot of time trying to get trusts to talk to each other to agree on standard processes, but really this needs to be done at a national level.
4. Many hospitals will roll their own solutions because it is "cheaper". A huge number of hospital systems have been written by doctors who dabble in programming and grow into a big ball of mud. Indeed, our product started out like this (although the doctor in question was smart enough to hire some programmers early on). For me, this shows the lack of experience in the IT departments which allow this to happen, as it is generally not the right way to go.
There are many other challenging aspects to this market, but it does feel like there are opportunities for good software companies to make a difference.
I think one of the biggest problems with modern society is that due to the scale of institutions, there are way too many layers of abstraction and aggregation between decision-makers and the decisions they make. This breaks the feedback loop, since decision-makers can only operate against generalities and not actual knowledge, and it encourages a great deal of risk aversion that prevents the exploration and variation necessary to create real solutions.
Secondly you can not do agile things or indeed anything other than mainstream IT projects under the current procurement rules. I've tried (from both sides)
So reform will have to come from the top down. The good news is that this government does seem interested in root and branch reform so keep pushing. However it is going to require dramatic new thinking in an organisation (the civil service) that is fundamentally built to resist such a thing as part of its very foundations.
Take 2 or 3 teams of (really good) agile programmers, assign each to a local health authority and give them each a tiny budget (£10,000?) and see who can come up with the best/first working system.
If only the process of coding were more watchable...
I bet a small group of motivated people could get the work done faster, cheaper and with greater user satisfaction if they built out from a small project to the wider NHS.
I happen to be in the weird position of knowing some of the people who are currently running the UK. I was at Oxford at the same time as Cameron etc. and actually know Michael Gove. I wrote time him just before the election about this very issue. Who knows if they'll listen.