| It is possible to work in an agile manner with the NHS but it is not easy. I have been working for a small company selling software into NHS hiospitals for 7 years now, and we generally take a collaborative approach with customers when developing new functionality (which we can then upsell to our other customers). We have a progressive development environment with a small but talented development team. 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. |