[arctangent]

I'm the tech lead for the NHS website (www.nhs.uk) and I oversee the team who are building this frontend library.

I largely agree with what you have written above, however things work very differently now in NHS Digital.

Every piece of work we embark upon is based on strict requirements from a commissioning body (typically NHS England or Public Health England) and is managed tightly according to budget and demonstrated realised benefits.

We have a highly capable layer of delivery managers who help translate and interpret these "business goals" into things which our agile teams of developers can work towards.

It's not perfect, but we're improving all the time. If we fail then the money taps get turned off quickly, and we move onto something else.