[jlg23]

You are dealing with multiple vendors, who all bring their layers of customer support and sales people before you even get an estimate of the required change.

Contracts might include processes that must be followed for any modification so nobody gets sued afterwards.

The developers who implemented the software might not even be with the contractor anymore. So you pay for training someone else, too.

[teddyuk]

I personally think £40million is outrageous but how much does a system that cannot go down cost?

[DanBC]

Previous attempts to fix this cost huge amounts, and none of them worked properly.

care.data (about 10 million) https://en.wikipedia.org/wiki/Care.data

Connecting for Health: (over 10 billion!!!) https://en.wikipedia.org/wiki/NHS_Connecting_for_Health

[jen20]

This is an unwarranted slight on CfH, which _did_ produce lots of useful work.

Unfortunately it was far too ambitious and effectively killed private development of healthcare software for the U.K. market in the process, making (for an example relevant to one area of my expertise) dose-based eprescribing a pipe dream despite having produced a ton of useful standards.