It is generally assumed that a project of the size of NPfIT can only be carried out by one of a few suppliers big enough to handle it.
I must confess that this idea that an organisation has to be hugeto handle a programme of this size baffles me. It makes no more sense than believing that only a huge organisation could organise theInternet, or that only a massive, centralised organisation couldorganise keeping 15 million motor vehicles roadworthy in the UK.
The size of these organisations is actually a massive disadvantage, since all their effort has to go into managing the huge number of personnel they assume are required to do the job.
If the job was organised correctly, it could be done by a network oflocal providers, most of which already exist (e.g. local isps, localsuppliers of PCs, local providers of ICT services to NHS trusts). If it was done in this manner, it would also boost the local economy by the multiplier effect of the money being spent near the point of service provision, rather than the funds disappearing into the pockets of executives and shareholders of the half-dozen companies who won the contracts.