Re: Employ their own consultants
>>"Perhaps it's time that the NHS and the civil service in general employed their own IT consultants direct."
In my experience with this area, in-house actual work is the last thing that they will do. There will be plenty of in-house people producing paperwork and looking busy, but it will all be just liaising with the third party company(ies) and waffle.
There are two reason they wont touch actual work in-house. The first is that there is a fair bit of corruption at the upper levels and the aim of a lot of this is to funnel money to outside parties. Oh they will tell people, even themselves, that they're actually spending it for good, but they will still ultimately be funnelling money to their friends. A lot of the SPINE and Connecting for Health was done under Health Secretary Patricia Hewitt, formerly board member of Accenture. Who got tonnes of money for these contracts? Accenture.
There are a lot of rules and regulations about spending in government. But once you get it out into the third party, accountability goes down the drain, it's essentially a firewall against investigation.
Which leads to the second big reason which is one of accountability. No-one in upper reaches of the NHS or Department of Health ever risks having the blame for something land on their desk. They ALL have bits of paper that show it's actually not their fault. Doing work in-house, runs directly counter to that. And yes, that even includes specification which you thought was harmless but no - if there's a clear specification done in-house and it turns out to have been flawed and can be blamed for the ensuing disaster by the outside company, then whoever was head of the department or team writing that specification is going to be hung out to dry by the government as an easy scapegoat. So even writing the specification is outsourced where possible. They'll hire an expert consulting company to help draft and develop the specs.
The one thing you have to understand, if you really want to know why things like this happen, is that the ONE overriding concern of everyone involved on the government side of this, is THEY MUST NOT BE ABLE TO HOLD ME RESPONSIBLE.
And so, no-one is.