It's not just cloud
The NHS is being hammered for license cost for software too and we're not in the position to switch to linux due to staff simply not wanting to learn and many clinical systems having no hope of working with anything non-MS anytime soon.
Sad times but MS is gorging on whatever it can and we're not pushing hard enough as a country (UK, not England/Scotland/Wales/NI) for better pricing from them within the NHS.