It's not just the NHS Trusts
I work for a Hospice and we also came under the NHS agrrement. Which has meant we have never had to pay for software licenses. (except for the server and certain products).
Although we will eventually get the licenses transfered to us they are no good for our future use.
As we cannot transfer these to an academic agreement (Charitys come under this)
We cannot take out software assurance as it is more expensive than it is for us to re-buy the software out right.
The little NHS funding we get won't increase to cover any extra we are going to have to pay.
Biting the hand that feeds IT
