David Craig's book "Plundering the Public Sector" is a bit old, but it gives some details of how these projects were run and for whose benefit (there is a hint in the title):
About 15 years ago, when this project was just starting, I was a school kid, doing work experience in the IT department of the local hospital. I did stuff like tearing down desktop boxes for repair, and building install images (although I doubt these ever got used, security there was pretty tight.)
One day, everyone in the department trooped over to a lecture theatre, which was full up with all kinds of staff, doctors, support staff etc. It was about the newly conceived NHS IT project, which was at this stage just a patient records system. It was the slickest presentation I'd ever seen, delivered by a similarly slick government guy, who was on tour, preaching the good word about how amazing this new system was going to be. Even to me as a child, it was clear that he was not entirely to be trusted, mainly because he had obviously not made his own powerpoint. I remember a lot of stuff about "preferred partners," and thinking it was all very fishy indeed.
Afterwards, we in IT adjourned to our own meeting room, to exchange views. There was universal despair. Foreheads met table with some force. The meeting basically consisted of going round the circle, each battle-hardened techie sharing their particular view of why this would never work. "I once built a database of every vauxhall car in europe, with all their service records centralised. That was a fraction of the size of this, and it was still a fucking nightmare, even though the people designing it and the people building it were the same people, and we had absolute technological discretion." And so on.
The pretty much universal consensus was that this would be a disaster, a plague on all their lives for decades to come, for some, the rest of their careers. I credit this moment with warning me off corporate computing forever. Now I write ruby in a place where I am not obligated to wear shoes. Thanks NHS!
EDIT: as a part of my time there I also went to the records department, which was like a giant library with shelves up to the ceiling and moving ladders. On these shelves were the paper patient files, big fat green folders full of assorted documents bound together with those treasury tag things. This was what the slick guy wanted Fujitsu and friends to replace.
I saw the little green records request slips that came into the archive department. Doctors wrote them out when they wanted someone's file. If the file had already been given out to someone else, the archivist would find a slip of paper in it's place on the shelf, detailing it's whereabouts. They would cross reference various numbers, and then send the request slip on to the noted location of the file. When it got there it was quite possible that the file would no longer be at that location, having been given onwards to someone else. Doctors were under no obligation to return the files when they were finished with them, they could give them directly to the next person who needed them. However, they would have to write and hold on to a slip detailing where it had gone. In this way, the little green slips formed a linked list, sometimes 5 levels deep. There was much beeping of barcode scanners: they had built an in house computerised system for tracking the locations of the paper files.
I asked, and apparently the files never got lost. The archivists enforced this regime with a fascistic level of seriousness and intensity. Any doctor who didn't fill out the green forms correctly would face their wrath, and they didn't do this because they knew that if the system wasn't adhered to then they wouldn't be able to get the patient records they needed. The doctors had built the time-delay for file retrieval into their procedures, and everything ran smoothly around it.
This taught me ultimate respect for paper, and the folly of just throwing away a system which highly skilled people have built up over decades, even if you think your whizz-bang technology will be better.
