You're right that interoperability is a key priority for the NHS, but forcing a single unified IT system across the entire organisation has been tried before—and it tends to fail spectacularly.
The pattern is depressingly familiar: the NHS builds (or commissions) a large, complex system. It takes years, incurs major budget overruns and delays—one of the biggest and most ambitious of its era. Eventually, after huge effort, it finally works reliably.
Then someone convinces decision-makers that, because of all the earlier teething troubles and negative press, the now-mature system should be replaced with something “modern.” The replacement (e.g. RESUS for the original national catalogue/barcode system) again suffers massive cost overruns, long delays, and initially delivers worse functionality than the system it superseded—yet ends up being used for 30 years.
Attempts at “one big system” across the whole NHS (like the National Programme for IT) have repeatedly followed the same cycle: vastly over budget, years late, strong opposition built up along the way, and often scrapped or scaled back, sometimes for something inferior.
On the procurement and supply chain side, however, the NHS has genuine world-class strengths. NHS Supply Chain pioneered barcode scanning and a national product catalogue in the 1970s—one of the earliest large-scale implementations anywhere. Today, over 50% of trust orders use automatic barcode replenishment, 100% of orders to suppliers are electronic with full line-item invoicing—a level of maturity they've held for over 30 years.
At my company, Co2Analysis, we've been analysing procurement and supply chain performance across large public and private sector organisations since 2010. Our datasets cover ~70% of the Fortune 500, as well as healthcare systems worldwide, education (all levels), and virtually all parts of the public sector.
From this broad experience, NHS procurement data quality stands out as among the best in global healthcare, and they've been using AI for item-level supply chain carbon footprint tracking since ~2010—a decade ahead of most private-sector best practice. Overall, NHS Supply Chain outperforms 90% of Fortune 500 companies in procurement and supply chain management (supermarkets excepted—their non-food purchasing is often chaotic), and is an order of magnitude better than almost every other public-sector body worldwide.
Clinical and financial systems remain fragmented across trusts, partly because medical IT is inherently hard: mission-critical systems routinely outlive the hardware/OS cycles they were built for, and vendors (quite rightly safety-focused) restrict cheap, open interfaces. Poor interoperability is a global healthcare problem—private systems in other countries often don't talk to each other across providers either.
As one of the world's largest buyers, the NHS actually pushes harder than most for standards and interoperability, but the market still lags.
In short: the NHS has pockets of genuine world-leading excellence (especially supply chain), but the cycle of replacing systems just as they mature into reliable, high-performing assets has wasted billions. Far better to evolve incrementally, enforce strong interoperability standards, and build on existing strengths rather than repeatedly starting from scratch.