Trying to eat the Elephant in one bite gives you indigestion
I think "my mate dave etc etc" is more than likely correct in his analysis. I am nether an IT person nor a Health service person, but as a taxpayer I want best value and as a health service user I was a slick and effective system.
So free from the constraints of reality this is what I would do.
1) Do a piece of work to rank the trusts level of systems competence (both IT and non IT) - we are not going to publish the results, we are going to be honest and fair. There are no prizes, but.....
2) pick the three best (geography and possibly other factors may play a part) and keep the better 10..20 on board with regular updates and be open to comments and suggestions. Keep all the others informed of progress at 6 monthly intervals.
3) using the contractor's expertise married to the key trust's expertise and nicking good ideas from where ever you can build a system, keeping in mind the requirement for scalability.
4) Make the thing out of industry standard components, ensuring that compatibility with all potential devices is supported in a standard way. Where an equipment supplier tries to insist on a prop interface try not use them unless you really have to.
5) All equipment supply and installation effort is reversed auctioned off against a tight spec - ensure you are not necessarily committed to the lowest bid. Although in practice you will take this unless there is a good reason why not. Performance criteria must be specified and applied fairly - suppliers must be aware that this will be taken into account in further auctions. Part of the process is a risk assessment of the supplier.
6) When you have an operating system and have done the initial bug fix / minor redesign bring those trusts on the best 20 list into the process.
7) Upscale the project and continue to enhance.
8) open it up to all trusts who wish to buy in to the process.
Trusts are not forced to use the system
Trusts buy into the designed system (which of course incorporates best practice)
Funds are available it implement the approved system
Valid suggestions for improvements (IE developing best practice) are accepted and welcomed from anywhere at anytime
So you avoid fighting negative battles and when you have a demonstrably good system people will queue at your door voluntarely, especially as there is money to fund it.
Paris cos she takes it one at a time