Re: £150m deal was signed with Microsoft to update systems to Windows 10
"...people persist in thinking "The NHS is one entity" despite each trust being operationally independent and having it's own independent IT department...."
It's usually far worse than that. If you think there's only ONE independent IT department in a trust then you have a wakeup call coming, and several more if you think they're actually run by people who know what they're doing. Guerilla IT is a very real thing, as are managers who know nothing about complex network structures and think that everything runs on desktops.
Even when there are people who actually know how to manage the IT side, the politics of getting anything done without the flamethrower of pending criminal charges playing across certain people's feet makes swimming in treacle look like a pleasureable alternative.
I know of health trusts which have managed to get things right - usually by having IT report directly to the CEO and giving them the power to give orders to senior medics when needed, instead of the other way around.