At the start of September, the inevitable became a reality: a ministerial statement signalled the end of the £12bn NHS National Programme for IT (NPfIT) and replaced it with a decentralised scheme that will aim to save £700m.

For many health professionals and IT suppliers, the end of NPfIT has not been a time for mourning. Clinicians and NHS IT managers will be heaving a huge sigh of relief that, within a framework of common systems and standards, they will now be allowed to make their own purchasing decisions.

Rather than the all-encompassing strategy of the NPfIT, the new decentralised approach will give greater opportunities to medium-sized and smaller IT players (see further reading, below). The hope is that these nimble providers will be able to succeed where some of the larger suppliers on multi-million pound contracts have failed.

There are many reasons why the big players tended to dominate the original programme, and public sector procurement more generally. Industry experts recognise that certain larger players have a market monopoly (see further reading).

Existing NPfIT procurement arrangements have created an approved list that tends to limit government departments to procure products from certain suppliers (see further reading ‘’). The tendering process is expensive and few companies can go down the road of taking on the detailed demands of bidding for government IT work, while also recognising the financial risk of failure.

Of all the initiatives, the National IT Programme has favoured the large providers most – and in many cases the NPfIT has simply demonstrated that big players also bring significant cost, ongoing maintenance and slower delivery.

The hope is that the changes will lead to more opportunities for IT providers at a local level. More to the point, an open market could lead to opportunities for smarter and more flexible IT providers.

Modern business IT is all about drawing on a range of providers to suit organisational requirements. It is the smaller, nimble firms that will be able to meet such demands and are driving IT innovation. The smaller IT companies are also more able to provide flexibility and speedier delivery. And this has to be the diagnosis for a healthy NHS IT programme.