The NHS projects are a little more complicated than gov.uk front end implementation.

Have you seen any of the care pathway workflows? We're talking 128 page documents integrating police, social services etc as well, just for a birth. They're also all or nothing and have reliability requirements. You can't just agile this stuff; it's space shuttle up front design from day one.

One fuck up in one workflow instance and someone misses that imaging referral and then that person goes from stage 1 to metastatic cancer. How do you assign an appropriate cost vs risk trade off to that?

That may make it too complicated to complete to be honest but where do you go from there? You shelve it with a shit ton of bad PR and pay up the people who told you it's not happening.