Fiducia TogetherThe £10 billion lesson nobody learned
England's National Programme for IT remains the canonical horror story: over £10 billion spent on connecting the NHS digitally before the whole thing was dismantled. Not because the servers didn't work. Because the programme was designed from the top down, with barely any input from the people expected to live inside it every day.
That pattern isn't a one-off. Researchers have spent two decades cataloguing why health and care technology fails, and the results are strangely repetitive. A 2016 review of electronic health record adoption counted barriers appearing 125 times across 27 studies. A 2018 review did the same for telemedicine and found 33 more. A 2026 overview of clinical decision support tools sifted 721 studies and surfaced 101 distinct factors.
Different technologies. Different decades. Nearly identical lists: cost, disrupted workflows, inadequate training, poor usability, and a deficit of trust.
Read that again, because it tells you something crucial. If the barriers were about the technology, each technology would produce its own distinctive failure profile. They don't. The barriers belong to the organisations and the people, not the software. Which means any supplier obsessed with features and indifferent to your actual working day is solving the wrong problem.
Why ticking boxes doesn't work
The standard response to that barrier list is a checklist. Budget for training. Fix the interface. Address each obstacle in turn and assume adoption follows.
Except it doesn't, and researchers now understand why. A framework called NASSS, published in 2017 in the Journal of Medical Internet Research, reframed the question entirely. Its authors studied real cases of technology failure and found that programmes rarely collapse because one barrier proves fatal. They collapse because complexity piles up across several fronts at once, the organisation, the staff, the technology, the funding, until the whole system exceeds anyone's capacity to adapt. A 2025 review of 57 studies applying that framework confirmed it: almost every failed implementation reported problems across multiple domains simultaneously, with the organisation and the adopters, not the technology, hosting the most barriers.
Complexity multiplies. Checklists merely add. That's the gap where £10 billion disappeared.
And here's the part that should worry the care sector specifically. The research shows this compounding effect punishes small and under-resourced providers hardest, because they face financial, infrastructural and workforce pressure all at once, precisely where the capacity to absorb disruption is lowest. That describes an awful lot of care settings and schools. The organisations that most need good technology are the ones bad technology damages most.
There's a human cost too, not just a financial one. A 2026 meta-analysis in Frontiers in Public Health linked poorly designed record systems directly to clinician burnout, driven by excessive documentation and cumbersome workflows. Bad software doesn't just fail to help. It actively erodes the workforce you need to deliver care at all. Adoption isn't the finish line either; plenty of tools get bought, get used briefly, then get abandoned when the friction outweighs the benefit.
What the evidence says good looks like
Strip the academic language away and the prescription is refreshingly plain. Technology succeeds in care settings when it starts with the people, fits the actual workflow rather than an imagined one, earns trust through usability, and keeps adapting after go-live instead of shipping and vanishing.
That's the standard we hold ourselves to at Fiducia Together, and honestly, it's why we exist. We're a software company built for care and education, and our starting point was never the feature list. It was the paperwork burden crushing the sector, and the people, including the children and adults being supported, whose voices the old systems ignored.
So accessibility isn't a bolt-on for us; even our website adjusts itself for low vision, dyslexia, ADHD, autism and motor needs. Our tools are shaped around individuals: communication passports, AAC talk boards, wellbeing trackers, social stories, alongside the care management and compliance work that has to get done anyway. And because we're small and close to the people using our software, we tailor it. One parent told us the app has been life changing for her son, her family and his care team, largely because we kept adjusting it until it genuinely fitted his needs.
We won't pretend size doesn't matter. It does, just not the way the big vendors think. Two decades of evidence says the winning move isn't the biggest system. It's the one your people will still be using, willingly, in three years.
If your current software fails that test, come and talk to us. Have a look at what we build at fiduciatogether.uk, pick the features that fit your setting, or just email customercare@fiduciatogether.uk with the problem that's driving you mad. We'll tell you honestly whether we can fix it.