Saad Chaudhry spent the last stretch of his career sitting inside a health system, wrestling with the unglamorous mechanics of Epic modernisation, revenue cycle reform and enterprise technology upgrades from the inside. This week he became chief executive of Evergreen Healthcare Partners, a Wisconsin consultancy that exists to sell that exact expertise back to health systems, at a markup, once they have lost the people who once did it in-house. It is a small appointment in American trade press terms. In Britain it lands on a system that is living through the same migration of expertise, at far greater scale and with far less room to absorb the cost.

The NHS is midway through the most expensive wave of electronic patient record procurement it has ever undertaken. Four trusts across Somerset and Dorset signed a £222 million contract with Epic in March to build a single federated system called Healthset. Lewisham and Greenwich followed with a £52 million deal in April. University Hospitals Plymouth goes live this month. Stockport and Tameside and Glossop have signed with Altera. Coventry and Warwickshire's SystmOne rollout has already slipped and grown by nearly a million pounds. Each of these programmes depends on the same layer of implementation specialists, optimisation consultants and digital leadership that firms like Evergreen exist to supply, and each depends on it because the health systems doing the buying have spent years losing that expertise to the private sector rather than retaining it.

This is the pattern Chaudhry's own career illustrates without meaning to. Chief digital officers cut their teeth inside large integrated health systems, absorb years of institutional knowledge about how a specific electronic record actually behaves under pressure, and then move to firms that monetise that knowledge across dozens of clients at once. For years, the NHS's version of this system has been a source of concern for successive governments, but no meaningful solution has been found. Rachel Reeves promised in 2024 to rein in government consultancy spending. Wes Streeting, before he held the health brief and before his own resignation this summer, called NHS consultancy spending shocking as shadow health secretary. Neither pledge changed the underlying arithmetic. NHS England signed a four year, £40 million contract for commercial advice on the very reforms meant to reduce reliance on outside firms, and the Department of Health and Social Care has separately paid Korn Ferry to help manage the culture of the NHS England merger it is currently dismantling.

The evidence on whether any of this spending works is not encouraging. Research from Bristol, York and Seville examining more than a hundred trusts found that higher consultancy spending correlated with greater inefficiency rather than less, and that trusts with more internal specialist capability tended to perform better without buying it in. Meanwhile the practical cost of the current EPR wave is already surfacing. Analysis this year put the likely bill for correcting data errors after go-live at over £13.5 million across roughly nine major trust transitions, money that exists only because implementation expertise sits outside the organisations doing the implementing.

None of this makes Epic, Evergreen or any individual consultancy the villain of the piece. Epic's federated model genuinely addresses a real interoperability problem that has dogged the NHS for a decade, and firms like Evergreen exist because health systems on both sides of the Atlantic have created a market for exactly what they sell. The more useful question for NHS leadership is why the system keeps recreating the conditions that make that market necessary. Sir Jim Mackey's accountability agenda has focused heavily on financial discipline and provider performance, but it has said comparatively little about rebuilding the internal digital and analytical capacity that would let trusts negotiate EPR contracts, manage go-lives and fix data problems without importing the entire skill set each time.

Chaudhry's appointment will barely register in Whitehall. But it is a useful reminder that the traffic between health systems and the firms that advise them runs in one direction almost everywhere, and that every senior digital leader who leaves a hospital for a consultancy takes with them exactly the capability an NHS trust will later pay to rent back.