"It's a symptom of a wider cultural issue within all NHS tech organisations."
It's difficult to reap the cost benefits of free and open source software within governments when your IT resources are only used to installing Microsoft patches or getting consultants in to do installations and support. It's not to say FOSS is completely free, as you'd still be paying your internal IT staff, as well as hopefully contributing financially to the FOSS projects you use, but there should be cost benefits nonetheless.
"They've hired directors of everything, and yet they still haven't actually turned out any particularly useful products. The NHS COVID app, something they brandish as a success of NHSX... well, that was delivered by NHS Digital."
Too often, government ends up losing its ability to deliver internally. I've seen (and still know of) internal government employees getting paid average wages and actually supporting a number of open source applications that manage wide area networks, collaboration, video conferencing, and more. These services will all convert into expensive annually increasing subscription services when these employees leave one day. It's a worldwide trend, unfortunately, and one which will drain taxpayers. The culture of doing more with less is unfortunately not alive and well.
See When free and open source actually means £6k-£8k per package: Atos's £136m contract with NHS England
'All software must be safely and securely deployed within guidelines provided to us,' says outsourcer