Health systems do not have a data problem. They have a joining problem.
Almost every organisation already holds what it needs. What it lacks is one place where the record, the operations, the governance and the population view are the same set of facts.
The same four failures, in every health system we have worked in
Nobody holds the person
Each organisation holds a version of someone. Reconciling them is manual, so it is done at the point of harm rather than continuously.
Integration decays
An interface is a snapshot of two systems agreeing. Neither stands still, and nothing tells you when they stopped agreeing.
Lock-in is the business model
When the data model is proprietary, the cost of leaving grows with every year of data. The renewal negotiation is decided years before it happens.
The org chart is in the code
Reorganisation becomes a migration, so a platform bought in one organisational era has to be replaced in the next.
England has abolished and replaced every commissioner twice in a decade
It is the best-documented example, not the only one. A platform that treats reorganisation as a migration will be migrated, repeatedly.
| When | What | Instrument |
|---|---|---|
| 2013 | 211 clinical commissioning groups created | Health and Social Care Act 2012 |
| 2021 | 106 after eight years of merger | consolidation, no statutory change |
| 2022 | 42 integrated care boards; CCGs abolished | Health and Care Act 2022 |
| 2025 | NHS England abolished; transition into 2027 | announced March 2025 |
| 2026 | 36 integrated care boards | a single Order, in force 1 April 2026 |
| Announced | Aligned to strategic authorities | Cabinet statement, 31 July 2026 |
In commvita the commissioning map is a sourced, effective-dated record. A board merging changes which organisations participate in a case; it does not change the case, the person, the portal login, the key worker or the measure of local need — which is keyed to geography, and geography does not move when a board does.