A new report in the Harvard Business Review suggests that big IT projects are spiralling out of control, at considerable cost to taxpayers, shareholders and customers. Naturally it made me think again of the NHS’s own national programme for IT drama, running expensively since 2003.

By coincidence the Commons public accounts committee, chaired by Labour’s Margaret Hodge, had just tossed its latest despairing report on the project into the long summer grass. You will not be surprised to hear that it remains a scary story, largely incomprehensible to laymen (myself included). Also to many of those charged with managing the £11.4bn (down from £12.4bn) programme, to judge from some of the committee’s chaotic evidence-taking.

As senior responsible owner of the programme since late 2006-07, the normally formidable Sir David Nicholson (doesn’t he have quite a lot else on his plate?) did not come across as a man on top of his brief. Unfortunately for him, Tory MP and details-man Richard Bacon does.

Andrew Lansley has called it “another government IT procurement disaster” which showed Labour couldn’t be efficient, but that was in opposition.

More recently he called it “an expensive farce”. Former chancellor Alistair Darling has mused that we might save money by canning it. But that was in opposition too. As HSJ reported last week, ministers are poised to make a “better value for IT money” statement next month, one which will give local trusts more IT choice but not cancel major supplier CSC’s contract: that would cost too much.

That figures. It would take a lot of nerve to face down major contractors (with Accenture and Fujitsu retiring hurt, there remains only CSC and BT) and say “if you sue us, you will never work in Whitehall again”.

Francis Maude’s major projects Authority, now ploughing through all big Whitehall IT schemes, could in theory do that.

Neither the coalition nor Labour show much spirit when trying to renegotiate with commercial bullies, although we may all hope that the humbling of Rupert Murdoch will encourage boldness.

Radical critics say that in 2011 an NHS cloud – computing as a network service rather than a product – is the cheap, universal solution, but that the most we are likely to get is “keyhole surgery” which rescues as much as possible from the wreck.

Two points are gently worth making. One, as the Harvard paper points out, is that IT projects running over cost and out of control – three times more likely than, say, hospital construction – are just as problematic in the private sector, although their disasters get less publicity.

Two, as a former Labour minister – once in charge of NHS IT – said when I rang for retrospective wisdom, not all the programme has gone wrong. For instance choose and book is working well and the new GP contract was supported by a lot of new IT which integrated well. We were in too much hurry and failed to consult doctors enough on the design, he concedes. Sir David says the same.

Fair points, but the committee was focusing on the electronic national care record system – the “spine” meant to allow hospitals and GPs to access individual patient records at all times and anywhere. It’s £7bn worth and – as contractors and DH officials admitted to the MPs – it won’t and can’t deliver early promise, their report confirms.

Instead the goal now is locally developed systems which are compatible with programme systems. But remember, warns the ex-minister, Labour developed a top-down centralised blueprint precisely because of scandals like the local Wessex IT disaster in the Tory years.

Beware of “small is beautiful.”