I now work for a catering provider and we deal with Cunningham, Biostore, Civica NRS etc and all have their own issues with support. Its been easier now the new versions of Cunningham report to the cloud as no local server/db required based on what I can see.
CivicaNRS are in a situation where they is a issue with V7 going to V9 and cloud as cannot have both in a cloud instance but waiting to see how they resolve. Biostore does not have a cloud option to link I gather not will it, which would be benficial for a trust to centrally report. Anything to remove pain from local IT is a win I see as the people on the ground have to help support which is a pain, whether server, security etc with unpatched, old systems. Be good if there was a new company that comes in that links to MIS and is cloud based but not seeing it currently.