This paper presents data and analysis from a long term ethnographic study of the design and development of an electronic patient records system in a UK hospital Trust. The project is a public private partnership (PPP) between the Trust and a US based software house (OurComp) contracted to supply, configure and support their customizable-off-the-shelf (COTS) healthcare information system in cooperation with an in-hospital project team. Given this contractual relationship for system delivery and support (increasingly common, and 'standard' in UK healthcare) we focus on the ways in which issues to do with the 'contract' enter into and impinge on everyday design and deployment work as part of the process of delivering dependable systems.