One Trust I work in has everything locked down. You can't do anything. They argue it's a security issue, but it is absolutely crippling. Another Trust has the opposite approach --almost everything is open for tinkering. People who know what to do, can do it and will do so safely; those who don't know what they're doing are not interested and don't do it anyway. There have never been any security issues. Tells you something. Thing is: the NHS is full of bright people used to carrying responsibility for people's lives, safety and well being. They really are not going to dick about with mission-critical or patient data processing machines if they aren't really sure what they are doing.