Those of us interested in the genesis of high-profile national policy will have enjoyed the revelation, on Radio 4's Wiring the NHS programme, that in 2002 Sir John Pattison, then responsible Director for NHS IT, was given all of 10 minutes to make a pitch to the then prime minister for the creation of NPfIT.

The programme reminded me of my own time at the DH when I was asked by the incoming Labour Administration in 1997 to undertake a "root and branch" review of NHS IT policy. It was clear in these early days that the new government was determined to "modernise" the public services and to exploit information technology as far as it was possible to do so in the delivery of services.

As I worked on the strategy, I experienced the daily reality of the senior civil servants as they endeavour to deliver quick, high-impact changes that ministers demand without undermining the development of coherent long-term strategy. More than once I was asked to provide an early and newsworthy IT "deliverable" to incorporate in more imminent strategy documents.

In many respects it is this tension that is at the root of the current and widespread disillusion with the slow progress in delivering functionally useful IT to NHS clinicians.

Experienced practitioners in the NHS have always known that ‘wiring the NHS’ is the most complex and brain numbing change management challenge of all and that there is no quick and easy route to get there. It was evident that the politicians I worked with also knew this but when push came to shove they needed quick wins and headline grabbing initiatives.

This need for success within an electoral cycle accounts for the fact that political priority in NHS IT development has been given to ‘one off’ shorter term projects such as NHS Direct and Choose and Book at the expense of the more fundamental clinical benefits that will flow from integrated electronic health records.

NPfIT is the ultimate example of political impatience for results. It arose from frustration at the centre with the slow progress in local implementation of the 1998 strategy Information for Health. The creation of NPfIT represented a victory for those who had always favoured a top down approach and who assumed clinical IT systems could be purchased centrally and delivered ‘in the back of a van’ to NHS organisations.

John Pattison’s 10 minute pitch to the Prime Minister must have been mesmerising as it resulted in the replacement of the IFH approach to implementing NHS IT with a diametrically opposite philosophy and a target to deliver key systems to NHS Organisations within a period of just three years. It was a confident and brave change of direction that was backed up with undreamed of levels of resource. It was a bid for a ‘quick win’ on a monumental scale.

Regrettably, after allowing for the success in delivering PACs , the short cut to integrated clinical records that was the key driver for the creation of NPfIT seems to have turned into a dead end. The reasons for this are well known and are well documented in the recent report of the Health Select committee

Though the Government came to power in 1997 with an intention that ‘wiring the NHS’ would be a flagship modernisation policy, in its 11th year of office and six years after the creation of NPfIT it remains the case that only a minority of NHS clinicians have sophisticated clinical IT support.

As of now we have a grand total of 45,000 people (inBolton) with the beginnings of a shared clinical record which, in reality, contains only two potentially useful items of clinical information. Even the high priority Choose and Book programme is a long way from being fully implemented and supported.

Whatever the true nature of any high level discussions about the future of NPfIT that are rumoured to be under way we can only hope that NHS leaders and politicians have finally come to appreciate that ‘wiring the NHS’ is difficult, complex, frustrating and in the end far too important for 10 minute, off the cuff decision making processes.

We must also hope that in the interests of expediency they don’t choose to abandon the more complex, clinically related components of the project as these are the only elements of the NPfIT programme that remotely justify the£billions committed to it.

Frank Burns is a former NHS chief executive and was the author of the 1998 strategy Information for Health. He is currently a non executive director of Elision Health. Email fgburns@yahoo.co.uk

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