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First the good news. When the NHS Management Executive, as it then was, drew up and launched its 1992 information management and technology strategy, it effectively brought to an end the era in which healthcare computing was as much a mystery to those responsible for it as it was to patients.

For the first time, says a National Audit Office report this week (see news, pages 2-3), the Executive identified a vision and a set of basic principles for IM&T development which addressed the need for better information about patients, and it did so in a way most NHS bodies regarded as useful.

Furthermore, the revised strategy launched last year by the NHS Executive 'represents an improvement in design in several important respects'.

It is important not to underestimate the scale of this achievement - as NHS chief executive Sir Alan Langlands will be called on to tell the Commons public accounts committee when he answers questions on the report in just under a month's time. It is certainly hard to envisage a scandal on the scale of the Read Codes, let alone Wessex, taking place today.

And the bad news? After 1992, the Executive failed to translate its vision and basic principles into a single set of specific, measurable, achievable, relevant and timely objectives for the strategy as a whole, and had no overall business case which might have convinced the NHS of the value of getting involved in the strategy's various projects. Neither did it have a lifetime expenditure plan for the strategy, and, according to the NAO, it sees little merit in the argument that it should do any of those things now, arguing that the broad framework it intends to put in place will fulfil this role.

None of which would matter much if the strategy had transformed the way the NHS works. But it took until last year for the Executive to start using NHSnet as a communications tool, and there is still no national directory of connected organisations, so that each health authority or trust's ability to use modern communications technology has to be spread by word of mouth. Seven years after it became an objective to connect all GPs to the NHS communications system, only one in 10 still has full access.

Nor have the financial benefits expected of the NHS administrative register or the project to link GPs and their local HAs been forthcoming, while in the case of the register, there is duplication and overlap with other systems and services.

The slightly shambolic nature of NHS progress on IM&T is more than a little alarming as new policy initiatives emerge, each more reliant than the last on the health service's ability to make technology work. What chance of an ordinary member of the public reaching NHS Direct via the Internet when NHSnet returns e-mails to Sir Alan Langlands with the message, 'Name not recognised'?