Today's health service network is crying out for bandwidth to cope with the extra demands.An upgrade is coming, but, asks Jane Dudman, will it be enough?

The Department of Health has announced a£45m investment to allow GPs, hospitals and other NHS organisations in England to work over faster broadband networks.

The need for an upgrade is clear. At an NHS Information Authority meeting organised last year to discuss the existing health service network, NHSnet, the single biggest request from users was for more bandwidth.

The English NHS is also lagging behind its counterparts in Scotland and Wales. The Welsh high-speed network, Dawn2, is up and running and by September will provide broadband links for all 15 trusts and 600 GPs. Scotland has a more varied picture, but aims to provide all GPs with broadband.

NHSnet is to be completely replaced, with the contract for taking over likely to be awarded in January 2004. But it was clear that users could not wait that long for extra capacity, so NHSIA has announced this separate upgrade work to meet short-term requirements. Some in the health service, however, doubt whether even this stop-gap measure will meet their needs.

'We have been upgraded to 256 kilobits per second, but that is half the speed I have at home, ' points out David Plein, IT administrator at an eight-GP practice in Kilburn, north west London.

'We really need more, particularly if the plans go ahead to centralise e-mail.'

Mr Plein says his practice, which is now entirely paperless, uses a lot of e-mails internally, many with large attachments. 'At the moment, That is fine, because the e-mail is handled by a local exchange server, ' he says. 'But if the plans to centralise go ahead, we will need a lot more capacity, because those e-mails will have to go out to the central system and back again.'

The upgrade, which is being directly funded by NHSIA, will provide every GP practice with a connection of 256kbps into NHSnet.

Each trust, primary care trust and strategic health authority will be upgraded to links running at two megabits per second. That means NHSnet will provide broadband capabilities for the first time.

The upgrade work will help NHS bodies meet the requirements of the national IT programme.

Broadband capability is vital for plans to introduce electronic appointment booking, electronic care records and electronic prescribing.

It should also make it easier for NHS organisations to migrate over to the new network, known as N3, when it is rolled out. That will take up to 2006 and will be a fight between BT and Cable and Wireless.

At the moment, the NHSnet backbone service is run by BT, but both BT and C&W provide connections into the service. In order to limit any complexity, NHSIA says no organisation can switch supplier as part of the upgrade process.

It has also said that the£45m upgrade deal with both providers will run for a maximum of three years. But there is a cessation clause, so if a single provider wins the N3 deal and does not want to continue with a rival platform, those services can be pulled after a year.NHSIA's existing NHSnet contract with BT expires this year; the contract with C&W expires next year.

Last year, NHSIA picked EDS to run a nationwide e-mail system for the health service that will be one of the largest corporate e-mail and directory services in existence.More important still are those aspects of the NHS plan, such as online bookings and online access to pathology results.

Peter Dyke, market development head at BT Health, acknowledges that even with the upgrade, NHSnet users still need more capacity. 'With the full formal reprocurement of NHSnet under way, we expect the new NHS network to provide more services.'

He adds, however, that many NHS users will find the upgraded capacity sufficient. 'It is perhaps not what you would want to rely on in a perfect world, but will allow the levels of traffic being talked about.NHSnet is a good general workhorse.' l Jargon buster Bandwidth is how fast data runs across a network and is measured in bits per second.A standard phone line can handle voice and text, such as e-mails.But it struggles with picture files and is too slow to relay video.

Broadband is a term used to indicate a network that can transmit large amounts of data, generally one with a bandwidth of 2 megabits per second or more.Broadband can be delivered by upgrading phone lines (just), by installing digital subscriber lines (DSL), or by cable and satellite systems.