The NHS will not be able to meet the requirements of the NHS plan with a private IT network guarded by 'barbed wire boundaries', according to the NHS Information Authority's new head of access services.

Carrie Armitage, who will be responsible for much of the infrastructure underlying the plan, said there had been a subtle shift in emphasis between the Information for Health strategy issued two years ago and its update, Building the Information Core, issued in January.

While the former focused on the needs of people who manage and deliver services, the update talks about providing information, access to records and services and out-of hours services for the people who use them. 'In my view, the national network infrastructure will require access to patient information by NHS employees, social services, other public services and patients - 55 million of them, 'Ms Armitage said. 'In other words, everybody.

'We need to think in terms of an onion: about different layers and who gets access to what. We need to think about encryption and how we secure the data, rather than the network. '

Contracts for running NHSnet, the NHS's private intranet, run out within the next two years. A strategic outline case is being developed and an outline business case should follow in about six months. Ms Armitage stressed the infrastructure would have to adapt to new technology. But although NHS infrastructure will be built on Internet protocol technology, she did not expect the NHS to do all its business over the Internet. Instead, it may develop a core, secure network and an outward-facing public network: a model used in the banking sector.

At the information authority conference, a government e-envoy warned that the NHS had to take the emphasis on patients seriously or lose 'business' to the private sector. 'We deal with what I call the 'wash and go' generation - 'two bottles of shampoo in the shower? I do not have time for that', ' said Richard Barrington.

'When you can get a£20,000 loan in minutes, the way government offices work, Monday to Friday, nine to five, is no longer acceptable. If we do not do it, someone else will. '

Echoing Ms Armitage's call for a 'flexible approach' to procurement, Mr Barrington said 10-year service plans were 'no longer appropriate'. He said: 'Do not buy it: rent it.

When it does not work any more, move on.

Your focus should be your customer. '

The office of the e-envoy is responsible for driving the e-agenda. Key targets are ensuring everyone who wants it has access to the Internet by 2005 and all government services are online.