The revised IM&T strategy for the NHS promises a 'vibrant, networked' future. Haven't we heard that one before, wonders Lyn Whitfield

The summary of last week's revised IM&T strategy for the NHS provokes a strong sense of deja-vu.

Indeed, anybody who fails to scroll beyond page seven of Building the Information Core - implementing the NHS plan may think there has been little progress since its predecessor, Information for Health, was issued in 1998.

Most of the language is familiar, as are many of the targets. The NHS is still battling to get GP practices connected to NHSnet and now hopes to have 95 per cent of them linked up by March this year.

The projects to roll out patient booking systems and electronic records will continue - albeit as part of a general goal to create a 'vibrant, networked NHS' by 2005.

This stability is not a bad thing.

Sean Brennan, head of healthcare strategy at Northgate Information Solutions, says 'constant changes of direction would kill' progress on NHS IT. But it makes for a generally unexciting document.

This may be why section three, which deals with the role of IT in delivering the patient-centred service envisaged in the NHS plan, indulges in a flight of fancy about a Mrs Smith.

In the vibrant, networked NHS of the future, Mrs Smith 'turns regularly to NHS Direct Online for accredited information on reducing the risk of developing cancer through a healthier diet'.

When she finds a lump, she is able to turn to a GP 'armed with all the facts and NICE guidelines'.

The GP can reassure her that her local cancer centre has 'better-than-average results'.

Sadly, it does not say what would happen if Mrs Smith stumbled upon a flaky US website instead or, indeed, what would happen if her local cancer centre was anything less than average.

But full marks for trying to get beyond boxes on desks and projects with impenetrable acronyms.

As Mr Brennan says: 'We are in 2001 and every other industry is using IT much better than health.

We cannot deliver what is described in the NHS plan without using IT better, but the real challenge is to use it to redesign services. Most of the IT is not rocket science.'

The new strategy recognises the need to get kit to the service faster.

It promises that a quarter of trust staff will have desktop access to NHSnet and information services by next year and that all will have them by March 2003.

But there is widespread recognition that this will only be useful if staff actually use the new technology.

A project to ensure that all staff have basic IT skills - based on the European Computer Driving Licence, a modular course that can be completed over three years - should roll out later this year.

But Martin Sotheran, head of delivery for the NHS Information Authority's ways of working with information project, says the 'real issue' is not IT skills.

Instead, it is 'information - how you use it and share it to treat patients better and put them at the centre of that treatment'.

David Lane, Royal College of Nursing adviser on informatics, says the main barrier to doing that is not technology, but culture.

A vibrant, networked NHS will allow consultants, nurses, physiotherapists and a host of other staff access to the same patient notes.

But using that information to the full will require changes in long-established working relationships that some staff may not find easy to accept.

Mr Lane points out that it will also require all staff to speak and write the same language. In other words, standardisation will be essential.

Clinical information systems should all be using SNOMED clinical terms by March 2003. But standardisation goes further.

The strategy sets targets for moving NHS e-mail, browser and office systems to new standards that were set at government level.

It also envisages a much greater role for NHS-wide systems - national projects have been commissioned for digital TV and smart-card technology.

A 'national solution' will be developed for electronic booking systems, based on local pilots.

Even when it comes to 'more mature areas' of NHS IT - such as electronic patient records - local systems will be required to conform to agreed national and international standards.

Pete Dyke, head of marketing for BT Health, said the strategy is 'a corporate IT approach, the same as a large company such as Microsoft would use'.

He predicts that this will lead to more 'pigeon-holing' of suppliers.

A number will be picked to deliver big projects: other players will 'exit quite rapidly', as happened after AXA was chosen to support NHS Direct.

The 'corporate' NHS approach is already being pushed by government ministers.

It will undoubtedly please suppliers, who have found the NHS difficult to do business with. And it should lead to a faster uptake of technology.

As Mr Dyke says, large companies do not generally run focus groups asking 36,000 users what they would like.

'They start from the basis that 'this is the decision, live with it'' - an approach that 'means it is possible to make progress much more rapidly'.

But that is a world away from the early days of NHS IT - with enthusiasts pursuing projects in isolated trusts.

More has changed in the world of NHS IT than the introduction to Building the Information Core suggests.