Bill Gates himself would be hard pressed to deliver it

If Bill Gates were to announce that Microsoft would have all the world's churches on the Internet by 2000, his records suggest that he could keep the promise. When the NHS publishes its information technology strategy, seasoned observers can scarcely credit that it harbours such visionary aspirations given its abysmal IT record. On past performance, it hasn't a hope in hell of achieving entirely unrealistic targets.

The former Wessex regional health authority's£43m IT fiasco - revealed in the early 1990s - is but the most blatant in a long line of IT inadequacies. NHS computer professionals, for example, argued for ever more investment in mainframe computers when the rest of the world was adopting PCs. This was accompanied by a bizarre resistance to others being enabled to interrogate the expanding databases.

In airlines, key databases feature reservations. In banks, naturally, they relate to customer accounts. In manufacturing, they facilitate production scheduling.

Everywhere but in the NHS they are focused on the business's very lifeblood. There, the early emphasis was on payroll and stock control. Patient issues were largely ignored. In patient administration systems, which will continue to spew out questionable data, the emphasis was on administration. Hardly the stuff of clinical governance.

Who, pray, is supposed to affect this transformation? The NHS has great difficulty keeping IT staff. It has been a notoriously poor payer of programmers and other IT personnel. This is reflected in the calibre of those on the payroll. Mostly they are not the creme de la creme. Salaries couldn't be raised to competitive levels without demoralising other groups - notably, nurses.

Earlier IT initiatives have lacked a central direction. Indeed, the policy has been to encourage actively production of similar software in different settings. The service has consequently provided a veritable gravy-train for hardware and software suppliers. It surely can no longer afford the luxury of allowing every Tom, Dick or Harry, trust, authority or supplier to cobble together its own unique variant. A single national payroll system would have made sense 20 years ago, as would one PAS. The only chance of making any headway on the new IT strategy is to limit choice. Even then, it is madly unrealistic - and I would back that with a substantial wager.