Lord Hunt thinks trickling out the new IT network is better than the CSA's doomed big-bang approach

Here's a fact worth passing on, which might hold significance for the NHS. I found it reading Francis Elliott and James Hanning's new biography of David Cameron.

The Tory leader and his health spokesman, Andrew Lansley, go back further than I had realised. They met after Lansley, an ex-civil servant who had worked for Norman Tebbit, took over as head of the Conservative Research Department in 1990 whose political section was led by young Dave, as his friends still call him.

Ten years Dave's senior, Lansley - 51 this autumn - decided that the Thatcher government's problems with the poll tax might be helped by taking the offensive to organise 'a good summer being beastly to Labour' Dave, a late developer whose precocious maturity colleagues were beginning to notice, was part of the attack team launched at Neil Kinnock's Labour. He was a Thatcherite shrewd enough to keep in with the Heseltine-ites.

That may explain why Lansley kept his 2003 health portfolio when Cameron emerged from the pack to become Tory leader in 2005. The pair are not social friends, but they are political mates. That matters to the Cameroons.

Gordon Brown probably views 1990 the Tory government's fightback year when John Major took over No 10 in November as an interesting precedent: Major got seven years in power. But for the moment the initiative rests with the Tories who are even leading attacks on efforts by Gazprom, Russia's state-controlled energy giant, to raise its UK profile by offering cheap deals to NHS trusts.

Gazprom is not a name which often features in this magazine - unlike the national IT programme, on which the Commons public accounts committee pronounced severely this week. 'There is a question mark hanging over it,' declared the PAC's Tory chair, Edward Leigh MP.

Mr Leigh (no Cameron mate) and his committee conclude that the programme is late, technically over-ambitious and widely unloved, its uncertain eventual cost-benefits not yet sold to the 'sceptical clinicians' whose support is vital. Unusually, their verdict is tougher than the National Audit Office report which prompted the MPs inquiry.

When I checked Mr Leigh's remarks with a smart Labour member of the PAC I found the doubts reinforced, as they were the last time I spoke to IT-minded Labour MPs about the largest project of its kind anywhere.

Databases are part of the future, but there is 'a question mark over deliverability'. Is it too big, too ambitious? 'The whole thing is massively out of control and the medics have not been persuaded,' says the MP - who also marks down NHS IT supremo Richard Granger as an over-optimistic bully. 'He says it's fine, it isn't.'

In short, another opportunity for Mr Lansley to be beastly. But ministers are not giving in. Lord Hunt, who took over the IT brief from Lord Warner three months ago, is confident lessons have been learned from past IT disasters.

Notably there has been tough control over major suppliers - thanks to Mr Granger. The timetable is lagging - as the PAC confirms - but not the budget, Lord Hunt argues. Part of the delay arises from long negotiations with the medical profession over the crucial IT component, care records.

Tricky issues here revolve around three strands: technical; who is in control of the records (national or local?); and the ethical dimension, ie accuracy, security and patient confidentiality. If some GPs encourage their patients to opt out then the system will be hobbled.

As the man who ran reform of the Child Support Agency, Lord Hunt believes that trickling out the new network is better than the CSA's doomed big-bang approach.

From what he has seen in hospitals in Birmingham, he is passionate about the potential: picture archiving transforming
X-rays; electronically transferred prescriptions reducing fatal mistakes; barcodes on patients' tags to prevent lethal cases of mistaken identity.

He sees the day when Sir Lancelot Spratt's consultant grandson, Doc Lance, will be free to wander the ward reading patient notes on his tiny hand-held computer, thanks to that barcode. One day.