The following article was published in House Magazine, July 2008.

In the modern NHS, good informatics are essential. Managed by Connecting for Health, the National Programme for IT (NPfIT) is the largest and most complex civil IT project in the world, and aims to revolutionise the use of information and technology in the NHS. Undoubtedly NPfIT promises significant benefits for individual patients and the NHS as a whole, not least by facilitating easier sharing of information between the diversity of providers now delivering NHS care, and achieving major cost savings by using the NHS's mass buying power.

Some elements, such as Picture Archiving and Communications System (PACS), are already transforming how healthcare is provided and improving services. Available in most acute trusts, PACS allows the electronic storage and transfer of digital images of x-rays, CT and MR scans, and is delivering tangible benefits for clinical care as well as cost savings.

Other elements, such as GP to GP transfer, the electronic prescription service, NHS Mail and N3 Network, all promise significant benefits for patient safety, the quality of services, and more efficient working of the NHS. GP to GP transfer allows patients' records to be transferred electronically, quickly and securely if they change GP. E-prescribing will help to minimise prescribing or dispensing errors, risks of drug interactions and make it more convenient for patients needing repeat prescriptions.

Key to NPfIT is the Electronic Care Record Service (CRS), which will provide every patient with an electronic care record that can be accessed wherever and whenever they are treated. The potential benefits of this for the quality, safety and effectiveness of patient care are considerable.

The CRS will improve the sharing and use of information across the NHS, facilitating improved understanding of the working of the NHS, its customer base and use of resources. This should help to make NHS organisations more efficient and effective, and allow aggregation of information to identify the outcomes of treatments for large populations, and early warnings of side-effects and risks.

Despite its potential, the CRS has been dogged by delay, technical problems and controversy. Recent estimates from the National Audit Office suggest it is unlikely to be deployed fully across the NHS before 2014-15 - four years behind schedule, with uncertainty about whether some of the systems will be ready by this date. These delays have meant some trusts have had to invest in interim solutions to upgrade their systems.

Concerns about the quality of the systems on offer and the feasibility of developing three IT systems for all of the English NHS have undermined confidence in the programme. Of particular concern is the failure of CRS to provide comparable functionality to the systems it replaced in some trusts or to interface well with other IT systems. Increased availability and transfer of data has also raised concerns about data security and patient confidentiality.

NPfIT is more than just a major IT programme, and the tendency to ignore the significant behavioural and cultural changes required for the programme's success must be overcome. Involving staff who will use the systems at all of stages of design, development and deployment is vital so that systems are easy to use and deliver appropriate functionality. So too is training and support for staff before, during and after implementation. These will help to achieve improved compliance with systems and protocols, and improve overall data quality.

Public and professional confidence in the programme is essential, and an intelligent debate is required about patient consent and access to health records. Patient confidentiality and consent are important, but measures to protect confidentiality and guarantee data security must be workable in a service that operates 24/7, every day of the year, and allow staff to access information needed to provide safe and appropriate care.

Delivering such a complex and extensive project as NPfIT was always going to be challenging, particularly given the rapidly changing nature of IT and the NHS. The underlying principles of NPfIT are laudable, and there are welcome indications that Connecting for Health, the NHS and suppliers are beginning to learn from experiences.

However, real questions remain about the feasibility of such a national programme. Debate is now focussing on whether a more flexible approach, tailored to local needs, and conforming to common standards of security and interoperability, might be more appropriate. NPfIT is a means to an end - the delivery of better healthcare - and must be seen as an ongoing programme, not a time-limited project.