Delegates to Healthcare Computing '98 in Harrogate last week had to wait until the end to hear NHS head of IT Frank Burns preview his new information management and technology strategy.
But it was worth it, for his eagerness to recruit early converts led him to hint at much of what is still supposedly for ministers' eyes only.
Everyone, it seems, has bent his ear on where they think the NHS should go next. Now his listening is done, and he is engaged in what he calls 'very encouraging and positive' discussions with ministers.
Mr Burns claimed he would switch the emphasis of IM&T policy to support for clinical processes. The previous work programme was widely criticised as designed for administering the internal market.
But despite a move to 'user friendliness', he made it plain that some policies would have to be enforced from the centre.
'Ministers are determined to modernise the NHS, compelling it to exploit technology to improve services. So we need to have clear, and if necessary mandated, objectives to be delivered by everyone.
'Whether or not you were consulted before they did it, the NHS now has in place some important national resources: the NHSnet, the NHS number, the clearing service and soon the tracing service. We have got to be prepared to make use of these national infrastructures.'
As a foretaste of compulsion to come, Mr Burns advised a careful re-reading of The New NHS white paper. It demands that, by the millennium, all GPs must be receiving some lab results via NHSnet.
'That means hospitals are going to have to be able to send these messages. We have some work to do over the next six months to make sure we don't miss that target.'
The biggest surprise for delegates was when Mr Burns threw his weight solidly behind the Read codes as a key part of the compulsory strategy. 'I am very glad the National Audit Office report has asked us to do yet another evaluation of Version 3, because it will allow us to eliminate any lingering doubts about its roll-out across the NHS, ' he said. 'I see it as an opportunity, not to raise the question, but to dispel the lingering question mark that is hampering our capacity to get cracking.'
To deliver his big idea, Mr Burns made it clear he needed a standard clinical vocabulary, mandatory across the service - the national electronic patient record - with full patient histories available nationwide. Without the vocabulary, 'we can't deliver the EPR, or the white paper's messaging targets', he said.
The technology needed to turn the cliche of 'seamless care' into a reality was already available, he said. 'We have to move on from the idea that the electronic patient record is just a couple of pilots, that it's the cherry on the cake. It's not: it's the whole cake.'
Other planks in the strategy are:
Streamlining IT procurement processes to the absolute minimum, as demanded by the long-suffering, indeed, nearly suicidal, health computing industry.
Greater public access to detailed health information, if necessary provided or accredited by the NHS itself. The result will be patient pressure on clinicians to improve their performance and keep up with treatment options.
Information on clinicians' individual performance to be collected and fed back to professional audit groups, encouraging doctors privately to compare their performance with their peers.
Online electronic references to help the medical professions keep up to date with best practice and help them make decisions.
A shift in the emphasis of the performance framework, away from bottom line figures towards measuring services' efficacy.
A commitment to the 'grinding detail' needed to ensure patients and NHS staff come to no harm through year 2000 computer failures.
Wider adoption of tele-medicine and remote monitoring technology to deliver home healthcare for chronically ill or vulnerable people.
More aggregated information for local managers - measures of the adequacy, appropriateness, effectiveness, efficiency of local services, data on local population health status.
Cracking the concerns over confidentiality at the technical level, and moving the whole NHS to a more responsible use of patient information.
Who, then, will drive the policy? Mr Burns indicated that a small core group was not enough, and that what he called the 'critical mass issue' could not be dodged. 'We need an IM&T community strong enough both numerically and organisationally. We need to invest in IM&T skills and personnel, but especially in what is a strong organisation where there is intelligent building of critical mass, both in terms of projects and how we support them.'
There were warnings, too, for unenthusiastic top managers: 'If we don't have chief executives who understand what a challenge this is, if they leave it to luck or to others, if they are not personally aware of how important an agenda this is, and how much leadership it needs from them - then history shows what the consequences will be for individual organisations.'
Mr Burns admitted his programme would cost more than its predecessor.
The Treasury, where his proposal now resides, will insist his funds come from axing existing IT projects - for now, nameless.
And finally - when will it happen? 'I've always said we will publish in the spring and I still hope to do that, ' Mr Burns said. 'Some will say that the daffodils are out in Harrogate. I say, it's still spring until the last daffodil dies.'
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