How many less (or more) patients will die if foundation hospitals are or are not created. Not many, one way or the other. But today thousands of patients are at risk, because their hospital records are wrong, or because drugs are wrongly prescribed, or because archaic appointment systems increase waiting times. In 2001 the Audit Commission's report, A Spoonful of Sugar, estimated that 10,000 hospital patients a year have serious adverse reactions to medicines. It suggested that improved information systems could contribute to the prevention of 78 per cent of transcription errors leading to "adverse medical events". The National Programme for IT tries to counter all these adverse side-effects of medical mistakes with three initiatives: an Electronic Health Record for everyone, e-booking for appointments and e-prescribing.

In October last year, Lord Hunt, then the minister responsible for the NHS programme, appointed Richard Granger, from the Deloitte consultancy firm, as Director General of the National Programme - or NHS IT Tsar. By February, Granger had caused unease across the Health IT community, because he seemed to be addressing himself exclusively to selecting the software and project management firms who would be implementing the programme, rather than deciding what was to be implemented. Nor was he firing up the poor bloody IT infantry and the medics with the importance of his mission or his vision of the future.

At the end of March, he finally came out of his bunker. At the annual Healthcare Computing conference in Harrogate he addressed over 2000 health informatics professionals. He announced the creation of a National Design Authority. The NDA will develop and control the standards to which future NHS IT systems will have to adhere to. This new body looks as if may become the master planner, and resolve some of the confusion among the existing planning bodies.

Granger also started to involve the clinicians. He announced that Professor Martin Severs from the University of Portsmouth has joined the National Programme as Director of Clinical Assurance - he will take the lead on developing and ensuring clinician involvement in the National Programme. He will be helped by a panel of 240 other assorted medics.

At a seminar in Birmingham on 21st May, intriguingly called "the long and winding road", organised by ASSIST (the Association for ICT professionals in Health and Social Care) Richard Granger expounded some of his philosophy. The problem in the past was that trusts would waste months or even years, engaging in what he wryly called the NHS "rich tradition of debate", specifying complex systems with fancy features. By the time the systems were implemented the half-life of the technology was long gone. For the Integrated Care Record Service, the jargon name for setting up a national electronic health record, Granger wants to start with simple steps for the first phase, and bring in more sophistication later. He is particularly insistent that the screens will be easy for clinicians to use, all designed to a single pattern, wherever they are across the NHS. Granger estimates that 800,000 people in the NHS will at some time be accessing patient records. The screens have got to be uniform, to avoid retraining

The detailed plan for the first phase have just been announced, and even more importantly, the royal colleges have signed off what should be in the first version of the national electronic health record. As well as personal details, this will include blood groups and allergies, summaries of operations and treatments and names of GPs and hospitals where detailed patient records are held. This is really what everybody has been waiting for, as the building block on which everything else can be built,

It seems that Richard Granger is beginning to get the backing of top brass of the medical profession. At the ASSIST conference, I got the impression that the Informatics troops were now prepared to go "over the top for him". He has still not yet done enough to get clinicians at the coal-face into his tent. A few weeks ago, a hospital consultant admitted to me that he had never heard of Richard Granger, The National Programme for Information Technology or even the former minister responsible, Lord Hunt. Richard Granger has made a lot of progress since Harrogate. He still has still some way to go. But he is all we have got. There is no other way for the NHS to reach the 21st Century. Foundation Hospitals are really irrelevant.