Achieving the “robust, flexible and standardised” NHS information system envisaged by health secretary, Alan Milburn, will be difficult while the service continues to act as a loose federation.

That was a key message from a London conference on IT and the NHS Plan. The argument was made most strongly by BT Health’s general manager, David Rainey who said that before the last reorganisation he had 1,172 customers in the NHS all making their own judgements about how they should implement systems.

“So how do you make it consistent?” he asked.

He saw BT Health’s role as being the provider of an end-to-end managed, secure, robust, reliable infrastructure for the NHS. He envisaged something along the lines of BT’s own standardised system which manages 100,000 PCs, solves most problems on-screen, has a national directory and provides users with an e-mail address for life.

Mr Rainey concluded that the key to achieving this kind of standardised system would be to use simple, existing technology, replicate what works and put it all on a standardised infrastructure.

He cited teledermatology – the system which enables consultant dermatologists to assess using images sent via e-mail – as a good example the “keep it simple” philosophy. Early work showed that 97% of cases could be dealt with by using still photographs rather than moving images, thus reducing the technology requirements.

NHS Direct, he said, was a system capable of following the full patient journey, citing the example of a colleague who phoned the service and was advised to go her local accident and emergency department. She found that her details had been passed on, enabling the triage nurse to deal with her “in seconds”.

Mr Rainey said the technology was “nothing new, nothing clever, not whizz-bang and not expensive. And that’s the way I suggest we do it. Keep it simple.”