The resignation on Tuesday of Lord Hunt of Kings Heath, health minister responsible for performance and quality, leaves the government without a minister in charge of NHS computing.
It is a bad time for a vacancy to arise. As usual with IT ministers, Hunt was very junior, ranking fifth out of six in health secretary Alan Milburn's team. But he was a big fish in one pond - the £2.3 billion project to computerise the NHS in England. As ministerial sponsor of the "national programme", Hunt received a weekly report from Richard Granger, the IT director general charged with turning the programme into reality.
Without such a sponsor, Granger will have a more difficult time persuading the health service that the revolution is going to happen. The scheme will be in the spotlight next week, when NHS IT chiefs, including Granger, report to the biggest event in the healthcare computing calendar, the annual conference in Harrogate.
They will have an upbeat message: arrangements are well under way to replacing the NHS's alphabet soup of outdated systems with standard, national applications. And the biggest names in the industry are clamouring for the chance to supply them.
But if Granger thinks he will be speaking to a home crowd, he will be in for a shock. Although the attendees, whether doctors, hospi tal managers or computer specialists, are by definition interested in IT, they also tend to be pioneers. They are people who, often in the face of scepticism from colleagues, created the IT systems that Granger wants to replace with his "national applications".
The problem is that, although many deserve to be replaced, there are successes. Their creators don't want them to be thrown out with the bath water. One example is the new medical assessment unit at Queen Alexandra Hospital, Portsmouth. The unit is a revolutionary concept: it takes in patients referred by GPs or the A&E department for intensive monitoring and investigation, rather than letting them languish in general wards. The idea is to identify quickly those patients who need specialist care.
IT is vital to the unit. About 70 patients, suffering from a huge range of conditions, pass through the unit each day. Their details are stored on an electronic patient record, which displays at a glance every patient waiting to be admitted or receiving treatment, and the state of each of the unit's 58 beds.
The implications are interesting. According to Dr Paul Schmidt, a physician on the unit, 35% of patients in NHS hospital beds don't need to be there. The rest are waiting; to be seen, to receive results, for a prescription, for a discharge summary or for social care to be available. The electronic patient record identifies these factors, enabling the unit's workflow to be revolutionised in a similar way to Japanese car factories in the 1960s.
Doctors can see the initial diagnosis at a glance and share knowledge with other professionals in the "virtual team" that forms around each patient. NHS doctors normally carry this information on scraps of paper in their pocket.
Persuading doctors to use the system hasn't been easy, Schmidt says - "There are a lot of irrational fears" - but at the unit, the electronic record is now a fact of life.
The problem is where to go from here. Schmidt agrees the NHS needs to take a more corporate approach to its IT. But he is frustrated at the prospect of having to wait until national specifications are agreed and systems procured.
Granger says he does not want to stifle local good practice and innovation. But as the national IT plan rolls out, conflicts between centre and front line will inevitably arise. It's in these kind of situations that we need a minister in charge.
