There are three classic ways of ensuring that a government IT project fails:

• Do it on a national scale.
• Impose it on a complex organisation already facing unpopular reforms.
• Do it in a hurry to meet a politician's deadline.

On the surface, the £2.3 billion National Programme for IT in the NHS meets all these criteria but there are reasons for optimism.

First, the government has no alternative. After five years in office, ministers worry that Labour has failed to deliver demonstrable improvements. While spending on the NHS rose by 21.5 per cent in two years to 2002, the number of "finished consultant episodes" - the standard measure of hospital productivity - rose by only 1.6 per cent.

Many experts believe that the only way to close the gap is by better use of information.

Terry Young, professor of healthcare systems at Brunel University, says that the NHS is crying out for transformation along the lines of "lean" manufacturing industry.

A 'lean' process, in which care would always be available, would eliminate the cost of waiting lists, together with such overheads as car parks, waiting rooms and even beds.

'In industry, lean thinking typically liberates 50 per cent of value. Could we liberate 10 per cent in the NHS? That's about £7 billion a year - we can do a lot with that.'

Ministers are less blunt but are thinking along similar lines. Hence the National Programme's emphasis on electronic booking and the electronic transmission of prescriptions. Both promise a more efficient, leaner, process in a way that voters notice.

The second reason for optimism is that the people in charge are going into it with their eyes open.

Peter Gershon, head of the Treasury's Office of Government Commerce, says the project's leadership and resources appear to be in line with its importance: 'Clearly [IT director general] Richard Granger has got a very relevant and good track record.'

He welcomes the appointment of an identifiable minister in charge - Lord Hunt of King's Heath, a former senior NHS manager. And Gershon has one weapon up his sleeve: a Cabinet-level Central Scrutiny Group.

The National Programme still has serious fault lines:

Uncertain chains of command

The project was to be driven through strategic health authorities but the procurement plan says they will only 'contribute to the process of selecting' providers. Individual trusts will 'agree the timing and sequence' of new services and 'provide appropriate infrastructure and support'. The change of emphasis will make it harder to enforce the programme's rollout.

Ambivalence among doctors and nurses

Not for the first time, government is embroiled in a confrontation with medical professionals. One survey found that 51 per cent of doctors could not name the health secretary. New systems, especially electronic booking, are likely to become symbols of unwelcome reforms and resisted.

Disagreements on electronic patient records

How should they be coded and who should have access? Legally, health information can be shared only with a patient's "informed consent". According to one estimate, a national consent system would cost £400 million - a fact not considered in the National Programme.

The timetable

According to the Department of Health, the procurement process for the National Programme 'will be as rapid as good practice allows. That may clash with another central principle that systems will be precisely specified and tested, especially for interoperability, before they are ordered.

Industry resistance

Although the IT industry has welcomed the National Programme, contractors may balk at some of the procurement principles which stress that payment will be made only when systems deliver value and that risks will be transferred to suppliers.

Changing rules

The departing head of the Audit Commission, Sir Andrew Foster, warns the NHS may become 'slightly punch drunk' by change. But the national entitlement card may yet add to complications.

For the first five years of Tony Blair's government, IT has been a fringe issue in NHS reform.

That is now about to change. The design and implementation of national IT systems will be the battleground on which the government fights for reform - and for its whole reputation as a competent manager of public services. If the national programme fails, it will be a long time before anyone in power trusts the IT profession again.