The disclosure may help to explain why, nearly three years after the programme was launched, NHS trusts are still facing many uncertainties over the long-term costs, risks and technical implications of implementing the programme locally.
In a speech in the US, which has not been publicised until now, Richard Granger, director general of IT in the NHS, said he had discovered, on taking up his appointment in 2002, that the government's strategy document, 21st Century IT, had "no engineering basis" and had to be "reverse engineered".
Under the banner of 21st Century IT, a series of papers were published early in 2002, alongside ministerial announcements, which launched the multibillion-pound national programme for IT (NPfIT) in the NHS. Granger joined the programme later that year.
The 21st Century IT documents set out an architecture, technical standards, procurement strategy, timetable and responsibilities at various managerial levels of a "national strategic programme" for lifelong electronic health records, electronic booking of hospital appointments, e-prescriptions and a new broadband infrastructure for the NHS. One of the documents was more than 170 pages.
But the documents launched the programme and set timetables before the full implications were known and before there had been widespread consultation with clinicians. After Granger joined, the output specifications expanded to about 800 pages. In mid-2003, more than a year after the NPfIT was given the go-ahead, the Department of Health drew up a business justification and the national programme's project initiation document.
Granger told the Medinfo 2004 conference in San Francisco last year, "There is a document which was produced in 2002 called 21st Century IT which I discovered upon my inheritance was very much a strategy documentÉ I discovered that it had no engineering basis so we had to kind of reverse engineer that as we have mobilised this programme." In the context of his speech Granger was making a factual point, not criticising the document or the government.
His speech also revealed that 10,000 people were being sought from the private sector to work on the programme, which has 100,000 milestones.
A spokesman for the national programme said, "21st Century IT was the strategy document for the NPfIT and at no point has Richard Granger criticised 21st Century IT, the aim of which is to save lives.
"Following publication of that document, formal business justifications were drawn up and the necessary authorities to proceed secured from the Department of Health and HM Treasury. Project initiation documentation was also prepared. It is entirely to be expected that these would follow the publication of the strategy.
"In all large programmes run to aggressive timescales, it is quite normal for detailed planning and engineering to be conducted after the strategy has been agreed and published."
He added that the procurement process took full account of the complexity of implementing the NPfIT.
Geoff Reiss, chairman of the Programme Management Special Interest Group of the Association for Project Management and the British Computer SocietyÊsaid it was normal but not in line with best practice for politicians to give the go-ahead to a large programme before "discovery" work is undertaken to understand its implications.
But an official working for the NPfIT said, "You have to balance the need for detailed planning against the importance of seizing the moment to ensure that a major project actually is launched".