Replacing Richard Granger as head of NPfIT - how much does it matter to government who it is?

Many people inside and outside the NHS are asking: who is going to replace Richard Granger as head of NHS Connecting for Health?

The assumption is that whoever replaces Richard Granger will be in charge of the £12.4bn National Programme for IT [NPfIT]. That may not happen, however.

Although NHS Connecting for Health has been managing the NPfIT, it does not have overall responsibility for the scheme.

David Nicholson, Chief Executive of the NHS, has initiated the NPfIT Local Ownership Programme and as part of the new governing structure for the programme Connecting for Health is only on the second tier.

Connecting for Health’s agency management board reports to a National Programme Board which, in the governance hierarchy of the NPfIT, sits below an NHS Management Board. At the top of the NPfIT governing hierarchy is the Department of Health’s Department Management Board.

An IM& T stakeholder reference panel reports to a Department of Health IM&T subcommittee that does not report directly to NHS Connecting for Health.

When NHS Connecting for Health was formally established on 1 April 2005 it was described as the single national IT provider for the NHS, delivering the NPfIT.

Under Nicholson’s local ownership plan, which dates back to Autumn 2006, some accountability for delivery of the programme has been devolved from Whitehall.

Chief executives of strategic health authorities, primary care trusts and hospital trusts have been appointed as senior responsible owners of their part of the programme (which ignores the original idea of appointing a senior responsible owner as the one person who could be held to account if a project failed to meet the original objectives set for it).

So the new structure means that strategic health authorities, trusts and primary care trusts are in charge of the delivery and implementation of the NPfIT, though within the contracts agreed between Connecting for Health and suppliers. (This devolvement creates many uncertainties, however, in that the NHS can be fined by suppliers for failing to meet its terms of the contracts – yet no trusts actually signed any of the contracts).

Connecting for Health, meanwhile, maintains some national responsibilities: for contract negotiations with suppliers, for example, and for developing, maintaining the policing what has been described as a “national NPfIT architecture”.

But other parts of the national programme will devolve from Connecting for Health, including requirements development for the Care Record Service – which aims to provide a database of 50 million patient records.

Richard Granger sits on the National Programme Board and the Department Management Board so it’s likely his successor will too. But it’s also clear that the Department of Health now has overall responsibility for the scheme. David Nicholson is overall senior responsible owner for the NPfIT.

If Granger’s successor has his charisma he may soon be perceived, whatever his actual responsibilities, as head of the programme. If his replacement is more of a functionary than a leader the appointee may be seen as merely another official with a share in the responsibility for the NPfIT; and this is the sort of appointment Gordon Brown may prefer if, as some MPs believe, the new Prime Minister wants the NPfIT to have a lower public profile in the run up to a possible early general election.

In short many people are asking the question: who will replace Richard Granger? Another more important question may be: does it really matter from the government’s point of view?


NHS South Central Board Paper on NPfIT governance

NHS IT devolution plan goes into action

The biggest challenge – speech by Lord Hunt, minister in charge of the NHS’s £12.4bn National Programme for IT

Personal statement regarding Richard Granger