Whitehall has no firm plans to replace Richard Granger or conduct unrestricted review of NPfIT

Whitehall officials are making no commitment to replacing Richard Granger, Director General of NHS IT and Chief Executive of NHS Connecting for Health, which runs part of the £12.4bn National Programme for IT [NPfIT].

Richard Granger will remain in post until the end of this year. When asked whether he will be replaced an official, when pressed, replied: “Sometimes the simplest questions are the most difficult to answer.” He gave an answer, however.


It was carefully worded – studiedly vague. He said that in the light of developments since Richard Granger announced his resignation David Nicholson, Chief Executive of the NHS, has set up a review of how the NHS uses informatics to improve patient care; and health minister Lord Darzi has begun an NHS Next Stage review which will consider the contributions of Connecting for Health and the NPfIT.

He said: “In the light of these developments, David [Nicholson] now thinks the time is right to look closely at what skills and management arrangements we need to take Connecting for Health forward. We expect to be able to outline this before the end of the year. In the meantime, Richard Granger and his team continue to do an excellent job in leading the Programme.”

It was far from a commitment to replace Richard Granger.

Comment:

The official’s comments about Richard Granger were of less interest than his extraordinary defensiveness over an internal review by the Department of Health of NHS IT.

He was at pains to say what the review would not cover. Specifically he said it would not include the activities of NHS Connecting for Health, which has for years run much of the programme. And the review will not cover the NPfIT. It’s a review of “how the NHS uses informatics to improve patient care”.

The Department of Health should be saying:

“This project is too important to patients and is costing too many billions to allow it to be circumscribed by our fear of criticism. We receive and spend vast amounts of public funds by no specific mandate but on the basis of trust. So we will be particularly watchful of how every penny is used. As a result, our review of the world’s biggest civil IT-based programme will be robust. It will go where it needs to go. The reviewers wiill not tiptoe around any fragile sensibilities. And we will publish the results, because exposing the NPfIT and other major IT-related programmes that are funded publicly to rigorous external scrutiny and openness will contribute to sound, confident government.”

But the Department of Health is saying the opposite. Its message is that reviewers of NHS IT will be as careful as serfs carrying out an audit of the affairs of their feudal masters. This is Sir Humphrey without the smiles.

In 1991 the Department of Health reviewed how the NHS uses informatics to improve patient care, resulting in an IT strategy in 1992; In 1997 the Department of Health again reviewed how the NHS uses informatics to improve patient care and produced a new IT strategy, Information for Health, in 1998. Then the Department set up a new, quick and perfunctory review of how the NHS uses informatics to improve patient care. The result was the NPfIT, which was launched in early 2002. Now, five years into the NPfIT and after more than £2bn has been spent on the programme centrally, the Department of Health says once again that it is setting up a review of how the NHS “uses informatics to improve patient care”.

The Department of Health has an ever- changing staff so has no collective memory. Ministers come and go and usually rely on briefings from transient civil servants.

So the cycle of NHS IT strategy, serious problems and a new review of NHS informatics may continue indefinitely.

A credible alternative is an unconstrained, independent and published review of the NPfIT, as Derek Wanless advocated. That seems a step too far for Nicholson and his ministers.

However Whitehall’s fear of drawing back the curtains on reality is arguably the biggest threat to the programme. Nicholson and ministers are acting out a play. Ask a straight question and they quickly hold a mask to their faces.

And truth remains a penetrating dampness they want to hide with a wallpaper of statistics.

Doctors will begin to support the programme in greater numbers if they understand its real difficulties and challenges – the difficulties and challenges that would be exposed by a published independent review. They are more likely to sympathise with a programme that needs help than one that’s misleadingly advertised as being in good fettle.

The NHS IT programme won’t fail from want of the genial dew of media affection. It may fail because a majority of clinicians view the NPfIT as Pablo Picasso did the first moon-landing: “It means nothing to me. I have no opinion about it, and I don’t care.”

Links:

Whitehall appoints top-level executives who could provide some of the skills of the outgoing Director General of NHS IT Richard Granger.

Replacing Richard Granger as head of the NHS’s £12.4bn National Programme for IT – how much does it matter to the government who it is?

Derek Wanless 2007 – what he says in full about the NHS’s National Programme for IT

NHS IT boss quits

NHS IT boss quits “relentless” post

NHS computer records project chief quits – FT

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If there is to be no appointment to replace Richard Granger, how is CfH going to be managed?

From the DH point of view, NLOP may well mean "No longer our problem" - but *someone* other than the LSPs , with their financial penalties for SHAs who don't fulfill their obligations on purchase volume, needs to be in control.

The thought of this juggernaut being without a driver is even more scary than when it had a driver but no controls..

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