Granger to leave in transition by end of 2007

Tags: CfH Granger HIS iS Nicholson

16 Jun 2007

Connecting for Health chief executive, Richard Granger is to leave the agency responsible for delivering the National Programme for IT to the NHS in England 'during the latter part of this year.'

In a personal statement issued today, he said he would ‘transition’ from his full time post at the agency he was largely responsible for setting up.

The controversial and outspoken IT boss who joined the NHS from Deloitte Consulting in September 2002 will return to work primarily in the private sector during 2008. The statement says he is currently considering several significant approaches.

He said: "My decision should be seen in the context of the changing role of the centre of the NHS and the fact that when I took on this challenge I said I would give this job five years.”

"I am proud of what has been achieved by the team I established following my appointment in October 2002. I passionately believe that the programme will deliver ever greater levels of benefit to patients over the coming years.

“There remain a number of challenges ahead, but I firmly believe that the leadership of the programme by Lord Hunt, David Nicholson and my colleagues within CfH will ensure these hurdles are overcome. I want to acknowledge the enduring professional support I have received from my team and colleagues throughout the NHS. "

The statement said that in due course an announcement regarding the identification of a successor and transitional arrangements will be made by the Department of Health.

Health minister Lord Hunt said: "I would like to thank Richard Granger for his hard work and tremendous achievements in delivering the National Programme for IT for the NHS and wish him luck for the future. Richard will continue to lead Connecting for Health during the transition period, which we expect to be the late part of the year, and his decision will not affect the delivery of the NHS IT programme.”

Readers Comments

Why not gardening leave from Monday?

16 Jun 07 18:32

"Tremendous achievements in delivering the National Programme for IT". Spot on Lord Hunt! Richard Granger has indeed delivered a programme.

However, the $64,000 question is what has the programme delivered for the NHS? Most of us know the answer to that one so I can't see what will be gained by keeping him on till the end of 2007.

A watershed moment...

17 Jun 07 15:58

NLOP plus a change of leadership at the centre means there is now a unique opportunity to salvage some value from the mess that is NCRS. Though I suspect it is just a portent of the whole sorry saga being quietly closed down at huge, but hidden, expense to the taxpayer.

Did DH expect this?

mary.hawking@nhs.net

17 Jun 07 17:12

The only statement on the CfH website is a personal statement from Richard Granger dated Saturday 16th June, and there is nothing on the DH website (17:00 17th June) Was this announcement expected by the DH?

Saturday seems a peculiar day to announce something like this, and the lack of any simultaneous posting by DH seems like unexpectedly poor news management. NLOP has emerged as a means of transferring "ownership" of enforcement of NPfIT and LSP contracts to "local" SHA level without transferring any control over what IT is selected or needed.

When will the end users (who, remember, are *not* the customers, do *not* hold the contracts, and do *not* have any redress when things do not go according to plan) be informed about what is going on - and how it is likely to affect them?

Another long goodbye?

nhstechie@btinternet.com

18 Jun 07 00:23

Should we expect Richard to follow Tony's lead and embark on a World tour between now and his departure?

History will be the judge of whether either of them did more good than harm, but their friends and foes will all agree that it was time for them both to go.

Congratulations

18 Jun 07 00:41

May I be the first to congratulate the NHS on "bringing about this change".

The legacy can now be documented. On commencing this role we heard about "ruthless standardisation" which we assume partially meant web based software and compliance with eGIF. It was not possible to achieve the over-ambitious scope whilst complying with these standards, so rather than re-assess the scope we saw a push for agressive new development (against stated aims to buy proven products).

In the North it is well documented that old hospital based PASs have been deployed instead. In the South a knee jerk reaction led to Cerner being chosen. This is a supplier who was ruled out during a lengthy procurement phase and brought back in overnight in desperation. These offerings could have been deployed 10 years ago. And where is Lorenzo!

The contracts are stifling and encourage nothing but confrontation. You have to wonder about the cost and value both for NCRS and PACS - if only we could find out. In primary care we have been removed completely and pacified with GPSOC.

(post edited by EHI)

Best chance for success

18 Jun 07 08:46

At last the principle barrier to success has recognised that leaving the helm is the single most useful thing he could do. With suitable change of tactics the Programme could now be transformed into what was needed all along, and the NHS will be enabled to reap the benefits denied it up to now but so urgently needed and deserved. Let's hope some of the others at the top with no background in the NHS follow suit.

Disbenefits and excess cost

18 Jun 07 09:08

The disbenefits, excess costs, and delays of the approach taken by NPfIT vastly outweigh the benefits seen so far in my humble opinion.

And I would suggest the 'efficient' procurement methods and rigid standardisation are not standards worth replicating elsewhere.

A sad day

18 Jun 07 09:29

I know that some eHealth readers are going to disagree, but this is a sad day for NHS IT. Whether you agreed with the approach taken by NHS CFH or not, Richard Granger has driven things forward.

Ask yourself this. When has there been an NHS IT staff member known to so many people, both inside and outside the NHS. NPfIT has been firmly on people's agenda's and that has allowed it to deliver in the face of adversity.

It's going to be a quiter place in 6 months time, and not for the better.

Vacancy?

18 Jun 07 09:42

As we are going back to a re-branded IFH, can we have Steve Walker back to run it?

Post edited by EHI

News management

18 Jun 07 10:46

Interesting that CFH staff were not informed of this prior to the announcement - or even afterwards. So we won't be seeing Richard around Leeds anymore - plus ca change.

Sad day? Driven things forward?

18 Jun 07 10:48

In my opinion, progress in NHS IT has been severely hampered since Richard Granger's appointment. Vast amounts of tacit knowledge have been lost to the NHS as people have dissociated (pushed or jumped) from NPfIT. A once-bouyant and innovative UK health IT industry has been stifled. But - above all else - the local initiatives that were pressing forward across the whole spectrum of healthcare and delivering some real benefits have been in limbo whilst CfH has delivered little more that some PAS systems, a C&B system that has hardly met with widespread acclaim, and PACS.

IMHO it's not gone forward, not even stationary: NHS IT has been in reverse and it will take years of effort to recover the ground.

(post edited by EHI)

as predicted the fat lady sings...

18 Jun 07 12:32

'I did it myyyy way' presumeably... difficult to see how anyone could make a success of a programme this size. Good luck in his next role.

Building on Granger's Legacy

ewan@woodcote-consulting.com

18 Jun 07 12:44

Moving NHS IT from where it was at the end of the 90's to where in ought to be today required a radical approach and needed people who would robustly challenge pre-existing orthodoxies. It also needed additional resources, both in terms of straight cash but also in terms engineering and programme management expertise that were poorly developed in the existing health informatics community. The NPfIT has brought us these things but has struggled to combine them effectively with the world class health informatics skills that already existed in the UK.

The problems of the NPfIT relate to failures of vision, understanding and leadership. These failings can't be laid at the door of one man and certainly not that of Richard Granger, who we should remember, only joined the programme once the die was cast. He was brought in as a "hired gun" with a proven track record outside health, but with no experience in this uniquely complex domain. He was given a brief and asked to deliver it, not validate it! It is unfortunate that this brief was ill-informed, misguided and half-baked. In particular he was told that existing systems and expertise were so poor that they could be discounted and that the existing community, both the health informatics community and the broader clinical community, were the main problem and not part of the solution (this was of course never stated explicitly but was made clear to those who moved in the circles where the programme was born.) Granger and many of the other new people brought into the programme soon discovered the problems with their brief and have struggled to recover from the damage it did to relationships and the false start it created, but many of us who were initially ignored are working effectively with the NPfIT.

Four years into the programme it has not delivered on its core objective, of replacing all existing systems with monolithic integrated solutions, but now generally understands that the solution lies in integrating a much larger number of heterogeneous systems. Given that our community knew the monolithic approach was neither desirable or possible this has been an lesson learnt unnecessarily slowly and expensively (although much of it not at the tax-payers expense - one of Granger's successes) but I think it has been learnt by most involved.

Progress has been made that would not otherwise have been made, mainly in infrastructure, infrastructural services and national applications. However, in some areas progress that otherwise might have been made has be derailed or delayed. I find it hard to judge if we are further forward than we would have been without the programme, but am sure we could have made more progress if we had started differently.

However, the capacity and capability of the new community, which has now been created is much greater than anything that has previously existed and we should seek to apply it in the light of current understanding. This hard won resource is fragile and very vulnerable to ill-considered reorganisation and changes in Political and organisational leadership and we must resist calls for a radical review and reorganisation. Existing organisational and contractual structures may be seriously sub-optimal, but they exist and we have learned to work with them. It will take at least five years to put anything better in place so we must discourage the politicians from tampering - I already worry that NLOP has gone to far.

As for Richard Granger, it is probably a good time for him to move on, but I hope this change does not provide the catalyst for a disruptive re-organisation and would urge that he is replaced by someone who has lived and understands the history of the NPfIT so far.

Ewan Davis - Director - Chairman - British Computer Society - Primary Health Care Specialist Group

The legacy is a flawed programme

18 Jun 07 14:23

Whilst I can understand Ewan Davis's nervousness about wholesale reorganisation (and it's not clear whether this is a personal view or PHCSG / BCS policy), and whilst there's no denying that some of NPfIT's problems have been outside Richard Granger's direct control, I can see little evidence that simply replacing him with someone who has lived in and understands the programme will deliver what the NHS needs.

I'd argue that the programme is fundamentally flawed (objectives, structure, management approach etc) and that this is the opportunity for a radical re-think. If this leads to a major reorganisation (and I personally hope it does) then I don't think the disruption will be particularly noticed by the NHS. After all, the programme has had very little front-line impact even after 5 years.

Praise where...

brian.derry@leedsth.nhs.uk

19 Jun 07 12:22

There is no doubt Richard Granger has changed the face of IT across the NHS. He has raised the profile of informatics with Chief Executives and Boards, and secured unprecedented levels of funding. He has led from the front, building a modern IT infrastructure for the NHS and negotiating some excellent national deals. He will be a very tough act to follow.

Brian Derry Chair ASSIST ( http://www.assist.org.uk/ )

Re: Praise where

19 Jun 07 12:37

Building a modern IT infrastructure? I'm struggling to identify anything new. Hasn't he just continued to develop infrastructure plans that pre-date NPfIT?

Excellent national deals? Surely, these can really only be evaluated when they deliver on a national scale.

Changed the face of NHS IT? Can't disagree with that one!

Building on Granger's Legacy II

nhstechie@btinternet.com

20 Jun 07 00:56

I would strongly dispute Ewan's argument that RG "only joined the programme once the die was cast", as it grossly underestimates the level of influence and power wielded by the DG from a very early stage. He joined the Programme in October 2002 at which point only a very sketchy initial OBS had been published and there was a very open and public debate (in traditional NHS fashion) about whether the National Programme should attempt to integrate the hundreds of disparate locally specified, hosted, configured and procured SYSTEMS or promote the concept of ruthless standardisation and realise the benefits of scale enabled by a centrally specified, configured and procured SERVICE.

Anyone not wearing rose-coloured glasses will admit that if the former option had been chosen we would probably still be waiting for the interfaces to be written to enable islands of excellence at a minority of Acute Trusts (and admittedly the majority of general practices) to be able to communicate with each other, or with less fortunate community-based or MH colleagues. Granger's true legacy was driving through the latter option and introducing contracts which uniquely ensured that the financial risk of failure was borne by the suppliers and not the NHS.

The introduction of the spine-based PDS, which supplies a definitive MPI across the country (however imperfect this may be) is probably the most under-rated and under-celebrated achievement of NPfIT. It isn't glamorous or sexy but it is essential.

I'm sure our more literate colleagues will be tapping away in a bid to publish the first post-Granger prognoses.

At the risk of being accused of pedantry, isn't the term "monolithic integrated solutions" an oxymoron? The approach was never a purely monolithic one, but a compromise initially involving 5 regional systems (later amended to roughly one per "old" SHA) , local departmental systems and a central spine to hold it all together. Perhaps a monolithic approach might have been easier to implement, after all it works for other industries especially those not tied to Bill Gates's products!

If Richard Granger hadn't existed, the NHS would have had to invent him. Programme management isn't about winning popularity - someone had to act as a catalyst for change and, for all his human faults and weaknesses, he has certainly been that!

A thought from a frog in the swamp

malcolm.willis@nhs.net

20 Jun 07 08:10

As one of those who was told that GP computing was a swamp that needed draining - and when you do that you don't ask the frogs - it is good to see Mr Granger hop first. And besides there is biodiversity in swamps and ultimately that is good for the survival of the ecosystem.

(post edited by EHI)

Looking forward to the future

bruce.kay@btinternet.com

22 Jun 07 14:53

Now it's time for a bit of honesty.

The UK Government undertook a gutsy move when it decided to be the 'first-cab-off-the-rank' amongst a plethora of western nations that have been considering a national e-healthcare-record.

Many might say the move was premature and that enabling decisions about identity management and legitimate relationships , about clinical coding and terminology standards, and about centralised versus dispersed information models should have been concluded first.

Nevertheless the world has benefitted from the steep learning curve we are all going through.

NPfIT (or CfH or NCRS or whatever you like to call it) has suffered from the constant sensational bad press that the NHS suffers daily. In spite of the fact that any patient who has travelled to other countries will tell you that the UK actually does have a good healthcare system.

So what did Richard Granger and other senior NHS officials do? They constantly put a positive 'spin' on every aspect of the programme. (One of the world's largest, most complex programmes ever.)

Starting today we have a chance for the senior exectutives in the UK to take note and BE MORE HONEST.

Going forward complex large programmes will always have things that go wrong and outcomes that are less than perfect. We have to change the culture of large programmes and learn how to communicate better. We need to gain the confidence of ALL stakeholders. And the way to start is to open up and tell the truth to each other.

My 2p from an Aussie who came here to work on something we thought would benefit humankind.

(post edited by EHI)