After five years in charge of the biggest IT project in the world, NHS IT director-general Richard Granger has announced he is to step down later this year.
The former Andersen and Deloitte management consultant came to the NHS IT post on the back of his successful stint delivering the London Congestion Charge scheme, becoming the UK's highest-paid civil servant — a Freedom of Information request last year from ZDNet.co.uk's siter site, silicon.com, revealed he earns around £280,000.
It has undoubtedly been a turbulent five years and opinion is strongly divided on whether his time in charge of the £12.4bn NHS computerisation programme — also known as Connecting for Health — has been a success.
While Granger's hard-headed and no-nonsense approach meant tough new contracts for suppliers, who would only get paid for systems they delivered, it also led to accusations of a project being imposed on the NHS with little input from the doctors, nurses and patients who would be using it.
Professor Peter Hutton, who resigned from the NHS's National Clinical Advisory Board in 2004, called the consultation process a "sham".
He told MPs last year: "In those early days it was like being in a juggernaut lorry going up the M1 and it didn't really matter where you went as long as you arrived somewhere on time. And then when you'd arrived somewhere you'd go out and buy a product but you weren't quite sure what you wanted to buy."
A major report into the NHS IT project by the National Audit Office (NAO) last year provoked more controversy over accusations it had been watered down under protest from Granger and the Department of Health. The report was criticised by MPs for its "gushing" and "universally positive tone".
Granger has to take credit for the way he has taken suppliers to account for their delivery record
The NAO report said the central procurement of contracts included a sound balance of incentives and penalties, saving the NHS £4.5bn. But the report also revealed spending on the NHS IT project will hit £12.4bn by 2014.
Granger has always been quick to head off any criticism of the NHS IT programme by reeling off statistics about the number of systems delivered — at the latest count that includes 355,754 registered users of the Spine, more than 23 million prescription messages transmitted using the Electronic Prescription Service, almost four million Choose and Book bookings and 19,687 connections to the N3 broadband network.
The digital x-ray Picture Archiving and Communications System has also been hailed as a success.
But there are still problems and delays. Those on the frontline are quick to point to the fact that the core NHS Care Records Service is running late and that take up of Choose and Book is much slower than the original plan.
Then there have been the problems with suppliers. Some have been fined for delays while others, such as IDX, have been ditched, and last year Accenture controversially withdrew from its £2bn worth of NHS contracts to deliver new patient and GP systems in the East and North East regions.
Then there has been the whole iSoft saga. The company's Lorenzo clinical record software is a core part of the NHS IT programme but iSoft has been hit by protracted financial troubles that have only just led to it being rescued by a £140m takeover from Australian healthcare company IBA.
The main knock-on effect of all this has been further delays to the implementation of some of the systems, although Granger is quick to point out that the contracts mean the NHS doesn't have to pay the suppliers until working systems are delivered.
John O'Brien, senior analyst in Ovum's government practice, said: "Granger has to take credit for the way he has taken suppliers to account for their delivery record. Today in this programme the suppliers are only getting paid for systems delivered and working properly."
But still the criticism mounts up. A report by two MPs said the problems with the NHS IT project are a consequence of "over-centralisation, over-ambition and an obsession with quick political fixes".
Granger's departure, however, does coincide with a move away from this central management for NHS IT.
O'Brien said: "There is a shift in the actual focus of the national programme now, which is the next challenge, to more local accountability."
And for Granger's next move when he does finally step down later this year? He says he will return to work "primarily" in the private sector during 2008 and is currently considering "several significant approaches". The rumour mill has also linked him with the 2012 London Olympics chief information officer role.
He said in a statement: "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 passionately believe that the programme will deliver ever-greater levels of benefit to patients over the coming years."
