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Richard Granger resigns as chief executive of Connecting for Health

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39251.605475.DB (Published 21 June 2007) Cite this as: BMJ 2007;334:1290
  1. Adrian O'Dowd and Michael Cross
  1. London

    The NHS's electronic care records system is on track to be rolled out next year despite the sudden resignation of Richard Granger, who was in charge of implementing the system, the Department of Health claims.

    Mr Granger is chief executive of the Department of Health agency Connecting for Health, which is responsible for new information technology (IT) systems in the NHS. He announced his departure two days after giving reassurances to MPs as part of the health select committee's inquiry into electronic patient records.

    Although Mr Granger will stay in the post until October, there are fears that his departure could destabilise the £12.4bn (€18.3bn; $24.4bn) National Programme for IT in the NHS.

    The programme includes electronic prescription and appointment booking services, a patients' care records service, and an x ray archiving and electronic transmission system.

    MPs asked Mr Granger about current concerns over the core information exchange system for the programme. It is called the Lorenzo system and is being developed for the NHS by the company iSoft, which is currently the subject of a possible takeover.

    Mr Granger said that any problems being faced by iSoft would not prevent delivery of the Lorenzo system and that trials of the system would start within two weeks in Germany.

    “We expect the first live secondary care versions of Lorenzo to be available next year in the NHS in England,” he said. “It will start to be rolled out next year. I expect there will be some difficulties with the product in the early sites.”

    Also giving evidence was Frank Burns, former chief executive at the Wirral Hospital NHS Trust, who was seconded by the department for 18 months in the late 1990s to write a draft information technology strategy for the NHS.

    Mr Burns said that clinicians wanted functioning technology that supported their daily work, but many were frustrated about the focus by Connecting for Health on care records, he told MPs.

    “It's the elements of the technology that support the care of patients that is slowest in coming forward, and in many parts of the country people have begun to despair as to whether it will ever arrive,” he said.

    John Feehally, president of the Renal Association, also present, said, “There has been an appalling communication failure from the beginning. They have not really listened to clinicians.”

    The health minister Lord Hunt, giving evidence at the session, said he would be tackling the matter of “clinical buy-in” to the project.

    Accordingly, he announced he would be forming a high level group with the Academy of Medical Royal Colleges to encourage clinical engagement and commitment at a local level in the NHS.

    Mr Granger, the highest paid UK civil servant on a salary of about £290 000, aims to return to the private sector when he leaves his post.

    Several specialists in information technology paid tribute to Mr Granger. The Cheshire GP Amir Hannan, whose practice is already achieving the goal of allowing patients to view their own electronic medical records, said that doctors should be grateful for Granger's legacy.

    The programme has put in place the tools for a computer revolution, he said. “Many of the things we are doing today, for example the QOF [quality and outcomes framework] for GPs and the related software that helps to pay GPs was a spectacular success.

    “Choose and book into hospitals; PACS [picture archiving and communications system] to enable x rays, CT [computed tomography], and MRI [magnetic resonance imaging] scans to be readily seen throughout the hospital and beyond; and electronic transfer of prescriptions could not have been done without the work that he led and systems he helped to develop.

    “He managed to procure a service that enabled some of the best IT companies in the world to support delivery of next generation IT systems. Along the way, some very hard lessons had been learnt by all but which the tax payer was cushioned from, because of the way the contracts were made by him—something we rarely hear about in the press.”

    Even longstanding critics of the programme paid tribute to aspects of the Granger legacy. Ewan Davis, chairman of the British Computer Society's primary healthcare specialist group, said that the programme's problems related to failures of vision, understanding, and leadership. “These failings can't be laid at the door of one man . . . who only joined the programme once the die was cast” with “no experience in this uniquely complex domain.”

    Although Mr Granger learnt quickly his legacy has been mixed, he said. Although progress had been made in national systems, such as choose and book, others have been “derailed or delayed.”

    The BMA, which Mr Granger once likened to the National Union of Mineworkers because of its position on electronic medical records, declined to comment.

    In a statement issued after the evidence session, 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.”

    The select committee will publish its report later this year.

    See Editorial doi: 10.1136/bmj.39252.411192.80