Five years ago, as the NHS considered the Wanless report's call for increases in national spending on health1, nearly everyone involved in trying to computerise health care agreed on two things: firstly, that information technology (IT) needed new investment, ringfenced so it could not be diverted to more urgent needs; secondly, that IT needed strong central leadership to coordinate developments and to ensure that money was wisely spent.

Remarkably, the government granted both wishes. The 2002 public spending round included £2.3bn (€3.4bn; $4.6bn) earmarked for healthcare IT in England. In June 2002 a Department of Health strategy announced that a “new national IT programme director” would be appointed to “improve the leadership and direction” given to IT and ensure “ruthless standardisation.”2

Five years on the 2002 consensus has evaporated. The constituency of individuals with opinions about IT in the NHS—vastly broader than in 2002—is divided over the technology, management, and ownership of electronic health information. The polarisation of debate, and the fact that it now involves clinicians, politicians, and civil liberties campaigners, as well as IT specialists, is a legacy of the man hired as IT programme director, Richard Granger.

Granger, who has announced that he plans to leave his post later this year (BMJ 2007;334:1290 doi: 10.1136/bmj.39251.605475.DB), was recruited in autumn 2002 after a career with management consultancies, where he specialised in installing …