No other public sector technology programme, however controversial, has generated quite the same furore as the £12bn National Programme for NHS IT (NPfIT).

The project is held up as a paragon of tight contracting, technical vision and world-leading innovation.

But it is also used as an exemplar of the worst excesses of disastrous government IT: autocratic, unworkable and a spectacular waste of money.

Richard Granger’s combative stewardship of the programme for the past five years has created almost as much controversy. And his departure in a few months, announced this week, will have a significant impact.

Electronic X-ray systems and the high-speed N3 broadband networks are both widely acknowledged as successful.

But there are still problems with the hospital software needed to make the most of the electronic bookings, prescriptions and patient records schemes. And although pilots of summary care records are about to begin, and corporate issues with key subcontractor iSoft may be nearing resolution, both remain significant challenges for the new director general.

Reaction to the news of Granger’s resignation veer from eulogy to condemnation. But, personalities aside, his resignation is part of wider changes for the programme.

Critics of NPfIT have two major complaints. First, they say it was designed and run as a monolithic dictatorship that took no account of the diversity of the NHS. Second, they say it did not engage sufficiently with clinicians.

‘People at the centre configured and scoped the programme when they didn’t know what they were doing,’ said one senior NHS source.

But three initiatives launched in the past 12 months are all working to push power away from the centre.

The Local Ownership Programme gives strategic health authorities and NHS Trusts more say in choosing NPfIT products and the timing of deployments. The Alternative Supplier Catalogue offers trusts pre-contracted ‘best-of-breed’ software that meets defined interoperability standards. And the GP Systems of Choice initiative allows practices to choose the system they want, providing it is accredited as interoperable with NPfIT systems.

Opinions differ. Some say the changes are possible only because of the forceful standardisation imposed by Granger in the early days of the programme – others say that time has been wasted.

Either way, Granger’s dominant management style may no longer be necessary.

‘If you wanted to be kind you could say that he has taken the programme to the point where it no longer needs him,’ said one insider.

Experts, suppliers and NHS IT professionals all agree that NPfIT is moving into a new phase. ‘Granger’s style of leadership has helped establish a strong momentum,’ said Ovum senior analyst John O’Brien.

‘The big question at this point is whether the programme still needs the same approach.’

Alongside the boost to local control is a growing focus on implementation.

‘What we need is somebody who is more pragmatic and more of a team player,’ said one industry source. ‘We need someone who wants to get everybody on side.’

At the halfway point of the 10-year programme, perhaps its most significant effect has been to raise awareness of the potential for IT in the health sector.

‘Granger will be remembered for bringing IT to the top of the healthcare agenda, as it should have been 10 years ago,’ said NHS IT consultant Colin Jervis.

That impact has also been felt across the government IT sector as a whole. Granger was one of the first of a spate of private-sector appointees to top Whitehall IT jobs, and his stringent contracts set new standards in an environment previously dominated by procurement fudge.

‘He defined the other end of the spectrum from the old days of suppliers running rampant,’ said a senior industry source. ‘And he brought into the public sector a more results-oriented approach, with a firmer line on where the buck stops.’

Granger’s procurements were unprecedented in government, says Tim Smart, president of supplier BT Global Services, a major NPfIT supplier.

‘They ran to a short timescale, and we had a business person at the other end rather than a procurement person,’ said Smart.

‘There has been widespread adoption of more punitive penalties and rewards but there is little evidence of the same approachability across government IT. That is the next stage of evolution.’