NHS IT boss puts suppliers second

Richard Granger, director general of NHS IT, has warned computer suppliers that commercial concerns will be 'fundamentally subordinate' to the government's £2.3bn drive to modernise healthcare systems.

The National Programme is a five-year plan to create the technology infrastructure needed to support a truly 21st century health service.

There are four main projects involved - nationwide applications for ebookings and eprescriptions, electronic patient records, and an upgraded broadband NHSNet connecting GPs and hospitals across the country.

Granger's warnings to suppliers came as the process of picking new Local Service Providers to run IT systems across health authorities gets under way. The new arrangements will involve prime contractors taking over hundreds of local deals between NHS organisations and specialist IT firms.

'I have experience of some of the concerns that existing providers will have about their revenue streams, intellectual property and so on,' said Granger.

'But I'm much more concerned about delivering coherent and consistent IT in the NHS, and their concerns are fundamentally subordinate to that objective.'

He also warned that the customer - the Department of Health rather than individual authorities or trusts - will be in control of the contracts. The idea is that 'we don't perpetuate a process, where, during a procurement, the balance of power shifts to the contractor'.

Although the procurement process for both Local Service Providers and suppliers of national applications began on schedule in January, Granger says the process of building his National Programme Office has taken longer than expected. One key vacancy, that of chief operating officer, could not be filled because one government department refused to release the successful applicant from their job. A locum appointment will be announced shortly.

The office is still recruiting project managers from the private sector and across government. Granger says he is looking for individuals with 'a track record of serial success in delivering large programmes'.

He also revealed details of the newly-created Design Authority, set up to ensure the functionality and interoperability of new NHS systems (see Computing 13 February). Its first task is to turn overall strategy documents into specifications of systems. Deadlines will be tight if standards are to be in place in time to start work in the autumn, as planned.

'The Authority's work will cover everything from issues like the web interface and whether to go for thin client architecture, right through to the presentation layer,' Granger said.

It has already drafted a specification for the most contentious of the new national systems, a shared electronic health record for the entire population. 'We've defined what the basic record will look like.'

It will also help create a standard electronic desktop for NHS staff. Because many doctors and other clinicians work in more than one location, standardisation is essential, says Granger.

'Many of the [healthcare] systems I look at are not wholly intuitive, require quite intensive training and are quite inefficient in terms of time required to get data from them.

'An essential deliverable of the national programme is to improve the interface.'

In many cases, this will mean giving doctors wireless terminals so they are 'not having to familiarise themselves with a new IT system because it happens to be Tuesday.

'There is a case for migrating to a common look and feel and there is also a case for examining the number of end users who have wireless devices.

'As we move from around half a million NHS employees having access to IT to around 800,000, we need to think quite carefully about the practicality of that deployment. Wireless devices will be one of the answers.'

During February, 'a discrete team of individuals from a number of suppliers' also worked in the Design Authority team. Their role will be wound up as the formal procurement gets under way.

However Granger said that he is anxious to maintain a dialogue with the industry, especially with smaller UK-based suppliers with NHS expertise.

'Without running a five year consultation process, we will try to be as inclusive as possible,' he said.

The first of the new national applications to become reality for the NHS will be electronic booking. Meanwhile, four clusters of strategic health authorities, led by London, will roll out shared electronic records.

Granger dismissed any suggestion that the national programme is repeating the mistakes of other large government IT projects such as the disastrous Libra system in the magistrates' courts.

'It's wrong to see it as a monolithic single implementation. This is not a programme that says: 'here's a date on which it will be switched on'. It is incremental in terms of geography and in terms of functionality.

'The scale of the programme is very large, but each of the projects in themselves are entirely in scale with other successful IT implementations.'

For all the stories about the NHS National Programme, go to Computing's NHS: The Real Story website at www.computing.co.uk

Richard Granger - curriculum vitae

September 2002: appointed director general of NHS IT at the Department of Health

October 1998: joined Deloitte Consulting as a partner. Clients included Transport for London, the then-named Department for Education and Employment and the Department of Social Security. Work for TfL included project management and systems integration for the controversial congestion charge scheme which went live last month.

1996 - 1998: worked on a number of large IT programmes for clients including London Underground Ltd and the Vehicle Inspectorate.

1994 - 1996: worked on a number of national IT programmes in Slovakia, the Czech Republic and Poland.

1989 - 1993: worked as part of the team computerising the UK benefits system.

1987: graduated from Bristol University and went to work for Andersen Consulting (now Accenture) and in the oil industry.