As director general of NHS IT, Richard Granger has his work cut out. Michael Cross examines the role of his national IT programme as it continues the NHS

IT revolution A big cuckoo is hatching in the NHS IT community's nest. The National Programme Office, Richard Granger's can-do team of procurement and project management experts, will grow to a maximum strength of 150 by this summer.

Mr Granger is the former management consultant who became director general of NHS IT last October.He says his new team is 'completely focused on the procurement and deployment of national systems in the NHS'.

The National Programme Office adds to, and draws on, the resources of the NHS Information Authority and the Information Policy Unit. It has also spawned its own sub-agency, the NHS Design Authority, to work out specifications for national systems.

The national programme itself is the latest leap forward in five years of permanent revolution in the NHS's central IT infrastructure. This began when the 1998 IT strategy Information for Health announced the replacement of the multiple organisations that made up the old information management group with two new bodies, IPU and NHSIA.

Information for Health's author, Frank Burns, was taking on an idea, conceived in a document drawn up by Labour in Opposition, to split IMG into a 'customer' and 'contractor' function. The aim was to prevent IT projects taking on a life of their own.

NHSIA was created as a special health authority, based in Birmingham, in April 1999. Its first two years were dominated by internal reorganisations and rationalisations, such as the closure of the centre for coding and classification in Loughborough.Multiple projects that had been taken on in a hurry to meet badly thought-out political objectives were rationalised into four coherent strategic objectives (see box overleaf ).

Then in March 2002, the authority's second chief executive, Dr Gwyn Thomas, announced that he was ready to create a new IT infrastructure for the NHS. It would be 'as important to the NHS as the provision of the road and rail networks and gas and electricity utilities in daily life'.

At the same time, however, ministers were deciding that the urgent reform of NHS IT needed a new kind of organisation, at least for procuring and implementing new systems. They had noticed that the most public IT success of Labour's first term, NHS Direct, was conceived and pushed through outside the existing IT infrastructure.

HSJ understands that the original idea was for the 'ruthless standardisation' of NHS systems to be carried out by a national infrastructure team working within NHSIA and IPU. But when major new funding became available after the Wanless report - and it became clear that time was running out - it was decided that something more radical was needed.

Therefore, when junior health minister Lord Hunt last summer unveiled the latest (and current) strategy, Delivering 21st Century IT for the NHS, he also announced that a high-flying director general would be recruited to run the national programme.

Mr Granger is based in the Department of Health's research and development directorate offices in Richmond House and Leeds. Strictly speaking, his immediate superior is Sir John Pattison, the DoH's director of research, analysis and information. In practice, Mr Granger has been given a free hand, though he reports to Lord Hunt weekly.His central task has been to turn strategic principles into specific contracts, to set the procurement process in motion, to persuade major companies to bid for contracts to supply systems - and to get the NHS to install them.

To do all this on an unprecedentedly tight timetable, Mr Granger has recruited a team of like-minded individuals. The key qualification to work on the national programme, he says, is 'a track record of serial success in delivering large programmes'.

Some key figures, such as Phil Sissons, a former managing director of a major supplier, now retained by Mr Granger to keep the industry in line, are NHS experts. But Mr Granger has looked to other government departments for many members of his team. The Department of Work and Pensions, which recently completed a major national IT upgrade, features strongly.

Mr Granger has also drawn on staff from NHSIA and the NHS Policy Unit. 'Those individuals who feel their future is in a rigorous project environment are joining the national programme, ' he says.

NHSIA's main input has been to provide infrastructure: offices, an e-mail system and a personnel department.

It has also been instrumental in setting up the Design Authority.

Among the senior NHSIA people involved in that are Anthony Nowlan, director of stakeholder relations, and Jeremy Thorp, one of the architects of the Integrated Care Record Service.

During February, the Design Authority also had the support of an 'internal think tank' drawn from industry. This is due to be shut down at the end of this month as the formal procurement process gets under way.

Mr Granger says the Design Authority will continue to draw on NHS expertise, however, and industry will have a voice through the trade body Intellect. 'It is important that it includes mid-scale and small UK-based suppliers with specific NHS expertise.'

Like the National Programme Office, the Design Authority's role will change with time. It has started by taking the strategy documents issued during 2002, refining and decomposing them into documents that will become specifications against which suppliers can deliver.

Its work will cover everything from the electronic architecture of solutions to the human-computer interface.

Old hands will recall that earlier projects to define systems, such as the Integrated Clinical Workstation, ran for years. The Design Authority has months.Mr Granger says that it has already completed a specification of the core Integrated Care Records Service.

A bigger, and longer term, challenge will be to develop a common 'NHS desktop' so doctors can log in wherever they may be.

This is essential in a mobile workplace like the NHS, Mr Granger says. 'I would really like to see a situation where a consultant working in three different places doesn't have to be familiar with three different systems.'

One solution is likely to be wireless terminals, capable of being used almost anywhere. '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, 'Mr Granger says.

Once basic specifications have been drawn up, the Design Authority's role will evolve towards ensuring that new systems interoperate with each other.This is not a trivial task.Given the slow process of agreeing technical standards in healthcare informatics, it is also one that is likely to continue indefinitely.

With all the excitement (and funding) surrounding the national programme, IPU and NHSIA could be forgiven for feeling like unloved chicks, in danger of being squashed by their big, brash new sibling.

At a session of this year's Healthcare Computing conference in Harrogate, both will explain their role in implementing the programme - and, by implication, why they should continue to exist.

For the time being, however, both look secure (see box above).Mr Granger says that IPU, under head Dr Peter Drury, will continue its standard business, such as preparing ministerial briefs and answers to parliamentary questions. Indeed, as the national programme attracts more political and media attention, this workload is likely to build.

But Mr Granger says he has had a free hand to 'cherry pick' the best IPU staff to join the national programme, and the same goes for NHSIA. 'There is an ongoing dialogue between Gwyn Thomas and myself identifying individuals. It is a great career opportunity for them.' l National express: what is the NHS Information Authority?

The NHS Information Authority's remit is to do 'what's best done nationally' in NHS IT. Its four main strategic objectives are to:

l Support the effective use of national electronic health records to improve patient care.

l Provide information services for staff, patients and the public.

l Establish and maintain health informatics as a recognised and respected national profession.

l Provide reliable and secure information infrastructure services to the NHS.

NHSIA sees itself as providing the 'technical foundations' for the national programme, pointing to its role in drawing up the specifications of the Integrated Care Records Service.

It will also continue to manage several national services.These include:

l NHSnet, which is in the process of re-procurement.

l The NHS-wide clearing service, which captures hospital activity data.

l The National Strategic Tracing Service, which finds NHS numbers.

l National health applications and infrastructure systems that hold administrative details for the 55 million people registered with the NHS, calculate payments to GPs and ophthalmologists and manage the national cervical and breast screening programmes.

l The National Electronic Library for Health.

l The website www. nhs. uk which provides information on NHS services, including waiting times.

In addition, NHSIA has a role in developing and supporting clinical terminologies, dataset definition and support for national service frameworks, helping organisations to benchmark their performance and developing health informatics and basic IT skills.

See feature, pages 13-15.