Interview: NHS IT director general Richard Granger

"Think about the alternative." That's NHS IT chief Richard Granger's response to the mounting criticism of the 10-year £7bn Connecting for Health (CfH) modernisation programme, which has been described as the largest civil IT project in the world.

Many of those critics - and he includes members of the press in that group - simply don't understand the unique complexities and the scale of the project, according to Granger.

Granger told silicon.com: "We always need to be careful to think about the alternative. Is the alternative to do nothing? That didn't seem satisfactory to most people because they want to see a modern NHS. Was the alternative to send the money out on a trust by trust basis? Well I'm sorry that's what we've been doing for 12 years and we can measure the progress on that."

Granger's objections, though, haven't stopped various people in the medical profession, MPs and a group of academics rounding on delays to various parts of the NHS IT programme such as the Choose and Book electronic referral system.

Criticism stems from delays to various parts of CfH, which have led to one of the lead suppliers, Accenture, taking a $450m hit on its profits. But Granger maintains that genuine progress is being made.

He says: "People who think the NHS is homogeneous are ill-informed. Every institution has things about it which are unique. It's not a simple job. We just keep plugging away and every day in several places things go live. I think it's inherently good to have a stretch target and to go a long way towards achieving that and have the humility to recognise that some things didn't go as well as they should, and fix them. It's a tough programme to lead."

He describes CfH as a "work in progress" and says the requirements of many of the systems have changed substantially since the start of the project. "We've done a lot of things we didn't think we were going to have to do. The Rubik's Cube and lining all the colours up is an ongoing activity," he says.

One of the projects that has come under scrutiny is the Spine, a central database that will store electronic patient record summaries that can be accessed by NHS staff using smartcards and PIN numbers. A messaging system will direct requests for patient details to the various parts of the Spine where the information is held and retrieve the details.

Granger responds that the Spine already has basic demographic information on patients, has 228,000 registered users, and that it is already acting as a message exchange for the Choose and Book and Electronic Prescription Service systems.

The problem, he says, lies with the various parts of the medical profession deciding what clinical information should be added to the patient summary record that will be stored on the Spine.

He says: "The enabling infrastructure is there and working. But some hospital doctors want a full view of everything that might be relevant to treating the patient in front of them and many GPs want the information they collected with a patient on a basis of trust. We're waiting for the white smoke on what they want in terms of the personal information summary to move around the system."

The latest target is for a decision on the patient summary record by "early next year".

Granger says many of the issues affecting the rollout of the NHS IT systems are out of his control but adds he has no problems being held ultimately accountable.

He says: "I don't have sloping shoulders. I'm more than content to be held responsible for the things that I can do something about, even the many things for which I wasn't originally responsible. The bigger context is that it is a 10-year programme to put digital infrastructure in place for a massive, diverse, heterogeneous organisation that is itself changing while this is being implemented. I think we get a bit obsessed with short-term targets."

Those short-term targets are expected to come in for criticism on a long-delayed National Audit Office (NAO) report on CfH now due in the summer.

Granger says: "My only interest in the NAO report is in ensuring that it is fact-based, that it is balanced and that the conclusion has been drawn from a balanced representation of the facts. That is my statutory interest in that and that is my only interest. The timetable for the production of that report is a matter for [head of the NAO] Sir John Bourne."

So will Granger be around to see through the 10-year CfH programme? "I'm not going to be drawn on that," he says. "I have worked 60 to 80 hours most weeks for fast approaching four years. I haven't seen my wife and I have three children who I hardly ever see. There will come a time where the job is better done by somebody else."

In one last attack on those who "sit in ivory towers" and comment on the progress of CfH, Granger says his over-riding responsibility is to deliver systems that work and that are safe and secure.

He says: "[If it's a] choice between safe and late, I'm afraid safe comes first. If we have to take a step back before we go forward then we will do. Some things are going to take longer. One of the challenges of leading a programme like this is you've got an appetite to get things done quickly as per a pre-published programme and you've got an over-riding requirement to ensure things improve privacy and safety and efficiency. There can be conflicts between them."

silicon.com will reveal the details of the answer to our Freedom of Information Act request to the Department of Health regarding Richard Granger's salary - and his comments - next week.