Richard Granger, the man in charge of the NHS National Programme for IT (NpfIT) has left the building. The UK's highest paid civil servant announced his resignation last year, but his actual departure was only confirmed on 31 January.

In a letter to staff dated February 6 2008, Granger is praised for the “major success in rolling out technology-enabled change to the NHS under his leadership”.

Hugh Taylor, the Department of Health’s most senior civil servant, said, “Richard has done a great job in leading the National Programme for IT, which has connected every hospital and GP surgery to a common network.” So, the beleaguered former chief of NHS IT gone and history is being rewritten. But what can we learn from his departure?

This week there are conflicting rumours about the latest ambitions for NHS IT. For example, the Department of Health (DoH) press office denies any suggestion that London’s spine is to be separate from the national spine, and that BT was automatically awarded a new contract to develop that – having failed to deliver the original one. Such a scenario would beggar belief and would be an about-turn on supplier management. (BT has announced this week that it will not tender for work on the proposed ID card scheme.)

Granger himself was hard on suppliers and expected to get a great deal for the NHS and taxpayers. Suppliers were held to some very tight deadlines and penalised when they didn’t deliver. Whether or not those deadlines were realistic is a moot point.

Since the original plans were released there have been many cries of ‘foul’, and a great deal of renegotiation has taken place. Some suppliers claimed to have been excluded unfairly, while others were discarded en route.

One of the critical issues raised by many CIOs within the health service is the way the NHS has approached the whole NPfIT programme. There has been a lack of stakeholder and clinician involvement.

The other main issue is the name. This programme is called the National Programme for Information Technology. So IT is not an enabler for all those good things like change, transformation and people engagement – those things that get CIOs a ticket to the board and buy the right to participate in massive change programmes. No, it's another tech programme.

By settling on a name as mundane as NPfIT, the perception by clinicians and patients was that this is simply an IT programme and (predictably) people switched off. Why? Because no one outside of the IT department wants anything to do with IT. The recruitment problems that beset innovative CIOs are testament to that problem.

So, come February 2008 we see a familiar lack of stakeholder and clinician engagement. It beggars belief that as the rest of world is looking at engagement and relationship management, the largest transformational change programme in the world decides to do exactly the opposite.

So what are the consequences? Firstly, the programme signed contracts centrally without any true understanding of what was required at a local level. Healthcare needs are very complex, and by trying to get to 'one shoe to fit all', people at the centre have not taken account of the regional and local challenges faced by the NHS.

Then the centre decided that it would be a good idea to compound this initial error by insisting that clinicians take backward steps with their current systems to move to the centralised solution. Many clinicians refused. Why should they move to a system which provides only some of the functionality of their legacy applications? (This type of after-the-fact approach whereby technology dictates management needs is typical of projects that ultimately fail – as Chris Middleton explores in his blog this week.)

The NHS CIOs we’ve spoken to about the current farrago made several recommendations that the new incumbents would do well to take onboard.

• Don’t run before you can walk. New systems need time to be designed and properly implemented. Take the time for discovery, and make sure that the needs of the business are addressed. It’s not too much to ask.

• Communication, communication, communication: At the moment, a lot of good work is not communicated to the public or to stakeholders. Sing praises, acknowledge mistakes and explain how those will be fixed. Indeed, there are lessons there for the entire outsourcing industry.

• Set realistic timeframes. Whitehall meddled time and again and tried to deliver the majority of the programme in a very short timescale. The programme is slated to run until 2014, so there is no need to drive everything forward at once (except, perhaps, electoral necessity and party politics, neither of which are conducive to public programmes such as this). Getting the major thing right – delivering a national spine – would be a massive advance.

• Engage your partners. If this had been a true partnership with the suppliers, as opposed to a firm and fixed contract of deliverables, there would have been a great deal of scope to deliver what was required. A basic working agreement between all parties to seek to work towards a final connected solution for the whole of England would have been better than lines and lines about which product functionality would be delivered when, and the relevant penalties for non conformity. Penalties are important, but then so are deliverables.

• Stop changing your mind! As is so often the case with the public sector, once a project is started, we cannot leave well enough alone. Goalposts are constantly moved and criteria changed (Inland Revenue, anyone?). This leads to escalating costs, changed timescales, demoralised staff and – eventually – sloppy processes and procedures.

Something else we have learned is that Granger will not be directly replaced. The DoH is to appoint a chief information officer for health, who will focus on delivering an overall IT vision and report directly to NHS CEO David Nicholson.

The CIO will have the status of director general who will be the head of development and delivering the overall strategy for information on health and social care. Until an appointment is made, Matthew Swindells, policy adviser to the Secretary of State for Health, will act as interim CIO.

This is all very well, but that sounds like an awful lot of Whitehall.

Meanwhile, a report in Health Service Journal quotes the DoH's informatics review manager Tom Denwood as saying current “chaos” surrounding the NHS IT strategy will be resolved within weeks, with a major shake-up at the DoH to establish “unified governance” and clear decision- making, as well as to try to integrate strategic management of health and social care information, and establish clear responsibility for IT strategy and information within the DoH.

Speaking at a conference, Denwood, previously head of the Choose and Book, said NHS IT bosses have said there is, “a complete absence of a function that translates policy into business requirements”.

There is no rationale for pouring more taxpayers’ money (£12 billion and counting) into anything that doesn’t translate into, and meet, business requirements. So much for a national service; it’s more of a national scandal.