As the Chancellor moves into No 10 next week, the first and most enduring measure of his premiership will be the choice of people he makes to serve in the Gordon Brown government. Inevitably, attention will be paid to the politicians he puts into key jobs at the Treasury, the Foreign Office and at Home.

But if the new Prime Minister wants to show that he understands the real business of modern government, then he will pay personal attention to an all-too-easily forgotten but critical appointment: director of IT at the NHS.

Richard Granger announced this week his plans to stand down after five years in the job, leaving the £12.4 billion National Programme for IT project not even half-finished. He has been a controversial figure, infuriating many in the health service, who claim that the consultation process with the medical profession has been perfunctory, and enraging contractors, who have complained of his high-handed “my way or the highway” approach.

Mr Granger, no doubt, lacks a bedside manner, but he has been a crusader against the terrible loss of life that results from woefully inadequate systems in the NHS. He has, sought, at least, to ensure that contractors rather than taxpayers bear the risks, as well as the rewards, of the development of this project. And he has brought energy and urgency to what is arguably the most important government infrastructure project of the decade.

The Munich Economic Summit this week provided an extraordinary perspective on how an ageing population will transform the agenda of business and government, and nowhere more keenly than in healthcare.

A few key statistics to explain. Life expectancy for human beings everywhere has risen by 21 years from 46 to 67 between 1960 and 2005. (India’s life expectancy has gone up from 39 to 64 and China’s from 41 to 73.) The soaring number of old people has, of course, had a direct impact on healthcare: spending on health as a percentage of GDP rose from 7.7 per cent to 9 per cent in Europe between 1992 and 2003 and from 13 per cent to 15.2 per cent in America.

In Germany, there are now five times more people who work in the healthcare business than in the automotive industry, nine times more in Europe and nearly fifteen times more in the United States; and there is more innovation these days in healthcare than in IT, at least as measured by patent applications in 2005.

However, in the words of Klaus Kleinfeld, the outgoing chief executive of Siemens, the “bad news is that healthcare quality sucks”. In an address at the summit, he pointed out the extraordinary costs of inefficiencies in the industry: that there are 25,000 deaths a year in Germany because of medical treatment errors, that 50 per cent of X-rays are redundant and one in four consultations are done because the doctors are missing or have incomplete patient data.

There are complex problems underlying cost overruns, inefficient allocation of doctors and nurses as well as the unnecessary deaths in the NHS. But there are, at least, signs that improved management and systems can make a meaningful difference.

The Journal of Patient Safety, as cited by Mr Kleinfeld, identified in 2005 how the introduction of integrated processes and state-of-the-art imaging improved outcomes at hospitals conducting cardiac bypass surgery. On average, patients stay nine days in hospital when they undergo such a procedure. At the Heart Centre of Indiana and the Nebraska Heart Hospital, where they introduced new systems, the patient stay average was brought down to 6.4 days and 4.8 days respectively.

And the level of patient dissatisfation, 2 per cent and 6 per cent respectively, was also well below the national average of 20 per cent.

The point is that Mr Granger’s successor, who will be appointed by the Department of Health, has the potential to have as great, if not a greater, impact on lives than anyone else that Mr Brown will appoint to his government.

If the new prime minister is committed to improving services, he needs to start with systems. As any executive in a customer-facing business will tell you, it is all very well to have grand plans, but they just won’t happen without the IT guy.

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