The Department of Health appears to be having problems retaining its most senior IT and informatics leaders, and has not yet found replacements.

At the end of January Richard Granger finally departed as the head of NHS Connecting for Health (CfH), leaving some mighty big footprints to fill. And last month Richard Jeavons announced that he will quit as CfH’s director of service implementation.

The real surpise, though, came last week when Matthew Swindells announced he would step down as the Department of Health’s acting chief information officer, before his eagerly anticipated root and branch review of NHS informatics is published.

A former director of clinical services at Heatherwood and Wexham Park Hospital and head of IT for Guy’s and St Thomas’, Swindells, who been leading the DH’s Informatics Review, is seen as sensible and well-informed by many involved in NHS IT.

His departure to the private sector before his report is even published, and the DH’s confirmation that it is still seeking a high level chief information officer for England, to cover both health and social care, suggests that the review’s conclusions, in private at least, might not been well received.

Though not expected for another few months the review of NHS Informatics, is understood to have been completed and has been discreetly trailed at a number of events.

It is expected to stress that informatics is absolutely central to delivery of the strategic direction of the NHS as being pursued by the government. In addition to securing improvements in cost-effective patient care, key policies such as choice, competition and practice-based commissioning and payment by results all depend on the effective use of IT and information.

And although the department has repeatedly stressed that Swindells’ work is not a review of NHS CfH per se, the report is thought to have included an assessment of the NPfIT programme’s contribution to date, including the problems encountered. To not take in the £12.4bn programme in a review of NHS Informatics would have been tantamount to Swindells ignoring the 800lb gorilla in the middle of the room.

There have been some clear indications from early trails of the review’s findings that it would be critical of key aspects of the NHS IT programme and make appropriate recommendations. This includes a call for clear, consistent strategic leadership on informatics by the DH. There are also suggestions that the review will recommend setting a pragmatic course, giving more local autonomy on IT strategy and decision making.

With the NHS IT programme under pressure to respond to new policy imperatives the outlines of the Swindells review recommendations sound very sensible.

However, the problem that Swindells may have inadvertently run into is that NPfIT has not proved easy to re-direct or amend. This despite the NPfIT local ownership programme brought in last year and the contracts having been under almost continuous renegotiation.

The biggest stumbling block for the DH, though, would most likely be conclusions critical of the approach taken at acute trust level to electronic patient records. The DH has already sought to shrug off some pretty tough criticism of its track record on EPRs from both the Public Accounts Committee and Health Select Committee. What if an internal review has come to the same conclusions?

Despite many real successes, the central area covered by NPfIT – delivery of detailed care records systems – progress has proved slow and difficult. The jury remains out on whether the original contracts will be fully delivered, but DH shows no sign of abandoning them yet. In fact one of the attributes of the NPfIT programme to date has been the remarkable level of political support it has enjoyed.

But while Swindells heads off to the private sector, the DH is left with the challenge of finding credible new IT leaders – both a new departmental CIO and head of the NHS Connecting for Health agency – willing to stake their reputation on delivering an IT strategy and approach that is proving far tougher than was originally anticipated.