Charged with delivering the £6.2 billion project to modernise the health service’s IT systems, Granger is quick with the stick, slow with the carrot.

A few months ago, he compared the NHS project to a sled being pulled by huskies. “When one of the dogs goes lame, and begins to slow the others down, they are shot,” he said. “They are then chopped up and fed to the other dogs. The survivors work harder, not only because they’ve had a meal, but also because they have seen what will happen should they themselves go lame.”

Last week, one of Granger’s huskies went lame.

Accenture, the American technology consulting firm that hoped to make £2 billion from delivering systems to health authorities in east and northeast England, admitted it had run into severe problems, and would have to make a $450m (£259m) provision against future losses. These look set to continue until at least 2008.

This was an embarrassment for Bill Green, Accenture’s chief executive. Last July Green assured his shareholders that the company had got to grips with earlier difficulties that caused it to run up $140m losses in 2005.

That upbeat message was reiterated only last month. A British executive at the firm told The Sunday Times: “We are quite comfortable we are on track. We are comfortable the NHS programme is in good shape.”

Despite these assurances, Green was forced on Tuesday to eat his words. Accenture blamed the latest setback on delays with software being developed by iSoft, a British company, along with recent changes made to the NHS IT scheme to allow doctors more choice in the systems they can use.

Green told Wall Street the results were “unacceptable”, and said he was “taking personal responsibility for getting the NHS issue behind us”. He held out the hope that Accenture’s contracts with the NHS could be renegotiated, ensuring a fairer balance of risk and reward.

Accenture’s announcement sliced 8% off the value of its shares. Its side-swipe at iSoft caused even more damage to its much smaller British partner, whose shares fell more than 15% to a four-year low.

Green’s comments and explanation received an icy reception from the pugnacious Granger.

In a statement, Connecting for Health queried Accenture’s assertion that its problems reflected recent developments or had much to do with iSoft. The agency pointed out that Computer Sciences Corporation (CSC), another lead contractor, was already pushing ahead with deployments of earlier versions of the iSoft software in the northwest and the West Midlands, and that Accenture itself was rolling out the iSoft product to health authorities in its regions.

“We believe that the issues are within Accenture’s control and have requested key personnel changes within the Accenture organisation,” said Connecting for Health. Granger rejected the suggestion that there was any need to renegotiate the NHS contracts.

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