The mediation between MPs, doctors, and looking after
our nation’s health
Written by Sir Liam Donaldson, Chief Medical Officer for England
Ever since the creation of the role in 1855, the Chief Medical Officer (CMO) has had a unique position in looking after the nation’s health. As a non-political permanent civil service appointment, the CMO does not change with a change of government. Therefore, the Chief Medical Officer is able to represent the public and the medical profession to governments in a consistent and objective way. This unique opportunity to work closely with government while remaining an independent voice is central to the success of the role. In fact, Wilson Jameson, the ninth Chief Medical Officer, successfully used this position to mediate between government and a reluctant British Medical Association in the years leading to the foundation of the NHS in 1948.
As the principal medical adviser to the United Kingdom government, the essential role of the Chief Medical Officer remains unchanged. However, as the nature, scale and delivery of healthcare have changed dramatically over the last 150 years, the nature of the work has changed considerably. In 19th century England infectious disease and basic sanitation were the main public health concerns – indeed the role of the Chief Medical Officer emerged in the wake of several cholera epidemics. Today chronic diseases, often caused by lifestyle factors such as smoking and obesity, have become huge concerns, and there is a greater understanding of how social deprivations cause poor health. In my 2003 Annual Report, I recommended the restriction of smoking in public places, which was taken up by government and subsequently implemented in 2007. My previous Annual Reports have also highlighted the growing public health concerns of excess alcohol intake and the “time bomb” of obesity.
There has frequently been an international component to the work of the Chief Medical Officer. In 1885, Richard Thorne-Thorne negotiated for the United Kingdom at the Sanitary Conventions in Rome. In 2007 I published a discussion paper, which led to this year’s government launch of a UK Global Health Strategy creating international partnerships to improve health worldwide. Diseases such as pandemic ‘flu do not respect national boundaries, and therefore work to ensure the United Kingdom is adequately prepared can only take place in partnership with other countries.
As a bridge between government and the medical profession, I have to listen to doctors to understand their concerns and to learn from their ideas. I maintain contact with clinicians through conferences, visits and through junior doctors employed as clinical advisers within my team. The physical and regulatory environment in which doctors work has changed a great deal since the inception of the NHS. Following the Shipman enquiry, as Chief Medical Officer I was asked to undertake a broad review of medical regulation to address how to promote and assure good medical practice, the implications of which are still being translated into practice. Changes in the nature of modern healthcare have meant that the traditional model of medical training has had to change and, as CMO, I continue to lead and advise on this.
Ultimately, though, my main obligation is to the public. By highlighting health inequalities and variations in healthcare outcomes the CMO can advise as to priority areas for intervention. Through trying to create safer living environments, I can use my position as Chief Medical Officer to help reduce harm to the public. I am passionate about improving both the quality and safety of healthcare, and push for ever higher standards for the NHS. All this is possible because of the special position of the Chief Medical Officer which is close to, yet independent from, the government.
The 60th anniversary of the NHS is an exciting time for the United Kingdom. When the NHS was established on 5 July 1948, it was the first time the world had seen a comprehensive, universal health system for all, paid for from taxation. Although the size, cost and complexity of the project has expanded tremendously, the essential nature and purpose of the organisation is unchanged.
I am proud to inhabit a role where my predecessors fought for the establishment of universal free healthcare, the elimination of unsanitary conditions and consistently highlighted the need for investing resources in public health improvements. Whether the challenge has been cholera, diphtheria or AIDS, the Chief Medical Officer has been at the forefront of medical leadership in tackling the issue. No one can know what challenges the future will bring, but the office of the Chief Medical Officer and the NHS are two great and worthy British institutions with which to face it.