Volume 15: Government and Public Administration
4. Integrating professional advice into policy-making
The Chief Medical Officer (CMO)

4.17 Although there were CMOs for Wales, Scotland and Northern Ireland, advising their respective Ministers on matters affecting those parts of the United Kingdom, ¹ the responsibility for advising the UK Government on matters affecting the United Kingdom as a whole fell to the CMO for England.

4.18 During the BSE period (1986-96), that post was held by Sir Donald Acheson until his retirement on 30 September 1991, and then by Dr (later Sir) Kenneth Calman from that date until March 1996 (and beyond). Sir Donald noted that his responsibilities had been both wide and deep:

The Moseley Report observed of the CMO post that 'the sheer scale of personal responsibility seemed to have dimensions which distinguish it even from some of the highest posts of all within Whitehall'. ² Paper comes into the CMO's office on a scale which normally applies to Ministers rather than to officials. There is an abnormally heavy commitment to meetings (both internal and external) and essential representational functions and international work has to be dealt with. Demands being made on the CMO in the field of public health are also unusually heavy. ³

4.19 He told the Inquiry that:

The Chief Medical Officer is the principal adviser on medical and public health matters, not only to Ministers in the Department of Health but to the Ministers in other government departments and to the Government as a whole. ⁴

4.20 The post had a long history ⁵ and carried a 'complex, varied and demanding portfolio of responsibilities'. ⁶ Unlike the CVO, however, the CMO did not have oversight of an executive organisation. Sir Donald Acheson commented:

While the CMO may offer guidance on medical or public health matters to all doctors or to Directors of Public Health, neither he nor his predecessors, at least since 1919, have had a management line or any power of direction to doctors outside the Department of Health. ⁷

Although he was a member of the National Health Service (NHS) Management Board and its successor, the NHS Policy Board, this did not carry with it any executive responsibilities.

4.21 The importance of the post of CMO was reflected in its grading - 1A (Second Permanent Secretary). The post holder had direct access to Ministers, including the Prime Minister, and DH Ministers mentioned to the Inquiry the close daily contact they had with the CMO.

4.22 As well as having responsibility for medical and public health advice, the CMO was charged with ensuring that an adequate quality of advice was provided within DH by its professional staff. Until 1995, he acted as the ultimate line manager for over 100 medical and around 40 scientific personnel. A restructuring of DH in 1995 ended the direct line management role, although the CMO retained responsibility for the professional performance of these staff.

4.23 When the post was advertised immediately before Sir Donald Acheson's retirement, its role outside the Department was described as follows:

The CMO occupies a senior position within the medical profession nationally. The post holder is a member of key Government and professional committees, including the General Medical Council, and the Medical Research Council. He (or she) is responsible for maintaining links at the highest level between the Government and the medical profession nationally, and with colleagues in Scotland, Wales and Northern Ireland. The CMO represents the UK as appropriate on health matters within the European Community . . . and within the wider international field, including leading the UK delegation to the World Health Assembly. ⁸

4.24 As the 'nation's doctor', issuing guidance to the public on a wide range of health and related lifestyle issues, the CMO was expected:

To produce an independent Annual Report on the State of the Public Health and to highlight major issues where health has improved, and where there is concern about health. ⁹

and was:

. . . a recognisable 'public' figure, regarded by the media as speaking with an independent and personal professional authority. ¹⁰

A representative of the Consumers' Association told the Inquiry:

The role of the Chief Medical Officer is a particularly interesting one because that role is, if you like, slightly sideways the normal controls of civil servants, because that person is supposed to have a professional integrity that gives them a public role to advise Ministers in a particular kind of way. ¹¹

4.25 Sir Donald Acheson added that the CMO was:

. . . not accessible to lobbyists or the representatives of commercial interest groups, eg, the food industry. At no time during the BSE crisis was I approached by, or did I meet with, any representative of the food or farming industry. ¹²

4.26 Sir Donald Acheson told the Inquiry that his advice to Ministers, the public and others was always based on briefings by officials and the views of relevant expert advisory committees (their role is described in paragraphs 4.56ff). On BSE and related issues, apart from his key advisers, he would, if necessary and time permitted, speak personally to the Chairman of the Spongiform Encephalopathy Advisory Committee (SEAC) or seek the views of the microbiologist Sir Joseph Smith, ¹³ who was one of a panel of some 80 consultant advisers drawn from the top ranks of the medical profession and covering all specialities. ¹⁴ The reasons for this support are considered in more detail later in this chapter.

4.27 The CMO attended the regular meetings between the Permanent Secretaries of DH and MAFF, along with the CVO or a deputy, and normally dealt directly with the MAFF Permanent Secretary when necessary. He also regularly met his fellow CMOs for Scotland, Wales and Northern Ireland on an informal basis.