Volume 16: Reference Material
7. The organisation of MAFF and DH, 1986-96
The Department of Health (DH)
Introduction
Responsibilities for BSE

Introduction

7.22 In 1986 DH was part of a larger organisation, the Department of Health and Social Security (DHSS), from which it separated two years later. A large part of its work and the bulk of its programme expenditure related to the National Health Service (NHS). ¹ The central Department was, however, changing fundamentally its relationship with the NHS:

Until 1983, the Department's functions in relation to the NHS were integrated with its wider, non-NHS responsibilities. Thus policy for particular services, for example maternity services, carried with it responsibility for delivery of that service by the NHS. There was a central unit, the Regional Liaison Division, whose function was to act as a link with the health service. ²

7.23 Between 1983 and 1991, the DHSS moved away from day-to-day management of the NHS. An NHS Management Board was set up, chaired at ministerial level and including the Chief Medical Officer (CMO) and several Grade 2 DH civil servants. ³ From 1989 policy-making was separated from day-to-day management, with the establishment of an NHS Policy Board - comprising Ministers, the DH Permanent Secretary, the CMO and appointed members - and a separate NHS Management Executive (NHSME) of executive directors. Following another review, in 1993, the NHSME was renamed the NHS Executive, but remained 'within the central government framework as an integral part of the Department of Health'. ⁴

7.24 The rest of DH became known as 'the wider Department', having relinquished day-to-day management responsibility for the NHS. It had an 'established pattern of multidisciplinary working . . . through which the Professional Divisions are engaged with their administrative counterparts in work on each of the main businesses'. ⁵ Until 1995 there were two parallel hierarchies: administrators reporting to the Permanent Secretary, and medical staff reporting to the Chief Medical Officer (CMO), as follows:

Unit	Administrative title/grade	Medical title/grade
Group	Deputy Secretary/Grade 2	Deputy Chief Medical Officer (DCMO)/Grade 2
Division	Under Secretary/Grade 3	Senior Principal Medical Officer (SPMO)/Grade 3
Branch	Assistant Secretary/Grade 5	Principal Medical Officer (PMO)/Grade 4
Section	Principal/Grade 7	Senior Medical Officer (SMO)/Grade 5

7.25 By 1994, there were three medical ('Med') divisions:

. . . paired with corresponding administrative Divisions with whom they work to shared objectives under the supervision of a Divisional Management Board led jointly by the administrative and medical heads. The paired Divisions do not match exactly, there are some cross-cutting boundaries and some professional staff explicitly provide support to both HSSG [the Health and Social Services Group] and the NHS Executive. ⁶

Responsibilities for BSE

7.26 The lead responsibility for BSE was given by the CMO to Dr Hilary Pickles, a Principal Medical Officer (PMO) in Med SEB/B Division, which advised on scientific services, equipment and buildings, including pathology and blood services. By October 1989 it had acquired responsibility for some international health issues and had been renamed Med ISD3 and then Med ISP/3. ⁷

7.27 In September 1991 lead responsibility for BSE and CJD passed to Dr Ailsa Wight, a Senior Medical Officer (SMO) in Med MCD - see below - and remained with her until March 1996 and beyond.

7.28 Work relevant to BSE was handled by the following Medical Divisions:

1. Advice on zoonoses and Creutzfeldt-Jakob Disease (CJD) was provided by Med IMCD. The major part of the Division's work was its responsibility for international health, microbiology of food and the environment, communicable disease policy and immunisation, and relations with international bodies such as the European Community/Union and the World Health Organisation. The Division was renamed Med MCD in late 1989, as international matters were progressively transferred to Med ISD; this task was completed by May 1990. The Senior Principal Medical Officer (SPMO) was located in Whitehall with the AIDS unit; the other staff were in several other buildings in Southwark, south-east London.
2. By 1992, the zoonoses and CJD part of Med MCD had joined HEF (M), which focused on health aspects of the environment and food safety, on which it worked in parallel with an equivalent administrative division, HEF (A). These were merged from April 1995.
3. Medicines Division (from April 1989, the Medicines Control Agency) was responsible for licensing and classifying medicines, and licensing manufacturers and wholesale dealers; monitoring and following up adverse reactions; and inspecting and enforcing statutory requirements for manufacture, distribution, sale, labelling, advertising and promotion, etc.
4. MedH CPNM1 was responsible for medical advice on matters concerning children, and hence the uses of bovine tissues (eg, bovine eyeballs) in education.

The following administrative units handled BSE-related work:

1. CMP3 (Child Health, Maternity and Prevention), responsible for a number of public health issues, including slow viruses. The Branch Head at the time explained that '[BSE/CJD] did not fall into any existing category of public health issues and it was therefore allocated to my branch'. ⁸ BSE was transferred to HS4 in the summer of 1989, but CMP3 retained administrative responsibility for CJD until around July 1990, when this transferred to EHF Division. ⁹
2. HS (Health Services) Division, the responsibilities of which included dangerous pathogens, food safety and, from the summer of 1989, human health aspects of BSE. Around the end of 1989, HS Division was reorganised and these responsibilities passed to:
3. EHF (Environmental Health and Food Safety) Division, which dealt with microbiological and chemical food safety (including hazard management); irradiation, novel food and composition and contaminant issues; food hygiene policy; BSE and (from early 1991) CJD. By 1992, EHF had become:
4. HEF (A) (Health Aspects of Environment and Food). It retained the same responsibilities and from May 1994 also managed the CJD Surveillance Unit budget. ¹⁰ It merged with HEF (M) from April 1995.

7.29 The regulation of medical devices, including quality and safety assessment and product evaluation, was the responsibility of:

1. prior to August 1990, the Supplies Technology Division of the Procurement Directorate;
2. from August 1990 to September 1994, the Medical Devices Directorate ; and
3. from September 1994, the Medical Devices Agency. ¹¹