Wednesday, 16 June 2010

The Chief Medical Knight

The post of Chief Medical Officer was created in 1855. There have been fifteen incumbents, all of whom have been male, and all but one has received a Knighthood. The role of the CMO is set out here by the Dept of Health.

In the 2002 New Year Honours List, Liam Donaldson, CMO since 1998, received a knighthood in recognition of his achievements in health and health care.

So what are his achievements. They are set out here in a positively glowing document, again by the Dept of Health. At first site it looks pretty impressive but look again more critically and most of it is waffle and hype. For example he has received an award “in recognition of his achievements in the field of patient-centred care” Of course we were not doing that before he came along. Then again “The country's first comprehensive health protection strategy (Getting ahead of the curve)” I am afraid when people start using phrases like “getting ahead of the curve” and all the other business and management jargon that permeates the NHS today I just think “oh no, he is one of those!” In fact most of the achievements listed are in a similar tone.

His list of achievements also includes leading the drive for revalidation, which I have commented on before.

Finally his list for some strange reason omits his most memorable achievement. One which has had more effect on many doctors than anything else he has done. I am of course talking about MTAS. Now why do you suppose that is not on the list?

There is a more impartial appraisal of his performance here, but I would take issue with some of the positive points mentioned here. It is stated that “The smoking ban in public places, introduced in 2005, will be remembered as Sir Liam’s greatest success.” Firstly the ban in England was introduced in 2007, not 2005. In 2007 the prevalence of smoking in England was 21%, since when it has not fallen, and may even have increased, so how does this constitute a success? While it is true that enclosed public places are more pleasant places to visit we now have the unedifying sight of smokers huddled outside every public building like naughty schoolboys behind the bikesheds. Also even though I am a non smoker I think a total ban in pubs was a ban too far. Most pubs have a separate room which could be set aside for smokers and the total ban has had unintended consequences. Pub closures were running at 100 to 200 per year before 2007. In 2008 there were 1400. For many pubs on a financial knife edge the smoking ban was the final straw, and many rural communities, instead of having a smoke free pub now find themselves with no pub at all.

Donaldson is also campaigning aggressively for minimal pricing on alcohol. I think this is an oversimplistic approach. It ignores the fact that many countries with cheaper alcohol than the UK do not have the same problems. It is also very likely that hardened drinkers, the ones who are the greatest concern, will economise elsewhere in order to maintain their habit.

I do not see that treating smokers and drinkers as pariahs is somehow “a success”.

As for swine flu, preparedness is one thing, but can anyone explain why the government bought 130 million doses of vaccine, when a single dose is adequate and the total population of the UK is only 65 million. Presumably this was on the advise of Donaldson.

So all in all I have to agree with the comment made by Orthopod on the Hospital Doctor article. “He was never a ‘leader of the profession’, just a senior bureaucrat who happened once upon a time to have been to medical school.” A suit full of bugger all then.


  1. I have to disagree with your view of the smoking ban. I do not believe it was the main cause of pub closures. Instead, with country pubs charging c. £3.30 a pint it is rather price. Two pints stand you at the minimum wage. A far bigger culprit would be cheap supermarket booze, which I (as a moderate and sensible drinker) would be very upset to see go. Not only that but we also see certain country pubs flourishing, while the weaker ones happily bite the dust. Certainly, within five miles of me (rural Suffolk) there are still 7 pubs.

    Also, this being my first post read on your blog, I can only assume the post at 6.31am is before a day of surgery?

  2. While I agree that some pub prices for beer are over the top, (and soft drinks are even more of a rip off) this has been a constant factor for some years and can not account for the five fold increase in closures in the 12 months following the smoking ban.

    The timings given on google blogs are I believe Eastern Standard Time (US)

  3. In fact I was wrong, it was Pacific time, now corrected. Thanks