Website of the Department of Health

Why was the post created?

The Chief Medical Officer role dates back to Victorian times. I am the 15th in a line that started in 1855. Essentially the Chief Medical Officer is the UK Government's principal medical adviser. He or she also serves as Chief Medical Officer for England (there are also Chief Medical Officers for Scotland, Wales and Northern Ireland).

The Chief Medical Officer provides advice to the Secretary of State for Health and other Health Ministers, Ministers of other Government departments and on occasions to the Prime Minister directly.

The role goes beyond a simple advisory remit. My responsibilities are to:

How independent is the role?

I am independent in the way I operate. Holders of the post over the years have been individuals of high professional standing and integrity.

The post is not a political appointment and does not change with a change of Government. This contrasts with the position in many other countries where equivalent postholders are appointees of the Government of the day.

The appointment takes place after an advertisement and open competition. An appointment board is chaired by a senior member of the independent Civil Service Commission. Candidates are assessed and interviewed and recommendations made by the appointments board to the Prime Minister. As with all top Civil Service posts, final approval is given by the Prime Minister. The Chief Medical Officer holds the civil service grade of permanent secretary.

Given the nature of the post and the method of appointment, the Chief Medical Officer is not under political pressure to shape his or her advice in any given way nor to take any particular action that might be expedient but not in the public interest.

How is the Chief Medical Officer supported?

The post is based within the Department of Health. I am part of the department's management team and head of one of the directorates, the Health and Social Care Standards and Quality Group.

This group is staffed by civil servants, scientists, professional staff and managers. There are two deputy CMOs and I also lead a team of nine regional directors of public health. These are senior public health officials, based in one of the nine regional government offices and responsible for implementing a wide range of strategies to improve health, reduce health inequalities and protect public health in their areas.

I also provide leadership to all public health staff in the country, particularly the directors of public health in primary care trusts and strategic health authorities. These public health officials are all employed by local NHS bodies but form part of the public health workforce in England.

What is your role in relation to doctors and medical students?

Most doctors are employed by local NHS bodies (such as NHS Trust hospitals) or, in the case of general practitioners, they are independent contractors to the NHS. Medical students are undergraduates studying to be doctors in a university with a medical school.

I do not have a role in the employment or management of NHS doctors. However, my responsibilities include providing national leadership to the medical profession, helping to explain the health policies of the day and listening to the concerns of the profession and their ideas. In this way I can provide, where necessary, a bridge between the medical profession and the government.

Over the course of a year, the Chief Medical Officer comes into contact with large numbers of doctors through conferences and visits.

What kind of things do you do?

Almost all days are long and packed with many different types of activity. These can range from meetings to discuss a new policy for the NHS, to reviewing health protection plans, to listening to ideas for improving services.

Some meetings will be with single individuals or groups of people from the NHS, non-governmental organisations, the education and training sector, or with visitors from overseas. Some meetings are longer and more formal with, for example, the major professional bodies, other government departments or patient representative groups. Some of my day will be taken up with visits or speaking at conferences.

The day will often end with a working dinner. Sometimes this is a small group discussing issues of mutual concern and sometimes a ceremonial event, such as a royal college annual dinner. Much important business is achieved in this way, outside the setting of formal daytime meetings.

A small but important part of my work involves international health matters. This involves some overseas meetings, particularly under the auspices of the World Health Organisation, and receiving visitors from other countries.

On top of all this every CMO learns to expect the unexpected. In a service as big and complex as the NHS, problems will inevitably occur. Sometimes they will be very serious and of national importance. There are constant risks of new and emerging threats to the health of the public arising from infectious diseases or other unforeseen hazards.

I often become involved in trying to resolve such problems, working with ministers to provide the necessary expertise in analysing the situation and taking necessary and appropriate action.

It is in this arena that the media role of the Chief Medical Officer becomes prominent. I am well placed to explain the context of the problem, provide advice and reassurance where possible and appropriate, and respond to questions and concerns. I am also asked by ministers to lead press conferences or present a new policy to the media.

What projects have you been involved with?

I took up post in the autumn of 1998 following the BSE (Bovine Spongiform Encephalopathy) crisis. It was a time when public confidence in government advice and handling of health matters had been seriously dented. Some believed that the public's attitude towards science and its benefits was more negative because of the way the BSE story had evolved.

Public concern about standards of NHS clinical care was also heightened, following a number of high-profile service failures (notably the British Children's Heart Surgery Service). And health inequality was once again at the top of the government's agenda, with widespread acknowledgement that the longstanding differences in health status between the 'haves' and 'have-nots' could only be tackled by concerted cross-government policies, addressing the root causes of poor health in disadvantaged communities.

The NHS, a much-beloved national institution, had just reached its 50th birthday. All the evidence showed that it required major reform if it was to meet the needs and expectations of 21st century consumers and the aspirations of a dedicated modern workforce.

Since then, much of the work that has been carried out has been directed towards addressing these challenges.