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What is Prof Sir Liam Donaldson’s legacy as CMO?

It’s the Chief Medical Officer for England’s last week in office.

Prof Dame Sally Davies is primed to act as interim CMO after Prof Sir Liam Donaldson’s departure. There will be an open competition for the role during the summer.

What lessons should the next CMO learn from Sir Liam’s 12-year tenure?

Well, there are quite a few. On the positive side, they would do well to emulate his campaigning style on public health issues.

The smoking ban in public places, introduced in 2005, will be remembered as Sir Liam’s greatest success. He galvanised political support – threatening to resign over the issue – following John Reid’s appointment as health secretary, who was opposed to legislation.

He’s also been campaigning aggressively, if a little piously, over a minimum pricing structure for units of alcohol. That debate is set to continue, though it’ll take something from his successor to enthuse the Tories.

Also on the plus side was our preparedness for Swine Flu. I know he took criticism for sensationalising the risk but, having chaired a flu pandemic conference a few years back, the potential consequences are truly terrifying. I’m looking at it as a decent practice run for the next one (and I just don’t buy into the pharma company conspiracy theories).

Other good stuff includes his advocacy for presumed consent on organ donation and rapid introduction of the WHO’s surgical safety checklist.

But, like all journalists, I’m more interested in the bad stuff. When it comes to supporting the profession, Sir Liam doesn’t come up smelling of roses.

In the past couple of weeks his name has been bandied about the high court as part of a pressure group’s legal action against the GMC. Remedy has taken the GMC to court over the alleged blocking of a fitness to practise enquiry into the CMO. It concerns Donaldson’s management of the disastrous computerised recruitment system, MTAS, in 2007.

He was complicit in damaging – and in some cases destroying – the careers of a generation of young doctors, who either found themselves in the wrong jobs or unemployed.

As the Health Select Committee subsequently said: “Candidates and assessors alike were justifiably outraged by the sheer inadequacy of MTAS. The period between February and August 2007 was characterised by unrelenting chaos and severe anxiety for thousands of junior doctors…The reputation of both the Department of Health and the leaders of the profession were severely diminished.”

The judges will make their decision later this month but, whatever the outcome, MTAS represents a big black mark against Sir Liam’s name.

I’d also suggest revalidation counts against the positive public health legacy.

The Shipman Inquiry was highly critical the GMC’s approach to managing dangerous and incompetent doctors, and called for reform. Dame Janet Smith, chair of the Shipman Inquiry, went on to challenge the GMC’s initial plans for revalidation.

The GMC postponed the introduction of revalidation and the Chief Medical Officer reviewed revalidation afresh. It culminated in the current plans, which include re-licensing.

But revalidation, as currently envisaged, is an expensive and overly complicated way of proving competence. It’s in danger of becoming a meaningless paper chase for the overwhelming majority of doctors.

So, what are the lessons for the next CMO? I’d suggest the first thing they do is clarify the role. On the DoH website, the CMO is described as the ‘UK government’s principal medical adviser and the professional head of all medical staff in England’.

The successes of the role have been in providing independent advice to the government on public health issues (and then campaigning hard for appropriate action).

However, when it came to being the ‘professional head of all medical staff’, the CMO appeared little more than a ‘Nulabour’ stooge.

If I were CMO for England, (Lord help us should it come to pass), I’d either get that bit struck from the job spec or take a crash course in understanding the real professional issues affecting medicine. So Dame Sally, if you want the job in a permanent capacity, you have been warned…

Read a summary of the CMO’s final annual report.

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2 Responses to “What is Prof Sir Liam Donaldson’s legacy as CMO?”

  1. NHS Reform says:

    I believe every human being has both positive and negative aspects of life. What i find most interesting in Sir Liam Donaladson’s legacy is his fearless and honest annual report 2007 which is unprecedented (to my knowledge) on racial discrimination as outlined in the following two links,,

    http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_086183.pdf

    C:\Documents and Settings\Arshad Siddique\My Documents\DH\BMA_News_Magazine.mht

  2. Orthopod says:

    He should have resigned over the MTAS fiasco, but then that wasn’t the NuLabour way. Revalidation and relicensing are just a very bureaucratic way of trying to control the profession, resulting in a huge amount of extra work without achieving anything of note other than reducing our clinical effectiveness, very NuLabour.

    He was never a ‘leader of the profession’, just a senior bureaucrat who happened once upon a time to have been to medical school.

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