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Doctors in Whitehall: medical advisers at the 60th anniversary of the NHS

Sheard, Sally (2008) Doctors in Whitehall: medical advisers at the 60th anniversary of the NHS. History & Policy .

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• The government’s requirement for expert medical advice from the 1850s led to the development of a medical Civil Service, which reached its peak in size and authority in the 1970s. • The successive Whitehall efficiency reviews from 1979 onwards culminated in 1994 in the merger of the parallel reporting hierarchies, effectively reducing the Chief Medical Officer’s ability to call upon the support of medical civil servants, at a time of increasing new health threats such as AIDS and MRSA. • In the last ten years, the government has become more imaginative in its use of temporary specialist medical advisers (tsars) brought in from the NHS, in relaxing the formal Civil Service hierarchies, and quietly abandoning the statutory Standing Medical Advisory Committee (SMAC). • Historical examples show that when the government has failed to give adequate support to its Chief Medical Officers, the medical Civil Service has suffered from poor morale, experienced recruitment difficulties, and the ability to respond to health crises has been compromised. • Virtually none of the Whitehall and NHS reviews have considered their historical context. The current NHS review has been crudely timetabled to produce a politically favourable report in time for the 60th anniversary in July 2008. As with earlier reviews, it does not appear to be addressing more deep-seated issues such as the location and management of medical expertise. • The government needs to acknowledge that some of its tasks, such as protecting the public’s health, do not easily fit into fashionable Public Service Agreements or the ethos of New Public Management.

Item Type:Article
Additional Information:No volume, issue or page numbers available.
Uncontrolled Keywords:National Health Service; Civil Service; Department of Health; Chief Medical Officer; government reviews; public health; policy; history of medicine and health
Subjects:R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
D History General and Old World > DA Great Britain
Departments, Research Centres and Related Units:Academic Faculties, Institutes and Research Centres > Faculty of Medicine > School of Population, Community & Behavioural Sciences
Publisher's Statement:This paper was first published online in Sally Sheard, 2008, Doctors in Whitehall: medical advisers at the 60th anniversary of the NHS,
Related URLs:
ID Code:1185
Deposited On:11 Aug 2009 16:29
Last Modified:19 May 2011 17:45

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