Annex A > Chapter 4 - National Accountabilities and Roles > The National Framework: responsibilities for healthcare > The CMO and the NHS Executive
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The CMO and the NHS Executive
15 The Chief Executive of the NHSME was a manager, not a clinician. The CMO and his staff were mostly clinicians. Medical staff with the DoH reported to the CMO more widely during the earlier period of the Inquiry than during the later period. Following the Banks Report, medical staff of the DoH, apart from a half dozen or so secretariat staff, reported either to the Permanent Secretary or to the Chief Executive of the NHS and `... the Chief Medical Officer therefore had no direct reporting medical staff'. [18]
16 Despite the difference of background between the CMO and his staff on the one hand, and the Chairman/Chief Executive on the other, the evidence was that there was no inherent priority of view on any issue between them. Sir Christopher France, Permanent Secretary, DoH 1988-1992, [19] emphasised that:
`... the decision-making process ... always relied on weighing the merits of the various arguments, whatever their source, and not on recourse to some set of rules which purported to indicate which should prevail. Such "rules" simply did not exist.' [20]
17 Although the NHS is a national health service, the posts of Chief Executive and CMO, as described, were appointments in respect of England alone. Each of England, Scotland, Wales and Northern Ireland had its own NHS Chief Executive, and its own CMO. Each reported to the relevant Permanent Secretary (e.g. at the Welsh Office and Scottish Office, which were responsible for the health services in those countries). [21] There was no formal structure or committee dealing with matters of interest or importance common to each of the four constituent parts of the UK. However, there was an informal meeting once or twice a year between the Chief Executives and the relevant Permanent Secretaries, and there was contact at more junior levels on an `as required' basis between the DHSS/DoH and the Welsh and Scottish Offices. [22] According to Professor Sir Kenneth Calman, the CMOs for England, Scotland, Wales and Northern Ireland also met at two-monthly intervals between 1989 and 1998. [23]
18 Because of the close geographical proximity of Wales to Bristol, the consequent ease with which patients from South Wales could be transported to Bristol, and evidence that the development of cardiac surgical services for infants had an influence on the Bristol unit, the Inquiry also studied the relevant structure of health services in Wales.
19 Healthcare delivery in Wales was not [24] under the auspices of the DoH. [25] Instead, NHS provision in Wales is one of the responsibilities of the Welsh Office, both administratively and financially.
20 Mr Peter Gregory, Director of the NHS in Wales from March 1994 to 1999, stated in his written statement:
`The Department of Health was, throughout the period 1984-95, the "lead" UK Health Department, although the Secretary of State for Wales had the responsibility of providing a health service for the people of Wales.' [26]
`The NHS legislation places upon the Secretary of State for Wales the duty of providing health services in Wales. That is not a duty which falls on the Secretary of State for Health.
`The Secretary of State for Wales has, therefore, the statutory powers to provide health services. As a consequence, the Secretary of State takes decisions about health services in Wales which are relevant to the circumstances of Wales. The Secretary of State is, of course, a member of the United Kingdom cabinet and that imposes its own political restrictions which are not unimportant in terms of developing policies ...' [27]
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Footnotes
[18] T66 p.4-5 Professor Sir Kenneth Calman, former CMO
[19] WIT 0055 0001 Sir Christopher France
[20] WIT 0055 0002 Sir Christopher France
[21] T52 p.93-7 Sir Graham Hart
[22] T52 p.93-7 Sir Graham Hart
[23] T66 p.75-6 Professor Sir Kenneth Calman
[24] And was not at any point during the Terms of Reference
[25] The Departments of Health and Social Security were separated on 26 July 1988 (see evidence of Sir Christopher France, Permanent Secretary to the DHSS until 26 July 1988 after which time he became Permanent Secretary to the DoH, WIT 0055 0001)
[26] WIT 0058 0001 Mr Gregory