Sally Sheard and Sir Liam Donaldson, The nation's doctor: the role of the Chief Medical Officer 1855–1998, Oxford, Radcliffe, 2006, pp. xxii, 238, illus., £40.00 (paperback 1-84619-001-0).

Abstract

Since John Simon's appointment in 1855 as Medical Officer to the General Board of Health there has existed a post for a public health doctor within the British government. In this work, Sally Sheard and Sir Liam Donaldson examine the office of the Chief Medical Officer (CMO), aiming to trace the development of the role and its interpretation by individual incumbents. Rather than adopt a chronological approach, the authors have chosen to organize their account thematically. After initial chapters dealing with the career of John Simon, the initial underlying principles and surviving practices of the CMO post, and the selection of men for the post (a woman has yet to hold it), succeeding chapters highlight episodes in the tenure of different CMOs in order to explore an enduring aspect of the office. Thus, the third chapter, which examines the importance for health policy of the interaction between CMO, Permanent Secretary and minister, shifts focus between time periods. Other chapters also move backwards and forwards in time. Chapter four, illustrating the combined role of the CMO as manager of a government department and resident expert, is especially fragmented, the non-chronological structure making it difficult to grasp changing departmental structure. Chapter five covers the relationship of the CMO with the medical profession, chapter six the CMO's importance as a co-ordinator and interpreter of internal and external advice in guiding policy, and chapter seven the CMO's interaction with the public. One drawback of the authors' chosen approach throughout is that it is often disorienting; a linear narrative is taken up intermittently to be quickly dropped, and this is not effectively balanced by the very brief profiles of each of the CMOs at the back of the book. Overall, this tends to obscure a sense of change over time, which lends this volume an emphasis on continuities. The authors are evidently concerned with the recurring themes they have identified in their analysis of the role of the CMO. This is where Donaldson's agenda as the current CMO makes itself felt. In chapter eight especially, which deals explicitly with the “common threads” (p. 167) running through the role of the CMO from 1855 onwards, it is difficult to escape the sense that Donaldson, at least, is keen to laud the office and draw attention to its pressures and problems. The issues of fair remuneration, access to sufficient staff and resources, and the heavy impact of the National Health Service on the duties of the CMO, are prominent themes, as is the tension between meeting the demands of government and the medical profession while maintaining the confidence of both sides. These are probably valid insights but, unfortunately, the book lacks the detailed and contextualized historical analysis to bring them to life. There is barely any attempt to consider the political, social or intellectual context within which the CMOs in this story acted. Even the economic background is usually mentioned only in passing—paradoxically, given the concern with depicting the struggle for resources faced by successive CMOs. Statements such as, “The [new] Ministry [of Health] … should have provided a centralized administration to integrate existing services [but] it failed to capitalize on its potential power [and services remained] under the control of local government”, for example, ignore the well-established precedent of local control with permissive rather than directive central legislation that pertained in 1919. In other places, attempt at historical analysis has been abandoned entirely, as in the statement that “Newman appeared to burn out” (p. 27), the only explanation offered for what is seen as a reprehensible failure on his part to effect change. Strong personal bias is evident in the treatment of various CMOs: for example, the description of George Godber verges on hagiography while George Newman is clearly held in contempt. Such judgements, unsupported by close and balanced analysis, beg many questions while answering none. It would seem unreasonable to expect the first major study, as the back cover blurb informs us this work is, of the office of the CMO also to be the last word on the subject. Notwithstanding this, The nation's doctor will greatly disappoint historians with its shallow evaluations and presentist bias.