Quacks and Clerks: Historical and Contemporary Perspectives on the Structure and Function of the British Medical Civil Service
Quacks and Clerks: Historical and Contemporary Perspectives on the Structure and Function of the British Medical Civil Service
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DOI：
10.1111/j.1467-9515.2009.00708.x
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发表时间：
2010-04-01
影响因子：
3.2
通讯作者：
Sheard, Sally
中科院分区：
文献类型：
--
作者：
Sheard, Sally
英国政府从19世纪50年代开始要求专家提供医疗建议，这导致了医疗公务员制度的发展，该制度在20世纪70年代达到了规模和权威的顶峰。当时，首席医疗官直接管理着170多名具有医学资格的公务员，他们就新的医疗方法的开发和实施以及更广泛的健康保护和促进问题提供专门知识。自1979年起，白厅的效率审查在1994年达到高潮，合并了卫生部平行的医疗和公务员报告等级制度，有效地降低了CMO在艾滋病和MRSA等新的健康威胁不断增加的时候要求医疗公务员支持的能力。这篇文章使用政府报告来描绘英国医疗公务员制度的兴衰。它讨论了在过去的十年里，英国政府如何变得更加富有想象力，在使用从NHS引入的临时专家医疗顾问（沙皇），放松正式的公务员等级制度，悄悄地放弃法定的常设医疗咨询委员会（SMAC）。本文认为，当政府未能给予其CMO足够的支持，医疗公务员士气低落，经历了招聘困难，并在健康危机的反应能力受到影响。它突出了英国卫生政策发展中长期缺乏历史意识的问题。
The British 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. By this time the Chief Medical Officer (CMO) had direct management of a staff of over 170 medically qualified civil servants, who provided expertise on the development and implementation of new medical treatments as well as on broader health protection and promotion issues. The successive Whitehall efficiency reviews from 1979 onwards culminated in 1994 in the merger of the parallel medical and civil service reporting hierarchies in the Department of Health, effectively reducing the CMO's ability to call upon the support of medical civil servants, at a time of increasing new health threats such as AIDS and MRSA. This article uses government reports to chart the rise and fall of the British medical civil service. It discusses how, in the last ten years, the British 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). This article suggests that when the government has failed to give adequate support to its CMOs, the medical civil service has suffered from poor morale, experienced recruitment difficulties, and the ability to respond to health crises has been compromised. It highlights the chronic lack of historical awareness in the development of health policy in Britain.