Exclusive: NHS gets first medical director as Sir Liam's role is scaled back

As medical director, Sir Bruce will be charged with managing the clinical delivery and clinical outcomes of the health service.

The medical director post was created in May as part of the fresh health service top team, which separates the running of the NHS from the DoH (see news, 17 May). At the time NHS chief executive David Nicholson said in a letter to NHS chief executives that the role would be to 'champion clinical engagement throughout the service'.

He added that the medical director would also be charged with improving safety and quality in the NHS.

HSJ understands that Sir Bruce will be accountable only to Mr Nicholson and not to chief medical officer for England Sir Liam Donaldson.

Sir Liam's role will now be scaled back, with the focus on the wider public health function. Although he will still have a place at the top table, Sir Liam will be charged with health protection and health inequalities as part of the his role as the government's senior medical adviser.

The appointment to the new post is still subject to formal sign-off by prime minister Gordon Brown.

Commenting on the creation of the post, NHS Confederation chief executive Dr Gill Morgan said that while the chief medical officer would remain responsible for the health of the public and would maintain relationships between medical professionals, the medical director would be interested in hospitals and how the health service was performing.

She denied the creation of the medical director post would undermine the chief medical officer's role.

'It has previously been the job of a deputy chief medical officer to do some of the managerial work in terms of the relationship with the health service. We are going back to a system whereby this job will be the direct responsibility of an individual.'

UCLH chief executive Robert Naylor agreed. 'The chief medical officer post has previously been very wide-ranging and has been a huge remit,' he said.

Sir Bruce is currently clinical director for cardiothoracic surgery at the Heart Hospital, part of University College London Hospitals foundation trust, at which he is also professor of cardiac surgery.

He led the Healthcare Commission's work in publishing the mortality and survival rates for individual heart surgeons and hospital heart surgery units throughout the country, and is one of the organisation's commissioners.

Earlier this month the Healthcare Commission published figures for the second year running, which show patient survival rates for heart surgery for 2005-06.

Health Foundation chief executive Stephen Thornton said he was 'overjoyed' at the appointment. 'He has been an extra bridge between the clinical community and the management system of the NHS while maintaining clinical credibility. He has talked truth to power.'

Mr Thornton added that Sir Bruce understood the patient's perspective. 'It is an unusual appointment in that he has not been a public health director or a medical director, and someone at the top has been brave,' he added.

A source close to the appointment process applauded the choice of Sir Bruce: 'I think this is a fantastic appointment and will bring real credibility in the eyes of the service.'

Another source added that Sir Bruce's relationship with both Sir Liam and junior health minister Lord Darzi would be crucial. 'I think the three of them will work very well together.'

Professor Sir Bruce Keogh

Sir Bruce is world renowned for his work in developing the central cardiac audit database published by the Healthcare Commission.

He has previously worked as a consultant cardiothoracic surgeon at Hammersmith Hospital, London, and Queen Elizabeth Hospital, Birmingham, where he was associate medical director for clinical governance and cardiac surgical service lead.

As a commissioner on the Healthcare Commission he chairs the clinical strategy group. He was a member of the national task force for coronary heart disease and was on the NHS standing medical advisory committee.