Sir, Professor Wilson questioned whether the role of the Chief Dental Officer (CDO) (New Chief Dental Officer – a changed role, BDJ 2014; 218: 1) had been weakened by the changes following the introduction of the Health and Social Care Act 2012. This response argues that the CDO role remains a vitally important and influential one.

Following the Act, the Department agreed that it would be sensible for NHS England to host the Chief Professional Officers and other leading clinical positions, including the CDO role. This recognised the central role that NHS England was to play in improving health outcomes for people in England, with less direct control from Ministers. This is an aim that I suspect many dentists would support.

Professor Wilson questioned whether as a result of these changes 'the profession ... may be left worse off in terms of high level advice to Ministers and the government'. This has not been the case. The CDO has continued to advise Ministers on topics ranging from dental contract reform to professional regulation. It is clear that Ministers very much value the CDO role and the perspective it can bring. The esteem in which the CDO's advice is held has not been diminished.

Furthermore, the CDO continues to make a contribution well beyond NHS England and the Department of Health. Since April 2013 the CDO has offered advice across Government including to the Department for the Environment and Rural Affairs on reducing the use of dental amalgam in order to comply with EU policy on minimising the impact of mercury on the environment. There has also been significant engagement with the Department for Business, Innovation and Skills around the numbers of dental students in training and the issue of products that are appropriate to use for both children and adults in tooth whitening.

This reality is confirmed by the job description for the new CDO which makes clear that the post holder will 'provide leadership and advice to the Department of Health (DH) to enable it to discharge its functions with regard to the dental profession, and to advise other government departments' and it explicitly names Ministers as recipients of advice.

The real substantive change to the CDO role following the reforms is not actually picked up by Professor Wilson. That is the enhanced part played by Public Health England in terms of preventing dental disease and championing initiatives such as fluoridation through its Director of Dental Public Health. This is only a diminution of the role if there is a feeling that there has to be one figurehead for all oral health issues. Arguably it is better to have a broader coalition committed to this agenda.

This leads to a further point – the issue of scale. Professor Wilson suggests the CDOs in the devolved administrations have a broader remit. This is not that surprising when you consider that Scotland has a population of 5.3 million, Wales 3.1 million and Northern Ireland 1.8 million. They are much smaller nations than England, with its 53.9 million inhabitants (www.ons.gov.uk/ons/taxonomy/index.html?nscl=Population). In such a large health system, it is surely good to supplement the CDO role with other experts in policy, oral health and dentistry. Yet in doing this, the CDO role will always remain the most important and influential of all.

Finally, it is worth mentioning that the application process for the new CDO has never had a greater input from dentists with a professional advisory panel drawn from the Royal Colleges and the Dental School Council.

So for dentists in England, the CDO role continues to provide excellent professional leadership. It has been a privilege working with Barry Cockcroft as outgoing CDO. The new CDO will build on his achievements to provide the leadership and advice to improve NHS Dentistry and the oral health of the nation.

Professor Nairn Wilson responds: The response by Professor Sir Bruce Keogh and Peter Howitt is most helpful and reassuring. I anticipate the profession being pleased to learn that the role of the CDO in England has not been diminished and will remain vitally important and influential, and that Ministers will very much value and regard with esteem the new CDO and the perspective brought to the post. It is considered unfortunate and unhelpful to all concerned, however, that the range and extent of the role and responsibilities of the new CDO England, as described by Sir Bruce and Peter Howitt, are not captured in the 'job purpose' as set out in the job description. That said, I believe that the profession will look forward to the new CDO taking interest in issues and developments in all sectors and aspects of dentistry, and working with the many and varied groups and organisations which contribute to dentistry and oral healthcare.

1. Medical Director, NHS England

2. Dental Policy Lead