Clinical Academic Staff

Part of the debate – in the House of Lords at 4:10 pm on 1st December 2005.

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Photo of Lord Turnberg Lord Turnberg Labour 4:10 pm, 1st December 2005

rose to ask Her Majesty's Government what steps are being taken to reverse the decline in numbers of clinical academic staff.

My Lords, I am delighted to have the opportunity of introducing this debate on a cold Thursday afternoon, but never has there been a more important moment for us to discuss investment in medical research. I should declare my interests as a former professor of medicine and a Fellow of the Academy of Medical Sciences.

Enormous opportunities are now opening up for us and we are poised to enter a golden age of medicine. Every day we read of advances in research which offer the potential to prevent heart attacks, cure cancer and the like, and undoubtedly we are living longer and healthier lives. A child born today will live two years longer than one born 10 years ago. We gain two years in every 10, and it is reckoned that around 50 per cent of that gain in longevity is due to advances made in medical science.

But all the marvellous new insights in molecular biology, immunology, biochemistry and new technologies become of practical value only when they can be applied to the care of patients. Let me give an example of what I mean. Many years ago a substance was discovered in the body called tumour necrosis factor, TNF. It was found to have wide and important effects in biology, especially in the immune system. Enormous amounts of research were done on how it works and what it does, but it was only when TNF was applied to treating human disease that it was found to be of great clinical value. Workers at the Kennedy Institute in London did all the clinical research that was necessary and showed that antibodies to TNF could be used safely in patients with rheumatoid arthritis. This has revolutionised the treatment of the disease. For carrying out that work, Professors Maini and Feldman won the Lasker prize.

The point I am making is that it is only the application of basic science to patient care at the end of the line, where the clinical research has to be done and where paradoxically we are currently lacking the key figures to pursue the sort of research which Maini and Feldman did so successfully. At a time when basic science is marching ahead, clinical research is faltering. At a time when we have probably the best clinical laboratory in the world in our single, comprehensive healthcare system, with its common goals and infrastructure, we are failing to take advantage of it. And while there are many reasons for this state of affairs, it is the fall in the number of those who engage in clinical research, the academic clinicians, which has been so damaging.

Let me give some rather disturbing data which have been collected by the Council of Heads of Medical Schools over the past few years. At a time when we have seen the creation of four new medical schools and an increase of up to 50 per cent in medical student numbers—a time when one might expect the number of medical academic teachers to increase at least a little—we have seen a considerable fall instead. Between 2000 and 2004, there was a fall of 42 per cent in clinical lecturers and of 11 per cent in senior lecturers. In some disciplines the falls have been extreme. In pathology, where there were 64 lecturers in 2000, there were a mere 12 by 2004. Psychiatry experienced a fall from 114 to 40; public health from 62 to 22 and surgery halved from 98 to 50. Although the number of professors has risen a little, there remains an overall drop of 12 per cent. Similar patterns can be seen in academic dentistry, and there are also difficulties in academic nursing. There is clearly a gross mismatch between the needs of young students to be taught and the number of clinical academics available to do so, to say nothing of the falling prospects for clinical research.

The reasons for these falls are multiple and well recognised. They include such pressures as the prolonged time it takes to train a clinical academic in both clinical practice and in research; their poorer financial rewards, research and teaching being squeezed out by the care of patients which always comes first; and the heavy regulatory burdens on researchers. Is it much wonder that many are turned off and take the easier option of going into primary care or consultant practice rather than take on this uphill struggle for smaller rewards?

It is against this background that a number of recent initiatives by the Department of Health have been extremely welcome and should go some way to addressing the balance. First, the clinician scientist fellowship scheme set up four or five years ago has seen the appointment of a small number—so far about 80 out of 250 proposed—of elite, young clinical academics with protected time to undertake research. Secondly, the creation of the UK Clinical Research Collaboration, the CRC, is a very important initiative, with funding promised to allow a number of developments. But perhaps the major initiative has come through a CRC sub-committee, headed by Mark Walport of the Wellcome Trust, which has come out with some excellent proposals, the majority of which, I am happy to say, have been taken up by the Department of Health.

The intention is to appoint 250 academic clinical fellows and 100 clinical lectureships each year, and that once up and running for three or four years these programmes will support as many as 750 fellows and 400 clinical lecturers. Funding for these is, of course, key, and this is promised for 25 per cent of the salaries of the fellows and 100 per cent of the lecturers. It is a remarkable and very welcome indication of the Government's commitment to medical research.

On top of all this, the Higher Education Funding Council for England has committed to fund 50 per cent of 200 new-blood senior lectureship posts over 10 years and apparently has agreed to provide £50 million in partnership with the NHS.

Finally, the NHS R&D Directorate has recently released a consultation document, entitled Best research for best health, outlining a new NHS research strategy which bodes well.

You might ask, therefore, "What is the problem when all this frenetic activity is going on which seems to be the answer to every academic maiden's prayer? Why look this set of gift horses in the mouth?". Well, it is always wise to check whether the gift horse has teeth in the right place, and it is here that I would like to seek reassurances from the Minister about a number of aspects.

The new money for research registrars is said to cover 25 per cent of the costs of their salaries so that the lucky ones can spend a quarter of their time in research. But is the 25 per cent really new money? Will the postgraduate deans, who are responsible for at least the clinical training of these doctors, be able to take on board this influx with dual training requirements, both research and clinical? Will the new clinical lectureships be taken on by the universities, which, after all, are responsible for academic appointments? There is not much mention in the consultation document of university or medical school involvement in the appointment of these posts. The major issue is whether the new money proposed for these welcome initiatives continue to be forthcoming over the next few years as promised? I hope it will, but it would be nice to have it confirmed by my noble friend.

Of course all these developments are extremely welcome and for the first time in many years there is a sense of optimism that medical research will be given the attention it deserves. But, even though it may seem churlish of me, I have to say that to make a career in academic medicine an attractive option for all these new lecturers we are hoping to see come in, we will have to correct some of the disincentives I hinted at earlier.

The first is the heavy regulatory burden facing clinical researchers. Much has been done following the review of research ethic committees, which the Minister initiated and have done so well, but there are many other regulatory bodies which need similar attention. There are now so many different types that it is the multiplicity of regulatory bodies which poses the burden. I hear from researchers that delays of six months are the norm, and 12 months not uncommon, because of the need to jump so many regulatory hurdles. Many active research groups have to employ staff specifically even to understand the regulations, let alone respond to them. I hope the Minister will bring his renowned skills at bureaucracy-busting to bear on these bodies too.

Then there is the issue of the very large number of women coming through medical schools. Sixty per cent or more of new medical graduates are now women and we are ill prepared to meet the needs of this tidal wave, a veritable tsunami, of women coming through the ranks of medicine. I know the noble Baroness, Lady Finlay, will expand on this issue and I look forward to hearing more from her.

We are at an extremely exciting time, when the returns from investing in clinical medicine are considerable, and not only in health. Calculations made in the United States demonstrated that for every dollar put into medical research, they got a return of $5 to the overall economy. There is a fivefold economic return on investment in medical research. I expect that we could get similar rates of return here, quite apart from the advantages gained from research on better health.

We must be clear that, for the NHS, research is not an add-on, an optional extra, but an integral part of what the health service should be all about. We must take full advantage of the initiatives now taken by the department. They provide a golden opportunity, but only if they are delivered as proposed and continue to be delivered over the next few years.