My Lords, I thank the noble Lord, Lord Turnberg, for initiating the debate. Given his remarkable, distinguished contribution to education, medicine, science and public health, I could spend seven minutes talking about the noble Lord, but that is not the purpose today. However, there could be nobody better fitted to introduce this debate.
I declare an interest: I chair St George's University of London, a medical school in south-west London, established 250 years ago, and I am on the board of the Brighton and Sussex Medical School, which was established just three years ago. I mention that because I have been struck by how similar the problems are in both medical schools, which are both very successful. They are so different in their character and geography yet they have the same difficulties in academic medicine. As the Government are well aware, in some specialties clinical academics are as rare as hen's teeth and much needs to be done.
The noble Lord, Lord Turnberg, has mentioned already the UK Clinical Research Collaboration and the sub-committee of Modernising Medical Careers. Like others, I rejoice that much is being done; quite embarrassingly, I have to congratulate the Government on that. I look forward to the Minister's reply, as I am sure that he will tell us more about that, and particularly to hearing what the long-term commitment is to funding the Walport recommendations. The long term is essential to remedy some of the mess that we are in.
Given the shortage of doctors, I am sure that the Minister will welcome the fact that, for next year, St George's medical school has attracted 11 applicants for every student place and Brighton and Sussex 20 students for every place. Yet neither institution can attract a professor of surgery. It has not been for want of trying; there just have not been any credible applicants for those posts.
Surgery is not the only specialty in trouble, as the noble Lord, Lord Turnberg, has mentioned. Nationally, we know through the Council of Heads of Medical Schools, last year alone, anaesthetics lost 15 per cent of clinical academics, pathology has lost 40 per cent, radiology 30 per cent, occupational medicine 60 per cent and both paediatrics, and gynaecology and obstetrics have lost 11 per cent.
My first question is: who will teach those bright, aspiring young doctors, when there is such a shortage of clinical academics? With 208 vacant senior posts, 91 of which are professorial chairs, there is a lot to make up. Secondly, with so much of the curriculum delivered in general practice and a decline in clinical lecturers since 2003, how does the Minister propose to remedy the situation in the short term, as it will take quite a while for the initiatives to produce results, and will he address the discrepancy between consultant clinical academics' pay and that of senior academic general practitioners? Thirdly, the introduction of multiple providers further complicates the position. What measures will the Government put in place to ensure that there are sufficient training places for students in those environments?
I shall now deal with the NHS. Recently, I received a letter from Sir Iain Chalmers, who, as noble Lords will know, is a founder of the Cochrane Collaboration and editor of the James Lind Library. He wrote to me in my capacity as chair of the working group for the Royal College of Physicians on its report on medical professionalism, which we will release next week.
Sir Iain writes:
"Over the past 30 years, there has been collective uncertainty about whether patients admitted to hospital with acute traumatic brain injury should be prescribed systematic steroids. This uncertainty has been reflected in dramatic variations in practice—some doctors have given steroids, guessing that they were useful; others have withheld steroids, guessing that their risks were likely to outweigh any benefits. It was not until very recently that this collective uncertainty was addressed by doctors around the world who agreed that acquiescence in this ignorance was incompatible with responsible professional practice. Thanks to these doctors, we now know that this treatment has been killing patients for 30 years. This is just one example of many that I could cite".
As a lay person, I find that chilling. If ever there was a case made for clinical academics, surely it is that one. We need them not just for patient safety but for more than that—for more than being the translators of science into medicine. We need them as leaders and teachers, and we need them now. Yet the NHS appears to have a disincentive to employ these people.
There is no financial incentive for a thrusting foundation hospital or a trust on the margins of fiscal viability to employ a consultant academic. They are a complication; they have two employers—the trust and the university; they are expected to deliver high quality teaching, carry out internationally respected research and do their clinical work. Some would say that that workload, executed to a high standard, is the equivalent of three full-time jobs, and without protected time, it is undo-able. Yet we know that this combination is extremely powerful in improving the care of patients and making the UK a world leader in academic medicine and the education of doctors.
Of course, SHAs and foundation trusts are expected to make allowances and support all these activities but when pressurised to fulfil targets and achieve more stars, it is the service that always wins the day. With the full implementation of payment by results, there is likely to be an even greater reluctance not only to decrease the number of patients seen and treated but to increase costs through employing staff with research sessions. I do not think that job plans are the answer.
It is disappointing that the Healthcare Commission did not include education and research within its core standards. High quality research should be recognised as essential in the delivery of high quality care. My fourth question to the Minister is: will the Government ensure that the Healthcare Commission explicitly recognises research and education as a trust's responsibility in its performance assessment? Lastly, what guidance will he give to PCTs in their commissioning role?