My Lords, I, too, thank my noble friend Lord Turnberg for initiating this very timely and important debate with characteristic understanding and passion.
The decline in the numbers of clinical academic staff is striking and also worrying. As my noble friend pointed out, since 2000 there has been a 12 per cent drop in the number of clinical academics, amounting to as high as 42 per cent among the clinical lecturers. This drop is particularly high in certain disciplines— 28 per cent in the case of psychiatry, 50 per cent in pathology, 13 per cent in surgery and 9 per cent in medicine. It is also worrying with regard to dental schools. In 2004, we had 30 fewer dental academics than in 2003. I am also a little worried that 50 per cent of clinical academics today are over the age of 45, and the number of young medical graduates going into academic medicine is not rising proportionately.
In the light of all this, there is a reason to worry. But I am delighted that the Government are fully aware of the situation and have taken a number of major initiatives. The Chancellor has given high priority to medical research. There is increased funding for NHS research and development, going up to £100 million by 2008. There is also a proposal to encourage research collaboration with other agencies and I am particularly pleased that the Government intend to establish 250 academic clinical fellowships and 100 clinical lectureships per year. The Department of Health consultation document, Best Research for Best Health is also full of interesting ideas.
All these initiatives amount to one of the most progressive steps forward in the past two decades and I want to salute the commitment and conviction of the Government. However, no government alone can tackle a problem of this magnitude. Other institutions also have an important role to play, such as the universities, the General Medical Council, NHS staff and Wellcome and other generous foundations. In the next five or so minutes I want to briefly suggest a few ideas for non-governmental agencies and also a couple for what the Government could do in this area.
First, the NHS culture must change profoundly and clinical research must be seen as an integral part of it. That has two important implications. Consultants and others should see their roles not only as providers of clinical services. They should also be willing to undertake and participate in academic research. It also implies that clinical researchers are seen and accepted as an equal part of the NHS staff as much as the doctors and healthcare professionals.
Secondly, it is important that the training of doctors and dentists in our medical and dental schools should involve research as an integral part. Students should be exposed to clinical academic research and imbibe the spirit of intellectual excitement and acquire basic methodological training. They should see themselves not simply as people who are going to acquire certain skills which they will then apply, but also as reflective and creative minds who will not only be applying their skills but accumulating knowledge and contributing to the growth of medical science.
To digress for one moment, this can also happen to some very talented students. In my own case, two of my sons went to Oxford to read medicine and I had hoped that they would become doctors. Tremendously excited by the sheer prospect of creating something new, both of them became distinguished scientists and one of them is now a professor of cardiovascular physiology at the University of Oxford. I say that not so much to talk about myself, although that is what I have inadvertently done, but to make the point that the excitement of research is something that can be implanted and cultivated in students. Unless we do that, we will not have a large number of new graduates wanting to do medical research.
Thirdly, it is extremely important that there should be greater co-operation between basic biological research and clinical work. Although pure research is important, medical science has increasingly moved in a direction where clinical collaboration with fundamental medical research is extremely important. After all, it was the collaboration between Frederick Banting and Charles Best which allowed them to discover insulin.
Fourthly, it is worrying that the representation of women and ethnic minorities among clinical academics is so small. Women represent only 12 per cent of clinical academics and ethnic minorities barely 2 per cent. Steps need to be taken to increase their representation either by addressing the factors that deter them from moving into this area, or by earmarking a percentage of fellowships and lectureships that the Government contemplate for women and ethnic minorities, or at least by making flexible and part-time working arrangements.
Fifthly, the research assessment exercise has acted as a disincentive—I can say that from my own experience as a professor, but also by looking at what has happened in the field of clinical medicine. Clinical research takes a long time to result in academic publications. The productivity of clinical academics therefore tends to be rather low, and their departments get low RAE ratings. That inevitably puts pressure on universities to reduce investments in certain disciplines, as we have seen in the case of so-called craft disciplines such as surgery, cardiology, radiology, obstetrics and gynaecology and, of course, anaesthesia. It is very important that promotions are not delayed, and that tends to happen if the RAE rating of an individual is not up to scratch, not because of his fault but because the publications take a long time to come through.
Sixthly, unlike medical staff, clinical academics lack a clear route of entry and a transparent career structure. There are disparities in pay and working conditions. As the BMA cohort report of 1995 clearly shows, some very talented medical graduates refuse to go into an academic discipline because they feel profoundly devalued, or because they are in danger of earning less pay or because they find few higher academic posts to which they can aspire. Equally important, they are afraid that by going into an academic discipline, they are in danger of being deskilled and might not be able to return to mainstream hospital or general practice medicine, if they fail as academics.
Finally, I shall emphasise a neglected point. Clinical academics need to develop greater international contacts and undertake co-operative international research. That should involve not only our European partners but also the Commonwealth. We have unique advantages in this country, as nearly one-third of our doctors come from Asia and Africa and have close links with hospitals and research institutions in those countries. We shall also be able to understand better our own ethnic minority population's medical problems if we keep in touch with researchers in other countries. Therefore, I very much hope that clinical research in our country does not remain merely confined to the NHS trusts, universities and so on, but becomes more entrepreneurial and reaches out to other countries.