My Lords, I join other noble Lords in congratulating my noble friend Lord Turnberg, on proposing this important debate. He has drawn the attention of the House to an issue that is becoming increasingly pressing. I declare an interest as chief executive of Universities UK. Universities are of course responsible for the education of our clinical academics as well as our medical students.
Since 2000—and I am repeating a statistic that will probably be a death knell for the Minister—there has been a 12 per cent decrease in the number of clinical academic staff. During that period, the number of medical students has increased by 40 per cent and four new medical schools have opened. The expansion is set to continue. Medical schools are currently bidding for an additional 100 student places in England, and we expect further increases to follow. In the past two years alone there has been a 17 per cent drop in the number of clinical lecturers. In dentistry, clinical academic numbers reached a 10-year low in 2003 and have since declined still further from 473 in 2003 to 444 in 2004. That is at a time when the Government are seeking increases in dental student places too.
That has an impact not only on teaching but on research, in which the UK is recognised as second only to the United States. The research conducted by clinical academics is highly marketable and it supports patient care in the NHS. Some 90 per cent of NHS research is conducted by clinical academics. A reduction in the research capacity of the UK in this field would compromise our ability to innovate and lead the way in all areas of healthcare.
Take, for example, one of the subjects referred to by my noble friend Lord Turnberg—pathology. An understanding of the basic underlying cause, nature and origin of disease is critical to all medical practice and is at the forefront of medical research. A shortage of academic pathologists at all levels will compromise medical training as well as the UK's research capacity. There are now only 12 clinical lecturers in the whole country, and they are concentrated in just six schools. Four years ago, there were 64 clinical lecturers, which means that 80 per cent of the medical schools in the UK are without clinical lecturers in pathology.
The reasons for the shortages are mixed, depending on the specialism. Various factors—such as the length of time needed to train; short-term and temporary appointments with limited career prospects; more attractive career opportunities and pay in other sectors—all play a part in leading talented individuals to conclude that the demands on clinical academics are excessive and that the pressure to maintain clinical activity, research and teaching all in one role is simply not possible.
Governments have been aware of this problem for at least 10 years. Successive reports have highlighted the staffing problems in teaching and research. Most recently, the Department of Health and the Department for Education and Skills Strategic Learning and Research Advisory Group commissioned work on the development of the workforce. The resulting report, Developing and Sustaining a World Class Workforce of Educators and Researchers in Health and Social Care, identifies some possible solutions. The report makes recommendations for government, for higher education institutions and for the health service, particularly about career planning and development, to ensure that we have the workforce that we need for teaching and research in both sectors. While partial funding has been made available for a limited number of lectureships and fellowships in medicine only, the effects will none the less take some time to feed through into the wider health and education sectors, and the nature of the funding mechanism proposed is not stable. So I hope that the Minister will be able to say something about stability and sustainability of funding.
However, it is important that we should not only be concerned about the strength of the teaching workforce for doctors and dentists. In nursing and the allied health professions there is a need for a much more far-sighted workforce-planning role to support students in practice and to address the expected increase in retirements from those professions over the coming years. The Government should consider how they can make the best use of all healthcare professionals, as new types of practitioner emerge in the health service and the mix of skills required continues to change.
If the UK is to reduce its dependence on qualified medical professionals from overseas, particularly those from nations that can least afford to lose such personnel, we must take steps to ensure that we can be self-sufficient. Expanding the number of medical schools and increasing the number of available places is part of that, but without suitable staff to teach the students and placements for clinical practice, we are unlikely to make the advances that the public have every right to expect.
There are many powerful reasons why the Government should take action—to enable us to deliver expansion, for the sake of the international development agenda, and because high-quality teaching and research are essential to the provision of high-quality healthcare. I therefore hope that the Minister will recognise the importance of collaboration between the higher education and health sectors, and of providing greater support and encouragement for that collaboration. I also hope that he recognises that the underpinning education and research that sustains health professionals needs stable funding, a longer-term perspective, and careful planning.