My Lords, I am also grateful to the noble Lord, Lord Turnberg, for initiating this timely debate. It is interesting that during the debate, optimism has been expressed in the future tense, but gloom and foreboding have been expressed in the past and present tenses. As the noble Lord, Lord Rea, said, we will see how successful the innovations that the Government have outlined are in the event.
The medical employment field is full of problems at the moment. Recruitment, deployment and retention, in particular, raise a series of concerns to which many noble Lords referred. They have also mentioned the four new medical schools that have been created to increase the number of doctors. That is all very well, but it is endangered by the concurrent changes in the career pathway for hospital doctors, who will be the consultants of the future, and has caused a shortage of junior training grades. Many recent medical graduates are finding great difficulty in getting a foot on the ladder. It may be a glitch at the moment, but it will have adverse consequences for the future.
The medical curriculum has undergone radical changes. The age-old concept of pre-clinical training has been all but exorcised. I am advised that there are coherent reasons for that, and that it is important that medical students should be introduced to patients from the outset of their studies. There may be a cogent case for this very radical departure, but I cannot avoid the suspicion that it conveniently disguises the fact that in recent decades, as many noble Lords have pointed out, it has proved to be extremely difficult to fill posts in the established pre-clinical subjects: physiology, anatomy and biochemistry. That was largely due to the fact that academic salaries lag considerably behind those of hospital doctors. As a consequence, pre-clinical teaching is very patchy in quality and I worry how well versed future doctors will be in the basic subjects of their calling. Moreover, the problem has been compounded in clinical teaching where many chairs in clinical medicine remain unfilled, as many noble Lords have said, because of the disparity in the salaries and workloads of academics and consultants. Neither of those factors is to the advantage of British medicine.
There are two further concerns. First, most of the pioneering research in medicine is undertaken by medical academic staff. The reduction in their numbers puts this in serious jeopardy. It is short-sighted in itself and, furthermore, impacts directly on the quality of the practice of medicine in hospitals and GP surgeries. In my view—and this was referred to by the noble Lord, Lord Parekh, and other noble Lords—not enough of the university medical sciences score 5A ratings in the research assessment exercise to guarantee that the UK stays in the forefront of medical advance.
Secondly, this alarming picture on the research side is paralleled by the growing reliance on private contractors to provide hospital services—again a fact to which many noble Lords have referred. I accept the need for a mixed economy in such services if waiting lists and so on are to be reduced and services improved, and there are other related benefits. But there are also two very serious disbenefits. First, private hospitals recruit graduates from medical schools to which they make no financial contribution. Secondly, they invariably make no provision for training placements. Other noble Lords have referred to that. On both counts they are the beneficiaries of a system for which they pay nothing. They are classic free riders. The growth of private medical provision, which continues apace, has serious implications for the next generation of doctors.
The situation regarding dental academics also causes concern. There have been reductions in the number of dental academic staff, as has been noted, there are a number of unfilled vacancies, and those in post are an ageing cohort. The creation of a new dental school, which the Government propose, without adequate resources, will further exacerbate the problem. I declare an interest as a resident in the region, but I trust serious consideration will be given to attaching the new dental school to the Hull and York medical school: there is a chronic shortage of NHS dentists in the region.
This debate has highlighted the parlous state of academic medical and dental teaching and research. There are serious medium and long-term consequences unless the situation is rectified. We must hope that the Government's new initiative will do that. In the short term, as many noble Lords have said, there are immediate problems that need to be addressed by government. I select two of the most pressing and ask the Minister for his response.
First, following the remarks of the noble Baroness, Lady Finlay, what concordats will the Government enter into with private hospitals to allow for training placements for junior staff? Secondly, as the noble Baronesses, Lady Cumberlege and Lady Murphy, and the noble Lord, Lord Winston, have said, what guidelines will the Government issue to ensure that hospital trusts, foundation hospitals and primary care trusts make adequate provision for sustaining academic medical research and teaching? I should be grateful if the Minister in closing would address these questions.