My Lords, this is one of those occasions where I am left feeling somewhat redundant after so many excellent speeches in which almost everything has been said. The noble Lord, Lord Turnberg, has spoken with great authority and clarity, as he always does, and I feel that all that is left for me is to add some points of emphasis.
The first point of emphasis is very easy. We should be in no doubt of the importance of the issue. I take a very simple view of clinical academics. They are that essential cog without which none of the constituent parts of the NHS engine can begin to function. Upon them depends not just the teaching of our future doctors but also, in a very real sense, the maintenance of those standards of clinical leadership which have always put the UK in the front rank of specialist medical excellence. And, as we have heard so eloquently expressed, upon them depends the maintenance of that vital bridge—the bridge between the expanding state of our knowledge about the basic mechanisms of disease and the development of new treatments which are of direct benefit to patients. Without clinical academics the NHS cannot advance or function. That is why the steep decline in their numbers over the past few years is a cause of deep concern.
Perhaps my second point of emphasis ought to be a tribute to the Government. They are quite clearly taking this problem seriously. The creation of the UKCRC; the substantial new money for NHS R&D; and, most recently, the Walport report, which has led to the creation of new academic clinical fellowships and new clinical and senior lectureships, are, in anybody's language, just what the doctor ordered.
As with so many problems in life, money alone will never be enough. Problems associated with the decline in clinical academic numbers concern much more than that. If you ask many clinical academics what oppresses them in their professional lives, they say that it is all too much. It is like doing two or more jobs simultaneously. As well as that, the constituent parts of the job have become unbalanced, with NHS priorities—the clinical pressures—squeezing out the time available for research. There is frequently an unspoken feeling that research is a bit of a bolt-on extra to the real task of doctors in hospitals, which is to treat patients. Somehow, that unspoken feeling must be banished. That is an issue for management as much as clinicians themselves.
All the time, everyone needs to remind themselves that effective treatment of patients is about more than just using tried and tested techniques. If we are to call ourselves a world-class health service, it is also about creating sufficient capacity in the system to evaluate new tools coming our way from academia and industry. Only by careful evaluation of those interventions will they become usable. As that happens, patients get early access to novel therapies; clinicians become familiarised with their benefits; and the standards of clinical practice move ahead. We are talking about fostering and maintaining a culture—a culture of inquiry—that the UK has always had but which many people are saying has started to ebb away.
The noble Lord, Lord Parekh, was absolutely right about what drives that culture. Young trainee doctors are enthusiasts for what they do. Many may be fired up by the idea of small-scale clinical research in which they can personally play a part. In the past, that sort of early exposure to research was what so often led to a trainee wanting to follow a research-based career. But enthusiasm is quickly dampened by the regulatory hurdles; the shortage of time spent at the bedside of patients during training; and by the difficulty of attracting grant funding, other than for large research groupings. In that context, the announcement of the new academic clinical fellowships was particularly welcome.
However, it is not enough to make the career pathway more attractive in the abstract. We need to ensure that nothing in the system acts as a barrier to innovation in any given discipline. The recent proposal to set up a linked group of academic medical centres may well have potential, but I am worried that that may unreasonably disadvantage other centres of excellence and that there will simply not be the necessary capacity to pursue high-quality research in some key specialties. We often hear it said about the research assessment exercise—the RAE—that, for all its merits, it does little to help struggling schools improve and that, for the reasons given by the noble Lord, Lord Winston, it often may not accurately reflect the quality of the research being carried out. We hear of staff being reconfigured and research themes being re-jigged simply to notch up high RAE scores. One casualty is career stability. Another is the quality of teaching, for which there is already little enough incentive.
Worthwhile patient-based research can be a long-term business. Somehow, we need to reverse the decline of the past few years in research relating, for example, to public health, pathology and a number of the so-called craft specialties, such as anaesthetics, obs and gynae and radiology—many of them, ironically, key priorities for the NHS. Universities do not want their hands tied on the areas of medical research on which they focus, but there is a good case for having some mechanism to ensure that there is national coverage of all relevant specialties. Will the RAE in 2008 take those issues to heart?
The NHS is currently a cauldron of change in which service provision is the main driver. Amid all that change, teaching and research can all too easily be afterthoughts. The pattern of commissioning by PCTs, not least to independent operators, may restrict the pattern of research conducted in NHS teaching hospitals. The rise in student numbers—welcome in itself—can serve only to put yet more pressure on clinical academics and, in so doing, may dilute the quality of training and research. We need to be alert to those risks.
The proposals put forward in the recent consultation paper, Best Research for Best Health, may not be right in every particular, although I think that they are very promising. But, alongside the Walport report, they represent a golden opportunity to turn the tide, which must be followed through if there is to be any hope of resolving the grave problems to which the noble Lord, Lord Turnberg, has drawn our attention.