Clinical Academic Staff

Part of the debate – in the House of Lords at 5:25 pm on 1st December 2005.

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Photo of Lord Warner Lord Warner Minister of State, Department of Health, Minister of State (Department of Health) (NHS Delivery) 5:25 pm, 1st December 2005

My Lords, I join other noble Lords in congratulating my noble friend Lord Turnberg on providing us with the opportunity to discuss this important topic. As a government concerned with ensuring that the UK has a knowledge-based economy and committed to continuing to improve our NHS, we recognise the important contribution that clinical academics make to research, teaching and patient care. This is why we are determined to secure a strong academic base to support both research and the expansion of medical and dental education. The noble Baroness, Lady Finlay, rightly identified the economic case for a strong research base. We share many of the concerns expressed by noble Lords about the decline in numbers of clinical academic staff, which is why we are acting. But, without being complacent, we are pleased that the Council of Heads of Medical Schools and Council of Deans of Dental Schools in their June survey show a slowing in the rate of clinical academic decline—a "spring shoot" in trying to move forward into the future with more success.

My noble friend Lord Rea was right about the need for the UK to be competitive in attracting clinical research to this country. Universities need to reflect on that in what they charge pharmaceutical companies. Those are issues that we all have to reflect on. I recognise that clinical academics play a crucial role in teaching, research and patient care, but we must also remember that NHS consultants and other professionals do the bulk of practice-based teaching. Since 1997, there has been a 30 per cent increase in consultants in England with honorary contracts to do teaching and/or research in the education sector, which is up from 1,685 to 2,184 in 2003. None of that is to diminish the contribution of clinical academics, but it is important to recognise this other and growing teaching resource.

Let me say something about how we are responding to the challenge that my noble friend Lord Turnberg and other noble Lords have set out so well. I am grateful to noble Lords for the acknowledgement that we are acting in that area. In England, we are investing nearly £33 million over 2004–05 and 2005–06 to support the extension of the new consultants' contract to clinical academics. I remind the noble Baroness, Lady Cumberlege, that another £3 million is specifically to support senior academic GPs—so we are putting money into that area. As a number of noble Lords have said, in the 2004 Budget, we announced an extra £25 million in each of the next four years to strengthen clinical research in England. I will certainly write to my noble friend Lord Rea and other noble Lords about the detail of that development.

We are undertaking a major reform of postgraduate medical training through our Modernising Medical Careers initiative. This has proved a timely opportunity to promote academic medicine by offering trainees more academic placements and dedicated academic specialist training programmes. The first phase of Modernising Medical Careers saw the introduction in August 2005 of two-year foundation programmes, which replace the pre-registration house officer year and the first year of senior house officer training. We announced funding earlier this year for academic placements for 5 per cent of all foundation trainees, which will provide early experience that should stimulate interest in and recruitment to academic medicine.

Modernising Medical Careers has joined the UK Clinical Research Collaborative, which a number of noble Lords have mentioned, in developing new academic training programmes for post-foundation trainees. The joint Academic Careers Sub-Committee, under the excellent chairmanship of Mark Walport, again to which a number of noble Lords have drawn attention, reported in March proposing solutions to problems in academic medicine with the goal of improving all aspects of academic careers for medically and dentally qualified researchers and teachers. I announced on its publication in March this year that the Department of Health would provide funding of £2.5 million to start as quickly as possible new programmes under Modernising Medical Careers for clinical academics. I did this so that we could make a start on implementing the Walport recommendations, conscious that inevitably we would have to do more work on mapping out the detail. But I thought it important to make a start, which I hope is reassuring to my noble friend Lady Warwick, who asked about long-term financial planning and stability.

As a result of taking action quickly, we have been able to begin the process of enabling more academic clinicians to follow their chosen career path. On 6 October the UK CRC launched a competition for an integrated academic training programme for doctors and dentists in England and Wales. The first fellows will start in 2006, and programmes will provide up to 250 clinical fellowships and 100 clinical lectureships each year as part of the specialist training stage of an academic medical career. Once fully established, these programmes will support around 750 academic clinical fellows and 400 clinical lecturers. We are currently planning for full establishment by 2010.

The noble Baroness, Lady Cumberlege, asked about the long-term commitment to funding. She knows the rules around governments and future commitments outside the current spending review period. My response to her is this: judge us by the action we have taken so far. We are committed to taking this programme forward energetically.

The first phase of the integrated clinical academic training programme, academic clinical fellowships, supports those in specialist training, while the second phase, clinical lectureships, provides opportunities for post-doctoral research career development or higher educational training and attainment of the certificate of completion of training. These will help to alleviate the problems so clearly identified by a number of noble Lords.

Additionally, the Higher Education Funding Council for England is committing up to £50 million over 10 years to support up to 200 "new blood" senior clinical lectureships, in partnership with the Department of Health. There will be five annual rounds of awards following the competition launch this month, with the first lectureships commencing in 2006.

In addition to government departments, healthcare organisations and universities along with several major UK medical research charities have joined this important opportunity to revitalise clinical academic training. The British Heart Foundation, Cancer Research UK and the Arthritis Research Campaign will be promoting expertise in specific clinical disciplines through focused investment. The Health Foundation is making a new investment of £5 million to support up to nine talented clinical academics over five years. Applicants for its clinician scientist fellowships will come from those working in identified national shortage disciplines; namely, radiology, pathology, anaesthesia, surgery, psychiatry and public health. In tackling the problem, we are seeing the kind of partnership approach that we tried to promote when we established the UK CRC in early 2004.

We continue to work with NHS employers and the Universities and Colleges Employers Association to implement contracts of employment for clinical academics which deliver the joint planning and appraisal recommended by the Follett report, encouraging staff to enter clinical academia and gain fulfilment from all aspects of their role.

The noble Baroness, Lady Finlay, also raised the subject in the context of VAT. I have some good news for the House on this issue. The Government have been taking action on the VAT implications of the Glasgow ruling. A form of contract has been devised which satisfies the contractual requirements of Her Majesty's Revenue and Customs so that clinical academic posts will remain outside the scope of VAT. A joint meeting of Her Majesty's Revenue and Customs, the Department of Health, DfES, NHS employers and the Universities and Colleges Employers Association is being convened to formalise this solution in the near future.

It is encouraging that universities are maintaining good teaching quality at the same time as they are expanding student numbers by making strategic links across university departments. This brings together, for example, physics and chemistry lecturers to support the core scientific elements of the curriculum, thus allowing a more focused use of the particular skills of clinical academics. It is worth remembering that medical school intake has increased by 2,870 places since 1997. We have opened four new medical schools and five new centres of medical education associated with existing medical schools. We have been able to do this because we have been more creative about the way in which we use the talent around in universities, as well as clinical academics, to take on some of the important roles of teaching.

Dental education is experiencing the biggest programme of investment since the inception of the NHS. Additional recurring funding, rising to £29 million a year by 2010–11, is providing 170 additional undergraduate training places. So we are expanding in dental schools as well as medical schools.

I shall try to answer in the time available a number of noble Lords' questions which I have not already answered. My noble friend Lord Turnberg asked about the new money for research registrars: what would happen to the 75 per cent and would it be forthcoming from post-graduate deans? For the academic clinical fellowship programme, that 75 per cent will come from the usual sources that currently pay for clinical training. The post-graduate deans are part of the organisational partnerships that submit the applications of the programme, so they have to be fully signed up to the training programme and for their responsibilities under it.

A number of noble Lords have raised issues concerning the research assessment exercise. The revised HEFCE-led research assessment exercise has been designed to recognise excellence in applied research and in fields crossing traditional discipline boundaries. The changes include the appointment of people with experience of commissioning and using research from industry and the public sector. This should ensure that practice-based research conducted by clinical academics is better recognised. We expect this to be demonstrated in the 2008 research assessment exercise.

As to the issue of the Healthcare Commission and standards, I am afraid that I do not have time to respond to the questions of noble Lords but I shall write to them about it.

Once again I thank my noble friend Lord Turnberg for giving me the opportunity to demonstrate the continuing commitment of the Government to clinical academics and the vital role they fulfil. We accept that there are still problems but we are trying to tackle them on a partnership basis, and with vigour, to overcome them.