Select Committee on Science and Technology Third Report


3rd December 1997

  By the Select Committee appointed to consider Science and Technology.



1.    The United Kingdom has a high reputation for medical and dental practice, teaching and research. These three things are interdependent, and come together in the person of the "clinical academic": a doctor or dentist who divides his or her time between teaching and research in a university medical or dental school, and providing clinical services through the NHS.

2.    In 1995 this Committee reported on Medical Research and the NHS Reforms (3rd Report 1994-95, HL Paper 12), expressing serious concern about the state of clinical academic medicine. We found recruitment and retention to be poor; we ascribed this in large measure to increasing and conflicting loads of service provision, administration and teaching, and we anticipated that the "Calman" reforms to specialist training might make matters even worse. We concluded, "The disincentives to an academic medical career are now so great as to warrant an immediate enquiry in their own right".

3.    The Government did not share our view. However the Committee of Vice-Chancellors and Principals did, and commissioned an independent task force, chaired by Sir Rex Richards (Vice-Chancellor of Oxford University 1977-81), to conduct the enquiry which we proposed. Their report, Clinical Academic Careers, was published in July. It concludes, "there is a potentially serious problem ... Academic medicine and dentistry are suffering the fate of any servant with two masters; in this case the NHS and the universities ... staff in each work at a higher intensity with increased demands and expectations on them, and often with an increased administrative load ... it often appears that clinical academics work under greater pressures and receive less reward than NHS doctors and dentists".

4.    The task force make numerous recommendations, addressed variously to the universities, the Higher Education Funding Councils and the education departments; NHS Trusts, the NHS Executive and the health departments; the medical Royal Colleges and other professional bodies; and the charities and other funders of research. In particular, they recommend a range of mechanisms to protect time for research; to mitigate the material disadvantages of academic medicine compared with purely clinical practice, and of academic general practice compared with other disciplines; and to improve co-ordinated management in university hospitals and medical schools. They recommend further work on the organisation and funding of dental education and research.

5.    On 3rd November, Sir Rex and some of the members of his task force met us to present their report and discuss its recommendations. The record of that meeting is appended to this report. We inspired the task force, though we did not commission it; and we congratulate Sir Rex and his colleagues on the work which they have done. We are persuaded more than ever that there is a genuine threat to academic medicine in the United Kingdom, and therefore to health care as a whole.

6.    Unless action along the lines recommended can be taken, the situation will get worse. Many of the actions proposed are essentially cost-free; but adoption of others would require the allocation of additional resources which have not yet been quantified. Such allocations would of course depend on hard choices being made about priority between competing claims for both health and higher education, and many other problem areas in both sectors would rightly wish to be involved in the debate.

7.    We draw particular attention to the recommendation that "more work should be done to explore the concept of the `University Hospital NHS Trust'". Any consideration of the management structure of teaching hospital Trusts should also cover the management structure of the large number of Trusts which, though not formally teaching hospitals, have an increasing involvement with one or more medical schools. The question whether such Trusts would benefit from an additional Non-Executive Director, nominated by the relevant university, deserves examination. Any of these proposed changes to management structures would require primary legislation; however this might be done by including the provision in any National Health Service Bill.

8.    We welcome a joint initiative by the NHS Executive and the Higher Education Funding Council for England, announced in June in a letter to Vice-Chancellors, Deans of Medical and Dental Schools, NHS Regional Directors and NHS Regional Directors of R&D. The letter says,

    "The partnership between the NHS and the university sector is unparalleled and we both recognise the importance of ensuring that the funding policies of one sector take account of the needs of the other. We have therefore agreed to schedule regular meetings and to address particular issues through specific task groups. The first task group to be set up should consider the best ways to handle health services research in the next Research Assessment Exercise (RAE). A second task group, which will be established when the report of Sir Rex Richards' Task Force on Clinical Academic Careers is available, will examine more closely the links between teaching, research and patient care and their implications for the RAE."

9.    This is welcome evidence that the Government acknowledge the problem, or at least an important part of it. More such evidence is to be found in a letter to us from Mr Alan Langlands, Chief Executive of the NHS, which is appended to this Report. We now look for action, to safeguard the future of health care in the United Kingdom. We intend to keep this matter under review.

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Prepared 14 January 1998