THIRD REPORT
3rd December 1997
By the Select Committee appointed
to consider Science and Technology.
ORDERED
TO REPORT
CLINICAL ACADEMIC CAREERS
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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