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Lord Rea: My Lords, my noble friend Lord Turnberg has been so successful in recruiting speakers to this short debate that we have very limited time. As he recruited me only yesterday, my contribution will be more a series of snapshots than a deep analysis.

I agree with my noble friend that the Government have taken important steps, which he outlined, to reduce the shortfall. As well as that, they have promised an additional £100 million per annum by 2008 for NHS R&D. It would be interesting if the Minister were able to tell us how that funding will be allocated in relation to the problems outlined in the debate. However, most clinical academics will reserve judgment on those rather grand-sounding initiatives until results begin to come through. There is a long way to go.

It is surely unacceptable that clinical academic staffing levels nationally have been allowed to dwindle at the same time as student numbers have greatly increased. It is of course much easier and more politically visible to increase student numbers than create and fill new clinical academic posts. However, without that parallel increase, the end product will inevitably be of lower quality. As other noble Lords have said, it is the quality and quantity of research that is suffering most, as the clinical academic service demands on clinical academic staff are more pressing and urgent, especially when time and staff numbers are short. My information from the coal face comes from my son, who is a senior lecturer in oncology at Birmingham University and is involved in multi-centre chemotherapy drug tests. His unit is up to full strength,
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but other parts of the medical school are less lucky. Posts have not been filled as they have become vacant, with the results that I described.

Many clinical students have to travel some distance to peripheral hospitals to find sufficient numbers of patients with whom to gain all-round clinical experience. That practice is not new and has much to commend it; I felt that I gained a lot by those attachments to non-teaching hospitals. Teaching hospitals have a higher proportion of less common conditions, and students there have less hands-on experience. Although the National Health Service staff at peripheral hospitals who teach clinical students are good doctors and teachers, they mostly do not have protected time for teaching or research. In particular, they are often much too busy to attend academic seminars and other events at the university aimed at keeping teaching clinicians at the forefront of clinical knowledge. Those out-of-town clinicians are in fact keeping our medical schools going, especially now that student numbers have risen so much. They deserve better recognition, better academic status and facilities and, above all, dedicated paid teaching sessions. Although peripheral GP practices are perhaps treated better, many of the same factors apply there, too.

Another area pertinent to the debate is the joint funding of clinical trials and other research by the pharmaceutical industry and universities. The industry has to find not just 100 per cent of the universities' overheads, but now 110 per cent. In their present financial straits, universities naturally see this as a way of augmenting their income. After all, the company may make a large profit through application of the research. That actually means that less research is coming to the UK, despite its excellent reputation and research skills. Countries in Europe, especially the new members of the EU, are much cheaper and are rapidly increasing their skills. The Government should make it easier for the international pharmaceutical industry to continue to carry out research here.

It is vital that the Government's good intentions be translated speedily into action; otherwise, the danger is that this country's fine record in clinical research and teaching will be relegated to Division 2, instead of vying for the top place of Division 1.

4.56 pm

Baroness Murphy: I, too, thank the noble Lord, Lord Turnberg, for the debate. I shall speak for a short time on the impact of the decline of clinical academic medicine on the NHS. It is a topic about which I have been hopping mad for at least a decade, so I am delighted to have the opportunity to be hopping mad in public.

For 15 years, I held a clinical chair in one of the so-called Cinderella specialities, geriatric psychiatry. Indeed, I hold a visiting chair at Barts and The London, Queen Mary's School of Medicine and Dentistry, to which I contribute an hour every year. Until very recently, I sat on the councils of Queen Mary, University of London, and of City University,
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which has a thriving and successful academic nursing department and other academic departments relating to professions allied to medicine. Now, as chairman of the strategic health authority, I have been an active go-between between the NHS and our higher education institutions and chair the joint strategic partnership board, and I am all too aware of the tensions between a medical school's priorities of research and teaching and the NHS drive for improved service delivery.

I have witnessed with increasing dismay this past 10 years the impact of education and science policy on the development of local health services. The collateral damage from the RAE—the "Exocet" that has winged its way into the health service—and the focus on molecules and bioscience away from the applied science of delivering care has had the following serious and negative impact. We have heard about the reduction in the number of academics, but I shall just talk about the departments. Academic radiology is now down from 12 departments in 1997 to three departments now. It is almost dead. Academic anaesthesia is going the same way. Some 50 per cent of academic care of the elderly medicine departments have gone, the rest are failing rapidly and the quality of surviving departments is mixed. Academic psychiatry survives by being utterly disconnected from the needs of patients with mental health problems in most places, although there are a few notable and laudable exceptions. As we have heard, a quarter of academic psychiatry posts have disappeared since 2001.

Health services research is barely surviving, and few quality departments are available for training, even though the Department of Health, for example, in its recent review of cancer research priorities, put such research as its absolute top priority for delivering cancer research to the population. Public health and social medicine are in decline, and primary care academic departments of general practice are in a parlous state in many areas. In east London, we are the baby production capital of western Europe and are very proud to be. We deliver 25,000 babies every year, and yet we have no chair in obstetrics and no prospect of recruiting one. Only a handful of serious academic departments of obstetrics is left.

I have no doubt that my foundation chair—the first in geriatric psychiatry in this country and, I think, in the world—which was funded by the NHS in 1983, would not now be created. King's College would no longer accept the money—the risk would be too great. The research funding that I was able to attract came largely after my appointment. These days, people have to be RAE stars already to be appointed to academic departments.

If I talk to my NHS management colleagues about my concern, they tend to shrug and say, "So what? These professors were very costly anyway. They did not all do the work that we wanted them to do in the NHS. They concentrated on the wilder shores of research medicine". It is true, too, that globally, on this World Aids Day, there is a serious disjunction between the need to solve the world's biggest health problems and what academic medicine wants to research. That was raised not long ago in a series of articles in the
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British Medical Journal. After all, the NHS is largely populated by fascinating patients with rather boring, everyday diseases. The RAE has encouraged research at the biosciences cutting edge, not perhaps the incremental painstaking studies that improve stroke outcomes or better help people with long-term conditions to avoid hospital admissions. Many NHS managers do not have much sympathy with the problem of the reductions.

The outcome of the loss of academic role models and of some of the brainiest doctors in academic medicine is that younger doctors and their professional colleagues see such dying academic specialties as second-rate. It is a self-fulfilling prophecy. The quality of the NHS services declines when a local academic department closes. That has had a real impact nationwide on the quality of maternity and psychiatric services. The care of older people in some areas is going backwards, in spite of the splendid work being done on the national service framework, which one would expect to be led by some of our brightest clinicians. In fact, we have a dearth of stars. My point is that the moment that an academic department closes locally the NHS suffers profoundly.

Why was it that back in 1973 those at Hope Hospital in Salford were rather keen to have a bright young gastroenterologist, Dr Turnberg, set up a new academic department of medicine? They were keen because they knew that it would have a serious impact on the culture and quality of medicine delivered to Hope Hospital and to the people of Salford—and so it proved. We no longer have those opportunities, and the Department of Health should say why it no longer provides support to universities to get that right. Therefore, I should like to know what the Department of Health and the Department for Education and Skills are doing jointly to stop their policies working against each other to the detriment of the National Health Service.

5.3 pm

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