Baroness Chisholm of Owlpen (Con)
My Lords, I begin by thanking the noble Lord, Lord Hunt, for securing a debate on this important subject. He has spoken today about the vital role fulfilled by clinical pharmacologists and the contribution they make to effective treatments for the population of this country.
As the noble Lord pointed out, pharmacology lies at the heart of biomedical science, linking together chemistry, physiology and pathology. Those that take up the speciality work closely with a wide variety of other disciplines, including neuroscience, molecular and cell biology, immunology and cancer biology, to name just a few. They improve the lives of millions of people globally by providing vital answers at every stage of the discovery, testing and clinical use of new medicines.
The ability to use medicines effectively, to optimise their benefit and minimise the risk of harm to people, relies on pharmacological knowledge and understanding. We hear much about new diseases such as Ebola and Zika and their emergence and also hear much about older medicines—most notably antibiotics—no longer working as well as they did, so the contribution of pharmacology to finding better and safer medicines continues to be vital.
While it is true that there has been a decline in the number of clinical pharmacologists practising in the UK, it is important that we recognise that the fall in numbers is relatively small. Data from the British Pharmacological Society and the Royal College of Physicians show that the number of CPT consultants in the UK fell from 74 in 2002 to 72 in 2013, and that 52 of the 72 consultants were based in England, but perhaps a drop of even that amount is important.
As regards the supply of the profession, as noble Lords will be aware, from being established in 2013, it has been Health Education England’s responsibility to ensure that there is sufficient future supply of staff, including those needed in specialist fields such as this, to meet the workforce requirements of the English health system. It is the responsibility of the devolved Governments to ensure their health systems have the staff they require. Each and every year, Health Education England produces a national workforce plan for England. This is built upon the needs of local employers, providers, commissioners and other stakeholders who, as members of the local education training boards, shape their local plans.
Health Education England therefore has a responsibility for ensuring an adequate supply of trainees to provide the consultant workforce of the future, but is not responsible for setting the number of consultant posts inside the NHS. As I have just set out, this is the role of trusts, commissioners and others. HEE annually reviews the number of training places in medical specialties in response to demand expressed by the NHS. It is therefore crucial that trusts have a clear view of how they wish to utilise and promote clinical pharmacology and therapeutics positions in their hospitals.
To its credit, HEE has increased the number of training posts available. However, not all of these have been filled. Clinical pharmacology and therapeutics has suffered in terms of its fill rates against other high-profile specialties. However, as my noble friend Lady Gardner of Parkes mentioned, there needs to be more recognition of the career, more involvement with related healthcare organisations and perhaps more understanding of how fascinating and interesting this career can be, as the noble Baroness, Lady Thornton, said. In an attempt to counter this, HEE has been working to make the profession more attractive to junior doctors as they begin to specialise, including making the role more flexible to trainees, offering joint training with other specialisms and actively promoting the role at careers fairs.
The noble Lord, Lord Hunt, mentioned people not coming forward because of the uncertainty of a job. That is why some clinical pharmacologists already train towards a dual CPT, which then broadens the scope of their practice, making them more desirable to employers due to increased flexibility. I am aware that HEE has also been undertaking a review of this area and will, in due course and upon completion, share these findings with stakeholders, including the British Pharmacological Society. Leading on from that, the role has also been promoted by the chair of the British Pharmacological Society and is supported by the four UK health systems.
It may be interesting to note that the supply of clinical pharmacologists is primarily domestic, with only a very small number coming from overseas. In the three years 2012 to 2015, only one of the newly appointed consultants was trained outside the UK. Both the Royal College of Physicians and the British Pharmacological Society feel that there is a need for growth in this area and assert that current and predicted supply is insufficient to support that growth, and as such are calling for more training posts. There is, though, a lack of consensus between the Royal College of Physicians and the British Pharmacological Society about the level of future demand and the numbers required. This is perhaps an indication that it is not easy to evaluate future demand or possibly indicates a lack of understanding of these roles out in the wider health system.
Given the need to spend taxpayers’ money responsibly —and the difficulty filling the existing training posts—HEE is not able to increase the number of training positions until the demand is signalled by the NHS. At this stage, no significant increase in demand has been signalled in HEE’s annual collection of forecast demand from providers, which forms the basis for the annual training commissions for medical specialties.
In summary, I strongly encourage professional bodies with an interest in this field of medicine to actively engage locally with NHS trusts to ensure that where there is a need for additional clinical pharmacologists, they feed this in to the HEE workforce planning process. This process is the fundamental bedrock for NHS workforce planning. HEE actively engages with its stakeholders in developing its annual workforce plan, and any change in workforce planning numbers needs to be debated and resolved through this process. It is interesting that this is obviously not only a problem in the United Kingdom, because several reports have come out of the United States which show that it is having similar difficulties.
I thank the noble Lord, Lord Hunt, for giving us the opportunity to discuss this important matter.
Lord Hunt of Kings Heath
I am most grateful to the Minister for giving way and for the eloquence of her response. From what she said, the Government’s view is that this is solely a matter for Health Education England, and I understand that. However, does she accept that because HEE is concerned only with the accumulation of the local plans, it is not able to take any account of the national significance of this clinical speciality, and that there is a risk here because local employers do not see this as particularly important, although nationally we can see that it is vitally important? Is there a case for asking HEE to look at the national strategic importance of the professions? That would be one way of looking at this from a rather different viewpoint.
Baroness Chisholm of Owlpen
The noble Lord stopped me just as I was about to say that very thing. This is one of the important problems. There is not joined-up thinking—certain bodies are not aware of the importance of this—so it becomes a kind of vicious circle. I was going to say that we need joined-up thinking, and I hope that debates such as this will increase awareness and get people to think further. I will be happy to meet those bodies involved; they might well prefer to meet my noble friend Lord Prior but I will be happy to accept on his behalf.
I thank all noble Lords who have taken part in this debate.