Health: Academic Health Partnerships

Lord Alderdice Excerpts

Monday 29th November 2010 Lords Chamber

[Lord Alderdice]

My Lords, I too want to express my appreciation to the noble Lady, Baroness Finlay of Llandaff, for obtaining this debate. As the terms of the motion are reasonably wide in referring to academic health partnerships, there are a number of elements that I would like to address briefly in the few minutes that are available to us.

When one thinks about academia, it seems to me that one should think not just of research but of the teaching of undergraduates that helps them to develop, of training—the clinical dimension of the work has to continue even in the postgraduate period—and, of course, of research. However, over the past 30 or so years, quite substantial changes have taken place in our approach to academic health partnerships. If one goes back 30 or 40 years, a great deal of academic work focused on medical practitioners who had a particular interest in and aptitude for this kind of work. Such practitioners spent part of their time employed by the National Health Service, largely, but they also did academic work, often with honorary contracts with universities.

Two or three major changes have occurred since then. One is that, as health trusts of various kinds—primary care trusts, hospital trusts, community trusts and so on—were set up and became increasingly business orientated and managerial in their approach, each trust looked at how far research was helpful to its own business plan. If the research was not directly productive, there was a disincentive to doctors to focus on research. As time has gone on, that has become an ever greater problem because doing research has itself become more difficult. There are many more ethical hoops—quite understandable in many cases, though not all—and funding has become more difficult. Junior medical staff, who might have been more than delighted to participate in research 20 or 30 years ago because it helped their curriculum vitae, now find that such research does not benefit them too much and it is much more difficult for them to find time for it. Research has become a much more difficult exercise with the increasing managerial approach in the NHS.

Universities, too, have had to look at whether or not they could be collaborative in that rather relaxed, laissez-faire way. Universities have demanded clinicians who focus very heavily on research and do well in the RAE, while NHS physicians have increasingly focused on their NHS clinical work. In addition, of course, there is now a much wider body of healthcare professionals involved in all these activities. The focus is not just on doctors but on the whole range of healthcare professionals—and quite rightly so—and that means that the picture has changed very dramatically. Meanwhile, the amount of resource available for research has not increased in a commensurate way. That is also true for teaching. Therefore, it has sometimes been the case that there has been a widening without necessarily a deepening of the quality of teaching and training.

It is not as though the new Government are coming to a situation in which everything has been perfect. In the past few years, there was a recognition of some of those issues by the previous Government. Following the Darzi report, the Government promoted some important centres of excellence, which have already been referred to in the debate and which are to be commended and supported. One of the concerns of the noble Lady is that the Government’s proposals should take away nothing from the progress that has been made. I very much hope that my noble friend will be able to reassure us on that, because the White Paper makes clear that,

“The department will continue to promote the role of Biomedical Research Centres and Units, Academic Health Science Centres”—

which were, of course, what came out of the Darzi report,

“and Collaborations for Leadership in Applied Health Research and Care, to develop research”.

At this stage, where change and development is being proposed, one wants to be reassured that those centres of excellence will indeed be built upon. There is, in fact, a tribute earlier in the White Paper to the importance of the work of the noble Lord, Lord Darzi. I also note that specific emphasis is given to the NHS commissioning board taking some responsibility for promoting involvement in research and the use of research evidence.

However, although it is extremely important to ensure that the relatively small number of high-quality centres of excellence is maintained, sustained and developed, that is not enough. There must be some way in which we can begin to rekindle the interest of young doctors, nurses, psychologists, social workers and the panoply of health professionals to realise that research is an important component in their own professional development and that, if they are to understand the implications of research papers, they must have at least a little experience of research early on. Therefore, I seek some reassurance from my noble friend that, as we move forward into potentially exciting opportunities for a newly configured health service, we will try to regain some of the creative excitement about research and academic work of all kinds that I think has been somewhat lost in the overly managerial and overbureaucratic approach that has been applied not only to healthcare but, at times, within some of our leading academic institutions.