Health: Academic Health Partnerships

Baroness Finlay of Llandaff Excerpts

Monday 29th November 2010 Lords Chamber

Tabled By

[Baroness Finlay of Llandaff]

To ask Her Majesty’s Government how they propose to preserve United Kingdom academic health partnerships.

[Baroness Finlay of Llandaff]

My Lords, I declare my interest as a clinician and as a former vice-dean of a medical school. Clinical academics are at the heart of academic health partnerships. Traditionally, clinical academics have mostly been doctors and are the clinical academic leaders of today. But other health professions are joining this group who are employed by universities to research and teach, as well as having direct patient responsibilities. Medical schools are at the heart of this unique position that juxtaposes research abilities within the clinical context, stimulating questions that need answering and permitting studies to be planted in reality.

The UK has a fantastic record in biomedical research. Some 10 per cent of all the academic output in the world is from the UK, but we have less than 1 per cent of the world population. Twelve per cent of listed medical research citations are from the UK, second only to the US, and 19 of the 75 most widely prescribed drugs were discovered here. Investment in biomedical research made over the past 20 years is reaping dividends. The challenge is to get the findings translated into routine practice. Research assessment exercises have tended to steer towards basic science as it is easier for the RAE than applied research. Simultaneously, NHS management has been driven by targets. It is the UK medical schools that sit in the middle of this financial tension. Although tension can be creative, there is a danger that knee-jerk financial responses can undermine long-term, potentially very profitable investment if academic and clinical medicine are forced apart by short-term commissioning decisions.

Countering this pressure has been the National Institute for Health Research, in large part inspired by Dame Sally Davies. Its impact has been phenomenal. Schemes it has supported are being copied and rolled out in the devolved Administrations. Clinical academic training fellowships are attracting increasing numbers of the brightest young doctors as state-of-the-art activities are introduced into trusts, adherence to guidelines improves and evidence-based best practice spreads. The five major health sciences centres in England, Imperial College, King’s College, University College London, Manchester and Cambridge, are direct products of this initiative. They build on the juxtaposition of research and direct clinical care, with major laboratory research linked to clinical practice. But there is also a major benefit to UK plc from all the other academic centres. So I ask the Minister for reassurance that the Department of Health is working closely with the Department for Business, Innovation and Skills to maintain our profitability from clinical academia.

There is good evidence that clinical outcomes are better from all routine clinical services that are research and teaching active. Indeed, that was recognised in the White Paper. Medical schools responsible for the undergraduate teaching of tomorrow’s doctors are all active in research and they have clearly demonstrated that investment pays dividends. For example, every pound of public money invested in cardiovascular research has, after 15 to 20 years, generated a benefit of 39 pence annually in perpetuity. Recent translation of research into practice is illustrated by the reconfiguration of stroke management in London, with better clinical outcomes now that many stroke units have been rationalised down to centres managing hyper-acute stroke providing rapid thrombolysis, decreasing morbidity and long-term care needs.

We take for granted the many previously unimaginable surgical procedures and drug treatments that are now an everyday occurrence. When people are seriously ill they want a specialist to guide their management; someone who is research-active in the area of their disease. I ask the Minister how the importance of academic medicine will be recognised by the GP consortia, many of which will be led by GPs who are not involved in research. How will public health research be supported and financed as public health moves to local authority control?

The health and wealth agenda is served by maintaining the momentum in clinical academia, yet we are already seeing an adverse drift. The pharmaceutical industry is drifting off to other countries with consequent revenue and job loss to the UK. In 2002, 6 per cent of the clinical trials in the world were conducted here but by 2007 this had fallen to 2 per cent.

The recent NHS White Paper speaks strongly of the benefits of research with 10 distinct references to it. It states:

“The Government is committed to the promotion and conduct of research as a core NHS role”.

It goes on to recognise that, particularly in lean financial times, research can provide routes to improve health outcomes and reduce inequalities. Following the consultation on the White Paper, can the Minister reassure us that the commitment to those centres that develop research and unlock synergies between research, education and patient care, remains stronger than ever?

Medical schools have been working with their NHS university hospital partners to plan for the future. They recognise that health and higher education have flourished with political support over recent years and that the global recession’s impact on the UK’s economy will change this growth trajectory. Future success and sustainability require that the core businesses of teaching, research and healthcare delivery are aligned to weather the changes in the financial climate. Collaborative working, not competitive vying for resources, will be the way forward.

Within the NHS the governance system should be based on proportionality of risk rather than “one size fits all”. Clinical research ethics committee processes have speeded up but bureaucratic blocks to research still exist so that opportunities cannot be grasped even though economic recovery will depend on them. Inspection processes, such as the Medicines and Healthcare products Regulatory Agency inspections, can seem excessively laborious. I ask the Minister: what levers are there in the new NHS to address such blocks to innovation and research?

The new GMC document, Tomorrow’s Doctors, requires the doctors of the future to focus on leadership and a lifetime commitment to improvement in recognition of the importance that such a skilled workforce will bring to the wealth of the nation. Training does not end with a medical degree. Postgraduate training takes years and currently it is the responsibility of postgraduate deans, but where will the postgraduate deans sit? They are not mentioned in the White Paper.

Clinical academics emerged during the postgraduate years. The Wellcome Trust postgraduate fellowships aim to recognise and grow the UK’s future medical academics. As specialty and primary care trainees develop an understanding of applied research when working clinically, and as strategic health authorities disappear, it makes sense for universities to be persuaded to house the postgraduate deans, who will not usually be RAE returnable and so will need to have some honorary contract arrangement. However, these deans need a ring-fenced budget to have a lever on foundation trusts to employ this workforce and ensure high-quality training.

Vice-chancellors, too, need to understand the benefits brought from effective partnerships with the NHS and from engaging with the postgraduate training agenda. Structures and performance that match the NHS agenda require incentivisation: for example, by adding locally relevant work with industry to the criteria rewarded by panels assessing the impact of research for the funding councils.

Academic health partnerships can bring solutions to pressing public health issues, both here in the UK and globally. They represent an investment in our foreign policy. They can bring solutions to the requirements of an ageing population susceptible to multiple chronic diseases. Even stronger links between education research and service delivery can optimise the health and wealth of the nation. I look for reassurance that there is an ongoing and, indeed, increasing commitment to this agenda.