Universities

Baroness Finlay of Llandaff Excerpts

Thursday 14th November 2024 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I have the privilege of being an observer on the Medical Schools Council, I have a role at Cardiff University and I am on the advisory council of Brunel Medical School.

The relationship between medical schools and universities goes back centuries, and this report is timely as we face changes. There is a shortfall in our workforce in medicine. Places in medical schools need to expand, and the number of medical schools is expanding, but we have another crisis because of the shortage of clinical academics.

Clinical academics are those doctors who are employed 50% of the time treating patients in the NHS and 50% in research and teaching. They are jointly employed, even though HMRC treats them as though they have a single employment. There are costs associated with the newly agreed contractual arrangements for these doctors. The UK’s future research strength is now jeopardised because, unfortunately and erroneously, the funding for the new contractual arrangements for NHS consultants omitted clinical academics. So I ask the Government whether they are making arrangements to reimburse universities somehow for the estimated additional £20 million of costs that this is going to result in for universities.

These clinical academics are, by and large, the research-active doctors. Academic clinical medicine accounted for 35% of all higher educational institute research grant income in 2022, valued at almost £2.5 billion. When all bioscience-related categories are included, the figure rises to around £4 billion, or about 57% of total research income. However, clinical academics represent a decreasing proportion of the workforce. The proportion aged over 55 doubled from 18% in 2005 to 36% last year, meaning that we have more approaching retirement without the flow of younger academics coming through. Only 4% of consultants are clinical academics, compared to 7% in 2005. These are the people needed to research and teach the next generation of doctors; their contribution to the national economy through money invested in research must not be underestimated. The numbers of clinical academics coming from general practice are tiny, even though they have risen slightly to 0.6% of GPs in the last 10 years.

The work to recruit applicants into healthcare from a broader section of society through widening participation is proving effective. The number of entrants to medical school from the most deprived areas has more than doubled from 6% to 14% in the last 10 years. The proportion of female applicants has certainly increased, up to 63%. Asian applicants increased to 29% and the proportion of black applicants has grown from 6% to 10%.

For those coming from schools in more deprived areas which have no selective intake, it is important to ensure that the entry tariff is appropriately adjusted. University league tables look at the average entry tariff, but those which have adjusted to take students from this broader proportion of the country—that is, deprived areas—risk being relatively downgraded in rankings, yet they are providing the future medical workforce for the most deprived areas in the country. Those responsible for student finance arrangements should consider the impact of the cost of living crisis on medical students, with their slightly longer courses, inability to take on other jobs and difficulty of success in a course that is rigorous and demanding. Will the Government support the recommendation from the Medical Schools Council that organisations publishing university league tables should consider removing average entry tariff from the criteria and include diversity and inclusion? Without diversity and inclusion, we will not begin to redress the imbalance in supply of workforce to these most deprived areas of the country.

The decline in clinical academics risks hampering the sector’s attempt to expand medical school places, as set out in the NHS Long Term Workforce Plan. There is a tension here. Without urgent action to increase the numbers and retain pay parity with NHS colleagues, the commitment set out in the long-term workforce plan will not be met, as we risk losing the vital workforce and the benefits it brings. There is also strong evidence that patients cared for in research and teaching-active institutions can have better clinical outcomes. These are benefits to wider society, not only to the innovative aspects of research in our community.

In 2021, the research excellence framework classified over 90% of clinical medicine research as world leading or internationally recognised. We all recall the Oxford AstraZeneca Covid vaccine, which resulted in 3 billion vaccine doses worldwide. As the House of Lords Science and Technology Committee stated in its recent letter to the Secretary of State,

“we heard concerning evidence that the future of clinical research, and the clinical academic workforce in particular, is under threat”.