TUESDAY 7 DECEMBER 1999

JOHN DENHAM MP, YVETTE COOPER MP, LORD SAINSBURY OF TURVILLE AND DR PAT TROOP

  Thank you very much indeed for coming to this Committee. I think it is the first time since I have been on the Select Committee that we have had the privilege of having three ministers from two different departments, and it is very good to see you. We have essentially three blocks of questions and we will try and keep to a fairly vigorous schedule, perhaps allowing maybe 20 minutes for each group. What we generally do in this Committee is, as we go along, to declare our interests. As you might imagine, all of us here will tend to have interests which are involved. It has been pointed out to me that I have a conflict of interest with almost every question that is on the paper, so clearly we will need to declare those as we go.

  1. I wondered if I might start perhaps with Mr Denham on our first question? This is the vexed issue of clinical academic career prospects. We want to make sure that the Government shares our very considerable concerns about the long-term prospects for clinical academics—the issue of people being pulled out of the very science which develops the National Health Service and which ensures the best standards for young clinicians in training.
  (Mr Denham) Lord Winston, thank you very much for the opportunity of discussing these issues. Could I take the opportunity of congratulating you on the award of the Royal Society's Michael Faraday Award? I think it was well deserved. I can reassure the Committee that we do recognise the vital role that clinical academics play in training future doctors and, of course, providing NHS services and conducting research. I think that, in its reports, the Committee highlighted a set of concerns that needed to be addressed. I would hope that the series of initiatives that have been set out in the memorandum that we have presented shows that the Government is serious about addressing them. Some of those were issues that fell directly to government to address, such as the concerns about pay parity that wereraised in your earlier report. Many of the issues are ones where our role, I think, is to play a leading role in partnership with many of the other organisations that are involved in supporting the role of clinical academics. I would hope that the memorandum shows that not only have we done that but we have identified areas of further work, and progress has already been made.

  2. Do you have any problems about the general Calman system of training, whereby there is an allotted structure for research which is within a fairly rigid framework? Do you think that actually contributes to the best form of research training in the NHS?
  (Mr Denham) When the Calman reforms were first brought into place the initial interpretation of the way in which they would work was seen as restricting the opportunity for doctors in training to undertake academic research. I think the view of the Department is that was a misinterpretation of the position and that is why the supplement to the guide to specialist training was produced, to make clear the opportunities and the flexibilities which did exist within the training system. I understand that last year, for example, the Medical Research Council received 270 applications and was able to award 56 MRC fellowships to doctors in training grades. So I think that we have been done a fair amount to make it clear that there are opportunities to do research. I understand that 9 per cent of specialist registrars are currently out of training undertaking research. Nonetheless, the symposium which was held in October did identify this issue as one that needs further examination. That will be taken forward by the AGMITS Academic and Research sub-group in due course. The short answer is that the problem was not as bad as it was perceived and we have done quite a lot to make sure the opportunities are there. There may well be further issues that we need to look at.

Chairman

  3. You mentioned the MRC training fellowships but, of course, these are very few, as are, indeed, the ones from Wellcome. One of the issues is how you fund that training programme, that research training programme. I do not know whether you feel that it is a very narrow band at the moment?
  (Mr Denham) I certainly recognise that the funding of training places is an issue again that was identified in the seminar which took place in October and needs further examination. I do not think that I am in a position, certainly this morning, to commit myself to further action in that area but I am perfectly willing to acknowledge it as an issue that needs further examination.

  4. It is more than seven years since I worked as a clinical academic but I did chair the enquiry conducted by the Select Committee some years ago into research in the NHS in the light of the last Government's reforms. It was this that led to the establishment of the Richards Committee to which you have referred. At that time there were 47 vacant clinical chairs in the United Kingdom; now there are 74, and of those 74 vacant clinical chairs, half have been vacant for more than 12 months. So the position is not at present improving. You make a number of very helpful suggestions in your memorandum. The Calman training programme is one problem but that will be dealt with, I think, when we come to the Academy of Medical Sciences report. Another is the effect of the research assessment exercise. But one that is not referred to in your memorandum is the pressure which is being imposed upon clinical academics to see more and more patients, to increase patient throughput, to reduce waiting lists, all to the detriment of the time available for teaching and research. What are the Government doing about protecting that teaching and research time which should be part of the academic contract?
  (Mr Denham) There are two key issues that I have highlighted. The first is that Task Group 1, set up jointly with HEFCE following the Committee's previous report and the Richards report, did look directly at the question of the research assessment exercise and have, as you know, made suggestions for changing the next exercise, which should mean that the gap that is perceived between the quality of research and the way in which it was assessed should be addressed. As far as the workload pressures are concerned, what has been done through a number of different fora, including perhaps particularly the Joint Medical Advisory Committee study, is to highlight good practice around the country. I have to say that a constant theme of what I will say this morning is to drive the best practice that does exist across all the medical schools and the universities which have not yet caught up. What is very clear is that, in a number of areas, the particular issues of pressure on the individual are being well addressed by the proper use of job planning and the proper use of appraisal of the individual's workload in the context of a shared approach to all these issues by the university and the NHS. I think it is quite critical that we develop a culture of openness and sharing of approaches between the NHS and the university sector and that is then reflected at the level of the individual, so that the pressures can be recognised, understood and properly managed.

  5. I wonder if I might press the Minister on the question of clinical academic careers, declaring an interest as Chief Executive of the Committee of Vice-Chancellors and Principals? I really want to press you on the urgency of implementing solutions because the lead time for preparing staff for the medical profession means that any steps we take now will still take several years for the benefits of them to flow through. A recent BMA survey, which also highlighted the number of vacant chairs, indicated that the numbers of qualified candidates have been decreasing over a prolonged period and that short-lists are "often shorter than might have been hoped for". We do clearly need new initiatives to attract clinical academic candidates and I wondered whether you could say something about the urgency with which you might be approaching that?
  (Mr Denham) It is very frustrating that in terms of hard data about vacancies, the length of time posts are left unfilled, the range and quality of candidates coming forward, I have to tell the Committee that we are not much further forward than was the position when the Committee last discussed these matters—and that is despite a considerable amount of effort by AGMETS Academic and Research sub-group that is looking at these issues. A very considerable attempt has been made to work through the various stakeholder organisations to produce the hard information we really need to have to identify the scale of the problem and to tackle it effectively. The reality, I am told, is that the response in terms of the range and quality of information volunteered by the different organisations concerned has not been as good as we would like and so we still do not have a hard picture. I think it is absolutely essential that we redouble our efforts to improve the quality of the data and the monitoring that we have about vacant posts and the difficulty in filling them. That has very much been identified as a priority in the October seminar. It is on their worklist and it will be looked at by the AGMETS sub-group in January. Could I make a plea that anybody—there are a number around this table—who has any influence on the various organisations, encourage their help to produce that data? That will be very useful, because designing an appropriate response must be based on a firm rather than anecdotal or partial survey assessment of the situation. We do need to do that quickly. We are expanding medical training places. The universities that have submitted their bids have told the Joint Implementation Group that they are confident about filling the clinical academic posts that are required. But you are absolutely right: making changes in any workforce, especially in the NHS at specialist level, does take time. I would not like to see us miss the opportunity to do that, not least because we have a much more wide-ranging workforce review under way in the NHS at the moment and we have to make sure that we have taken the complete picture and not a partial picture in that work.

  6. One of the groups has some of this data, apart from the Royal Colleges, which I know is patchy, is the postgraduate deans. I wonder whether you feel the system of postgraduate deans is an ideal system, given that so many of these postgraduate deans have very little research experience themselves and generally not in the area of specialty that the registrars in that particular region are involved in?
  (Mr Denham) You have put a question to me that I would like to reflect on. It is not one that I feel that I would like to volunteer a firm opinion upon at this stage in the specific context of clinical academic careers. What I would say, is that the workforce review which we are looking at the moment obviously raises some questions about approaches to training, though has come to no conclusions. It will review the role of all the structures that we have in place at the moment, including the role of the postgraduate deans, and it may reinforce the point I have just made—that, if we identify that we need to take action on clinical academic careers, perhaps we should make sure we are looking at that issue at the same time.

  7. Following on from the discussion we have just been having, could I ask about the implications of the phased increase in medical school intakes, which has been well publicised and is mentioned in paragraph 3 of your memorandum? What are the implications of that for the numbers of clinical academics that are needed to provide for their training? There is already a shortage. Is the accelerated expansion that is necessary to cope with the increased number of students on track?
  (Mr Denham) We believe that it is. The bids that have been successful suggest that around 140 new clinical academic posts will need to be filled when the implementation is complete, which, of course, is in the period between now and 2005, which is the date at which we expect to achieve the 20 per cent expansion in the number of medical school places. Most of those are concentrated in the six medical schools that have the bulk of the extra places. In the majority of schemes that have been established so far, there have been links with existing institutions to ensure that there is the necessary academic support for those new clinical academic posts. The analysis of the bids that were made suggests that none of the universities is anticipating any difficulty in attracting applications. Some, indeed, reported that they had received significant numbers of applications or recruited significant numbers of clinical academic staff in recent years and had always been able to maintain a good field of high-quality applicants. I recognise that assessment is not identical with other things that have been said this morning, but that is the assessment of the universities that are responsible for carrying out this expansion and obviously their proposals were scrutinised very closely by theJoint Implementation Group, which made recommendations to HEFCE on the allocations.

  8. As you suggest, it does not square with the 70-odd vacant clinical chairs. Possibly there are plenty of recruits coming up the system but who have not reached the level to apply for chairs yet. I am just putting that forward as a possible suggestion.
  (Mr Denham) Certainly, sitting here this morning, I do not have significant concerns about our ability to recruit the clinical academics that we need to carry through the expansion of the programme.

  9. The Government may be aware that the BMA is publishing tomorrow a major report on medical student selection[1], which I imagine you will wish to examine carefully. It is relevant to that particular issue. Turning now to the Savill Working Party of the Academy of Medical Sciences, its report is not yet finalised but in draft it suggests that those intent on an academic career should undergo a three-year doctoral programme after they have completed their early graduate training following the pre-registration year, and should then be able to undertake a five-year clinician/scientist post which they hope will have some kind of guarantee in the long term of leading to a major academic career. I think this is a very important and innovative suggestion. Are the Government aware that this is likely to be proposed by the Academy of Medical Sciences?

  (Mr Denham) I obviously have not seen the report itself. I know that Professor Savill was involved as a participant and speaker in the October symposium on clinical academic careers and that every effort has been made to feed the emerging conclusions of his work into the report of that symposium. All the issues there are going to be looked at by the AGMETS Academic and Research Sub-Group in January, and so we need to take that forward as part of the sub-group's further work.

  10. Thank you, because that is when the Savill Report is likely to be approved by the Academy.
  (Mr Denham) We are keen to make sure that the process is a coherent one and we are not wasting insights and ideas which should be taken into account.

  11. Clearly in the longer term the supply through the medical schools is going to be terribly important for, for example, recruiting to a doctoral programme such as we have just been talking about. What do you feel about the importance of the intercalated BSc at the undergraduate level as a platform from which to recruit those medical students who might well become the future academics?
  (Mr Denham) I will take the question, if I may, a little bit more broadly than you posed it. I will write to you on this[2] but, in general, the expansion of medical school places does include a number of innovative approaches for entry into medical education for people who have not done medicine as their first degree. There is a possibility, therefore, that there will be new routes into medicine for people who have already graduated doing another degree for a shorter period of training than would otherwise be the case, which may in turn produce people who can go on to research degrees.

  12. One final brief point, touching on your memorandum: are the Government still considering the issue of distinction awards for academic GPs?
  (Mr Denham) Yes, we are.

  Chairman: Thank you. We will turn now to the question of therapeutic cloning. It seems rather unfortunate that this whole area of science or medicine, call it what you will, is called therapeutic cloning. I think it has clouded the issue. I find it slightly alarming, if I may say so, being a scientist who is interested in the development of embryology for purposes to improve human health and somebody who is an active researcher in the field, that I am reported by the Genetic Interest Group[3] as saying: Lord Winston condemned the Government's position as "immoral". That is not correct. What I have said was that it was immoral not to use technology which might save or improve human lives, and I hope that everybody understands that. Lord Soulsby?

2   See supplementary memorandum on page 28. Back

3   In a Genetic Interest Group policy paper Therapeutic Use of Human Cloning Technologies, October 1999. Back