Examination of Witnesses (Questions 1
TUESDAY 7 DECEMBER 1999
MP, YVETTE COOPER
MP, LORD SAINSBURY
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.
Clinical Academic Careers
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 academicsthe 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.
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.
Lord Walton of Detchant
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.
Baroness Warwick of Undercliffe
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 mattersand
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 anybodythere are a number around
this tablewho 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
madethat, 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.
Lord Walton of Detchant
9. The Government may be aware that the BMA
is publishing tomorrow a major report on medical student selection,
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
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.
Lord Walton of Detchant
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
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.
1 Selecting our doctors, British Medical Association,
1999, ISBN 07279 15177. Back
See supplementary memorandum on page 28. Back
In a Genetic Interest Group policy paper Therapeutic Use of
Human Cloning Technologies, October 1999. Back