Volume 1

Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology.

  • Great Britain. Parliament. House of Lords. Science and Technology Committee.
Date:
1995
Catalogue details

Licence: Open Government Licence

Credit: Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology. Source: Wellcome Collection.

    70/132 (page 68)
    awareness of the need for a strong research base for the NHS...The extent to which research experience during training influences how willingly clinicians take on board R&D findings in their career-long clinical practice needs further enquiry. The same applies to identifying the best ways of providing this research experience”. The Royal Society of Edinburgh made the same point (p314). 22. Dr Kendell, the Scottish CMO, believes that these concerns merely manifest fear of the unknown. By shortening specialist training, the new system may make research easier. “Much in practice will depend on the attitudes of the Colleges and of the Postgraduate Deans” (Q1145). His colleague Professor Bouchier is not so confident (Q1148); he fears a sharp drop in the number of consultants with experience of research, which “augurs poorly for the future of health services research, in particular clinical trials”. 23. Professor John Swales, on the contrary, anticipates that the new system will mean that all junior doctors will do a period of research training, and he welcomes this (Q840). His concern is that the number of consultants will not be increased sufficiently to take up the burden of clinical services no longer being performed by doctors in training, and that research will suffer in consequence. Professor MacKie made the same point (Q1071). On the other hand the HEFCs (QQ1360-62) are concerned that the number of consultants will increase, and diminish the influence of clinical academics over the culture of the teaching hospital and the wider NHS. They want training numbers to be “liberally” available to junior doctors opting for research. Professor Stout of Belfast (Q717) hopes that some of the new consultant posts will be academic. Similarly the CDMS expect the new system to mean fewer junior doctors on academic units, with less time for research (p462); they say, “It is essential that funds are found either from NHS or HEFCE sources to match the increase of NHS consultants with additional senior lecturer posts so that the staffing levels on clinical academic units can be maintained”. 24. The Association of Young Medical Scientists, anew organisation aspiring to represent clinical and non-clinical research fellows, is concerned for the flexibility of the system (p319). The Calman proposals fail to recognise that “‘a research training cannot simply be added on to aclinical training, but is part of a training that leads an individual into a different role and career structure”. AYMS does not agree that every junior doctor benefits from a taste of research; in their view, poor-quality research done by people whose future careers do not demand it will have “detrimental effects on future perceptions of the research community”. This is not however the view of the higher training committees, which consider that some involvement in, or exposure to, research is a fundamental part of the training of all specialists, whether destined for an academic career or not. 25. The Arthritis and Rheumatism Council (p413) considers that the new system “may have a very damaging effect on the NHS R&D effort”. Fewer registrars will mean more clinical work for consultants, including academic consultants; the ARC suggests that, in default of new money from the HEFCs, the NHS might use some of the money saved on registrars’ salaries to pay for some new senior lectureships. Junior doctors who work the new system by doing their PhD before embarking on the new, more intense specialist training may find after five years of full-time clinical work that they cannot get back into research. Doctors who do their PhD in the middle of their specialist training will, if allowed to take their training number with them, leave the more academic specialties cluttered with visiting registrars from overseas; if they have to surrender the number to another trainee, they may have difficulty getting it back in order to complete training and earn their CCST. Either way, the new system will produce a “training time penalty” for aspiring clinical academics of 2-3 years. The BMA (p407, Q1376) are similarly concerned that junior doctors “will come under significant pressure not to step outside the [unified training] grade in order to pursue academic, including research, interests”. While they prefer junior doctors to “follow their bent” rather than conduct research by obligation, they do not wish time spent in research to count against the researcher. Sir Leslie Turnberg is President of one of the Colleges and Chairman of the Conference which brings them all together; his concern (QQ889, 892) is not for flexibility, since “most programmes encourage periods of time out” and the numbering system will permit this, but for the disincentive effect of the time penalty, and for the position of the home department while the trainee is away. Professor Wyllie takes the same line (Q1085); Professor Edwards is likewise concerned about the position of the home department (Q999). 26. When we met Dr Graham Winyard, NHS Director of Health Care, in February, he said (Q590): “Most of the Colleges are recognising up to one year of research, and that year need not include clinical work, as part of the programme leading to the CCST; but I think more