The future of clinical research in the NHS is under threat
26 January 2023
The House of Lords Science and Technology Committee has written to the Minister of State for Health and Social Care with the findings of its short inquiry into clinical academics in the NHS.
- Letter from Baroness Brown of Cambridge to the Rt Hon Steve Barclay MP, Secretary of State for Health and Social Care
- Inquiry: Clinical academics in the NHS
- Science and Technology Committee
Clinical research in the NHS has historically been a strength for the UK. It has led to life-changing improvements in clinical care, supported the UK’s healthcare system and life sciences industry, and had international impact, as exemplified by the RECOVERY trial during COVID. There are promising possibilities for clinical research to make further advances – for example, in genomic medicine for cancer treatments. However, concerns are growing about the state of clinical research in the NHS and problems in the future pipeline for the workforce, with the number of consultant clinical academics set to decline in the coming years without urgent action to reverse this trend.
The Committee’s overarching conclusion is that, rather than an additional pressure on the resources of the NHS, engagement with research can help to mitigate workforce challenges through improving recruitment and retention of staff. An NHS that values and has the resources to engage with and conduct research at all levels would improve patient outcomes and the efficiency of the health service by bringing the latest developments rapidly into the front line of clinical care. A report from the Association of the British Pharmaceutical Industry showed that the number of industry trials initiated in the UK declined by 41% in the four years from 2017 to 2021. This has resulted in the UK’s global ranking for Phase III industry trials declining from fourth in 2017 to tenth in 2021, jeopardising the long-term future of clinical research in the UK. However, the clinical research environment in the NHS is on a dangerous precipice and without urgent action we risk losing out on these benefits. The Committee’s letter identifies a number of areas a number of areas for urgent action to secure the future of clinical research.
The Chair of the Science and Technology Committee Baroness Brown said:
“Clinical research in the NHS is responsible for some of the UK’s greatest success stories in science and medicine. The COVID-19 pandemic RECOVERY trial is just one recent example demonstrating the unique capacity the UK has to combine its academic excellence in the life sciences with its healthcare system to change and save lives.
“However, throughout the course of our inquiry we heard alarming reports about the declining state of clinical research in the NHS. There is a ‘leaky pipeline’ for consultant clinical academics who often drive medical breakthroughs into frontline patient care. If issues in pay and pension inequality are not addressed, we are in danger of permanently eroding the clinical research workforce and it is patients who will suffer.
“For clinicians and healthcare professionals who are not consultants, the picture is no better, with substantial pressure on time that they would like to devote to research and often limited recognition and resources available. Significant regional inequalities persist in the opportunities for clinical researchers, which drive inequalities in health outcomes.
“Against the backdrop of intense pressure on the NHS, clinical research is on a precipice. Clinical research is not a ‘nice-to-have’ but vital for the healthcare service to become more efficient and effective. Rather than an additional pressure, the ability to engage with research can aid recruitment and retention for staff, and can bring in industry funding.
“Without urgent actions from the Government, such as those recommended in our letter, the UK’s clinical research capacity could be permanently diminished, leaving the NHS, patients and the UK economy worse off in the future.”
- The Government should urgently address inequalities in total remuneration that disincentivise clinical academia as a career path. It should work with universities, Governmental and non-Governmental research funders, and NHS trusts, to ensure that clinical academics are not financially disadvantaged by pursuing research compared to what they could earn as full-time clinicians.
- The recommendations by the Health and Social Care Committee on NHS consultant pensions and tax should be implemented at the earliest opportunity to remove the perverse incentives for early retirement.
- The NHS should implement mentorship schemes in different regions, respecting equality, diversity and inclusion, to ensure that would-be clinical academics have examples to follow. The Government should address regional inequalities, for example through additional ring-fenced funding for clinical academia in certain regions, bursaries for clinical academics in less well-off areas, and/or hub-and-spoke models where established centres can support those in the surrounding region.
- NHS trusts and hospitals must set out a plan as to how they will meet the statutory commitment to allow consultants to spend an average of 25% of their time on supporting professional activities on average.
- The Government should ensure that medical schools expose trainee doctors to clinical research, even where the intercalated BSc is not mandated or offered.
- Governmental research funders should support initiatives such as pairing schemes which bring together clinicians with academic partners. They should ensure that applied clinical research is accessible to a wider range of healthcare professionals than just consultants and that funding for these projects is more easily obtained.
- The Department for Health and Social Care should work with the NHS to identify specific metrics for research performance, which should be reported on annually by integrated care boards. These reports should be made to the Secretary of State under the overall supervision of the Chief Scientific Advisor for the DHSC.
 Association of the British Pharmaceutical Industry, NHS patients losing access to innovative treatments as UK industry clinical trials face collapse (20 October 2022): https://www.abpi.org.uk/media/news/2022/october/nhs-patients-losing-access-to-innovative-treatments-as-uk-industry-clinical-trials-face-collapse/ [accessed 5 January 2023]