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Health: Academic Health Partnerships

Volume 722: debated on Monday 29 November 2010

Question for Short Debate

Tabled By

To ask Her Majesty’s Government how they propose to preserve United Kingdom academic health partnerships.

My Lords, I declare my interest as a clinician and as a former vice-dean of a medical school. Clinical academics are at the heart of academic health partnerships. Traditionally, clinical academics have mostly been doctors and are the clinical academic leaders of today. But other health professions are joining this group who are employed by universities to research and teach, as well as having direct patient responsibilities. Medical schools are at the heart of this unique position that juxtaposes research abilities within the clinical context, stimulating questions that need answering and permitting studies to be planted in reality.

The UK has a fantastic record in biomedical research. Some 10 per cent of all the academic output in the world is from the UK, but we have less than 1 per cent of the world population. Twelve per cent of listed medical research citations are from the UK, second only to the US, and 19 of the 75 most widely prescribed drugs were discovered here. Investment in biomedical research made over the past 20 years is reaping dividends. The challenge is to get the findings translated into routine practice. Research assessment exercises have tended to steer towards basic science as it is easier for the RAE than applied research. Simultaneously, NHS management has been driven by targets. It is the UK medical schools that sit in the middle of this financial tension. Although tension can be creative, there is a danger that knee-jerk financial responses can undermine long-term, potentially very profitable investment if academic and clinical medicine are forced apart by short-term commissioning decisions.

Countering this pressure has been the National Institute for Health Research, in large part inspired by Dame Sally Davies. Its impact has been phenomenal. Schemes it has supported are being copied and rolled out in the devolved Administrations. Clinical academic training fellowships are attracting increasing numbers of the brightest young doctors as state-of-the-art activities are introduced into trusts, adherence to guidelines improves and evidence-based best practice spreads. The five major health sciences centres in England, Imperial College, King’s College, University College London, Manchester and Cambridge, are direct products of this initiative. They build on the juxtaposition of research and direct clinical care, with major laboratory research linked to clinical practice. But there is also a major benefit to UK plc from all the other academic centres. So I ask the Minister for reassurance that the Department of Health is working closely with the Department for Business, Innovation and Skills to maintain our profitability from clinical academia.

There is good evidence that clinical outcomes are better from all routine clinical services that are research and teaching active. Indeed, that was recognised in the White Paper. Medical schools responsible for the undergraduate teaching of tomorrow’s doctors are all active in research and they have clearly demonstrated that investment pays dividends. For example, every pound of public money invested in cardiovascular research has, after 15 to 20 years, generated a benefit of 39 pence annually in perpetuity. Recent translation of research into practice is illustrated by the reconfiguration of stroke management in London, with better clinical outcomes now that many stroke units have been rationalised down to centres managing hyper-acute stroke providing rapid thrombolysis, decreasing morbidity and long-term care needs.

We take for granted the many previously unimaginable surgical procedures and drug treatments that are now an everyday occurrence. When people are seriously ill they want a specialist to guide their management; someone who is research-active in the area of their disease. I ask the Minister how the importance of academic medicine will be recognised by the GP consortia, many of which will be led by GPs who are not involved in research. How will public health research be supported and financed as public health moves to local authority control?

The health and wealth agenda is served by maintaining the momentum in clinical academia, yet we are already seeing an adverse drift. The pharmaceutical industry is drifting off to other countries with consequent revenue and job loss to the UK. In 2002, 6 per cent of the clinical trials in the world were conducted here but by 2007 this had fallen to 2 per cent.

The recent NHS White Paper speaks strongly of the benefits of research with 10 distinct references to it. It states:

“The Government is committed to the promotion and conduct of research as a core NHS role”.

It goes on to recognise that, particularly in lean financial times, research can provide routes to improve health outcomes and reduce inequalities. Following the consultation on the White Paper, can the Minister reassure us that the commitment to those centres that develop research and unlock synergies between research, education and patient care, remains stronger than ever?

Medical schools have been working with their NHS university hospital partners to plan for the future. They recognise that health and higher education have flourished with political support over recent years and that the global recession’s impact on the UK’s economy will change this growth trajectory. Future success and sustainability require that the core businesses of teaching, research and healthcare delivery are aligned to weather the changes in the financial climate. Collaborative working, not competitive vying for resources, will be the way forward.

Within the NHS the governance system should be based on proportionality of risk rather than “one size fits all”. Clinical research ethics committee processes have speeded up but bureaucratic blocks to research still exist so that opportunities cannot be grasped even though economic recovery will depend on them. Inspection processes, such as the Medicines and Healthcare products Regulatory Agency inspections, can seem excessively laborious. I ask the Minister: what levers are there in the new NHS to address such blocks to innovation and research?

The new GMC document, Tomorrow’s Doctors, requires the doctors of the future to focus on leadership and a lifetime commitment to improvement in recognition of the importance that such a skilled workforce will bring to the wealth of the nation. Training does not end with a medical degree. Postgraduate training takes years and currently it is the responsibility of postgraduate deans, but where will the postgraduate deans sit? They are not mentioned in the White Paper.

Clinical academics emerged during the postgraduate years. The Wellcome Trust postgraduate fellowships aim to recognise and grow the UK’s future medical academics. As specialty and primary care trainees develop an understanding of applied research when working clinically, and as strategic health authorities disappear, it makes sense for universities to be persuaded to house the postgraduate deans, who will not usually be RAE returnable and so will need to have some honorary contract arrangement. However, these deans need a ring-fenced budget to have a lever on foundation trusts to employ this workforce and ensure high-quality training.

Vice-chancellors, too, need to understand the benefits brought from effective partnerships with the NHS and from engaging with the postgraduate training agenda. Structures and performance that match the NHS agenda require incentivisation: for example, by adding locally relevant work with industry to the criteria rewarded by panels assessing the impact of research for the funding councils.

Academic health partnerships can bring solutions to pressing public health issues, both here in the UK and globally. They represent an investment in our foreign policy. They can bring solutions to the requirements of an ageing population susceptible to multiple chronic diseases. Even stronger links between education research and service delivery can optimise the health and wealth of the nation. I look for reassurance that there is an ongoing and, indeed, increasing commitment to this agenda.

My Lords, I am grateful to the noble Baroness, Lady Finlay of Llandaff, for initiating this important debate. My interest in academic health partnerships arises from my time as a non-executive director at King’s College Hospital and currently as an independent panel member of the National Institute for Health Research, and to that extent I declare an interest.

The formation of King’s Health Partnership was the result of an enormous amount of discussion and consultation among the foundation trusts of King’s, Guy’s, St Thomas’s and SLAM, together with King’s College London. It is not the first time there has been co-operation between universities and hospitals; it is a long and honourable tradition. What is new for this country is the extent to which that co-operation takes place. To integrate care, education and research through governance and staff co-operation is vital if patients are to receive the full benefit of the existing research which is taking place.

While not attempting to claim that the King’s Health Partnership is the only viable model, its networking approach has some huge advantages—buy-in from the staff, transparency and galvanising the support of the local communities in the area. AHSCs are important because of their potential for co-operation with the pharmaceutical industry and in attracting the best staff from home and abroad. In this, I add my plea to the Government that they will not stand in the way of attracting the world’s best researchers and clinicians to this country. The intergovernment concession will not fit this particular case and it would be a tragedy if we were to slip down the league table because we were not able to recruit from abroad; this is a highly mobile population.

As a panel member for NIHR I can see for myself the wonderful work which is being done in this country by highly distinguished clinical academics, a significant number of them clustered around academic health science partnerships. Groundbreaking work is being done on Alzheimer’s, multiple sclerosis, diabetes and various forms of cancer which will be translated into treatments within the foreseeable future. However, some of this work is expensive and some of the research is not cost effective in terms of the tariff received. The AHSCs were established without any guarantee of extra money and have been consolidated through good will, commitment and a vision for the future. Unless the Government take these extra costs into consideration, it will be difficult to see how this good will and vision could continue indefinitely. I ask the Minister for an outline of the Government’s commitment to the continuation of these partnerships and some information about how they intend to promote them.

My Lords, I too want to express my appreciation to the noble Lady, Baroness Finlay of Llandaff, for obtaining this debate. As the terms of the motion are reasonably wide in referring to academic health partnerships, there are a number of elements that I would like to address briefly in the few minutes that are available to us.

When one thinks about academia, it seems to me that one should think not just of research but of the teaching of undergraduates that helps them to develop, of training—the clinical dimension of the work has to continue even in the postgraduate period—and, of course, of research. However, over the past 30 or so years, quite substantial changes have taken place in our approach to academic health partnerships. If one goes back 30 or 40 years, a great deal of academic work focused on medical practitioners who had a particular interest in and aptitude for this kind of work. Such practitioners spent part of their time employed by the National Health Service, largely, but they also did academic work, often with honorary contracts with universities.

Two or three major changes have occurred since then. One is that, as health trusts of various kinds—primary care trusts, hospital trusts, community trusts and so on—were set up and became increasingly business orientated and managerial in their approach, each trust looked at how far research was helpful to its own business plan. If the research was not directly productive, there was a disincentive to doctors to focus on research. As time has gone on, that has become an ever greater problem because doing research has itself become more difficult. There are many more ethical hoops—quite understandable in many cases, though not all—and funding has become more difficult. Junior medical staff, who might have been more than delighted to participate in research 20 or 30 years ago because it helped their curriculum vitae, now find that such research does not benefit them too much and it is much more difficult for them to find time for it. Research has become a much more difficult exercise with the increasing managerial approach in the NHS.

Universities, too, have had to look at whether or not they could be collaborative in that rather relaxed, laissez-faire way. Universities have demanded clinicians who focus very heavily on research and do well in the RAE, while NHS physicians have increasingly focused on their NHS clinical work. In addition, of course, there is now a much wider body of healthcare professionals involved in all these activities. The focus is not just on doctors but on the whole range of healthcare professionals—and quite rightly so—and that means that the picture has changed very dramatically. Meanwhile, the amount of resource available for research has not increased in a commensurate way. That is also true for teaching. Therefore, it has sometimes been the case that there has been a widening without necessarily a deepening of the quality of teaching and training.

It is not as though the new Government are coming to a situation in which everything has been perfect. In the past few years, there was a recognition of some of those issues by the previous Government. Following the Darzi report, the Government promoted some important centres of excellence, which have already been referred to in the debate and which are to be commended and supported. One of the concerns of the noble Lady is that the Government’s proposals should take away nothing from the progress that has been made. I very much hope that my noble friend will be able to reassure us on that, because the White Paper makes clear that,

“The department will continue to promote the role of Biomedical Research Centres and Units, Academic Health Science Centres”—

which were, of course, what came out of the Darzi report,

“and Collaborations for Leadership in Applied Health Research and Care, to develop research”.

At this stage, where change and development is being proposed, one wants to be reassured that those centres of excellence will indeed be built upon. There is, in fact, a tribute earlier in the White Paper to the importance of the work of the noble Lord, Lord Darzi. I also note that specific emphasis is given to the NHS commissioning board taking some responsibility for promoting involvement in research and the use of research evidence.

However, although it is extremely important to ensure that the relatively small number of high-quality centres of excellence is maintained, sustained and developed, that is not enough. There must be some way in which we can begin to rekindle the interest of young doctors, nurses, psychologists, social workers and the panoply of health professionals to realise that research is an important component in their own professional development and that, if they are to understand the implications of research papers, they must have at least a little experience of research early on. Therefore, I seek some reassurance from my noble friend that, as we move forward into potentially exciting opportunities for a newly configured health service, we will try to regain some of the creative excitement about research and academic work of all kinds that I think has been somewhat lost in the overly managerial and overbureaucratic approach that has been applied not only to healthcare but, at times, within some of our leading academic institutions.

My Lords, I congratulate the noble Baroness, Lady Finlay of Llandaff, on having secured this important debate. I declare my own interest as a clinical academic and chairman for clinical quality at UCL Partners academic health science centre.

Healthcare systems around the world are facing considerable challenges. We know that in developing countries there is now an epidemic of diseases not previously experienced in those countries, such as diabetes, obesity, cardiovascular disease and so on. In our own healthcare system, we face similar challenges from chronic diseases that will need to be managed in an effective way, frequently with attention on prevention rather than just on treatment. We also still face serious disparities in access to healthcare, clinical outcomes, escalating costs for healthcare and variable quality across the healthcare system, as we have seen this past weekend with the publication of the Dr Foster report on adverse events experienced throughout the healthcare system in England.

Over the past 50 years, many of the advances that have helped us to improve outcomes and the quality of care that we provide to patients have been academically led. There is a growing recognition that the contribution of academic medicine is potentially even greater now than in previous decades because the challenges that we face are much greater. As we have heard, there is a developing movement throughout the world, certainly in mature healthcare systems, for the development of academic health science centres, which are well placed to face the challenges that have been identified as the pathway of discovery care. That continuum needs to be bridged to ensure that research activity, stimulated by endeavour, careful thought and intellectual enterprise, can be converted into new interventions, therapies and systems and into pathways of healthcare to improve clinical outcomes.

It is now well recognised that there are two important gaps that academic medicine and institutions can overcome in this discovery care continuum. The first is the gap characterised as “from bench to bedside”, taking those discoveries and having appropriate translation medicine to ensure that those discoveries can be tested and presented to the wider clinical audience—clinical colleagues and other healthcare professionals, as we have heard—in such a way that they might be adopted to improve clinical care and outcomes.

The second gap is to move from a very difficult place where there is expert acceptance of the discoveries and their evaluation from basic and clinical research, and to ensure that those are broadly adopted. Indeed, it is quite shocking—here I must declare a further interest as director of the Thrombosis Research Institute in London, which is involved in many collaborative research programmes with industry in the area of thrombosis—that this weekend we saw, in the Dr Foster analysis of adverse events in our healthcare system, some 62,800 reported adverse events, 30,500 of which were deep-vein thrombosis or pulmonary embolism. That is quite striking as we have known for over 30 years, thanks to research, much of which was conducted in the institute that I am now director of, that there are simple ways to assess patients at risk of thromboembolism and simple methods that can be applied to those at risk to reduce their risk of developing a blood clot while in hospital or soon after being discharged. It is well recognised by experts. We have guidelines. Indeed, we have the active programme from the Department of Health in this area. There is still a gap, however, in its widespread adoption. I very strongly believe that academic health science systems have an important role to play in overcoming this gap and ensuring that what we understand can be applied not only in single institutions but broadly across healthcare systems to improve clinical outcomes, and in ensuring that the research effort is properly applied to benefit the largest number of potential patients.

We have also heard that there are important economic benefits to be derived from having a strong academic clinical base. One of the purposes of the five academic health science centres, which we have heard about previously in this debate, is to ensure that the United Kingdom remains an important target for inward investment by the bio-pharmaceutical industry for research and that the opportunity to collaborate with industry delivers not only clinical benefit for our patients but economic benefit for our country.

Will the Minister confirm—I am sure this is the case—that academic health science centres remain at the very heart of Her Majesty’s Government’s agenda for healthcare and ensuring that we can achieve the very best clinical outcomes, quality, access and value in our healthcare system? Will he also confirm that the opportunity will be taken to explore whether the remit of academic health science centres can be explored so that they focus much more on becoming academic health science systems across entire sectors or health economies, driving the potential for broader integration—both vertical integration across primary, secondary and tertiary care, and horizontal integration, as we have done at UCL Partners—in developing provider networks that are focused not on the outcomes that an individual institution can achieve but on the outcomes that are achievable across the entire patient pathway and are focused on improving clinical outcomes for the continuum of care, particularly for the management of patients with chronic conditions? Will he also confirm that we will look at how academic health science systems can facilitate primary care commissioning as that moves forward and is developed in the coming years, and that we will continue to ensure that the contributions that the United Kingdom can make globally to academic health science systems and centres are maintained and that our country continues to benefit from participation in those systems and centres?

My Lords, I, too, thank the noble Baroness, Lady Finlay, for the opportunity to discuss what I think is a very exciting and positive feature of our national scene: the partnership between academic and health activity. It is also a pleasure to follow my noble friend Lord Kakkar, whose professional interests, as he has explained, lie in north London but whose personal interests lie, like mine, in south London.

The question asked by the noble Baroness, Lady Finlay, is how the Government propose to preserve academic health partnerships. I should declare an interest as chair of King’s Health Partners, one of the five national AHSCs about which the noble Baroness, Lady Donaghy, has already spoken so fluently. Indeed, I endorse everything that she said. The noble Baroness, Lady Finlay, was right to emphasise the great advantages that Britain has in contributing academic research to medicine and how this country punches above its weight in those areas. As the noble Lord, Lord Kakkar, said, this is not only a benefit to health treatment but an enormous economic benefit through the investment of big pharma in this country. Perhaps that investment is second only to financial services in its importance to the economy of the country. But it is fragile, and we have already seen some signs of that fragility with GSK’s decision to move many of its activities to Shanghai and Merck’s departure. We must strive to maintain this country’s attraction for big pharmaceutical companies. It is very reassuring that the Government recognise that. The emphasis on the importance of research in the Government’s White Paper is also greatly welcome.

As other speakers have said, the five AHSCs are among the most valuable instruments for bringing together academia and the National Health Service, which might, as the noble Lord, Lord Alderdice, said, have drifted away from each other somewhat in the past 15 years. I pay tribute to the steps that the previous Government took to reverse that trend, not least by establishing the AHSCs. To reflect on the partnership with which I am associated, what does that partnership bring together? In King’s College London, it brings an outstanding research university and a leading medical training institution; in Guy’s and St Thomas’ and King’s College Hospital, it brings two of the world’s leading teaching and clinical care hospitals; and in the South London and Maudsley Hospital, it brings one of the nation’s leading psychiatric hospitals.

I invite the House to consider what we can achieve in modern healthcare by closer links between those institutions. First, as has been mentioned, we can bring research and clinical care closer together, and accelerate the translation of the very exciting discoveries that are made all the time in research to the care of the patient.

Secondly, there can be a closer link between mental and physical care. I particularly emphasise this in the case of the partnership with which I am associated. It is a weakness of our present system that psychological morbidity in patients with physical illness and physical morbidity in patients with mental illness have not been sufficiently recognised and addressed.

Thirdly, there are the integrated pathways of care for patients. This is, I think, very close to the Government’s heart and their policy in the White Paper. Like the other two London AHSCs, King’s Health Partners is working with local GPs and local authorities to establish new models of preventive medicine and community care, as well as tertiary care.

Finally, there can be more effective medical training not only through the university and teaching hospitals but in the community through the health innovation and education cluster—the HIEC—for which King’s Health Partners has been given the lead for south London.

This link between research and clinical treatment is personified in the chief executive of King’s Health Partners, Professor Robert Lechler. He is not only a distinguished researcher and clinician at Guy’s Hospital but vice-principal of the university. This link is repeated in many others who hold joint appointments in the university and member hospitals. The challenge for the AHSCs is to realise the opportunities that these existing links represent.

As has been mentioned, the previous Government, in setting up the AHSCs, did not give them any extra funds, unlike the Dutch Government, who recognise the importance of their equivalent of AHSCs through higher-intensity payments for them. Despite the lack of a financial incentive, when I came into this work, I, like others who have spoken, was hugely impressed by the enthusiasm and commitment not only of the four partner institutions in the AHSC with which I am associated but also—again, this has been mentioned—among the world-renowned researchers and clinicians who form part of them. This really is a movement that is supported at the grassroots level by those who work in the field. Like others, I hope the Minister will be able to say tonight that the Government endorse the objectives that I have described and see AHSCs as crucial to achieving them.

My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Finlay, on drawing this important matter to the attention of the House. As has so often happened in the past, the noble Earl and I are usually, or probably, the least qualified people to answer this debate, given the quality of the contributions that have been made this evening. I particularly thank my noble friend Baroness Donaghy for her thoughtful contribution.

Evidence from around the world demonstrates the profound role played by world-class research and teaching in driving innovation in healthcare. Academic health science centres are designed to maximise clinical and academic synergies by ensuring that clinical research and teaching staff work in concert to unified plans that transcend the separate structures of their respective clinical and academic institutions. In 2007 a review of healthcare in London led my noble friend Lord Darzi in a framework for action to recommend the creation of a number of academic health partnerships. In October 2007 Imperial College Healthcare became the first to be established in the UK when Imperial College London’s faculty of medicine merged with the Hammersmith Hospital and St Mary’s Hospital NHS trusts. I know that several more—mentioned by other noble Lords—have subsequently been established, notably Cambridge University Health Partners, King’s Health Partners, Manchester Academic Health Science Centre, UCL Partners, Barts and The London NHS Trust.

We can be proud of the achievements of these innovative partnerships and the benefits that they have brought in their own areas to the cities that they are in and across the world. The engines of clinical innovation— for example, at Barts and The London—will be 70 new clinical academic units, clusters of closely related specialties or sub-specialities working to a single plan for clinical care research and teaching. For example, guests from all over the world flew to London the week before last for the opening of a new cardiovascular biomedical research unit at the Royal Brompton Hospital. The BRU is a joint initiative between the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London and puts the partnership at the forefront of international research into the most challenging heart conditions. It is funded by the National Institute for Health Research.

There appear to be three legs to the AHSC stool. For it to work properly it needs excellent education, excellent healthcare and excellent research. It also needs time. This is not a five-year project; this is a 15 to 20-year shift in the development of excellence and innovation in these areas. My understanding is that the funding of the academic health science centres is a mixture of MRC, DBIS and NIHR. Under the current structure, SHAs and PCTs have delegated responsibility to administer research funding. In addition to his powers to conduct or assist research, the Secretary of State has a duty under Section 258 of the 2006 Act to ensure that facilities are made available for universities with medical or dentist schools in connection with clinical teaching and the research connected with clinical medicine or clinical dentistry. This duty is delegated to the strategic health authorities and PCTs under the regulations.

Therefore, my first question to the Minister—echoed around the House—is unsurprisingly: how will this particular aspect be delivered and funding allocated under the new NHS structure? Who will undertake these duties with the demise of the strategic health authorities and PCTs? Linked to that, we need to ask about workforce planning. As many noble Lords have mentioned, clinical academics need to be fed through to these bodies. How will that happen?

The British Medical Association has recommended consideration of the roles of networks, health innovation and education clusters and the National Institute for Health Research and how these will fit into the Government’s overall plans. Can the noble Earl assure the House that the funding for the National Institute for Health Research is, indeed, safe?

On the necessity for ensuring excellence in education, we also need to look at the implications of the Browne review of university funding because we need to know how the leg that concerns teaching and universities will be affected. Presumably the cutbacks in the funding of higher education will have an impact on AHSCs in relationships with universities as they collaborate with them. There is the potential for a double whammy here, both in costs to individual students and, indeed, in the cutbacks that universities are to suffer as a result of the CSR settlement. Like other noble Lords, I welcome the fact that research has been protected under the CSR, but it seems to me that at least two legs of this stool are looking a bit dodgy. I invite the Minister to tell the House how the Government intend to support the future of these partnerships in the long term.

My Lords, I begin by joining all other noble Lords in thanking the noble Baroness, Lady Finlay, for having tabled this debate and spoken to it with her usual deep knowledge and enthusiasm. She is absolutely right to highlight the essential links between universities and the NHS as well as the importance of medical research and education which are, as she so eloquently described, essential for the ongoing success of the UK economy and of a high-quality NHS. The Government absolutely recognise and support the need to maintain investment in these areas for the benefit of patients.

The noble Baroness raised a number of specific issues to which I will respond in a moment. It is right to remind ourselves that most of the issues that have been raised should be considered within the context of the UK. Although there will be shared principles across the four Administrations, we are also dealing with devolved matters. However, my responses today will inevitably deal with England alone.

Since the NHS was founded in 1948, investment in health research has brought incalculable benefits for patients. Treatments have been improved, inequalities have been reduced and productivity has increased. In both the strategic spending review and our White Paper, Equity and Excellence: Liberating the NHS, we have emphasised the importance of research, as the noble Baroness rightly noted. Despite the incredibly challenging pressure on budgets across government, we are committed to increasing spending on health research over the next four years. When funds are tight is precisely the time when innovation, investigation and invention become most valuable. In the long term, research saves money and allows us to identify new ways of preventing, diagnosing and treating disease. It is essential if we are to increase the quality and productivity of the NHS, which are, after all, the best ways of making savings.

The Department for Business, Innovation and Skills will ensure that Medical Research Council expenditure is maintained, ensuring that total health research funding will increase. Among other things, the extra funding will support the National Institute for Health Research. I was grateful to the noble Baroness for her appreciation of the NIHR’s work and, indeed, to other noble Lords for the tributes which they paid to it. Through the NIHR, the Department of Health spends more than £50 million every year to fund posts aimed at encouraging junior doctors to pursue clinical research careers. Through the intrinsic bond between the NHS and universities, the NIHR is turning laboratory-based discoveries into cutting-edge treatments that make a real difference to people’s lives. Through its internationally recognised biomedical research centres and units, the NIHR is helping to translate pure research into practical success.

The noble Baroness, Lady Donaghy, referred to academic health science centres, in particular the King’s Health Partners, and that was a theme strongly taken up by the noble Lords, Lord Kakkar and Lord Butler, among others. As the noble Lord, Lord Butler, said, there are now five academic health science centres in England. Their core mission is to bring together world-class research, teaching and patient care in order to speed up the process of translating developments in research into benefits for patients, both in the NHS and, as the noble Baroness, Lady Finlay, said, across the world.

The noble Lord, Lord Kakkar, referred to the UK as a target for inward investment in these areas. He will be interested to know that we are taking forward a range of measures to promote and develop the UK as a place for inward investment by global industry through the Office for Life Sciences and the health and business departments. The noble Lord, Lord Butler, referred, I think in passing, to funding for academic health science centres. It is worth pointing out that AHSCs are underpinned by funding from NIHR as well as the research councils and other funding sources.

The coalition Government confirmed in the White Paper that they see an important role for AHSCs in delivering the translational research agenda, unlocking synergies between research, education and patient care. As regards their potential development as institutions, which the noble Lord, Lord Kakkar, invited us to consider, as he knows, AHSC status was awarded in March 2009 for a period of five years and will be subject to review. However, we will be working with interested parties to determine the next steps for AHSCs, and I take his suggestions fully on board.

For now, I think it is right for me to acknowledge that the organisations in AHSC partnerships are already making extremely impressive contributions to the translational endeavour. Our announcements in the spending review will allow us all to work even harder to ensure that the breakthroughs made by our world-class scientists are pulled through into real benefits for patients. The noble Lord, Lord Butler, referred briefly to mental health research, and he was right to pinpoint that area as one on which we should focus. The Department of Health is the largest UK funder of mental health research, and our investment in research infrastructure is having a significant and positive impact on the numbers of patients recruited to clinical trials in this area.

The noble Lord, Lord Kakkar, referred very eloquently to the process of promoting translation from bench to bedside and into widespread adoption. I can confirm that undoubtedly the AHSCs have a role to play in crossing those translation gaps. Together with the NIHR investment in biological research councils, biological research units, and collaborations for leadership in applied health research and care, I am confident that we can make a real impact on getting cutting-edge ideas faster into improving health. We will continue to promote the role of BRUs, BRCs, academic health science centres and collaborations for leadership in applied health research and care, all of which can help develop research and unlock the synergies to which I referred earlier.

In England there are also 17 health innovation and education clusters, which are cross-sector partnerships between NHS organisations, the higher education sector and industry. Their task is to bring quickly the benefits of research and innovation directly to patients. They will also strengthen the co-ordination of education and training, and bring together those responsible for healthcare with the local academic community. Currently in their first year, they focus on a variety of healthcare themes in line with local strategic objectives. We need to reward locally relevant, high-impact work and to encourage partnerships with industry. Through HEFCE’s research excellence framework, we will continue to develop an assessment framework that rewards the impact that the highest levels of research excellence have on society and on the wider economy.

I doubt that many people do not also recognise the importance of medical education. It ensures that the next generation of clinicians develops skills and expertise to meet patients’ needs. Linked to this is the complex area of workforce planning—to which the noble Baroness, Lady Thornton, referred—to ensure that we have the right numbers with the right skills in the right places. Aligning workforce planning and education, both in universities and in postgraduate medical training, must be considered in the context of the White Paper proposals and of our forthcoming consultation on education and training. The White Paper reforms are bold, and the way that we plan and develop the healthcare workforce needs to respond to and support the reforms, and align with new ways of commissioning and providing services. There is an opportunity now to review and fundamentally reshape the whole system for planning and developing the workforce. The Government have committed to consult widely on the design of a new framework for education and training. We will publish a consultation document shortly. The new system will be driven by patients' needs, led by healthcare providers and underpinned by strong clinical leadership.

There has been concern in some circles about ensuring that graduates of UK medical schools are able to obtain full registration with the GMC by securing a place on the first year of the foundation programme. To date, this has always been the case. Although there have been more applicants to the programme for 2011, the programme office has predicted that all eligible applicants will secure a place.

The noble Lord, Lord Kakkar, also correctly highlighted the vital role that medical schools will play in preparing medical students for a future where a greater proportion of care will be delivered in the community. However, it is not only in medical schools that the emphasis on community care needs to change, but also in postgraduate medical training. That has been recognised in the priorities of the Government's advisory body, Medical Education England.

The noble Baroness, Lady Finlay, asked what levers would be in the new system to encourage research and innovation. My noble friend Lord Alderdice was absolutely right: it is largely thanks to the noble Lord, Lord Darzi, and to Dame Sally Davies in the department that these levers exist and will continue to operate. I have referred to a number of the ways in which the NIHR is continuing to support the system—not least the BRCs, BRUs and so on—by pulling through ideas from the laboratory into new approaches to healthcare. It is through these and the AHSCs that we will continue to see a drive to research and innovation in the new system.

My noble friend Lord Alderdice referred to the NHS Commissioning Board commissioning research. We expect that the board will promote the conduct of research and patient participation. He also rightly said that we need to encourage excitement among young clinicians. I fully agree: that is one reason why the NIHR is funding so many new clinical academic fellowships every year, which enable young clinicians to get enthused by this career path.

The noble Baroness, Lady Finlay, stressed the need for effective joint working between the Department of Health, the Department for Business, Innovation and Skills and other key partners. She is of course quite right. The Health and Education National Strategic Exchange provides a national forum where senior members of the higher education and health sectors discuss strategic issues and influence cross-government working. However, I of course agree that such links should be strengthened where possible in order to maintain our proud tradition of high-quality medical education and research, the purpose of which is, above all, to benefit patients.

Sitting suspended.