Future of clinical research in the NHS in jeopardy without urgent action, warns Lords Committee

From clinical trials with international impact like the Covid-19 RECOVERY trial, to lifesaving innovations in cancer treatments, the UK’s clinical research workforce represents a significant, often world-leading, research asset to the NHS and the life sciences sector with benefits for patients and the economy.

However, the Lords Science and Technology Committee has today written to the Minister of State for Health and Social Care Rt Hon Steve Barclay MP, warning that the current state of clinical research, pressures on the NHS and a declining workforce is putting the future of clinical research in the NHS in jeopardy and without urgent action patients will miss out on innovative treatments and the UK will miss out on economic growth.

Key findings include:

• Clinical academics play a vital role in the NHS and the wider medical research community bringing insights and innovations from clinical work into the frontline of medical care, such as genomic medicine leading to innovations in cancer treatment. It is through research and development of the type carried out by clinical academics that the NHS can become more effective and efficient, improving outcomes and helping to address the current NHS backlog.
• Industry funding brought into the NHS through clinical trials and research is under threat. The Committee echoes the concerns from the Association of the British Pharmaceutical Industry that the number of industry trials initiated in the UK has declined by 41 per cent in the four years from 2017 to 2021 resulting in the UK’s global ranking for Phase III trials declining from fourth in 2017 to tenth in 2021. This is jeopardising the long-term future of pharmaceutical research in the UK.
• There is an increasing precarity associated with clinical academic careers, especially at the postdoctoral level, as a result of factors related to career progression, pay, pensions and job security. The clinical academic workforce is set for decline with substantially fewer younger clinical academics to replace those who will retire in the next ten years. 

Lords Science and Technology Committee Chair Baroness Brown:

"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 Committee’s recommendations:

1. 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 the earning potential of full-time clinicians.
2. Governmental research funders should help to address the career precarity of clinical academics at the postdoctoral level by offering more longer-term postdoctoral positions – for example, with five years of funding and the expectation of a permanent position.
3. 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.
4. Clinical academics and GPs engaged in research should be contractually able to apply for local clinical excellence awards.
5. 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. More can be done to promote the value of clinical research to medical practitioners and to engage non-researchers with the research undertaken in their organisation, to engender a culture that values research.
6. The Government and its research funders 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.

The committee has requested a response from the Minister by 26 March 2023.

The letter can be read and downloaded at https://committees.parliament.uk/committee/193/science-and-technology-committee-lords/news/175630