Reforming research in the NHS

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7528.1339-c (Published 01 December 2005) Cite this as: BMJ 2005;331:1339
  1. D J Sheridan, professor of cardiology (d.sheridan{at}ic.ac.uk)
  1. Imperial College School of Medicine, Academic Cardiology Unit, St Mary's Hospital, London W2 1NY

    EDITOR—Cole highlights some of the challenges to the proposals to reform research support from the Department of Health,13 but the need to restore academic medicine does not reflect an intrinsic failure. Rather, it has been a victim of financial constraints, and clinical research has been marginalised in an increasingly citation and commercial focused academic environment.

    The proposed creation of a virtual National Institute of Health Research could provide a powerful national voice for academic medicine at a time of unprecedented change, facilitate research collaboration, and build a national networked research expertise. Several fundamental consequences of the decline of clinical academic medicine, however, seem not to have been fully appreciated.

    The central paradigm behind the success of academic medicine has been the two way interaction between “bench and bed-side.” The Department of Health proposals emphasise support for “research involving patients.” This would be much too narrow a concept. The goal must be to reinforce clinical research not in isolation but as an integral limb of the totality of biomedical research and its application.

    A key feature of the decline in academic medicine has been the flight of young clinicians from science.4 The proposal to provide £100m to support new clinical academic fellowships and lectureships2 over the next 10 years is encouraging. Clinicians appointed to this programme must be supported in undertaking creative original research, supervised by committed senior clinical academics willing to act as role models and mentors. They must also be protected from excessive service demands and offered appropriate career structures. Recent evidence of recovery of academic medicine in the United States seems to be linked to programmes addressing the specific needs of young clinicians.5

    The proposals would create five academic medical centres selected in open competition to be re-run every seven years. However, in a scheme where “the best get more,” advantage defaults to those initially successful and changes are less likely in future rounds. This may improve long term continuity of the centres selected, but the broad base of academic medicine would be squeezed by a handful of elite centres isolated by competition. The aim must surely be to raise the baseline more widely, while encouraging the best.

    These Department of Health proposals are a welcome initiative to restore clinical research in the UK and have much to commend them. The objectives are ambitious, but nothing less is appropriate.


    • Competing interests None declared


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