A healthy prognosis but note the risks

November 9, 2006

London leads the world in healthcare research and provision but its diverse and expanding population leaves no room for complacency, writes Pat Hughes

London has produced more Nobel prizewinners in medicine and attracts more external research funding than any other city. It has the highest number of academic staff in health fields - 9,000 - and 4,000 support staff, and it boasts 39 departments awarded a 5* or 5 rating in the research assessment exercise for healthcare subjects. The city hosts more than 50 clinical research organisations and more than 80 core biotechnology firms that employ 6,000 staff. It has more venture capital groups than the other cities in Europe's top ten combined.

This impressive research base has grown over generations, from medical schools, university departments and specialist institutes of medicine, with the individual efforts of earlier centuries becoming a community of collaborative world-class research in the 20th and 21st. Such achievement is one of which London and the UK can rightly be proud. Research informs teaching in healthcare. Evidence-based practice is the backbone of training and education in health, and London's healthcare education is outstanding.

London is the UK's most popular city for healthcare higher education study; it has almost 39,000 undergraduate students, of whom 6,500 are international. The city offers a huge range of degrees in healthcare topics, and 39 of London's 43 universities and colleges graduate students in nursing, medicine, physiotherapy, radiography, psychology and more specialised subjects. In part, research and education flourish in London because of its diversity, pathology and sheer numbers.

London has many social problems. Unemployment is a third higher than the national average and is especially high among London's ethnic minorities. The city has half the UK's reported cases of HIV/Aids, and in parts of the capital, the incidence of tuberculosis is six times the national average. Drug and alcohol misuse, and serious mental illness are big problems. It adds up to a disturbing picture of pockets of severe deprivation in a wealthy capital city: in some London boroughs, the chance of dying before the age of 65 are 50 per cent higher than in others.

Academic healthcare is funded jointly by the Higher Education Funding Council for England and the National Health Service. The NHS has budgets for education and research and many courses, and 40 per cent of clinical academics are NHS funded. The upside is collaborative planning for workforce, research and education, undergraduate and postgraduate. The downside is the academic community's vulnerability to the vicissitudes of NHS reorganisation. Recent changes to research and development funding will move money out of London, with potential for major knock-on effects on education and service.

The next five years could see London's international research base reduced as government income flows out of the capital. And although it trains more professionals than it needs, it cannot do without them: a high proportion of London-trained staff subsequently move out of the capital, with less than 10 per cent of graduates from other regions moving in. If it is to match the demand for qualified health workers - especially nurses - the city must have the capacity to train them itself. A loss of training places could create a crisis in a few years.

London has great strengths in healthcare. Its rich diversity and international outlook make it a natural nexus for excellence in service provision, in training and in research. But it is fragile. It will take only a small reduction in funding to degrade capacity and ultimately to threaten the quality of health provision.

Pat Hughes is dean of undergraduate medicine at St George's, University of London. She is also chair of the London Higher Healthcare Group.


My day

Teaching, research and service delivery are strongly entwined in the partnership between higher education and the National Health Service, as a day in the life of Emma Baker shows. She is a consultant in respiratory medicine and reader in medicine at St George's, University of London.

"I start the day with some admin. I check some results, find a worrying chest X-ray and talk to the patient.

"Next up is a lecture to 200 third-year medical students on acute asthma.

"Back in my office, I prepare exam questions, before turning to a submission for the ethics committee to request approval to explore new exhaled markers of respiratory disease in NHS patients. Approval is essential for a funding application to the British Lung Foundation.

"A fourth-year student arrives to discuss problems with her studies, followed by a clinical fellow who needs stats training.

"I chair a late meeting for a course for which I am programme director before cycling home awash with thoughts and plans for tomorrow."


Taking on TB

New strains of tuberculosis are being found throughout Europe - and London is not immune. But one academic is doing all he can to prevent the spread of the disease in East London, writes Jessica Shepherd .

Chris Griffiths at the Centre for Health Sciences at Queen Mary, University of Londonhas researched TB for five years.

He has helped complete the first trial outside Africa to test the effectiveness of TB screening and is involved in establishing whether vitamin D boosts the body's ability to fight the disease.

Griffiths is based three days a week at Queen Mary. He spends the rest of his time as a GP at a surgery in Hackney. He says: "Working on TB is attractive because it addresses a local problem, and the work can have both local and international relevance.

"The diversity of the population makes the GP work fascinating, and in the medical school I enjoy the freedom to develop my research interests.

"I started researching TB as a response to how prevalent it was in Hackney, where I have been a GP for 15 years.

"It is on the increase in the UK because it is uncontrolled globally. It remains a huge challenge to turn the tide."

Griffiths is particularly interested in improving the delivery of care for people in East London, particularly people of South Asian backgrounds. He also works with Social Action for Health, a London charity that addresses issues of health inequalities.

He says: "At Queen Mary, we are based right in the middle of the East End.

The diversity of the students reflects the diversity of the local population. There's never a dull moment."


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