Medics caught between two masters

November 14, 1997

I WOULD like to amplify the proposal to establish university hospital NHS trusts reported from the House of Lords Select Committee on Science and Technology (THES, November 7). A recommendation for such a proposal is contained in the report on clinical academic careers published by Sir Rex Richards's task force. There are many who believe that it merits full and proper debate.

One of the greatest problems confronting clinical academics arises from the fact that they serve two masters - the university/medical school (their employer) and the National Health Service trusts in whose hospital(s) they are expected to provide a clinical service. Changes in recent years in the NHS have resulted in such staff having to do more and more service work, invariably to the detriment of their academic roles of teaching and research. Yet it is on the latter that medical schools are judged and rewarded. Accountability to two organisations, each with its own objectives and management, causes difficulties, particularly as communication links, at local and government level, are poor.

Of course, each party relies on the other - the medical school on the hospital for the supply of "clinical material", and the hospital on the school for the provision of a large part of its service to patients. As Sir Derek Roberts said, the principle of "knock for knock" which governed this relationship in the past is one that is being destroyed by the accountants with the result that medical schools and the NHS have become very vulnerable to each other. This was demonstrated about four years ago when a London health authority attempted to remove the honorary status and funding of seven senior members of a school's clinical academic staff, a threat which was withdrawn after counter threats were issued. It is not difficult to conceive of ways in which a medical school could undermine the work of its hospital. Such a situation could be avoided if they were both part of the same organisation.

A single organisation, funded by the Department of Health and the Department for Education and Employment would be complex, but it would bring together the three complementary functions of teaching, research and service with tremendous savings and managerial advantages. For example, the amount of money, time and effort spent on determining which organisation is responsible for what and who should pay for it is considerable. Terms and conditions of staff, often doing the same job in the same room, would be standardised. The premises occupied by school and hospital would be the responsibility of one organisation simplifying responsibility for such matters as health and safety, etc.

It would be essential for this new organisation to have adequate representation of both senior academics and health service specialists on its board in order to create a wholly integrated teaching and research hospital. Academic excellence would continue to be monitored by outside bodies, courses and examinations run in accordance with university and General Medical Council requirements and the Royal Colleges continuing to regulate postgraduate training.

This would result in the training of doctors being more closely linked with the service they will have to provide. The health service would benefit not only from saving money but also from the improvements that such a united environment would create.

James Bowen


J. L. Bowen Consultancy Ltd

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