Researchers warn of 'quiet crisis' facing NHS Scotland

The Herald Scotland

2 days ago

This "lifeblood of future healthcare innovation" is "quietly being drained away," with a reported 30% drop in the most active cohort over the past decade.
They cite a complex combination of factors, including a lack of ring-fenced funding to train and support clinical researchers, inequalities that lead to challenges for female and minority researchers, competitive disadvantages compared to English institutions, and extensive time commitments required to complete training and enter the profession.
Despite the challenges, the authors highlight the important contributions of Scotland's clinical researchers and what is potentially at risk of the trend of decline continues.
"In economic terms, investment in medical research pays dividends—every £1 spent returns around £1.25 annually to the wider economy.
"Scotland has long punched above its weight in this field. From pioneering bowel cancer screening programmes using the faecal immunochemical test (FIT), now central to early detection efforts worldwide, to the EAVE-II platform, which was instrumental in understanding vaccine effectiveness during COVID-19, our clinical academics have delivered innovations with national and global impact."
Prof Rory McCrimmon, one of the authors of the letter and Dean of the School of Medicine at the University of Dundee, explained how these types of contributions are at risk of becoming increasingly scarce.
He said that there are more academics over the age of 55 than under the age of 35. Clinical researchers now make up just 3% of the overall workforce, and only 0.6% of primary care workers are clinical researchers.
Prof Rory McCrimmon has argued that clinical researchers need more practical and financial support in order to continue performing their life-saving work. (Image: University of Dundee)
He added that the shrinking supply of clinical academics, combined with the baked-in challenges in the field, is adding immense stress on researchers.
"It is undoubtedly harder to do out-of-programme research at the PhD or MD level, because obtaining funding for that is challenging.
"Students leave university now with a larger amount of debt, and it takes a long time. It takes maybe ten to fifteen years to become a consultant. If you add a further three to five years of research on top of that, that's an incredibly long time to become a clinical academic.
"I think it is also perceived to be really, really hard, because you are moving into a very competitive world."
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Prof Lorna Marson, Dean of Clinical Medicine at Edinburgh and a contributor to the open letter, said that clinical researchers have a significant impact on their patients and communities, in addition to their broader contributions to the economy and the field.
"Research-active hospitals have better outcomes for their patients in terms of morbidity and mortality.
"Also, engaging in clinical trials gives patients the opportunity to get expensive drugs for no cost.
"There are many significant added values to being a patient in a research hospital, so we need to support that as much as we can."
Prof Lorna Marson has said that barriers to people looking to break into clinical research should not distract from the passion that these academics have for their profession. (Image: University of Edinburgh)
Prof Marson added that the decline in the number of clinical academics was not due to a lack of ambition in the profession and that better general support for researchers could make the career more feasible for many hopefuls.
'It's extraordinary that there are still a good number of people who want to do this. I think that demonstrates the huge commitment that people are bringing to this field, and therefore, we have to support them and help them if it's what they want to do.
'But it is exceptionally difficult for women who also want to have time out to have a family, or those who have caring responsibilities and wish to prolong their training.
'Using women as an example, we need to look for ways to support them not only to have time out to have families, but to undertake their research and continue in clinical academia. That is where we see the biggest drop-off, and it is not because they don't passionately want to stay.
'They just can't see a way through it.'
All of this is against a backdrop of extreme competition for funding. Prof Ian McInnes CBE, co-author of the letter and Vice Principal and Head of College, College of Medical, Veterinary & Life Sciences at the University of Glasgow, called it a 'sadness' that young researchers are facing barriers to the profession at a time when there are many new opportunities on the horizon.
'Increasingly, academicians of the future will be data scientists. They'll be computing scientists. They'll be business scientists with MBAs and organisational design specialists.
'One of the ambitions I have for Scotland is that we actually become a model for an incredibly diverse community of academic clinicians with expertise in so many different areas.'
Due to the interconnectedness of the UK higher education sector, Scottish researchers and institutions are in direct competition with their English counterparts.
But different structures and priorities mean they are not always on an even playing field, Prof McInnes explained.
In England, for example, the time of clinical academics is often divided evenly between clinical work and research. However, in Scotland, the divide is closer to 80% clinical and 20% research time.
'That 80% grows arms and legs, because clinical medicine is busier, clinical surgery is busier, clinical psychiatry is busier. So we're at a substantial disadvantage in Scotland compared to England.'
There are also significant financial awards available only in England, which can further limit opportunities for Scottish researchers.
Despite this, Prof McInnes was clear that the situation is not a case of finding fault. The different structures north and south of the border represent different strategies and priorities.
The Scottish Government is currently pursuing health innovation projects through its Accelerated National Innovation Adoption (ANIA) Pathway, which focuses on developing and implementing new health technologies across NHS Scotland. The programme recently committed £6 million to a project helping people with type 2 Diabetes, stroke patients and babies born with a rare genetic condition.
In the end, Prof McInnes said he and his colleagues are making a call to find collaborative solutions to a common problem and preserve what he called 'fabulous careers.'
'Clinical academics enrich and embellish the quality of clinical care, and they do that by being part of that community.
'There is very good evidence that just being in a clinical trial leads to better long-term outcomes for most chronic conditions. Even if you just get a placebo, you become a beneficiary of an ecosystem that seeks the best option, not the most convenient option.
'Being a clinical academic is an incredibly enriching profession, and part of our concern is that the focus on funding and crisis in the NHS obscures the fantastically brilliant career that is available.'
Health Secretary Neil Gray said clinical research is "vital" for both the NHS and the economy.
'The need and case for this plan and its actions is timely – in recent years, the sector has suffered from the impact of Brexit and from UK Government immigration policies which have stemmed the flow of international talent into research programmes.
'We continue to provide over £.1.1billion to universities each year, including over £368million for research and innovation. Our Chief Scientist Office also continues to provide various funding opportunities for clinical research, working closely with our academic community to deliver clinical trials, develop new research and fast-track new innovations and technologies which benefit Scottish patients.
'However, we recognise the challenges and opportunities highlighted in the recent MRC report and we will continue to collaborate closely with universities, the NHS and industry to maximise opportunities for clinical academics here in Scotland.'