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LEADINGHEALTH Research and training excellence in London’s medical, dental and health care higher education Senate House Malet Street London WC1E 7HU 020 7664 4843 www.londonhigher.ac.uk Electronic formats of this report are available at: http://www.londonhigher.ac.uk/publications Picture acknowlegements: King’s College London St. George’s University of London University College London City University © London Higher 2006 LEADINGHEALTH Foreword London’s higher education (HE) is a powerhouse of health research and training. In medicine, dentistry and, increasingly, in subjects allied to medicine the benefits of our work are reaped not just by London and Londoners, but flow through a variety of business and professional links across the UK and around the globe. This report demonstrates the extraordinary connectivities our institutions have developed with the National Health Service (NHS). But we live in a time of change. The NHS is undergoing dramatic reforms in the structure of pay, management, service delivery and research which will change the face of health provision and Contents delivery in the UK – and with it, the shape of training and research in HE. This is the first in a series of reports by London Foreword 1 Higher intended to look at how these changes Executive Summary 2 will impact on HE in London. Introduction 4 The present study is focussed on research and development and begins the process of A Picture of Health: 6 demonstrating the extensive contribution that London -UK health capital, global health market place universities and higher education colleges make across all health related fields. Future studies will Higher Education and Health: 10 explore the funding of HE training, including the Local Delivery, National Benefits, Global Reputation Service Increment for Teaching (SIFT) and the commissioning of training. 1. Education and Training 12 2. Research and Innovation 18 We look forward to engaging with policy makers to ensure that as we move ahead, HE in London 3. Service Provision & Practice 26 is enabled to make a sustained and enhanced contribution to the health and productivity of 4. Collaborations and Networks 32 the UK in the future. Summary 38 The Challenges Ahead 40 Conclusions 44 Recommendations 46 Foreword About Us 48 Professor Adrian Smith FRS Chair, London Higher 1 LEADINGHEALTH In particular, it makes two crucial observations: • the capital has acute health and health care needs that are exacerbated by its growing Executive Summary 1. London leads in health because of the population; variety of constituents only a city of its This report demonstrates how London universities size, diversity and reputation can bring • recruitment and retention of professional and higher education colleges make vital together; health workers to meet these needs is a major concern for the city; contributions across the health sector in the 2. London leads in health because, once areas of training, research, service provision created, the skilled professionals and • recent Department of Health proposals to and strategic collaboration amongst others. innovations that emerge here flow change the NHS research and development throughout the UK and beyond. budget threaten to reduce the income of London Trusts and higher education The report also discusses the implications of institutions; recent proposals to change the way in which the NHS research and development budget is • it is estimated that these reductions will lead administered. to an 18-fold knock-on effect over ten years, resulting in the loss of thousands of staff and We present a financial model that estimates the the erosion of research capacity. potential long-term impacts of such actions on London’s health and health care higher education We consider the threat to London’s universities (HE) and make recommendations aimed at and HE colleges to be very real and the impact sustaining and developing the contribution very high. London HE institutions make to the health and welfare of the region, the nation and the world. If lost to London, this powerhouse of health training and research will be lost to the UK – it is Headline Findings irreplaceable and not replicable. • London HE institutions teach almost 39,000 students in medical, dentistry and allied We urge policy makers not to risk diminishing subjects including a third of all medical and such an important driver of national health, dentistry students from England; productivity and innovation. • within London, 39 departments have been awarded a top 5* or 5 rating for research excellence in health and health care subjects; • HE is playing a crucial role in training the future professional health workforce; 9 percent of NHS staff in London - more than double the proportion in England as a whole - are honorary consultants also working in HE; …there is no clear argument in favour of a readjustment of current ‘‘funding on a geographical basis away from London either on equity or Executive Summary Executive Executive Summary Executive efficiency grounds. PwC (2006) Impact Analysis: 3. 2 ’’ 3 LEADINGHEALTH Introduction London is a pre-eminent force in the field of medical, dental and health research - not just within the UK, but across the globe. The range and depth of its higher education institutions (HEIs), its skilled workforce and its world-recognized professional bodies, together with its role as the administrative, commercial, legal and political heart of the UK make it a powerhouse for teaching, research and innovation not replicated anywhere else in the UK and which is rightly the envy About this report This document, jointly funded by the London of the world. Development Agency (LDA) and the five London Strategic Health Authorities (SHAs),1 is intended to support arguments for sustaining and developing London’s health and health care HE. Who should read it? Structure of the report It does this by providing evidence for the depth Although the report is aimed primarily at policy The report is in three parts. and breadth of the sector in London, celebrating makers and opinion formers, in particular those the contributions it makes to London, the UK and listed below, the report will also be of interest to It begins by outlining the health and health care internationally and examining the policy issues a wide array of HE stakeholders including HEFCE, context in London looking, in particular, at the health that may compromise this success. Medical Deans and university marketing staff: challenges that face London and outlining the main policy drivers behind recent developments.The The report is based on two pieces of work • Department of Health (cf. sections on second part details the contribution HE in London commissioned by London Higher from Challenges and Recommendations) makes to the health sector. The final section sets PricewaterhouseCoopers LLP. • Department for Education and Skills out the challenges that face HE institutions engaged (cf. Education and Training; Collaboration in health research and training in London. One is an evidence base, collating publicly and Networks) available data on HE health and health care • Office of Science and Technology The report demonstrates the substantial benefits education and research in London and selected (cf. section on Research and Innovation) the UK derives from a vibrant London health and English regions.The other is a financial model • Department for International Development health care HE and urges policy makers not to estimating the impact of changes in research (there are paragraphs on international jeopardize this, but to support and grow this funding using data from the evidence base and impacts in each section) national and international resource. independent survey data. • the London Strategic Health Authorities (cf. section on Service Provision and Practice) The message is a simple one: To this body of evidence, London Higher has added • the London Health Commission (there are supplemental data from a variety of sources and examples of HE addressing London’s health a healthy London Introduction Introduction case studies to illustrate some of the points. challenges throughout the text) is a healthy UK. 1 North Central London SHA, North East London SHA, North West London SHA, South East London SHA and South West London SHA. A consultation has recommended that there be a single SHA for London. 4 5 LEADINGHEALTH The statistics speak for themselves: Health Challenges in London • the health market in London is worth in Of course, in a city the size of London - with a A Picture of Health: excess of £8 billion per year 2 and represents population of some 7.5 million people and 7 percent of the capital’s GDP; 3 growing - there are substantial health challenges. London – UK health capital, • it employs almost 200,000 people, c. 70 percent of whom are women; 4 These have been articulated in the London Health global health market place • there are five medical schools and over Strategy which sets out the strategic health 20 HEIs engaged in health studies supporting priorities for the capital. 7 They include the broad 75 NHS hospitals and 46 private hospitals; 3 themes: working for health and regeneration; Look at it this way: If you are involved in health or health • the total income generated by London HEI addressing inequalities and poverty; the health of care, is there anywhere else you would rather be? health and health care disciplines is black and minority ethnic people; and improving £1.1billion; 5 transport and related aspects of the environment. • London is home to over 80 core London is home to world-renowned centres of health biotechnology companies, employing around Within these are specific challenges for London, research excellence and professional training, the most 6,000 staff, and more venture capital groups such as: dynamic business hub in the world, the most diverse than the top 10 other European cities • coronary heart disease, stroke, lung and breast combined; 2 cancer (which together kill more Londoners population in Europe and the most august professional • it has more than 50 clinical research than anything else); bodies and learned societies in academe.