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Medical Research

My Lords, I thank the noble Baroness, Lady Hayman, for securing the debate this afternoon and for her very clear and concise remarks. She will not be surprised if I use the opportunity to say a few brief words about dentistry and dental research. The noble Baroness and I have debated dentistry many times in the past few years, and I assure her that I am not going to discuss the new dental contract and its effect on NHS dentistry. But I do wish to commend the excellent contribution that dental research has made to healthcare policy, and to highlight the worrying workforce planning aspects and the teacher/research pressures of the dental clinical academic research sector. The UK has an enlarging and ageing population, and the significance of wider psychological, social and functional elements in constituting the condition of health is now widely acknowledged. Society is becoming increasingly consumerist, and NHS reforms are attempting to harness consumer power to drive standards up and waiting lists down. Dental research is part of the political debate about patient access to dental provision and how good oral health is central to good general health. If we are to pursue preventive dentistry and good public health, it is imperative that we champion evidence-based patient care. There have been many examples. Recent well researched oral health studies have provided evidence to wider public health debates. For example, Birmingham University has done research into fizzy drinks and tooth erosion, and how the consumption of such drinks by 12 year-olds massively increases the chance of erosion. The university found that four or more glasses a day increase the chance of erosion by 252 per cent This type of work should play a key part in supporting government policy-making to phase out fizzy drinks from school vending machines. The UK is a major contributor to oral and dental research, but it often lacks the infrastructure to grasp the opportunities to develop the applications. An example of this was the research into light-cured dental resins. It was initiated in the UK, but its support environment was subsequently moved to the USA and Japan, and Japan ended up buying up the technology. The adoption of new technologies is more likely when demanded by patients and when financial incentives are available. Conversely, new treatments may be less likely to be implemented if they threaten the status of any group of clinicians or professional position. A recent staffing level report by the Council of Heads of Medical Schools and Council of Heads and Deans of Dental Schools found that dental clinical academic numbers had decreased by 6 per cent in just one year. The study also stated that there were more than 200 vacant senior academic posts in medicine, with the staffing problems being even more acute in academic dentistry. Yet the Government are increasing undergraduate training places by 25 per cent How do those two sets of statistics sit comfortably together? Fundamental decisions need to be taken when assessing the UK’s future role in research, innovation and the development of new technologies in the provision of oral healthcare. How much is the country prepared to invest in the generation of new technology? What is society prepared to fund researchers and innovators for? Is the UK a manufacturing or a service country? Do we want to produce high-quality scientists? Does the UK wish to be seen as an innovator? One challenge of the introduction of new technologies will be the impact that they have on the development of the dental team. An individual’s knowledge base will rapidly be out of date. Much more emphasis will be put on lifelong learning. Is it possible that the whole workforce might need to be retrained over a 10-year cycle? The value of change will need to be assessed. One drawback of systematic reviews is that, in a rapidly changing environment, by the time the retrospective assessment has been completed further innovation may render the assessment out of date. The demographics of the UK population will change. The movement into the country of individuals from overseas will show a change in the genetic mix, which may have an impact on the predisposition to oral diseases. The attitude to technological development in the UK is criticised in some quarters. Funding and ethnical approval are hard to obtain. A number of important policies need to be considered to facilitate technological development for benefits for the practice of dentistry. Key to that are UK policies on research funding. The new technologies are not unique to dentistry and need to be exploited within dentistry. Technological advances in the management of oral conditions need to take place within mainstream research. Collaboration between research groups should be facilitated rather than discouraged. Lessons should be learnt from the experiences of research councils which are no longer working in their own traditional areas but are looking at bringing people together from different backgrounds. Future developments in dentistry are more likely to come when links with physicists, mathematicians and engineers are established. UK patent laws put those who are in UK technology development at a disadvantage when compared to the USA. Exploitation of research can be hindered by the wishes of employers or sponsors, such as funding councils and health departments. The UK policy on clinical trials needs urgent review—perhaps moving away from the Cochrane review approach to one based more on risk assessment. A well trained research community with opportunities and a society prepared to invest in research and innovation are required. If that capacity is there, patients and dentists will benefit. There is an onus on universities and all stakeholders within the dental and research communities at large to stand back and look at where we are going. Academic dentistry is at a crossroads. Will we be modern and different, and grasp the opportunity to change? Bureaucracy and red tape that stifle an innovative and developmental culture need to be challenged.