INTRODUCTION

  1.  Universities UK welcomes the Cooksey Report on UK Health Research which we believe to be of central importance to the future of health research in the UK and to the UK economy as a whole. Universities welcome the implicit recognition in the report that investments in developing the workforce and technological capability of the health research community represent a top priority for the UK in the 21st century.

  2.  Universities look forward to working with OSCHR, the MRC and NIHR in taking forward the report's recommendations. Universities UK would also be pleased to provide oral evidence to the Science and Technology Committee about the contribution that universities can make in implementing the report recommendations.

  3.  The Cooksey review provides an excellent opportunity to develop health research further and to support the health needs of the future. However, there is a danger that the full benefit may not be realised if the opportunity is not taken to think broadly about the implications of the future health needs of the population, and the kind of research needed to underpin future health services. With an ageing population, and health services which will be much more community based and focused on the management of chronic conditions, research effort needs to bring together public health, community health and social care in an inter-disciplinary and multi-disciplinary framework. The will have an impact on the topics for research, as well as the research expertise and professional skills required.

  4.  This response starts with some general comments, and then makes specific references to: bringing together the budgets; governance; the OSCHR; MRC boards; the TMFB; unmet health needs; the forum for international development; and research training funds.

GENERAL COMMENTS

  5.  The move to recognise the imbalance between basic medical science research and clinical research, and the proposals to redress this imbalance, is welcomed. However the proposed changes are limited by the narrow scope of the recommendations, which will limit the impact on patient care and outcomes. In order to make a real difference to clinical care, the change in emphasis needs to incorporate clinical research and health services research, not just translational research. Translational research is that which makes the translation between basic science—the test-tube—to the clinical scenario—the bedside.

  6.  Although it may have been beyond the focus of this review, universities are concerned that no consideration appears to have been given to the social and environmental contributors to health and ill-health. Health research is assumed in the report to mean largely medical and disease related research. As such there is very little attention given to the pressing need for public health research, and scant acknowledgement of the need for research into non-medical aspects of health need and health care. This will require consideration of the relationship between the new OSCHR and other funding bodies such as the ESRC.

  7.  Throughout the report there is a strong emphasis on research carried out by medical professionals. It is assumed that the health researcher is a doctor, and the research considered is basic medical research or translational. Although occasional references are made to researchers from other professional backgrounds, and other types of research, none of the actual concrete proposals cater for them. This is a serious omission, as a much wider range of disciplines and professions are involved in health research, and this trend is likely to continue in the future.

  8.  Universities UK is concerned that bringing together the Department of Health and MRC research budgets may have a detrimental impact upon social care research, which is already under-funded in comparison with health care. The Department of Health is a substantial funder of research in social care and universities would not wish to see this diverted under the unified arrangements.

BRINGING TOGETHER MEDICAL RESEARCH COUNCIL (MRC) AND DEPARTMENT OF HEALTH RESEARCH BUDGETS

  9.  Universities UK supports the recommendation to create a single ring-fenced budget to support UK health research. A single budget, if properly managed, should reduce bureaucracy and erode the artificial separation between the research agendas of universities and their partner NHS Trusts. It would encourage closer collaboration between the two sectors, focusing attention on the applications of research to patient care, at the same time incentivising NHS staff to undertake research.

  10.  Under the present system, there are significant differences in the funding regimes for the MRC and DH which will need to be reconciled. MRC funds are earned on the basis of research excellence, as judged by rigorous peer review, and measured against national and international priorities. Funding awarded to universities by Research Councils and other external funders is ring-fenced and cannot be used for any other purpose. The majority of NHS R&D funds are allocated formulaically for research infrastructure, although it is often difficult to trace this income stream to specific R&D support.

  11.  Implementing a single fund for health research will therefore depend upon the success of the "Best Research for Best Health" (BRBH) ambition to make available for direct funding of research the notional funds currently included in block grants to NHS Trusts. In its submission to the Cooksey Review, Universities UK argued that whilst this may offer opportunities to incentivise research within the NHS, it will also take out about £550 million from the NHS, at a time when it is over £500 million in deficit. Even if Trusts are able to regain income equivalent to their current R&D levies under BRBH, universities remain concerned that the new income will be ring-fenced for specific research initiatives, reducing flexibility, and leaving an underlying deficit which could seriously destabilise clinical services. This could place an enormous strain on the university/health service research partnership, at a time when the financial impact of other reforms (for example, full economic costing, the review of SIFT funding and the introduction of payment by results), are becoming apparent. There is a risk that this combination of changes will fundamentally damage the underpinning infrastructure for health R&D. The transitional arrangements for the implementation of Cooksey's recommendations therefore need to be managed so that this does not happen.

  12.  Additionally, it will be important to re-evaluate the entire range of research interests and methodologies that exist along the biomedical research pathway from basic discovery to applied research to ensure that an appropriate proportion of spend is allocated across the spectrum.

  13.  The single fund should also consider setting aside funds for infrastructure development in areas such at IT and clinical research facilities, to support seamless working across partner organisations.

GOVERNANCE

  14.  We believe that a novel governance model is needed which draws on the best features of the two current schemes and acknowledges the interdependence of the NHS and its academic partners. All key stakeholders should be involved—government departments, research councils, universities, the NHS, medical charities, industry and patient groups.

  15.  While the proposed single budget and single resource allocation methodology are attractive, there are difficulties—principally, agreeing the appropriate proportion of the fund to be distributed to different elements of activity. Without careful management, basic research could benefit at the expense of more applied research simply because the metrics are more easily defined for laboratory-based research. It will also be difficult, we suspect, to resolve the "ownership" of a single fund in a way that both partners in the scheme will find equitable.

THE OFFICE FOR STRATEGIC CO -ORDINATION OF HEALTH RESEARCH (OSCHR)

  16.  The OSCHR will play an important role in facilitating and co-ordinating interactions between the MRC and DH Research and Development, as well as monitoring their performance. Given the increasing emphasis placed on the independent, community and voluntary sectors as health care providers, the OSCHR also offers an opportunity to promote research for the health of the whole UK population, rather than simply responding to the needs of the NHS. The need for a greater emphasis on applied and translational research is reflected by the recommendation that the new body reports to both the Health and Trade and Industry Ministers.

  17.  However, universities are concerned that the establishment of the OSCHR could lead to the introduction of a further level of administration within the system. Although described as being relatively "light", any further administrative level will create inevitable delays in approval processes and a top heavy administrative framework could potentially stifle research initiatives, particularly blue skies research. It is critical that the work of the OSCHR complements the "bottom up' approaches" pursued by many clinical researchers and avoids setting research priorities via a top down approach. The means by which the OSCHR will set objectives and assess outcomes should be clarified and the longer term appropriateness of this overarching office should also be reviewed following the initial transitional period.

MRC BOARDS TO TAKE ON WIDER RANGE OF HEALTH RESEARCH REPRESENTATIVES

  18.  The proposal to create a broader based MRC board is welcome. In seeking to embrace further applied and translational research and alongside the creation of the new Translational Medicine Funding Board, it is also timely for the Board membership to include representatives.

  19.  From a much greater range of academic disciplines and expertise.

THE TRANSLATIONAL MEDICINE FUNDING BOARD (TMFB)

  20.  Universities UK welcomes the creation of the new TMFB which should be at the forefront of funding both translational and clinical research based on peer reviewed scientific evidence to meet the future health needs of the population and to support current health service needs.

  21.  However, Universities UK would support CHMS's request for clarity on the scope of the new Board and in particular whether the TMFB would have responsibility for research likely to benefit public health, as distinct from clinical medicine. If this is the case, secure public health representation on the board will be necessary. If, however, this does not fall within the remit of the new Board, there should be a clear focus for the coordination of public health research, particularly in light of the current low investment from the DH in public health research and development.

DEPARTMENT OF HEALTH REVIEWS OF UNMET HEALTH NEEDS AND STRATEGIC DIRECTIONS FOR DISEASES

  22.  It is essential that he DH monitor more closely unmet health needs and consider ways of addressing them. While prioritising the major killer diseases is understandable, the social and economic impact of conditions that may not kill but cause long term morbidity must be recognised and funding for research in these areas should be enhanced.

  23.  While universities recognise that the setting of priorities for research under the new merged fund would be necessary and indeed desirable, Universities UK is disappointed to note that this is articulated as being wholly concerned with disease areas. This will undoubtedly be to the detriment of research into public health areas, such as obesity, where the associated morbidity will have an increasing impact on the economy as a whole. It will also be important to ensure that the new merged fund supports research into other health problems which researchers identify outside these priority disease areas.

THE FORUM TO FACILITATE COLLABORATION FOR HEALTH RESEARCH IN INTERNATIONAL DEVELOPMENT

  24.  The attention given in the Cooksey Report to the need to address research in a global environment is welcome, but further detail is required on the structure of this new forum. If research representation is solely from members of the NIHR, Universities UK is concerned that many experts with discipline specific knowledge who lack an honorary NHS contract will be excluded from participation. The forum may therefore find it is not able to access the most innovative and cutting edge thinking.

RESEARCH TRAINING FUNDS

  25.  Universities UK welcomes the suggestion that support for the training of clinical academics be ring fenced. As evidenced by the annual CHMS Survey of Clinical Academic Staffing, 2006 saw the number of clinical academics in the UK fall below 3,000 for the first time since 2000. Universities UK is pleased that the need to encourage the brightest young doctors into a clinical academic career has been recognised in the report, and expects to see the ring-fenced training extended to other professions and academic disciplines who undertake clinical roles as well.

January 2007