SIR DAVID COOKSEY

24 JANUARY 2007

  Q20  Mr Newmark: So delay is not an issue?

  Sir David Cooksey: The research proposals will not come anywhere near OSCHR. It gets the money, it sets the strategy, and then it is up to the MRC and NIHR to deliver on that. The decisions will be made in exactly the same way as they are at the moment, with one exception: the cross-cutting board, the Translational Medicine Funding Board, which will cut across the two. The idea of this is to try and pull the two operations together, to try to overcome a lot of the current perverse incentives that stop research moving forward.

  Q21  Mr Newmark: Is it streamlining research spending? Is that what it is about? Is it that you are allocating? I am not quite sure what the impact of this is.

  Sir David Cooksey: The impact is that the research spending will be allocated, yes, between MRC and NIHR by—

  Q22  Mr Newmark: Allocated but not necessarily streamlined?

  Sir David Cooksey: We talk a lot about streamlining in terms of cutting the size of boards, cutting out a lot of bureaucracy, and the idea is certainly to achieve streamlining.

  Q23  Mr Newmark: That helps with your issue of productivity then. You talk about productivity and that that is an important issue. I am a simple person. I see another layer going in there. I am trying to understand how that is streamlining; how that is giving better value for money; how that is giving greater productivity.

  Sir David Cooksey: Because it brings greater focus on the areas of need that we need to address.

  Q24  Mr Newmark: So do you see it as an outcome from that? More productivity, better value for money?

  Sir David Cooksey: Absolutely.

  Q25  Chairman: May I just interrupt on that? Can I deal with the issue of financial accounting? It seems to me that you now have the Treasury to whom you have to account. The money then comes down to DTI and Health, who also have an accounting procedure. It then goes to OSCHR, who will also have to have an accounting procedure. It will then go to MRC or NIHR, who will also have to have an accounting procedure; and then down to the university or the research institutes, who will also have an accounting procedure. That is five sets of accounting for one lot of money. Surely that increases bureaucracy?

  Sir David Cooksey: No, I am sorry, that is not the way it works. Essentially what we are doing is pulling it together. At the moment, you have the odd situation where the Department of Health, within its huge budget, applies in the Spending Review for a certain amount to be allocated for research and development. The OSI obtains funding for the entire Research Council budget. That is happening at the moment. All we are doing is just picking those two bits out of the NHS R&D budget and the MRC budget and putting them into a separate spending bid. The only increase in bureaucracy, or it could be seen as an alternative bureaucracy, is that separate application—

  Q26  Chairman: For OSCHR to be effective it has to have a financial accounting system, does it not, because it needs to be able to move funds along that continuum in order to support wherever the emphasis is?

  Sir David Cooksey: It will do exactly the same thing that Sir Keith O'Nions does in the OSI. He gets the OSI budget and then he decides how much will be needed for each Research Council. As far as OSCHR is concerned, what it will do is to decide how much goes to the NIHR and how much goes to MRC, and that will be it. That will be decided for the next Spending Review period. The actual funding does not come through OSCHR at all. OSCHR will not receive any funds at all. It will, as directed by OSCHR, flow through to the two secretaries of state and through the two accounting officers. The accounting officer stream and the whole system that is in place at the moment will continue exactly as it is at the moment, and that will not add to the bureaucracy or the layers of accountability in the system.

  Q27  Mr Newmark: I look forward to seeing that work in practice.

  Sir David Cooksey: There is a very complex diagram in the report.

  Q28  Mr Newmark: I hear what you say. I have two other brief questions. Health interventions range from drugs to medical devices. How much scope is there for other Research Councils, for example the Engineering and Physical Research Council, to be more closely involved in OSCHR, given their record of interdisciplinary research?

  Sir David Cooksey: To be involved in OSCHR?

  Q29  Mr Newmark: Yes.

  Sir David Cooksey: I certainly hope that OSCHR will be open to them, in terms of communicating with them. I mentioned earlier that one of the principal reasons for organising OSCHR as it is is to keep the MRC inside the Research Councils' UK organisation, which is really where that communication takes place.

  Q30  Mr Newmark: What mechanisms could be considered to include significant funders of health research from the charitable sector in the agenda for a co-ordinated health research strategy?

  Sir David Cooksey: For instance, we are recommending—and I believe this is proceeding—that one of the external board members of OSCHR should be a representative of the medical research charities. It is incredibly important to keep as much coherence as possible between what OSCHR is trying to do and what the medical research charities are doing, because they are such an important funding stream for basic research.

  Q31  Mr Newmark: Again, part of your remit is to present a better use of funding in your decision-making. Is that why it is important to have that connection with them?

  Sir David Cooksey: Yes, and it is also to make sure that, whilst a degree of competition is healthy between different research groups who have broadly the same objectives, what one wants to do is to make sure that in terms of the resources we have available in the UK—and they will never be sufficient to cover the ground that we would like to—we have a strategy for deploying the overall resources we have which gives the best possible improvement in health benefits in this country.

  Q32  Dr Harris: You state in your report that you want to see targets imposed for the MRC and the NIHR, to drive an increasing proportion of funding over time to research that involves working across interdisciplinary boundaries. As far as I can tell, you do not say in the report what evidence you have that targets are the best way of achieving that and how you deal with the problem of targets distorting behaviour in an adverse way. You get gaming and re-badging and behaviour nearer target being altered, in order to achieve the target at all costs. Do you give any pause for thought—at a time when targets are going out of fashion—for suggesting for the first time ever that, in the context of peer review, however you define it, this will be target-driven, not necessarily best research-driven?

  Sir David Cooksey: I think you have a situation at the moment where there are targets but they are set in a slightly different way from the way you have just described; inasmuch as, if you look at the MRC's various funding boards, the MRC council decides how much money will go to each of those. For instance, there will be very different percentages of successful applicants to the different boards, because the money is more freely available for certain areas of research than it is for others. You therefore have a situation where, by resource allocation, you are targeting at this time. I think that what we were trying to do was to extend the system right across the spectrum, because it is less specific in the NHS R&D function.

  Q33  Dr Harris: I do not think that you can say that budget allocation is a target, because you say that the MRC and NIHR should allocate an increasing proportion of funding over time. That is fine; that could be a desire, presumably based on there being something to fund. I am sure that is what they might want to do, but then you say that you are going to do that by setting targets. Not monitoring performance and asking them to justify the rate at which they are doing it, but saying, "In five years' time you ought to reach this". The implication—because that is the way the Government runs targets—is that heads will roll if they do not. It could be argued that that is not compatible with funding the best research, because you are looking over your shoulder about whether or not you will meet your targets.

  Sir David Cooksey: In the report we are very specific about the fact that OSCHR should undertake performance measurement of what is going on. If you are measuring performance, you have to measure performance against specific objectives. We have used the word `targets' here, but the repeat calls for performance against objectives. There is no point in measuring performance if you do not have objectives against which to measure it.

  Q34  Dr Harris: I am sorry, we could get into a debate about metrics. Clearly you measure performance under a metric. You measure it against something; but you can perfectly adequately do that without a target. Most forms of performance monitoring in business and in the public sector do not require there to be targets, which is a yes or no binary thing—"Do you reach it or not?" Some people would argue that sophisticated performance management tries to avoid distorting, yes/no, "Have you reached a target or not?".

  Sir David Cooksey: I think we would agree with each other that our use of language is not intended to create false objectives in the system. I agree with you to that extent.

  Q35  Dr Turner: Your report, quite rightly, sets great store by translational medicine. Of course, that means different things in some cases to different people. I would like to know what you think of as translational medicine and translational research. Perhaps you could spell out to us why you suggest that, in addition to OSCHR, you should have a translational research board, to make sure that translational research is carried out effectively?

  Sir David Cooksey: As far as I am concerned, translational medicine—and we identify two gaps in translation in the report—is taking basic research discovery and developing that discovery, not necessarily purely for the advancement of the scientific ideal but for the practical application to the healthcare system and to patients, in terms of improving their healthcare outcomes. It is the applied end of the research continuum. In describing the two gaps in translation, we were identifying the fact that there is very little incentive in the current way in which we organise basic research for basic researchers to go further down the system into the applied arena. It is simply because so little credit is given to them in the Research Assessment Exercise for doing so that they can actually lose out in terms of research funding by taking their research discoveries further. There is a second problem, which is that the National Health Service is a very conservative, slow adopter of new therapies. There is a real problem in getting the adoption of successful research discoveries into regular use in patients to achieve the research continuum.

  Q36  Dr Turner: I totally agree with you, Sir David, in the two problem areas that you have identified. Would you agree with me that it is equally important in terms of medical technologies as to simple molecules, or complex molecules even? In fact, most people, when they think of translation, think of `drug'. I think that there is more to it than that. Would you agree that there is? Also, the fact that it needs to an extent to be a two-way process, so that clinical medicine offers basic scientists or basic technologists with the problems that they can help solve? Do you subscribe to this popular approach which says that you must put everybody together, so that they can share the same team in order to make this work?

  Sir David Cooksey: We have a whole-page box in the report about the Weatherall Institute of Molecular Medicine at Oxford, where, in the same building, you have the basic researchers on one side of the building and you have the applied researchers, the clinical people, on the other side of the building. They all meet in the middle, in the tearoom, for discussion. Once every two weeks they have a seminar to debate a particular area of unmet clinical need. To those debates are invited people from other disciplines; it may be from physics, chemistry or engineering—whatever is needed to get to a solution. The situation there is that you have interdisciplinary teams naturally forming to take an approach to resolving those particular unmet clinical needs, which develop over time. Frequently, in the early stages of that process, the basic researchers are obviously much more involved. It is a real bedside-to-laboratory-and-back-to-bedside approach to the problem, which I think is very constructive and makes a big difference. You can see that in other places as well. The Hammersmith is another hospital where this really does take place effectively.

  Q37  Dr Turner: I think the original model for that is seen at NIH in Bethesda.

  Sir David Cooksey: Yes.

  Q38  Dr Turner: Would you agree that, in order for this to work effectively, you need a minimum critical mass? It has to be of a certain size and involve a minimum number of disciplines, whichever they may be, in order to get these sorts of sparking interactions?

  Sir David Cooksey: Exactly so, and this is why, in the evolution of Best Research for Best Health in the National Health Service, the identification and funding of the five centres of biomedical research excellence have been proposed and now identified, and that whole process is going forward. It completely builds on the thesis you have just proposed to me.

  Q39  Chairman: Could I ask, Sir David, were you disappointed therefore that you were not able to announce, or the Government was not able to announce, on the same day that your report came out that the move of NIMR to the Temperance Hospital site and UCL was part of that vision? Because it must surely be part of the vision that you have put forward in the report.

  Sir David Cooksey: Yes.