SIR DAVID COOKSEY

24 JANUARY 2007

  Q60  Chairman: Sir David, I do want to make sure that we do not leave you going away with the accusation that you were proposing skimping in terms of procedures, so I am going to ask if Dr Harris can come back on that issue because this issue of the clinical pathways and particularly what is going to happen at the Level 3 trial stage is important to put on the record.

  Sir David Cooksey: Thank you.

  Q61  Dr Harris: Yes, and as a fellow Oxford man who has been on the receiving end of a needle on an Ataxia trial at Weatherall Institutes, I would not want to offend you by suggesting that your particular background had led to necessarily wrong conclusions. Your discussion of the whole issue of what drugs should be available on the NHS is very interesting, something that I think is in the province of politicians as well to be rational and transparent about rationing. Therefore, it is an interesting contribution to a debate which is, I think, more political than other areas that you are considering, which is why it is quite controversial. In one of your proposals you talk about the Department of Health deciding what are key priorities in terms of major UK diseases, and giving some form of direction in a top-down way, as well as a bottom-up, I accept, to OSCHR. Would you accept that there is some concern that it is wrong that clinical research should be led by what the UK Government considers to be healthcare priorities, because perforce, for example, that will concentrate on UK healthcare priorities, and many researchers in this country do not see why they should be at a further disadvantage when researching greater killers, that is diseases of the developing world, as one example of the dangers of concentrating solely on that issue?

  Sir David Cooksey: In a sense, we are in dangerous territory here. If you look at public expenditure on health research in this country, I think, first and foremost, this has got to deal with the health needs of this country. I totally agree with you that a decision can be made that part of that expenditure should be more broadly available for the benefit of the developing countries, et cetera, but that should be a positive decision, not one which would allow investigators to choose to use all of the health research budget on Third World diseases. We have got to make an allocation decision on that. Going back to your first point, what is requested is that the Health Service should identify where it has the greatest unmet need and what it considers to be the priorities. It then hands that analysis over to OSCHR and OSCHR is asked to make the decisions as to where it puts the priorities, so the priorities are set not by the NHS but by OSCHR. The NHS is advising OSCHR as to what it considers to be the greatest needs. There is no reason why other bodies should not do likewise.

  Q62  Dr Harris: I do take issue with your assertion, which at least you have been clear about, that the MRC, for ex ample, has a strong tradition of doing a huge amount of work in respect of diseases of the developing world, and it has done that without being told to but without being told not to, and it is good, including the Weatherall Institute, of course, as you list in your report. You are saying we should move the current position to a position where they only do that as they are told to, a budget allocation is made. Do you accept at least that has risks, that researchers will say, "I am not going to work in a country where I can only do this work if I am fortunate enough to come within that budget envelope set by a politician concentrating on what the Daily Mail might say about NHS services"?

  Sir David Cooksey: First of all, I do not agree with you, because currently the MRC makes its bid for the spending review to OSI which then brings all the bids together and puts its bid into the Treasury. In setting its strategy and making its bid, the MRC tells OSI what proportion of its funding is going to go into the diseases for developing countries, et cetera. From that point of view, there has been this allocation process which has gone on through the bid process for a very long time. It is not complete freedom of action within the MRC, decisions on any particular proposal are entirely the MRC's, but the overall setting of the strategy is something which is done jointly with OSI.

  Q63  Dr Harris: You are proposing to go further, you are saying that the DH—it is very clear in your recommendation—should identify specific disease areas that are priorities for the UK and direct funding from this Translational Medicine Funding Board through OSCHR to those, so that is going further than the current arrangements. I am not saying there is no direction at all at the moment, I am asking you whether you accept there is a risk that that sector of our research may be undermined by this greater direction that you are advocating for perhaps good reason as far as UK health is concerned.

  Sir David Cooksey: What we are doing is saying that priorities should be set. You will have a situation which is very parallel to what happens now, which is the priorities are set, allocations made to the various funding boards of the MRC and through the NIHR's process, and they will consider applications as they arise. What happens is that the actual funding is guided, not determined, by the prioritisation process.

  Q64  Chairman: A final point to make sure that this is clear. At the moment MRC makes a bid to OSI in terms of its research funding, as does every other research council?

  Sir David Cooksey: Correct.

  Q65  Chairman: Under the new procedures, MRC will continue to make a bid to OSI for that?

  Sir David Cooksey: No, it will make a bid to OSCHR.

  Q66  Chairman: MRC will now make a bid to OSCHR, OSCHR will then make a bid to the Treasury, the Treasury will give the money back to the DTI who will give the money to OSCHR?

  Sir David Cooksey: What happens is it will tell OSCHR how much of the money it has applied for, it is going to get over the spending review period. It will then be up to OSCHR to determine the split of those monies between three bodies: MRC, NIHR, and the Translational Medicine Funding Board.

  Q67  Chairman: But in reality, Sir David, the Director General of OSI, Sir Keith O'Nions is a bit player there, is he not?

  Sir David Cooksey: No, because he will be very much a participant, and it is happening right now, in the process of formulating that bid. He would say to you if he was sitting here, "I need to tension the funding for MRC against the other research priorities there are". In helping to formulate how much money MRC should be applying for we will take notice of Sir Keith's overall requirements. We have agreed that this should be the case. Just to complete the cycle, once that allocation has been made the funding streams will come down through OSI and from the Department of Health.

  Q68  Dr Turner: The report is full of lots of interesting recommendations, what is your feedback from Government departments as to what they are going to do about implementing them all?

  Sir David Cooksey: I cannot tell you how delighted I was that the Treasury and both Government departments agreed to implement all the recommendations on the day of publication. At least that is happening. The team at OSCHR is being put together very rapidly and they have got to formulate their spending review bid within the next very few weeks, so there is a huge amount of effort going on there. I have been surprised at the speed at which the various recommendations are being addressed and, in some cases, already starting to be implemented. I think the signals are very positive at this moment.

  Q69  Dr Turner: Another feature of your recommendations, which I read with some wry amusement, is that everybody cites you in defence of their case, even if they are on opposite sides of an argument, so this has to be one of the best reports ever produced.

  Sir David Cooksey: All I can do is say thank you.

  Chairman: Sir David, I started this session by thanking you very much on behalf of the Committee for a far-reaching report and one which has given us a great deal of interest in terms of questioning you. We thank you for your honesty this morning, we expected nothing else. Thank you for taking on my colleague, Dr Harris, and putting him in his place. Thank you very much indeed.