EXECUTIVE SUMMARY

  Considering the increasingly broad scope for medical research, and following the recommendations of the Cooksey Report, it seems appropriate for the Medical Research Council (MRC) to review its role in funding medical research. The MRC, as the major source of government funding for medical research, has, with its unique mix of intramural and extramural research support, been extremely successful in maintaining a balanced mixture of basic biomedical research and translational and clinical research in the UK over many years. Through its intramural programmes it has been able to identify outstanding scientists and provide them with long-term support to develop research programmes of the kind and complexity that are not amenable to short term funding. Yet, at the same time, the Council has been able to fund and encourage work in fields directly applicable to day to day clinical practice, particularly through the excellence of its clinical trials and epidemiological studies. If, given the recent reorganisation of the relationship between the MRC and the Department of Health, and after consideration of some of the recently developed opportunities for both basic and clinical research, the MRC decides that its programme requires revision, it is absolutely vital for the future of research in the UK that the current balance between intramural and extramural research is retained intact; it has been, and will remain, one of the major reasons for its remarkable output of internationally recognised research based on, at least by international comparisons, small amounts of funding. By some relatively simple organisational changes, particularly involving the Department of Health's future role in research, and interactions between the major medical charities and industry, it should be possible to define the future role of the MRC while, at the same time, not endangering those features that have made it so successful in the past.

  1. The background to this short submission is that for many years I ran research groups, first in Liverpool and then in Oxford, that were supported by the MRC and medical charities. I was able to establish the first Institute in the UK, or globally, for the application of the new technology of molecular and cell biology directly to clinical practice, and, after my retirement, was invited to spend a year at the National Institutes of Health in Washington, the American equivalent of the MRC, to advise on their international programmes. My recent work for the World Health Organization has enabled me to observe the mechanisms of funding in many other countries and contrast and compare them with those of the MRC and British charities.

  2. Funding for medical research in the UK comes from a wide variety of sources, a fact which, though healthy, does present difficulties for developing overall strategies. The principle government funding is through the MRC, the Department of Health, and the Universities. A great deal of funding also comes through the major charities, notably the Wellcome Trust and the smaller specialist charities, and, to a smaller extent, from the pharmaceutical industry. More recently, and in recognition of its excellence in the field, funding has been obtained from large international agencies such as Gates for work in medical research related to the developing countries. The UK's role in this latter field, which has been grossly underestimated, will be the subject of a report later this year from the Academy of Medical Sciences. A modest amount of funding has also been available through the European Community.

  3. Given the heterogeneous sources of funding, and the fact that many of them are earmarked for particular areas of research, it has been left largely to the MRC and The Wellcome Trust to develop a balance of intramural and extramural research activities across broad fields extending from the very basic biological sciences through to work that has immediate applicability in the clinic and community. While there have been inevitable criticisms of bias towards the basic science end of medical research on the part of both bodies, the fact is that they have both been able to maintain an extremely good balance between these extremes. The MRC's intramural programme, as evidenced through the work of the Laboratory for Molecular Biology in Cambridge and its various units in different parts of the country, has been quite outstanding and is viewed with not a little envy by those who direct the various Institutes of the NIH in the USA. The MRC's traditional ability to pick outstanding scientists and give them long-term support through its intramural programme has produced some of the best basic and applied medical research in the post-war period. It is absolutely critical that, through pressures of short term objectives, these intramural programmes continue to form a major part of the work of the MRC, an approach that is also followed with great success by The Wellcome Trust. Overall, both these bodies, backed up by the smaller charities, have established a reasonable balance between basic biological research and clinical and epidemiological research and, in particular, have developed the training capabilities for this work to continue to flourish in the UK.

  4. While the recent initiative of the Government and Department of Health to fund several centres of excellence for translational research is extremely encouraging, the current difficulties of the National Health Service undoubtedly reflect problems in long-term planning of the provision of health services which require special areas of research expertise which should come under the auspices of the Department of Health as part of its long-term planning strategy. If the NHS is not to continue to be reformed almost weekly on an ad hoc basis, the Department must develop a clearly defined in-house programme of its own research which will be complimentary to that of the MRC, though will differ to some degree in its technology and objectives. Major reforms in health care require long-term strategic planning with scientifically-based pilot studies, programmes which are eminently suited to the NHS. There are some exciting new possibilities for health-care research including outcomes research, technology for analysing patients appreciation of risk factors, and a whole variety of highly practical approaches to improving healthcare both in the hospital and community that should be developed as part of a strategic R&D programme within the NHS. In short, the Department of Health should be persuaded to take advantage of the many new areas of healthcare research that are becoming available and develop its own internal R&D strategy based on research programmes of this kind. Given the new committee structure that has been established following the Cooksey Report it should be possible to monitor the balance between earmarked health-service research of this type and the much broader aspects of medical research required of the MRC and the major charities. It is clear from long discussions in the USA, Canada and other countries that this approach has not yet been followed in any country satisfactorily, but, because of the existence of a government health service like the NHS, the UK has a great opportunity to evolve a national R&D programme based along these lines.

  5. It is vital therefore that there is absolute clarity about the different roles of an R&D research programme in the Department of Health and the broader roles that are required of bodies like the MRC and the large medical charities. But it is also vital that, in reviewing the future of the MRC, its central role in maintaining a balance between the basic and applied aspects of medical research is maintained while, at the same time, continuing its ability to support unusually outstanding individuals through its intramural programmes. Since it is also vital that both the MRC and the major charities maintain and expand their activities in international health, as outlined in the recent report by Lord Crisp, they cannot be expected to also develop the critically important programme of health care research that is currently required to underline the work of the Department of Health and the NHS. There is an urgent need for a complete review and forward planning of R&D within the NHS.

  6. There is no doubt that from an international viewpoint, and from the ability of at least two British universities to remain in the top five of the international league table for success in medical research that, despite a very limited budget compared with the USA, this country has been extremely successful in both basic biological and applied medical research over the last 50 years. There is no question that much of this success rests with the work of the MRC and it is vital that any changes that are made do not detract from its continued ability to identify and encourage the work of particularly gifted scientists. Modern medical research, and work of this type for the foreseeable future, reflects a complex continuum from fundamental questions about how health care is organised and delivered in the community, through large clinical trials, and work in the ward and basic science departments, to applications that come from totally unrelated fields in the physical sciences. Increasingly, a body will be required to oversee the complex balance between these different inputs; the MRC has done this well in the past and should be encouraged to continue to do so in the future.

May 2006