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Medical Research

My Lords, it is with gratitude and respect that I rise to speak in your Lordships’ House for the first time. My gratitude is for the warmth of welcome, since taking my place in the House, from noble Lords across all Benches and from all staff—most particularly, from the Convenor of the Cross Benches, my noble friend Lord Williamson, and his staff. My respect is for being able to experience at close hand the courtesy, expertise, wisdom and integrity that reside in this House. I am grateful, too, to the noble Baroness, Lady Hayman, for initiating this debate, which is of particular interest to me. I am a generalist by background with a number of special interests, one of which is health. Previously, I was a lay member of the General Medical Council and chair of an NHS region. Currently, I am chair of the Chronic Pain Policy Coalition and a vice-chair of the British Lung Foundation. It is with that broad interest that I wish to contribute to this debate. Like the noble Lord, Lord Patel, in the recent debate on universities research and development, I applaud the announcement made by the Chancellor in his Budget Statement proposing a merger of the Medical Research Council and NHS research funding. However, a number of key issues still need to be addressed. A central issue is getting the balance right in what drives research. Is it the health and welfare of patients and the population as a whole, or is it economic considerations? Who will decide the priorities and what will be the involvement of patients and lay people unconnected with the commercial and academic sectors? A further concern is that the small amounts of money currently devoted to research on public health could be squeezed in favour of basic research in the medical sciences that will have commercial potential. There may be little or no commercial possibility in some public health research but enormous potential population benefit, which of course will deliver broader economic benefit, although not to our pharmaceutical industries or to our successful export market. We know that our pharmaceutical industries are a great economic strength. However, a balance must be struck. This makes the question of who will be involved in deciding our research priorities one of some significance. Another area to consider is the contribution of the separate research funded by the Economic and Social Research Council. It has much to offer towards improving the health of the population. Current examples of its research projects include: innovations in cancer pain relief technologies, ethics and practices; determinants of alcohol abusers’ success in changing; and understanding adolescent smoking initiation, a four-year longitudinal study. We also need to strike the balance between research into treatment of conditions and research into prevention of conditions. In my work with the Chronic Pain Policy Coalition, I have learnt that chronic pain affects one in seven people in the United Kingdom and one in three households, and that arthritis is the most common cause. From the British Pain Society, I have learnt how chronic pain changes lives. Some 49 per cent of people who live with chronic pain have taken considerable time off work, 72 per cent have become less physically active, 24 per cent have been diagnosed with depression and 25 per cent have lost their jobs. Therefore, a coherent research programme into the treatment of chronic pain and an effective management strategy would make a huge difference. I want to say a word or two about research and ageing. The April edition of the British Medical Journal drew attention to the fact that, of all the studies related to pain, just 1 per cent addressed the topic of pain and ageing. More generally, as elderly people are the main consumers of both new and old drugs for common diseases, it is essential that they are included in randomised controlled trials. In addition, research into models of care and models of rehabilitation methods for older people are needed. A conclusion that I draw from my own researches for this debate is the importance of partnership working and the emphasis on scientific method in the training of all health professionals at both postgraduate and undergraduate levels. Nurses and therapists may currently be more experienced in single-case and observational study designs, whereas doctors may focus more on the merits of randomised controlled trials. We need both. We need multidisciplinary research groups that marry the learning between the quantitative and the qualitative. These multidisciplinary groups would include the Association of Medical Research Charities and, of course, patients themselves. This approach applies not only to research and ageing, but also to many other kinds of research. Further, the organisation of the delivery of healthcare remains an under-researched subject area. If there were a better evidence base showing what worked best in delivering health services, perhaps the NHS would require less reorganisation, which may be as welcome to the Minister as to those who work within the health service. I also suggest that more useful work could be done to ensure that positive outcomes of medical research are efficiently introduced to individual practice and into organisations as a whole. Perhaps the old R&D label could be recast as RD&I: research, development and implementation. This would not only mean a well managed roll-out programme; it would also capture and evaluate the data and be able to provide effective feedback. My experience of chairing the national review group into the failure of a well researched hip prosthesis was that our work was hampered by a lack of information and data capture. I am pleased to say that, as a result of our work and our recommendations, we now have a national hip register so that the performance and effectiveness of the different hip prostheses can be properly measured and monitored. In conclusion, when it comes to medical research, we need to consistently raise our game. The merger of the MRC and NHS research funding is a good basis for better-focused research, but much still remains to be done. Einstein once said that the problems we face cannot be resolved by the same level of thinking as that which gave rise to them. Therefore, in addition to new structures, we need new and energetic thinking.