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Medical Research

My Lords, I add my thanks to the noble Baroness, Lady Hayman, for raising this debate. In preparing for it, I have been torn as to whether to approach the subject from the point of view of my current position as chair of a London strategic health authority—which I am shortly to relinquish—or that of the new position I will take up in the autumn as chair of the council of governors at St George’s, at the University of London, which is predominantly a medical school and a healthcare educational establishment. While one might think that those positions might be similar, in fact they are a little different. There are tensions and dilemmas, to which many noble Lords have referred, including the noble Baroness, Lady Hayman, between, on the one hand, what medical researchers and universities want and the science base that is relevant to developing that research capacity, and, on the other hand, what healthcare services would like medical researchers to address and the basic science education and training that can best serve our current health service needs. First, this is probably my last shot for the London health service and so I shall be wholly partisan. I shall be rather biased in what I say and I am sure that, as I speak, noble Lords will remind themselves that I am being partisan. I am particularly concerned about the decision to bring together MRC funds and NHS R&D. We know very well that there has been not a 100 years war but at least a 30 years war in trying to drag out NHS R&D funds from the infrastructure of London teaching hospitals and one or two other hospitals, where they are embedded deep within the fabric of the buildings and the establishment. We all want to see NHS R&D funds properly used. There has been a gradual improvement in identifying those funds, even though some of the Culyer gaming was something of a fiction. However, we have finally identified the funds and we know broadly where they are going. There has recently been increasing success in getting the funds attached to the right sort of research. The cancer research network has undoubtedly shown the way because NHS medical ““oncocrats””, if I can call them that, have always been better organised than other specialties, and other research networks are far less advanced. Now, it seems to me, when NHS R&D has just started to be properly developed—we have identified it and are beginning to turn it round a bit—it is going to be removed, centralised and returned in the form of academic centres, redistributed, I deeply suspect, on geopolitical grounds rather than on economic, health or science grounds. There is much hyped-up misinformation about London’s share of the NHS R&D funds. London currently attracts less than a third of them and, in fact, the figure is in line with London’s overall share of the higher education market. The prospect of a wanton withdrawal of revenue, which currently supports not only academic posts and research but, as I have said, also the infrastructure of some hospitals, is a pretty frightening calamity. Few teaching hospitals have yet got their heads around what that will mean. North of Watford there may be a good deal of optimism that at last these dastardly London teaching hospitals will get their come-uppance and that academic centres will magically alight on places that have the capacity but have never had the money, but there is no guarantee that the attractions of London as an international centre, attracting overseas researchers and private sector investors, will transfer elsewhere in the UK. After all, the Olympic factor was fine for London but it did not seem fine in Manchester. The health market in London is worth in excess of £8 billion a year—7 per cent of the capital’s GDP. We employ 200,000 people. There are five medical schools and, altogether, 25 universities in higher education supporting 75 NHS hospitals, 46 private hospitals, 80 biotechnology companies and 50 clinical research centres, and of course we train 40 per cent of the workforce in the UK. The contribution made by London’s health service and London’s NHS R&D is quite astonishing. We want to ensure that these funds are better used to support the NHS’s long-term strategy for health but I claim that that will not be achieved by the wholesale destruction of a thriving economy in London. There are better, more subtle ways of targeting these funds and improving outputs to the benefit of everyone. But it will happen. The jackpot should be £1.3 billion but, like the noble Lord, Lord Turnberg, I was very anxious to hear the announcement that the single pot would be £1 billion. I wondered what had happened to the other £300 million. There is a little gap there, and perhaps the Minister will be able to reassure us that the intention is to produce the full moneys. I would also like to be reassured that the priorities of Professor Sally Davies, who has been a great champion in the Department of Health for clinical and health services research, and the priorities of Professor Colin Blakemore at the MRC will be at one on how this future jackpot will be spent. I have my doubts that there is yet an agreement, but I look forward to seeing how it works out. I turn briefly to the education of basic sciences for underpinning. I am concerned that we are not engaging school leavers with top science qualifications in medicine. We are increasingly developing a medical research community that is far removed from the medical delivery of healthcare within our teaching hospitals. Clinical and applied research seem to move in parallel lines these days, which is very different from how it used to be. Professor Roger Jones, in a letter to the BMJ last week said that we need to do applied research, but we need translational research. He said:"““They need to understand that translational research doesn’t mean getting the protein out of the test tube into the zebra fish, but getting the therapeutic intervention into the patient and population””."