Government Office for Science – Department of Health Science Review
Comments from the Medical Schools Council
General points
While it always, of course, a good thing to have a continuing series of reviews of research,
we would question whether this is the time in which to survey the science and research being
carried out and funded by the Department of Health. At this time there is much churn in this
sector, under the new arrangements for Best Research for Best health (BRfBH). Biomedical
Research centres are only just being established, and we have only recently had the first calls
for programme grants and now the new academic units. Much money has been clawed back
to the centre, and currently we have yet to see a large part of it emerge in the form of new
funding. It is as yet unclear how and in which way the Medical Research Council, the
National Institute for Health Research and the Office for Strategic Coordination of Health
Research will interact, especially in view of the fact that the new CEO of the MRC is about to
be appointed. Indeed, the new DoH strategy under BRfBH was only launched in 2006, and
it’s stated aims, the development of a thriving research culture, the building of research
capacity involving both patients and health professionals, increased industry investment and
the development of a research led-culture within the NHS, are not meant to deliver until
2011.
In the presence of such early plans, it could be considered inappropriate to have a review of
the DoH’s science plans, given the extremely new structure under which it is working. It
might be more appropriate to wait until these mechanisms have bedded down and born fruit,
rather than to embark in what could be am expensive review which will, perforce, only give
interim conclusions contingent upon seeing how things go. Therefore in fairness to the
Department of Health, we feel that this review is premature.
But of course, the overall aim – to maintain and improve the quality and use of science in
government, is entirely a laudable and we cannot imagine anyone disagreeing with it.
Moreover, the instruments which have been put in place, in our view could be appropriate for
delivering this strategy by most criteria set out in this paper, although as set out below, we d
have concerns about the start that has been made.
Of the 10 criteria, again these seem reasonable and well-thought out, but we would comment:
1. Develop a clear, overall science strategy
The DoH does indeed have a strategy where funding research is concerned. Is new strategy,
under BRfBH which it is said will lead to the establishment of the NHS as an internationally-
recognised centre of research excellence, is indeed laudatory. Central planks in this strategy
are the development of a National Institute for Health Research (NIHR), of national research
networks, and of the National School for Primary Care Research. It is as yet unclear to us
how these will work, and there has been considerable confusion regarding the NIHR and it’s
membership criteria, which even now are unclear to many. Similarly, the introduction of
NIHR systems and infrastructure is at a very early stage. One of the stated goals of the
strategy is that researchers have the chance to win funding regardless of location. It has to be
said that with the establishment of only a small number of Biomedical Research Centres,
confined to one part of the country in the main, with no information as yet about how these
will be expanded to encompass the considerable amount of high-quality research contained
within other centres, there is concern about how this will be achieved. Moreover, the peer-
review process for the available programmes has been less than transparent. It is therefore
every difficult at this stage to comment on how value for money is being achieved.
We would advise that the role of the Chief Scientist has been largely undermined, and in
comparison with Scotland, where the office of the Chief Scientist has a major role in defining
policy and indeed in funding research, in England the position is hardly visible.
There is also a perception within the biomedical community that a great deal of expertise in
research and development has been lost in recent years.
There is also a perception that the Department of Health lacks real leadership on scientific
and research issues, and compares badly alongside, for example, the Food Standards Agecny.
We cannot therefore as yet agree with the statement that the funding schemes that underpin
this strategy are based on the principles of transparency, fairness and contestability’.
2. Horizon scanning
While the BRfBH strategy goes into considerable detail on how research – including indeed
blue-sky research – will be commissioned, the mechanism for ‘horizon-scanning’, as defined
in criterion 2, is unclear. Presumably this will be carried out by the membership and
leadership of the NIHR, although who these individuals might be, and the systems they might
use, are as yet uncertain.
3. Review and harness existing science, and identify gaps for future research
The BRfBH strategy makes impressive plans for introducing research into clinical care as
soon as it is feasible, and also for developing the networks for carrying this out. It is less
clear what the strategy is for identifying gaps in knowledge and developing the opportunities
for future research. Presumably mechanisms for carrying this out will be developed within
the NIHR and it’s membership but again it is unclear at this juncture how this will be done.
4 and 5. Commission and manage new science and ensure the quality and
relevance of the science they carry out and sponsor.
The strategy for commissioning new research is well set out in the BRfBH strategy. There
have been several calls for grants for new research in several fields, although it is yet unclear
how priority-setting in these initiatives is done. How the quality of this research is to be
maintained is less clear: so far the peer-review process has been less than transparent. One
major problem in funding long-term research, in Centres and programme grants, is the
feedback and continuing assessment, and the BRfBH strategy is rather opaque on this point.
6. Use science and scientific advances
We assume that this will be mediated through the NIHR bit as yet we are uncertain how this
is to be done.
7. Publish results and debate the findings and implications openly.
We assume that the DoH via BRfBH supports an open access publication policy and it will
be interesting how this is to implemented. The communication policy is as yet unclear.
Again the NIHR would appear to be an appropriate vehicle for such debates and we would
like to see how it is envisage that this will happen.
8. Transfer and management of knowledge
There are certainly elaborate plans for knowledge management and transfer through the
BRfBH strategy. There are many mentions of Connecting for Health and its role – it is to
hoped that these aspirations are realised.
9. Implementation of Guidelines 2005 and the Code of Practice for Scientific
Advisory Committees
We would envisage that the DoH would obtain suitable advice for policy making from the
NIHR, and we look forward to seeing how this will be done.
10. Use, maintain and develop scientific expertise
There is considerable concern about the decline in the medical academic workforce, the
expansion of which is a stated aim of the BRfBH strategy. Recent events surrounding the
recruitment of junior staff into academic posts have given little confidence that this is a
priority, and the DoH should give urgent attention to this important point.