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					           Submission by The National Physical Laboratory to
           the review of Science in the Department of Health
Summary
This submission is made on behalf of the UK’s National Physical Laboratory. As the UK’s national
standards laboratory, NPL underpins the National Measurement System, ensuring consistency and
traceability of measurements throughout the UK, through its world-leading capability in measurement
science, its practical application and knowledge transfer.
Our experience is that for science and technology to deliver the greatest impact there is a need to ensure
that metrology is considered at an early stage in the R&D process and developed in a coherent way in
parallel with new technologies, medicines and techniques etc. In the delivery of services to patients, every
day millions of measurements are made in hospitals from which diagnoses are made and treatments
controlled. The National Measurement System is the UK’s infrastructure that underpins all of these.
Looking forward there is a clear need to accelerate the uptake of emerging technologies and research
discovery into clinical practice. A lack of rigorous metrology integrated into R, D & D of these
technologies could hinder this. Ensuring DH science takes account of metrology and is plugged into the
UK and international infrastructure for measurement and standards at all stages of the journey from
basic research to delivery of services to patients would facilitate:
 pooling of data and results from multi-centre and multi-national research
 timely identification and removal of technical and regulatory barriers to implementation of new
    technologies and techniques
 consistent and optimal introduction of new, and delivery of existing, services
 transfer of best practice between centres, particularly as they seek to introduce new technology,
    medicines, techniques or practices
 regulatory compliance
 minimising the risk of a failure of patient care and subsequent litigation.
Our wide experience of collaboration with the public and private sector in maximising the impact of our
work also suggests that in all but the most basic curiosity-driven research it is important that Knowledge
Transfer (specifically how to shape and exploit science knowledge to maximise its positive and real
impact) is integrated into R&D from the outset and is carried through into ensuring service delivery is
optimised and consistent. It is vital that specific KT expertise is used to advise on the best mechanisms
(that go beyond a narrow view of KT as IP exploitation) to ensure maximum take-up and implementation
of new knowledge.
In the light of the above, we believe that:
 Given the importance of metrology and KT, these should be key and explicit components of any
    overall science strategy for the DH.
 It is important to develop a strategic relationship between the NMS and DH to enable them to better
    exploit our measurement capability to the long-term effectiveness of the DH and NHS. Hence links
    between the NMS and DH should be strengthened.
 Mechanisms should be put in place to facilitate collaboration between the DH and the UK’s
    measurement capability, including, if appropriate, co-funding that will leverage significant DIUS
    investment in this area
 Further discussion as to how NPL’s considerable experience and expertise in S&T knowledge sharing
    and transfer could be applied to DH aims and objectives would be valuable.


Introduction
This submission is made on behalf of the National Physical Laboratory. As the UK’s national
standards laboratory, NPL underpins the National Measurement System (NMS), ensuring consistency
and traceability of measurements throughout the UK.
Our role is to deliver world-class measurement science, to provide measurement infrastructure for the
UK and to maximise the impact that this science and infrastructure has on the UK economy and
quality of life, including the healthcare sector - from basic R&D through to clinical practice and
manufacture. Our work is directly relevant to the DH and this is reflected in the close relationship we
have at a number of levels with those engaged in R&D and in delivery of services directly to patients.
This submission draws on our expertise in measurement science and our experience in Knowledge
Transfer (KT) to provide input on the importance of measurement science (metrology) and
mechanisms for maximising the impact of science & technology (S&T). We then go on to relate these
general points to the specific success criteria against which the review is to be carried out.

The importance of measurement and documentary standards
Our experience is that for science and technology to deliver the greatest impact there is a need
to ensure that metrology is considered at an early stage in the R&D process and developed in a
coherent way in parallel with new technologies, medicines and techniques etc. Metrology is
also critical to the success and consistent delivery of diagnostic, therapeutic and other
services to patients.
In the delivery of services to patients, every day millions of measurements are made in hospitals from
which diagnoses are made and treatments controlled. These range from relatively straightforward
measurements of temperature and blood pressure, through to the more sophisticated and critical
measurements associated with diagnostic imaging or the consistent and accurate delivery of radiation
dose in radiotherapy. Each one of these measurements relies on having instruments that are fit for
purpose, calibrated to deliver accurate and consistent results, best practice procedures for making and
assessing measurements and staff trained in the use of instruments and the relevant procedures. The
National Measurement System is the UK’s infrastructure that underpins all of these.
Looking forward there is a clear need to accelerate the uptake of emerging technologies and research
discovery into clinical practice. A lack of rigorous metrology integrated into R, D & D of these
technologies could hinder their uptake. An increasing level of importance is being attached to
measurements and standards in health related R&D and this is reflected not only in practice but also
in regulation. Two recent examples of this in EU legislation are:
 The regulation of new pharmaceuticals now includes a requirement as part of the EU Clinical
     Trials Directive 2001/20/EC that any instruments used in-process or pre-release manufacture of
     products for clinical trials and 'specials' must be calibrated using standards from recognised
     bodies (for physical measurements in the UK these must be traceable to NPL).
 For development of medical diagnostics the In-Vitro Diagnostics Directive (98/79/EEC) requires
     that any diagnostic measurement device must be traceable to an appropriate reference procedure.
     This is an on-going issue in Diagnostic R&D, where regulators are tightening up on traceability
     and reference standards (and defining clinically relevant standards)
Overall the situation with regard to measurement standards needed as part of an R&D programme is
complex, but the clear trend is strengthening traceability and reference standards towards the stricter
standards set by the FDA.
Bringing multi-disciplinary S&T capability to bear in R&D or in service improvement and delivery is
also increasingly recognised as vital for rapid implementation of new S&T and/or improvements in
service delivery. This is as true in metrology as in other areas of science and is reflected in our efforts
to encourage and mobilise multi-disciplinary teams at NPL and the creation of explicitly multi-
disciplinary programmes.
Ensuring DH science takes account of metrology and is plugged into the UK and international
infrastructure for measurement and standards at all stages of the journey from basic research to
delivery of services to patients would facilitate:
 pooling of data and results from multi-centre and multi-national research
 timely identification and removal of technical and regulatory barriers to implementation of new
     technologies and techniques
 consistent and optimal introduction of new, and delivery of existing, services
 transfer of best practice between centres, particularly as they seek to introduce new technology,
     medicines, techniques or practices
 regulatory compliance
 minimising the risk of a failure of patient care and subsequent litigation.


The importance of planned and best practice KT
Our wide experience of collaboration with the public and private sector in maximising the
impact of our work also suggests that in all but the most basic curiosity-driven research it is
important that Knowledge Transfer (specifically how to shape and exploit science knowledge
to maximise its positive and real impact) is integrated into R&D from the outset and is carried
through into ensuring service delivery is optimised and consistent. It is vital that specific KT
expertise is used to advise on the best mechanisms (that go beyond a narrow view of KT as IP
exploitation) to ensure maximum take-up and implementation of new knowledge.
KT initiatives that are deployed without reference to, and without being integrated with, the core S&T
development and delivery, have in our experience a lower impact. At its most basic level, S&T has its
greatest take-up and delivers the best outcomes when scientists work closely with exploiters of their
knowledge. The scientists in turn learn through that close contact. Individual technical staff need to
retain responsibility for transferring knowledge from their work. If scientists are removed from being
directly involved in KT, awareness of the needs of the end users is reduced, and the quality and
relevance of science programmes suffer because formulation and delivery is less well informed.
At the level of an individual project, whether that project, R&D, infrastructure provision or service
delivery, there needs to be clarity from the outset of the expected outcomes and the delivery route for
the output of the project needs to be built in during formulation of the associated R&D or infrastructure
activities. At NPL we characterize our approach to KT as Foresight – Product - Take-up.
 Using Foresight to identify future needs and/or road maps to future science and technology.
 Ensuring the output of each project is a usable “Product”, i.e. is in a form that facilitates its take-up
     by users, whether they be the next step in the R&D chain or ultimate end-users/beneficiaries.
 Putting in place KT activities to maximize that Take-up.
Ideally as much emphasis should be placed in S&T proposals on exploitation of the outputs as is
placed on description of the technical work. Depending on the mechanism identified for maximizing
the impact of the science, a project may need to involve stakeholders directly in the delivery process.
It also important to identify where synergies with other intermediaries can be exploited. In our case
these are RDAs, trade associations, Knowledge Transfer Networks etc. In the case of the DH the best
candidates would need to be identified in each case.
Also of value, in our experience, is managing impact through a set of Key Performance Indicators
which can be regularly reviewed together with a formal impact assessment at regular intervals looking
at both quantitative and qualitative measures for benefits. We have invested significantly in developing
and understanding “impact metrics”.
NPL has now built these principles into the processes it uses to formulate and manage its science
programmes and it is working hard to bring about a culture change that embeds this in the thinking of
all NPL’s scientists – our experience is that these are valuable principles that have wide applicability.
Impact on “success criteria”
The following section highlights the relevance of the issues discussed above to a number of the
success criteria against which the review is being carried out, making recommendations for areas
where actions may lead to improved performance.

1.        Develop a clear, overall science strategy.
      Given the importance of metrology and KT, we believe that these should be key and explicit
      components of any overall science strategy for the DH. For existing services the strategy should
      consider the reliability of the science of measurements for patient service delivery and how to
      maximise the uptake and impact of best practice and new developments. Looking to the future
      there is a clear need to accelerate the uptake of emerging technologies. A lack of rigorous
      metrology integrated into R, D & D of these technologies could hinder their uptake – hence this
      should be explicitly considered in the science strategy.
3.        Review and harness existing science ………..
10.       Use maintain and develop scientific expertise
      The UK’s National Measurement Institutes (and in particular NPL - the dominant and Government
      owned NMI) represent a significant historic and continuing investment by DIUS in world-class (and
      in many cases world-leading) measurement science capability. In order to maintain, develop and
      maximise the benefit of this science capability for the DH we would make three recommendations.
     i.   We believe it is important to develop a strategic relationship between the NMS and DH to
          enable them to better exploit our measurement capability to enhance the long-term
          effectiveness of the DH and NHS. Hence links between NMI’s or the NMS programme
          directorate within DIUS and DH should be strengthened.
          DTI (now DIUS) recently carried out a review of the NMS. The recommendations of this review
          were approved by the science minister and are being implemented in 2007. One key
          recommendation was the establishment of advisory structures to oversee and direct the
          programmes. The review recommended that a “Measurement Board” be set up with a role in
           defining the strategic direction of the NMS. The review also recommends that expert Working
           Groups are attached to individual programmes.
           We welcome the appointment of a senior DH representative to the Measurement Board (Dr
           Peter Sneddon, head of National Research Programmes) and look forward to their valuable
           input to defining NMS strategy. We also welcome similar representation on the individual
           advisory groups and would encourage DH to continue to support these.
           We recommend that consideration be given to how the NMS (either the DIUS NMS directorate
           or the National Measurement Institutes themselves) might best be represented on advisory
           structures for science in the DH, given the importance of metrology to R&D and service
           delivery. In addition we would welcome the opportunity to work with DH to consider how we
           might further communicate the importance of measurements and drive best practise across
           the NHS.
           The recent Sainsbury Review of Science and Innovation highlighted that “Like other
           standards, measurement standards are a prime example of a "public good", whose provision,
           potentially, is not optimally provided by a market. As discussed in the section on standards, a
           public good does not allow its provider to capture all the returns from its use; consequently, a
           market may underprovide the good, offering a rationale for government intervention”. It would
           appear to us that in some situations the market created within the NHS may be leading to a
           less than optimal provision when responsibility for some aspects of metrology is delegated to
           PCTs. As stated above measurement is all pervasive in both R&D and service delivery. In
           many cases its impact in an individual procedure or service is small, but the integrated effect
           across the whole of the NHS is significant. In some situations we have found that it is difficult
           to identify the correct forum for addressing the tension between the needs and drivers of the
           individual Trust and the wider picture for the whole NHS.
     ii.   Mechanisms should be put in place to facilitate collaboration with the UK’s measurement
           capability (NPL, LGC, NEL and others), including, if appropriate, co-funding that will leverage
           the significant DIUS investment in this area.
           The links between DH and DIUS proposed above will have a positive impact on future
           collaboration. A requirement to explicitly consider measurement issues in R&D and other S&T
           projects as part of a science strategy would also encourage increased collaboration. However,
           to maximise the leverage from the DIUS investment in the NMS it would also be valuable to
           consider mechanisms for co-funding metrology such as working with DIUS or the NMI’s to
           directly co-fund work in the NMS.
           A mechanism whereby the DH could co-fund appropriate NMS work would leverage the
           existing capability to achieve the aims of the DH and/or enable generic work funded under the
           NMS to be applied to specific DH issues. The explicitly multi-disciplinary Metrology R&D
           programme is a prime example for such consideration.
8.         Share transfer and manage knowledge.
           Strengthening links between the NMS and DH as proposed above should also facilitate KT,
           which is vital to maximising the impact of the UKs capability in this area.
           Looking more generally at the issue of sharing and transferring knowledge, our experience
           discussed above, consideration should be given to how to drive best practice in KT throughout
           the DH and NHS. We would welcome the opportunity to further discuss our experience in this
           area and its applicability to the DH aims and objectives.



                                                                                           Dr Martyn Sené
                                                                          Director, Quality of Life Division,
                                                                             National Physical Laboratory
                                                                                                     th
                                                                                       October 12 , 2007

				
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