rose to call attention to medical research and its science base in the United Kingdom; and to move for Papers.
My Lords, I am delighted that the noble Baroness, Lady Fritchie, from among a distinguished speakers list, has chosen today to make her maiden speech. I am sure that we all look forward to hearing her. I am delighted, too, that my noble friend Lord Sainsbury will reply from the Front Bench. He has made an outstanding contribution in his term of office as Science Minister, and I look forward to hearing from him later.
I shall speak today about the record and the reputation of medical research in the United Kingdom, and about the resource and regulatory underpinning necessary to ensure continuation of that success. I should declare my interests as a member of the Human Fertilisation and Embryology Authority and chair of the Human Tissue Authority, both of which have regulatory responsibilities in respect of research governance.
Before that regulatory role, my connections with medical research have always been from a patient perspective, both in various roles in the NHS, where I ended up chairing a trust hospital, and in the charity sector, where, for three years, I chaired Cancer Research UK. From that patient perspective, as well as from the perspective of United Kingdom plc, it is important that we respond to the call of the noble Lord, Lord Patten, in this Chamber a couple of weeks ago, who said that we must,
"continue to blow the trumpet about the importance of . . . R&D in this country".—[Hansard, 27/4/06; col. 278.]
In the words of the Government's 2006 Science and innovation investment framework:
"Health R&D is an area of marked UK strength. In addition to the obvious public health benefits, the quality of the UK's health research base, including medical research, is an important factor in retaining and growing R&D investment from the pharmaceutical industry, already the UK's largest contributor to private R&D, with over £3.3 bn of investment each year. It has a growth rate of 4–5 per cent per year—exports in 2004 were £12.3 bn . . . the UK's biotechnology sector is the largest in Europe and second globally only to the US".
This year we overtook the United States for the first time when the UK gained top place among the G8 nations in the productivity of its biomedical and pre-clinical research—so, a proud record.
But back to patients: Professor Raymond Tallis, in his fascinating book Hippocratic Oaths, analyses the benefits that "scientific medicine", as he calls it—the relatively recent discipline of an evidence and research-based approach to therapeutics—has given to man, "the medicine-taking animal". He looks in particular at the contribution to increases in life expectancy made by science, as against those of the broad social advances which gave so much, particularly in the early years of the 20th century, in education, sanitation, housing, nutrition, and health and safety at work. He concludes:
"Whilst scientific medicine is not acting alone, its contribution—once the foundation stones of public hygiene and the welfare state are in place—is proportionately greater".
As a nation we have reaped benefits from the home-grown scientists and doctors, from Sir Richard Doll's work—as groundbreaking and important today as we debate the Health Bill as it was when he first made the connection of tobacco with cancer—from Charnley's hip replacements, and from Sir Peter Manfield's discovery of MRI.
Tallis was looking particularly at the spectacular advances in life expectancy in developed nations in recent years, but medical research can and does make a tremendous contribution in the developing world, even when the infrastructure that we take for granted is lacking. There have been achievements like the virtual eradication of river blindness in west Africa, the transformation—which I have had the privilege to see—in the lives of HIV/AIDS patients in Africa when antiretroviral drugs become available freely to them, and the possibilities opened up by the hope of a vaccine against cervical cancer. The effects of medical research in our country are felt well beyond these shores.
But for us as individuals and as funders of the National Health Service the challenge is about extending not only life expectancy, but healthy life expectancy. I know that many patient groups are very anxious that publicly supported research should be directed at areas which may not be in the forefront of scientific excitement but really matter to patients day in and day out, areas that have been neglected in the past—improvements in pain control in palliative care, and researching the combination of chemotherapy drugs that will give patients 18 months' survival with a good quality of life rather than 12 months. They are anxious too, like the Alzheimer's Society in its briefing for today's debate, that what is discovered and known on evidence to be the best treatment is put into practice across the board and in all areas. The responsibilities of NICE in this area are particularly important.
Moreover, there is the importance of clinical academics, an issue that has been discussed many times in your Lordships' House. The recent pledge to fund £2.5 million in this area is welcome, but I do not believe that we can emphasise too much the importance and benefit of having practising clinicians with a research mindset, and to give that research activity the respect it deserves. Professor Iain Chalmers believes that one of the biggest problems is the low status of clinical research. He said:
"The fact is that the smaller the thing you study in biomedical research, the higher your status—so prions have a high status and people who study whole societies have a very low status".
But of course we need people who study both.
There is a very precious baby here that must not be thrown out with the bathwater, and that is the blue-sky, abstruse, intellectually challenging science which is not directed at a specific end, and where the eventual destination of a line of inquiry is completely unknown.
One of the most fascinating challenges and difficult dilemmas that I faced when I was at Cancer Research UK was how to strike the right balance in funding decisions between, to put it very simplistically, giving brilliant scientists the resources to go away to see what they came up with, as against responding to specific research applications from scientists and doctors already working in a particular field, or considering areas that were under-researched but where there was no demand for funding, such as surgery, which is tremendously important to cancer patients. Where the applications did not come through, we had to consider how to set about capacity-building and stimulating high-class requests in such areas.
That was exactly the challenge that the Chancellor just put to Sir David Cooksey when he asked him to consider the best arrangements for delivering the full spectrum of publicly supported health research, and from the Nobel prize-winning research conducted by the Medical Research Council to the NHS's world-renowned work on health technology assessment. The budget proposals for that new single fund for health research have been broadly welcomed, but, as I am sure my noble friend is aware, there are issues about which the research community has concerns.
In particular, the community wants reassurance about the transparency of decision-making and of how we will safeguard the Holdane principle of independence from Ministers in day-to-day decision-making, and about how we will ensure that effective partnerships continue with the medical research charities, given their enormously important investment—about £700 million a year—in medical research. I know that there is also concern about infrastructure costs within the NHS in a programme grant-giving regime and ensuring that teaching and research hospitals are properly funded.
I want to highlight another concern. Government strategy states:
"Few, if any, other countries have a health service that provides researchers with the potential to access virtually the entire population for an integrated system of primary, secondary and tertiary care. It is a unique selling point for public sector researchers, charities and private organisations".
It is from that unique selling point, that invaluable base, that the National Cancer Research Network, established in 2001, trebled the proportion of cancer patients coming into clinical trials, putting us ahead of Europe and the US. The UK Clinical Research Collaboration hopes to replicate that across the board.
My concern is that the increasing fragmentation of provision within the NHS through independent treatment and diagnostic centres and the use of the private sector, where the impetus for research is hard to see, should not dilute that unique resource and integration on which clinical trial success so crucially depends.
To move from resources to regulation, the Health Minister, Rosie Winterton, recently said that,
"the UK is seen as a world leader in embryonic stem cell research, and this is largely due to the effective regulations that control it".
That is right. It is possible to strike a balance and provide a regulatory framework that supports rather than hamstrings researchers. If we get the regulation right, and take the public with us—that takes us into the area of the public understanding of science, which is another whole debate, about which the noble Baroness, Lady Greenfield, has spoken in this House—we can provide a framework that both gives public confidence and allows research to flourish. There are difficult areas here, to which we have to face up, and difficult balances to be struck. I especially welcome the AMS's recent report, Personal data for public good, which highlights some of those balances.
Things can go terribly wrong if we lose public confidence. I was a Minister responsible for GM crops during the time of the greatest public concern about the issue. It is frightening when the ability to have a rational debate is taken away from you in a wave of public feeling without any proper underpinning of communication. The communication of risk is an area that we have discussed before but which is of tremendous importance.
We need to be smarter in how we deal with European legislation. We need to get in earlier on decision-making. We need to ensure that the specific characteristics of UK research, such as its large charitable sector, are fully recognised. Finally, we just have to take a more robust approach against the seemingly constant desire to gold-plate.
Finally, perhaps I may say something else about what is necessary for the sector to flourish, and pinpoint another area of effective regulation. That is in the field of animals used in scientific procedures. I very much welcome the Government's action in legislating in this area through the Serious and Organised Crime Act and the police's willingness to investigate and prosecute those who use threats, intimidation and violence. I also applaud the efforts of the Research Defence Society and others to bring together patients' groups, medical charities, citizens and researchers to speak up for research. Transparency is a very powerful weapon in this area. We have nothing to be ashamed of in our regulatory framework, and the public recognise the importance of the work that is done.
The Motion refers to the science base as well as to medical research, because it is clear to anyone who has worked in this area or read anything about it that medical research needs a science base that goes far wider than conventional biomedical disciplines if it is to continue to succeed. As a trustee of Kew Gardens, I immediately think that plant scientists can make a contribution to medical research. Others, I am sure, will speak of physics and of chemistry. Then there is information technology—I have learnt a new phrase today, "pervasive computing"—which will be tremendously important in health service research in the future. The mechanical sciences can also help with different delivery systems for medicines, as can statisticians, social scientists, ethicists and philosophers, whom we need to help us to grapple with the ethical and social dilemmas and implications of medical advances. Above all, we need co-operation and cross-fertilisation between those different areas.
That point was brought home to me yesterday when I read the obituary in the Guardian of James Ambrose, the radiologist who helped to pioneer CT scanning. He was approached by Godfrey Hounsfield, a physicist who had never done any medical research and worked for a record company but was interested in this area. Their collaboration ended up with Hounsfield getting the Nobel prize in 1979. Ambrose's contribution was less grandly recognised, but without the partnership of the two—the clinician and the scientist—millions of patients would have been the poorer.
As politicians, we have the opportunity to play our part by creating an environment where the educational, financial and regulatory framework is one in which those sorts of partnerships and discoveries can continue to benefit patients and the public in the future. I beg to move for Papers.
My Lords, I thank the noble Baroness, Lady Hayman, for securing the debate this afternoon and for her very clear and concise remarks. She will not be surprised if I use the opportunity to say a few brief words about dentistry and dental research. The noble Baroness and I have debated dentistry many times in the past few years, and I assure her that I am not going to discuss the new dental contract and its effect on NHS dentistry. But I do wish to commend the excellent contribution that dental research has made to healthcare policy, and to highlight the worrying workforce planning aspects and the teacher/research pressures of the dental clinical academic research sector.
The UK has an enlarging and ageing population, and the significance of wider psychological, social and functional elements in constituting the condition of health is now widely acknowledged. Society is becoming increasingly consumerist, and NHS reforms are attempting to harness consumer power to drive standards up and waiting lists down. Dental research is part of the political debate about patient access to dental provision and how good oral health is central to good general health. If we are to pursue preventive dentistry and good public health, it is imperative that we champion evidence-based patient care.
There have been many examples. Recent well researched oral health studies have provided evidence to wider public health debates. For example, Birmingham University has done research into fizzy drinks and tooth erosion, and how the consumption of such drinks by 12 year-olds massively increases the chance of erosion. The university found that four or more glasses a day increase the chance of erosion by 252 per cent This type of work should play a key part in supporting government policy-making to phase out fizzy drinks from school vending machines.
The UK is a major contributor to oral and dental research, but it often lacks the infrastructure to grasp the opportunities to develop the applications. An example of this was the research into light-cured dental resins. It was initiated in the UK, but its support environment was subsequently moved to the USA and Japan, and Japan ended up buying up the technology.
The adoption of new technologies is more likely when demanded by patients and when financial incentives are available. Conversely, new treatments may be less likely to be implemented if they threaten the status of any group of clinicians or professional position. A recent staffing level report by the Council of Heads of Medical Schools and Council of Heads and Deans of Dental Schools found that dental clinical academic numbers had decreased by 6 per cent in just one year. The study also stated that there were more than 200 vacant senior academic posts in medicine, with the staffing problems being even more acute in academic dentistry. Yet the Government are increasing undergraduate training places by 25 per cent How do those two sets of statistics sit comfortably together?
Fundamental decisions need to be taken when assessing the UK's future role in research, innovation and the development of new technologies in the provision of oral healthcare. How much is the country prepared to invest in the generation of new technology? What is society prepared to fund researchers and innovators for? Is the UK a manufacturing or a service country? Do we want to produce high-quality scientists? Does the UK wish to be seen as an innovator?
One challenge of the introduction of new technologies will be the impact that they have on the development of the dental team. An individual's knowledge base will rapidly be out of date. Much more emphasis will be put on lifelong learning. Is it possible that the whole workforce might need to be retrained over a 10-year cycle? The value of change will need to be assessed. One drawback of systematic reviews is that, in a rapidly changing environment, by the time the retrospective assessment has been completed further innovation may render the assessment out of date.
The demographics of the UK will change. The movement into the country of individuals from overseas will show a change in the genetic mix, which may have an impact on the predisposition to oral diseases. The attitude to technological development in the UK is criticised in some quarters. Funding and ethnical approval are hard to obtain. A number of important policies need to be considered to facilitate technological development for benefits for the practice of dentistry.
Key to that are UK policies on research funding. The new technologies are not unique to dentistry and need to be exploited within dentistry. Technological advances in the management of oral conditions need to take place within mainstream research. Collaboration between research groups should be facilitated rather than discouraged. Lessons should be learnt from the experiences of research councils which are no longer working in their own traditional areas but are looking at bringing people together from different backgrounds. Future developments in dentistry are more likely to come when links with physicists, mathematicians and engineers are established.
UK patent laws put those who are in UK technology development at a disadvantage when compared to the USA. Exploitation of research can be hindered by the wishes of employers or sponsors, such as funding councils and health departments. The UK policy on clinical trials needs urgent review—perhaps moving away from the Cochrane review approach to one based more on risk assessment.
A well trained research community with opportunities and a society prepared to invest in research and innovation are required. If that capacity is there, patients and dentists will benefit. There is an onus on universities and all stakeholders within the dental and research communities at large to stand back and look at where we are going. Academic dentistry is at a crossroads. Will we be modern and different, and grasp the opportunity to change? Bureaucracy and red tape that stifle an innovative and developmental culture need to be challenged.
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.
My Lords, it is my privilege to congratulate and thank the noble Baroness on behalf of the whole House on her maiden speech. She explained her deep involvement in medical matters and, thanks to that, she spoke with insight and knowledge about them.
But the noble Baroness has had an impact on other aspects of our lives. She described herself as a generalist. How true. In 1999 she became Commissioner for Public Appointments. She was reappointed in 2002 and her appointment was extended in 2005, so she must be doing a great job in ensuring integrity and diversity in public appointments.
The noble Baroness spoke of ageing. Women have greatly benefited from her involvement with the Pennell Initiative for Women's Health, which addresses the needs of women over 45. She has received many honours from universities, including an honorary professorship in creative leadership at York University. What a wonderful and imaginative chair. She is an ambassador for places as far apart as St Andrews in Fife and Gloucestershire—places, no doubt, to which she feels a sense of loyalty and of gratitude.
There is more: charities, a building society, hobbies and family—she is a very busy person. Nevertheless, I hope that we will see her often here so that we can all benefit from her large and important contribution to public life.
My Lords, my noble friend Lady Hayman is absolutely right: we will not progress in health research without a strong science base. The science base is essential, but is it sufficient? Is a good science base enough to ensure that a good idea in the laboratory becomes a good idea in the market? The answer is no. It seems to me that there are three additional essential elements that we need to add to our science base. First, an outward-looking and open economy, secondly, a well regulated medical sector, and, finally, a well developed knowledge transfer system. Let me briefly explore each of these elements, because without them our science base could become an ivory tower.
An outward-looking and open economy is essential because research is international—it knows no boundaries—and so it does not matter where it is done as long as we benefit from it. It is a part of globalisation that we should welcome, and welcome the people that go with it. Critics of this policy—and there are many of them—argue that this openness sets off a race to the bottom. They argue that competition from emerging economies will constantly undercut our pay and conditions. But, in truth, we are learning that the opposite is true. Openness will help us win the race to the top—and winning the race to the top means giving up the low standards and old technologies which hold us back. This is why we need an open and welcoming economy in addition to our science base.
My noble friend Lady Hayman also spoke of sensitive regulation being an essential addition to our science base. I agree. As she said, without this, there will be less public support, but we also need public support because the medical records, tissues and tests used for research belong to the public. The public must see public benefit.
Biobank, and the way it has been set up, licensed and regulated, certainly has public support, but there are further questions. What are the property rights over tissues and embryos? These are ethical as well as commercial considerations, but regulators must put people in a position of control over their tissues if that is what they want.
Regulation also affects the researchers. In a debate on
Then there is the regulation of the commercialisation of medical research. When researchers become entrepreneurs, the regulatory balance is difficult. When I was in the United States recently, knowing that this debate was coming up, I asked some venture capitalists whom I knew from my previous life in business where the smart money was going in medical research. Diagnostics, was the answer. They told me that there is a new generation of tests which represents some of the first fruits of the long-anticipated genome revolution. Those tests could pave the way to personalised medicine and because of this, there could be—in their words—pharmaceutical-like profit margins. Fortunately, we have NICE in Britain to assess the value of these things. This is an important part of the regulatory process.
My final point concerns knowledge transfer networks. A top-class science base will remain a top-class ivory tower unless it leads to top-class products and companies. Science does not easily transform into a business. It is to the credit of the Government and my noble friend the Minister that over the years they have actively set up knowledge transfer networks to achieve this. I declare an interest as the honorary chairman of one such knowledge transfer network. Knowledge transfer networks speed up innovation, and the development of the research is not just left to chance. Healthcare workers and scientists add value to each other by each providing the answer to the others' needs. But these answers frequently lie outside a single source of knowledge; to make progress and to succeed in innovation today, you need a matrix of information. My noble friend Lady Hayman described this, speaking about IT, social science and, I think, record players.
It is collaboration between different disciplines that creates innovation. Public policy cannot create innovation in healthcare, but it can ensure that the ingredients are there. With the continuing investment in our science base, our open policy towards trade and science, our careful and thoughtful approach to commercial and ethical regulation and our understanding and encouragement of the networks by which science becomes healthcare, we can become a global hub for collaborative innovation and research and development in healthcare—a worthwhile and achievable ambition for our country.
My Lords, I thank the noble Baroness, Lady Hayman, for introducing this debate. Even though I am not involved in the medical sector and am not a scientist, I suggest that none of us can ignore the importance of medical research. The results of medical research have a bearing on our existence from conception to death, and all life in-between. We take it pretty well for granted, and seldom give sufficient thought to the huge and continuing benefits such science-based research has brought to us all.
I admit that I was not particularly interested until a mutation in a gene changed the lives of all the members of my family. My immediate family is affected by a rare inherited familial condition known as the Li-Fraumeni syndrome. The condition greatly increases an individual's risk of developing cancer. Families with this syndrome carry a mutation in a gene for a molecule called p53, an important factor in controlling cell growth, preventing cells from multiplying if their DNA is damaged. When p53 is damaged, cells go on dividing even if their DNA is damaged, and this can result in cancer. Another version of the syndrome carries a fault in a gene called CHK2, known as "check two". I think there was a reference to this on the radio yesterday morning. This gene is thought to play a role in repairing damaged DNA.
The syndrome can be confirmed by genetic tests for individual genetic faults. Such screening is available as a result of past medical research, and further research in this area has led to programmes being put in place for people from Li-Fraumeni families. They include annual check-ups for children and breast screening from the age of 20. In addition, because of the wide range of cancers that can develop, individuals with the syndrome are urged to discuss any health problems that concern them which last longer than about three weeks. Such programmes are a direct follow-on from the original medical research that discovered the syndrome in the first place.
I have gone into a bit of detail on this as it shows just how important it is to continue to support medical research, not only to save lives but also to reduce the huge need for resources required by health providers to cope with the sufferers of this syndrome, for example, if it is not diagnosed before the cancers start multiplying. Sadly, both my young siblings died prematurely, in large measure, I feel, because they were not diagnosed early enough as being Li-Fraumeni syndrome carriers. It is almost certain that it was passed on to them from my mother, who also died of cancer at a very early age, but before genetic testing was developed. Some 40 years ago Li-Fraumeni was not widely known.
In the case of one of my nephews, however, I have great hope. The research has progressed so far that he may well avoid the fate that befell his mother, my younger sister. He was diagnosed as having Li-Fraumeni when he developed adrenal cancer at the age of three. He had a torrid time. He lost a kidney, pituitary glands and goodness knows what else. It seemed like a total catastrophe for all those who remained, but now, some 25 years on, he is a healthy Oxford graduate leading a normal life as a father. His life is very little inconvenienced other than by regular medication and regular monitoring. The offspring of my siblings are regularly checked, and the deep anxiety of their possible, if not probable, succumbing to cancer has been lifted. Without medical research, that would not have been the outcome.
Cancer affects, or will affect, each one of us, either directly or tangentially through the experiences of close family members, friends or colleagues. Indeed, we have experienced it in this House. When this debate was brought to my attention, my mind quickly turned to the importance of medical research for cancer, for obvious reasons, and the importance of saving lives. I approached Cancer Research UK for background data. That organisation and its predecessors have achieved monumental public awareness of the causes and treatment of cancer. It has certainly lifted the stigma of cancer. No longer is it referred to in whispered tones as "the big C", as it was when my mother developed cancer.
Cancer Research UK has been at the forefront of focusing on lifestyle changes that we can and must adopt to fight this dastardly disease, and that is also as the result of medical research. I will not be tempted to get into the subject of smoking. Through the activities of Cancer Research UK we are all aware that one in three people will develop cancer at some time in their lives. What we may not know is that half of all cancers are potentially preventable. Without medical research that would never have been the case. Medical research has been responsible for the development of treatments that have helped save thousands of lives, and I believe the UK is the European leader in the development of novel anti-cancer treatments.
I have deliberately homed in on just one area where medical research has a huge impact, purely because I have had first-hand experience of both the benefits and the ongoing treatments. I know I have dealt with just a small part of the whole UK medical research picture, and that I have concentrated on applied research. I do not want to be seen as a blinkered, single-subject individual, and I am very aware of the major impact medical research has had on the UK economy.
For many years we prided ourselves on being the fourth largest economy in the world. Sadly we have slipped, for reasons known to all of us. However, our ranking in terms of share of citations in biological sciences and pre-clinical and health-related sciences is third in the world and first among the G8 nations. That, by any measure, is a most encouraging achievement when you consider that we have 1 per cent of the world's population. It shows that we are on the up by comparison with the slippage in overall ratings of world economic success.
In the helpful brief produced by Universities UK I was pleased to see—this has already been mentioned by the noble Baroness, Lady Hayman—that the Government have taken a lead and are to create a single research budget for the Medical Research Council and the NHS R&D programme, amounting to at least £1 billion per annum. I was even more pleased to learn, as the noble Baroness has said, that a very good business friend of mine, Sir David Cooksey, has been appointed to lead a review of the issues and to advise the Government on the best design and institutional arrangements for the new merged fund. That is an excellent choice. He will certainly stop any of the nonsense that tends to creep in when new units are formed, regarding who should be top, second or, indeed, third dog. We have even been promised a date for the publication of the review—next month—and not fobbed off with "shortly", "soon", or "as quickly as possible", which is the normal response to requests for firm timetables.
Backing winners has always been a good policy. I hope that the Minister will reaffirm—I am sure that he will—that such is his policy too and that the UK Government will continue to back UK medical research so that it continues to be one of the major players in the international field of medical research.
My Lords, I thank the noble Baroness, Lady Hayman, for obtaining and initiating this important debate. She and I first met when we were fellow chairmen of NHS hospital trusts. I remember meeting her when I was the Chief Inspector of Prisons and was shocked by the treatment of women prisoners at Holloway, who were kept in chains while they were in labour in the hospital of which the noble Baroness was the chair. She was as appalled as I was at what was going on. I discovered that rather than just being appalled, she was actively doing something about the matter and was trying to improve the conditions.
I was particularly interested to find that the noble Baroness was actively promoting research into other ways of treating prisoners; namely, that information on what was wrong with them could be video-linked to a doctor in another hospital and analysed there, rather than undergoing the expensive process of taking people under guard from prison into another hospital. Therefore, it does not surprise me at all to find the noble Baroness energetically pursuing the cause of medical research in many areas, not just in general scientific development.
It is a huge pleasure and privilege to follow the maiden speech of my noble friend Lady Fritchie. She and I were appointed to this House on the same day. I remember looking at her CV and being absolutely gobsmacked by its breadth. Having heard what she had to say, I can see exactly why so many organisations wish to have her on their pay roll.
I should like to pick up three points that have been made so far. First, I should like to pick up the point made by the noble Baroness, Lady Hayman, that the research that we support should be directed at areas which have been neglected in the past, and her concern about fragmentation in the NHS when matters are followed up. I want to focus on a poor relation in this scene; namely, prisons. Finally, I refer to the noble Baroness's point about cross-fertilisation, co-operation and partnership between patients and public being so hugely important.
I refer to two points made by my noble friend Lady Fritchie: first, the importance of deciding the priority of research; and, secondly, her point about research development and implementation going together. I wish to raise that because prisons and the prison population are the newest part of the United Kingdom population to join the NHS. It has been a matter of much concern that a very large number of people in prison are suffering from a huge variety of mental health problems. Until very recently nobody seemed to be picking up the responsibility of doing research into the incidence but also the implications of what they were suffering from and what ought to be done about it. No one was taking the lead in questioning whether imprisonment was making the condition of the patient either better or worse. As far as I was concerned, on inspecting it with my psychiatrist, it was invariably made worse because the conduct of imprisonment made for conditions which were completely against the proper treatment of a mental disorder. Coupled with the fact that there was totally inadequate psychiatric staffing, it meant that people were inevitably going to get worse.
I am absolutely delighted to declare an interest, in that I have been co-opted as an adviser by the Sainsbury Centre for Mental Health, which announced recently that one of its priorities was going to be research into every aspect of prison health, which so far has been neglected. I pick up the points made by the noble Baroness, Lady Hayman, and my noble friend Lady Fritchie because it seems to me that the Sainsbury Centre's work needs to have a priority put on it, but the priority should not necessarily be the priority of the centre—it should be the priority of the user. In theory, the user is the public, because all the prisoners are going to come out of prison, and their mental and physical health is a matter of public interest. It is also a matter for the Prison Service and the Home Office, to make certain that what could be done for people in prison is done, and it is a matter for the NHS, which will have to provide care.
What concerns me is that there does not seem to be agreement in the direction of the research coming from the Home Office and the NHS, to see that those people for whom they are responsible are having what is needed identified and prepared. It is no good just going into the research side; the implementation must go with it. Therefore, on behalf of the Sainsbury Centre, I am recommending that we should work together with the Prison Service and the NHS to find out what they feel is the priority in what should be looked at, and then enable that to be done, but only if there is a clear understanding that we are not just doing so for the sake of it, but are identifying what needs to go into the mainstream on behalf of the public and the patients.
My Lords, I am delighted that my noble friend Lady Hayman has managed to secure this debate. She introduced it with her characteristic intelligence and flair. I also say how much I appreciated the maiden speech of the noble Baroness, Lady Fritchie, which demonstrated enormous experience and knowledge and bodes very well for the future. I declare my interests as scientific adviser to the Association of Medical Research Charities, as a fellow of the Academy of Medical Sciences, and as an ex-medical researcher.
I say at the outset that despite the problems that may beset research in the UK, we do pretty well by any standards. We rank second only to the USA in any measure of medical research output. It has recently been demonstrated by Sir David King in an OST report of 2004 that we are way ahead of all other G8 countries. If you look at the amount of research that we get out per pound input, we are top; we do pretty well with Nobel prizes in medicine too. We have a Government who are clearly supportive of medical research, with a whole series of funding initiatives, and we have a strong voluntary sector with medical research charities putting in £3.25 billion in the past five years.
It is increasingly clear that we are gaining enormously from all this investment in terms of an increase in healthy lifespan. We are gaining two years' extension of life in every 10; that is, a child born today will live two years longer than one born 10 years ago. We are gaining about 30 minutes during the course of this debate. Half of that is due to advances in medical care. That gain is reflected in economic benefits arising from increased productivity. Recent calculations by the LSE show that, as in the USA, we gain £5 for every £1 put into medical research. A 5:1 return on investment must be music to the ears of the Minister.
With all that good news, it came as a surprise to hear that the Chancellor of the Exchequer, who is no slouch in reporting medical research and other research—he is excellent in that—surprised us by proposing to amalgamate the funding of the MRC and the NHS R&D budgets. But the unintended consequences of such a move may be considerable and, like the noble Baroness, Lady Fritchie, I have some concerns. The danger lies in the potential distortion of the balance between basic and applied research, away from the science base which is providing rich dividends, towards the applied, where there is a distinct possibility of its diffusion into NHS service—just as the NHS R&D funding is diffused into service, rather than into R&D. I hope that the Minister can provide us with some reassurance on all of that. Of course we are fortunate that Sir David Cooksey is overseeing this amalgamation, but he will need to pursue a delicate balancing act if he is to achieve a potentiation of research, rather than a damaging outcome.
I turn now to another problem that poses a threat to epidemiological research, which relies on information about patient data. Perhaps I may give an example. There was a suggestion that Gulf War syndrome patients were more likely to get cancer than others. It was only by an examination that compared the clinical records of thousands of Gulf War victims and other veterans that it was possible to show that there was no increased incidence. Similarly, only large-scale studies of the case records of thousands of children proved that MMR vaccination did not cause autism.
I believe that everyone—the public, patients and researchers—has a common interest in wanting such research to be carried out in an efficient and careful way, so that patients' confidentiality is preserved and that they will not be harmed or embarrassed by it. But now there has grown up an extremely complicated patchwork of UK and EU legislation—including the Data Protection Act, the common law on confidentiality, the Patient Information Advisory Group, Caldicott Guardians and the GMC—all of which require satisfaction; that is only a partial list. It is no wonder that researchers and ethics committees are confused and err towards preventing, rather than encouraging, research. Yet in most instances it is the interpretation of the law, rather than what the law allows or prohibits, that is the problem. That is because the law as it stands allows such research to be undertaken without consent, provided that such use is necessary and proportionate, respecting privacy and public interest benefit.
A reasonable and rational balance can be struck. All this is spelt out in an excellent publication from the Academy of Medical Sciences, to which the noble Baroness, Lady Hayman, referred, entitled Personal data for public good. It gives clear guidance on what can and should be done to inform and engage the public, to help ethics committees and researchers about what is allowable and what is not, and to ensure that a reasonable balance is struck between protecting individuals' rights and confidentiality and the public's need for research.
I hope that the Minister will take note of those recommendations. Unfortunately, I suspect that this matter is not in his department's responsibility; but, perhaps, he can pass on the message to the Department of Health, in whose court it may be.
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".
My Lords, as the noble Baroness, Lady Hayman, said, one of the UK's greatest assets is its science base. Much of the credit has to go to the noble Lord, Lord Sainsbury, for his unstinting support for the sector. Research in healthcare and medicine is the jewel in that crown. Since the discovery of DNA in Cambridge more than half a century ago, our scientists have redefined modern medicine. The UK today has tremendous strength in research and development across the whole health sector. We all benefit from health research, and today there is tremendous value to the economy from investment in health R&D.
Our pharmaceutical industry alone generates a trade surplus of £3.75 billion each year. In his Budget, the Chancellor announced combining the R&D spend managed by the Medical Research Council, the Office of Science and Innovation and those of the Department of Health. I, too, welcome that bold step.
This has created a dedicated, ring-fenced annual fund of more than £1 billion for health R&D. Sir David Cooksey's review does not have much time. Perhaps I could make a few suggestions. Obviously the new funding mechanism will have to fit into the nation's health priorities and science objectives. It will have to ensure key economic objectives: to produce high quality translational health research and deliver real economic as well as health benefits from the science base.
I firmly believe that funding should continue to be awarded on the basis of excellence across the whole spectrum of health, from basic to clinical to public health. We must maintain and enhance our skill base covering the whole range of science, engineering and technology, all of which is employed in supporting the nation's healthcare. I do not think that we should underestimate how long it will take for scientific breakthroughs to become practical medical interventions. It often takes decades.
I urge researchers to be patient. We must not raise false public expectations that fundamental research will rapidly produce miracle cures. Also, I do not think that the crucial role of technology and innovation has been appreciated. Only now are we fully recognising the importance of innovation. I am pleased to see that after more than a decade the Office of Science and Technology has become the Office of Science and Innovation. We spend some £3 billion a year on university research and only £100 million on encouraging the exploitation of that research in the form of innovation and knowledge transfer.
Is it not time to establish a technology and innovation council to join the ranks of the research councils to be specifically charged with fostering technology transfer? I have been arguing the case for such a council for more than a decade. After a long gestation now is the time for it to be born. We must step up our innovation effort with an institutional voice charged with making it happen.
You only have to watch an episode of the wonderful US drama series "ER" to realise the amount of technology being used in modern healthcare. While "ER" is a work of fiction, a weighty work of fact was produced by my noble friend Lord Warner in November 2004, the report of the health industry's taskforce. The taskforce defined the nature of the healthcare industry as an exciting, fast-growing sector, and went on to identify the opportunities for the United Kingdom.
What are these healthcare industries? They are the manufacturers of all the products used in the diagnosis, prevention, monitoring or treatment of human illness or handicap. They have grown out of other industries, such as engineering, informatics and biotechnology, which produce a vast array of devices, equipment and consumables for the health sector: from simple plasters and syringes to wheelchairs, from diagnostic test kits for blood transfusions to filtration devices, from radiotherapy machines to defibrillators and pacemakers, from anaesthetic machines and monitors to the highest of high technology scanners—all regulated under the European Medical Devices Directive.
More than half the UK population has contact with a medical device in any one day. It is a vast and fast-growing market: worldwide, it is already more than $170 billion. The UK market is about £6 billion, £4.5 billion of which is supplied by UK manufacturers, which also export some £3 billion of healthcare products. The Cooksey review could make a significant contribution to stimulating this industry. Since the creation of MRC Technology, the UK Clinical Research Collaboration and the new NHS R&D strategy, set out in Best research for best health, there is much to be done.
I declare a personal interest. All my academic life, I have been working at the science, engineering and technology end of the spectrum, transferring knowledge from university research bases to companies, working with NHS hospitals and medical faculties. As the director of the Warwick Manufacturing Group, I realised that there is a tremendous amount that one can transfer from engineering and technology, and what we have done in manufacturing industries, to the health sector. Therefore, I have decided to set up a £100 million programme, of which 20 per cent of the annual amount will be directed to healthcare. I am appointing a new chair in healthcare informatics, bringing one of the world's leading practitioners from Canada—the first of a series of appointments in this area.
Imagine: I work in the manufacturing industry and see the correlation between what happens in other sectors of industry and healthcare. If we can learn from one sector, and are able to transfer that to other sectors, there will be a tremendous improvement in productivity, such as we see day in, day out in the industrial sectors. Everything that Peter Gershon said about improving the efficiency and productivity of the health sector has come out of very simple technologies—not rocket science. We must learn from other sectors, and have a totally interdisciplinary approach in medical research and development.
My Lords, thanks to medical research, I expect to see the new year. Perhaps I may explain.
In March last year, I had an emergency operation for colon cancer. A subsequent scan revealed cancer spots on my liver. The doctor said that I must have chemotherapy. I asked, "If I don't have chemotherapy, how long have I got?". He said "10 to 20 months". So I had chemotherapy.
Before the treatment began, people gave me well meaning advice—not necessarily up to date. I was warned that, during chemotherapy, I would constantly be sick. However, the scientists had produced a wholly effective nausea suppressant, and I never felt the slightest twinge of sickness. Medical researchers had developed an array of modern drugs which were dripped into my shoulder every fortnight. After the seventh treatment, I had a scan. "The news couldn't be better", the doctor said, "you're normal. The cancer is not discernable".
Now, 13 of the original 10 to 20 months have passed. Without medical researchers and their amazing chemicals, I would never see another Christmas. However, because of their achievements, I hope to celebrate many Christmases in future. I only wish I could meet those scientists who have given me and countless others so much and say, "Thank you".
My Lords, I congratulate my noble friend on obtaining this debate on a subject that other noble Lords have demonstrated is extremely important. Although I was only briefly a full-time academic, I have initiated or taken part in a number of medical research studies over the years. I have also served on several inquiries of your Lordships' Science and Technology Select Committee that touched on medical research. The first was nearly 20 years ago and was on research and development in the National Health Service. It resulted in the appointment of the first director of research and development in 1991. So this topic is not unfamiliar to me, although it has required some homework to absorb recent developments.
The basis of my remarks will be the Department of Health document Best Research for Best Health, which was published in January this year, and two articles in the current British Medical Journal. The Department of Health's document is very positive and outlines plenty of ideas for the future of medical research in the National Health Service. It preceded the Budget Statement announcing a single medical research budget, but I gather it will slot into that framework—with its pros and possible cons, which have been outlined by my professional and noble friends Lord Turnberg and the noble Baroness, Lady Murphy.
Best Research for Best Health, while very optimistic in tone—a characteristic of government reports, of course—is honest enough to draw attention to some serious difficulties that need to be overcome if its proposals are to become reality. For instance, in the annex, on page 40, it states:
"Major change within the NHS has left clinicians under great pressure, with training and research too often taking a back seat . . . There has been a decline in the overall number of medical academics from 4,000 in 2001 to only 3,500 today. The number of clinical lecturers has declined by 30 per cent over the same period. Because of other priorities, universities appear reluctant to support those clinical academics that do exist".
Surely, that is another way of saying that they do not have the money. By way of explanation, the report states that:
"Between 40 and 50 per cent of clinical academic posts are funded by the NHS rather than by universities".
It would not be surprising if cash-strapped universities wanted that trend to continue. On this point, I ask my noble friend if the Government intend to fund the expanding number of clinical academics needed for the new strategy through the National Health Service rather than the HEFC? There is little in the report that addresses workforce planning for medical science, a problem emphasised in the briefing that I received from Universities UK for this debate. I am sure that that will be amplified by my noble friend Lady Warwick.
As my medical and dental academic friends have pointed out today and on other occasions, the number of medical students has continued to increase while the pre-clinical and clinical academic workforce declines. There are plenty of able minds among those entering medical schools who would succeed in a clinical academic career, given the right training. But soon there may be too few clinical scientists to train them to the high standards that we are used to. That has already happened in a few specialities, such as pathology. At the moment, the shortage of doctors opting for careers in research and teaching is largely due to the absence of a clear career pathway. Some of the problems involved have been addressed by suggestions in the Walport report. It would be interesting if the Minister could say whether any progress is being made. The Government must play an increased part and not leave the training of clinical scientists to the medical research charities, excellent though their work has been. I declare an interest in that my son obtained his PhD while he was holding an ICRF clinical fellowship.
Will the Minister say anything about the new primary care research network proposed in the document? How will this build on current academic general practice units in medical schools or the research support given by the Royal College of General Practitioners? There is rich potential for GPs to become more research-oriented and to acquire the research mindset mentioned by my noble friend. They could also become better trained in epidemiological and clinical research methods. If this network works well, it could be very important, as a huge gain could be had from using the lists held by every general practitioner. That resource is only just beginning to be tapped.
The two BMJ articles which I mentioned address different but relevant areas. The first, written by a Greek research team, analysed a series of frequently cited medical research papers and found that, during a recent decade, the proportion of industry-funded studies significantly increased in relation to publicly funded studies, particularly randomised drug trials. This occurred although the majority of authors worked in a public/university setting. The authors state:
"Clinical research"— that is, industry-funded clinical research—
"is dictated by the need to promote products of industry . . . academics may have indeed lost control of the clinical research agenda . . . Many important questions in clinical research have no connections with specific products and thus would not be supported by industry".
This was alluded to by the noble Baroness, Lady Fritchie, in her excellent maiden speech. In other words, it is easier to obtain industry funding for research than it is to obtain public funding, but it comes at a price. This situation is likely to continue owing to the huge imbalance in available research funds between the public sector and industry.
I shall just skim through the second article. A team led by the London School of Hygiene asked 3,000 people whether privacy was important in gathering information to be used for epidemiological studies. Eighty-eight per cent said that it would not be a problem for them. Only 8 per cent said that it would. Eighty-one per cent said that registration of all cancer cases should be made compulsory as in Scandinavia.
Concerns expressed about the need for informed consent or anonymity may have reflected the views of a minority. This does not mean that the minority view must not be taken into account, but it suggests that the great majority of the population would not wish excessive attention to confidentiality to interfere with gathering data essential for medical research.
My Lords, I join others in congratulating the noble Baroness, Lady Fritchie, on a maiden speech which was full of insight and inspiration. She emphasised the need for something for which she is renowned—new and energetic thinking—and from which all of us in this House will benefit.
I also congratulate my noble friend Lady Hayman on introducing this important debate. I value the opportunity in particular because it gives me a chance to reinforce her point that figures recently published by the Office of Science and Innovation show that, for the first time, the UK research base has outperformed the United States in key areas of the life sciences. That is excellent news. It is a huge area of work for our universities. Here I declare an interest as chief executive of Universities UK.
Research income relating to clinical medicine accounts for about 30 per cent of all research income to universities—nearly £700 million in 2003–04. Of that, 47 per cent is income from charity-funded research and 7 per cent from business and industry.
Just two weeks ago we debated investment in R&D in this House. It is clear that we have a long way to go in stimulating business investment in R&D, but the one success story, referred to many times in the debate, is research funded by the pharmaceutical industry. Another huge contributor has been charities involved in medical research.
There are two ways of looking at this. On the one hand, we should be doing all we can to encourage other sectors to engage, but, on the other, we cannot afford to be complacent about maintaining our attractiveness to investors in research in health-related fields.
So there are several issues we need to keep a close eye on. Many issues have been raised in this debate, not least clinical academic numbers, but I will deal with just two. The first relates to full economic costing. The Government already pay 80 per cent of the full economic cost of research funded through the research councils. That is very welcome and is moving the UK research base back towards financial sustainability. However, a very large proportion of research, particularly in health and medicine, is funded by charities, which generally do not pay full economic costs, for reasons we understand, although Universities UK is in discussions with the Association of Medical Research Charities about that.
Meanwhile, the Government have taken the very welcome step of setting up the Charities Research Support Fund, a funding stream directed through the funding councils as part of quality-related core funding set up to address the issue and to support charitable research through partnership. This is a very positive and helpful development, but we may need to look at how we can develop this further.
Secondly, the Government announced plans as part of this year's Budget to ring-fence the Department of Health's research and development budget and create a single health research fund of at least £1 billion per year. My noble friend Lord Turnberg and other noble Lords expressed caution about this, but in my view it could offer the opportunity to develop more effective focused structures to support world-class health research.
While the redistribution of funding may be destabilising in the short term, I have been reassured that the Government are committed to minimising that destabilisation. Universities UK is engaged in discussions with the Department of Health about how this will work in practice. I do not intend to dwell on the detail; however, I add one question to the various others raised on this issue today: has the Minister any comment on how the budgets will be managed, in view of the fact that the NHS R&D budget is an England-only budget, whereas the MRC budget is UK-wide? As the Minister will be aware, some concerns have been expressed that the smaller nations may lose out as a result of this change. I hope that my noble friend can provide some reassurance on that point.
Of course there will be discussions about how priorities for the new amalgamated budget will be determined. Here I simply lodge my own conviction that the Haldane principle—that individual funding decisions should be independent of government—should be preserved. Again, I would value the Minister's comments on that.
I should also like to mention one way in which universities are seeking to enhance their international reputation for quality in medical research. Universities UK, with the Department of Health, the higher education funding councils, the MRC, BBSRC, the Wellcome Foundation and other charities, has established the UK Panel for Research Integrity in Health and Biomedical Sciences. This is an important move because the panel's aim is to promote the highest standards in leadership, governance and management in research in these fields, to ensure that a culture of integrity is firmly embedded.
Fortunately, research misconduct in the UK is rare. However, a further aim of the panel is to develop a register of advisers, making the best expertise and experience available to the research community where there are allegations of misconduct. That is an excellent example of a proactive, university-led initiative to address potential threats to our international reputation for quality in research. I hope that the House will share that view.
As so many other noble Lords have said, we have much to be proud of in the strength of our medical research base. Its international reputation is hard-won and its contribution to high quality patient care beyond doubt. To preserve that, the Government must ensure that research remains at the heart of the agenda as they pursue NHS reform.
I happened to see yesterday a press release from the Australian Minister for Health and Ageing, announcing additional investment totalling 905 million Australian dollars a year for health and medical research. I understand that, since 2001, Australian government funding for medical research grants and fellowships has quadrupled. So I end by asking the Minister, in the context of the forthcoming spending review: may we, too, be optimistic of a similar step-change in our Government's level of investment?
My Lords, I thank my noble friend Lady Hayman for initiating this extremely important debate and congratulate the noble Baroness, Lady Fritchie, on her splendid contribution to it. I also compliment the Government on supporting a variety of important initiatives in medical research. I have in mind the Department of Health's document Best Research for Best Health. I also have in mind the idea of a single fund for the MRC and NHS health research, announced not long ago as part of the Budget. I know that the noble Baroness, Lady Fritchie, and my noble friend Lord Turnberg have some reservations about that, but I am inclined to share the view of my noble friend Lady Warwick that this may be one way of straddling, or at least undermining, the division that has developed between basic research and clinical research, about which I shall say something shortly. I am also very pleased that the Chancellor of the Exchequer has decided to contribute to medical research £1.2 billion a year from 2008. I especially welcome the appointment of Sir David Cooksey to decide how the money should be used.
If all those initiatives are to bear results, we need carefully to consider some of the structural problems that medical research seems to face in this country. I do not want to underestimate the enormous amount of research that is taking place, nor the fact that we are at the top among European countries and are second only to the United States. At the same time, there are certain obvious problems. I want to highlight five of them, which I think deserve some attention.
First, over the years a gap has developed between basic research or discoveries, on the one hand, and clinical research on the other. The recently set-up UK Clinical Research Collaboration, which brings together almost all relevant bodies, is a good initiative on which we need to build. But by itself, it is not enough. Simply throwing together people involved in basic science and clinical research will not generate a catalytic impact unless there is a constant movement between people engaged in clinical research and basic discovery.
Let us take, for example, someone involved in clinical research on asthma. He or she would benefit enormously from spending time in the universities where physiologists are involved in basic research on animal cells and animal tissues. It is important that basic scientists can effortlessly interact with and move into clinical research, because that is the only way in which the two groups of people engaged in two different kinds of research will be able to sensitise each other. Some interesting ideas on this have been expressed by people such as Professor Colin Blakemore. That deserves attention.
My second anxiety concerns clinical research itself. There are several reasons why, as several noble Lords have pointed out, clinical research has suffered over the years. There is an unsatisfactory career structure; there is insufficient flexibility in the balance between clinical and academic training; there is a shortage of properly supported staff; and, obviously, as several noble Lords have pointed out, there is the low status of clinical research. Obviously the Government's initiative in having 250 academic clinical fellowships and about 100 clinical lectureship training opportunities is to be warmly welcomed, but my feeling is that this is not enough by itself. We will need more. We will also need to find ways of bringing together clinical researchers in different areas and not simply letting them co-exist side by side. We will also need to attract talented individuals into clinical research because, given its low status, not very bright people tend to be attracted to it. We will also need to find proper career paths and raise the status of clinical research if we are to ensure that it flourishes as well as academic research has done in our country.
I want to highlight a third problem. The NHS is a wonderful environment for clinical research, but I am not entirely sure that this environment has been fully exploited. Various factors are responsible for this. The research culture in the NHS is rather limited, because the NHS seems to be geared mainly, or at least primarily, to dealing with patients. NHS trust managers are more concerned with their target culture than encouraging a research culture, and we have not devoted sufficient attention to devising incentives so that senior consultants and others do research rather than enter private practice or take early retirement. We would also find it useful to encourage GPs and hospitals doctors to spend time with those engaged in clinical and basic research.
My own feeling in this connection is that the way in which our medical graduates are trained needs to be looked at. Their training does not involve much research input, unlike at some universities such as Harvard and Yale, where I was privileged to spend some time and where students are encouraged to do both clinical research and a PhD, and where an MD involves not only clinical experience but also academic research. This combination of both research and clinical work is not sufficiently encouraged in our medical schools. Dr Anant Parekh, who is professor of cardiovascular physiology at Oxford University, tells me that, as a professor of medicine, he feels that research would be of enormous benefit if it were somehow incorporated into medical training as it is into the training of social scientists. People going into the NHS or other areas would then already have a research inclination.
My last point is that, although research is being done in all kinds of areas, we need to devote a little more time to collaborative research than we seem to have done, not only in the European Union but in developing countries. I can see several advantages to this. First—I am speaking here to a Labour Government—it would help us to establish research infrastructures in developing countries. It would outsource part of our work and therefore release our consultants and researchers for other kinds of work. It would also draw on the experiences of doctors and others working in those areas and who therefore have certain sensitive insights into how certain kinds of diseases occur.
I have a family foundation, and we have been encouraging exchange between doctors and others from Indian universities as well as British ones. It is very striking that these Indian doctors and research scientists bring with them certain intuitions, because they deal with a wide variety of diseases that no longer exist or no longer operate in the same way. These insights could contribute enormously to the kind of work that is being done here.
I therefore very much hope that, while this enormous amount of money is being injected into medical research—I hope more will be injected—and as we devise new institutional structures, we will attend to some of the significant structural problems.
My Lords, I want to take issue with a number of things that have been said this afternoon by noble Lords, the first of whom is the noble Lord, Lord Turnberg. Although the life expectancy of some of us might be extended by 30 minutes, whenever I stand up in this Chamber, mine is shortened by at least 30 minutes, even if I am speaking for only five.
I congratulate my noble friend Lady Hayman on introducing this very important and timely debate and on her chairmanship of Cancer Research UK during the difficult transitional period which she mastered wonderfully. I absolutely agree with her about its relevance to basic blue skies research. But I fear that at that point I rather take issue with her and I wish to part company, to some extent. At the moment, one problem in research—to which I drew attention in the debate two weeks ago and which we have heard a little about already—is regulation. It is inhibiting blue skies research.
I told a story two weeks ago about the difficulty in getting a simple project to do stem cell biology through the HFEA, and it being peer reviewed—although on what basis I do not understand. Incidentally, I understand from the HFEA that it was sent out to two peer reviewers. Only one bothered to reply, which was completely inadequate scientifically. We rebutted all the points. That reviewer replied, but did not answer any of our points. That is a disgraceful example of how projects should not be reviewed. I do not understand why, when you are not applying for public funds or trying to publish, it needs to be peer reviewed. One would think that the HFEA should have the expertise in house to deal with a fairly simple project of that kind.
With due respect, it is interesting that the HFEA keeps saying that it provides the conditions for public confidence. One could argue that having a regulatory authority may raise rather than allay public fears, which is an issue on which I do not think that we have ever done any research. We produce the mantra but we do not have any evidence from social science research one way or the other. It is about time that we did, particularly as the noble Baroness talks about the public understanding of science. It should be the public engagement with science. The public understand the science very well. By and large, they trust what is going on in stem cell biology. There is not much doubt about that, but the issue is whether we have found the right mechanisms for listening to their views.
One problem is that on taking a consultation based on a website, which the regulatory authority does, you inevitably get skewed opinions. You get people who are representing their opinions from extreme ends—people like myself. I have an interest as someone involved with stem cell biology as a medical researcher and with a spin-out company at Imperial College. On the other side, you will have the people from the right to life movement who have strong views. But the broad public opinion, which is probably largely supportive, will also be largely silent. That is an issue, too, that the noble Baroness rightly raised with regard to animal research. It is sad that it takes so long to get a licence. As I pointed out two weeks ago, it took me 13 months to get a licence to inject six pigs with a completely painless gene construct which caused no damage to the pig.
I want to come back to a key issue. This House, together with another place, overwhelmingly voted strongly in favour of a very important development in biology; that of stem cell research. The HFEA says—we have heard it said in this Chamber today—that we lead in stem cell biology. That is a little bit of an overstatement. This morning I downloaded all the English publications on human embryonic stem cell research from www.pubmed.co.uk, the medical index. There are now 14 licences on the HFEA website, although it seems to be nine months out of date, so there may be more. I am surprised that it is not updated more regularly. But most of the research projects have not yielded a single publication. Two units have managed 13 publications between them. The others have managed, altogether, just five. The number of publications from this country in stem cell biology, although this is an area in which we should be expert, is less than from Israel or Singapore, both of which have half the population of London. That is not a very impressive record. There is no question that clinicians are inhibited in this country from doing research by the regulatory frameworks. The HFEA is just one example. It happens throughout regulation with regard to ethics approval.
On the train yesterday I read the April issue of Human Reproduction, the leading and most high-impact journal in my field. That British journal contains some 35 publications, only three of which come from the United Kingdom; the rest are from other countries. That is rather astonishing. In part it may be because of commercial activity in the field, which is a problem, but I think it is also that we are finding it more and more difficult to attract clinicians to clinical research of any kind in this country. I fear that the regulatory framework may have something to answer for. In his speech I hope that my noble friend on the Front Bench will try to suggest ways in which we might speed up the regulatory framework. I think it is wrong for me to have seen published in Nature only a month ago research that I wanted to do over a year ago, but was not able because I have not been given permission to do it in this country. In the meantime, colleagues have conducted exactly the same experiment in the United States.
My Lords, I thank the noble Baroness, Lady Hayman, for giving us this timely opportunity to discuss a very important subject. I also welcome the noble Baroness, Lady Fritchie, to your Lordships' House. Her remarks about public health, in particular on research into ageing issues, were extremely interesting. I look forward to her participation in future debates.
Every day my school bus passed a building that had probably been a Victorian workhouse or fever hospital. No one paid much attention to it until 1978 when it became the centre of the world's attention. In that year it was where Louise Brown—to give her the full title: Louise Brown the first test-tube baby—was born. She was not born in Cambridge or London—I say in passing to the noble Baroness, Lady Murphy—and she was not born in America. Rather she was born in Oldham, with a clear view of the pitch at Boundary Park. It is a source of ongoing pride to the people of Oldham that she was born there and that her birth took place in an NHS hospital. Just why and how the remarkable team of Edwards and Steptoe created that remarkable breakthrough I leave for noble Lords to read in the forthcoming book of the noble Lord, Lord Winston.
Some 25 years on, it is right to assess the position of our country as the place where brilliant scientists have the freedom to make breakthroughs. That we are able to do so is due in part to the quality of our academic institutions, the strength of our regulatory framework—although I listened carefully to what the noble Lord, Lord Winston, had to say—and the freedom we give researchers to pursue knowledge without unwarranted interference from religious or political interests. I mention religious interests because researchers are now coming from the United States to work here because of intrusions by some religious organisations. As noble Lords have said throughout the debate, the NHS provides a marvellous base on which to conduct epidemiological public health research.
The announcement of the review by Sir David Cooksey is welcome in that it offers the potential to reduce fragmentation of funding and bureaucracy, the dual nightmare of researchers, as the noble Lord, Lord Winston, pointed out. It also promises a review of the research assessment evaluation exercise. In our debate on
First, it would appear from the documentation that the DfES is not a part of this review—it does not appear in any of the press releases or briefing materials—but, given that academic medicine is such an important part of the whole research package, it really should be included. Fifteen per cent of the R&D performed in UK universities is funded by charities. As the aim of the review is to rationalise medical research funding and maintain the UK's position, it seems rather strange that the DfES is not involved.
The noble Lord, Lord Rea, spoke eloquently and at some length about the pressures on clinical academic staff. The great concern is that the teaching burden on them is increasing exponentially so that the time available for them to carry out research will not be there. That will not only impact on patient care but, I suspect, it will ultimately impact on the workforce. If our clinical academics do not find that space and time in this country they will go to other places, such as China and India, where they will be given those resources, and we will lose their knowledge and the diversity within the NHS which is one of its greatest strengths.
The announcement on
The Minister will no doubt be aware that many of the medical research charities are concerned that the Department of Health funding will not be ring fenced. There is a further concern that, in the merged fund, research that has a greater commercial potential will flourish at the expense of research of a more theoretical nature or research which is more complex or longer term.
I remember talking to one of my colleagues who, on becoming a lecturer at Cambridge, found himself having dinner with a number of his colleagues, among whom there were two Nobel Prize winners. Everyone was making a great deal of one of them but said nothing about the other. My friend asked, "He has just won the Nobel Prize, why aren't people making a fuss of this guy?"—to which he got what I gather is the standard answer at Cambridge, "Well, it is not maths, is it?".
As many noble Lords have said today, it will be in fields which are not directly related to medicine that some of our biggest advances will come. Can the Minister tell the House whether the current review will address the concern about commercial drivers for research and, if so, how?
As we discuss this matter, the courts are delivering their verdict on the animal rights activists who terrorised the Hall family in Derbyshire. I am a passionate believer in the right of people to practise animal research and the need for it to happen. Computer modelling, epidemiology, cells, tissues, imaging, screening and clinical trials are all alternatives to animal research. As the law currently stands, animal experiments cannot go ahead if the research can be carried out without animals and each laboratory that conducts animal research has an ethical review process. However, at present it is not possible to recreate the interplay of vital organs, the workings of the immune system or the likely toxic effects of a new medicine in non-animal experiments alone.
It is imperative that in the review we maintain our support for those who are involved in the legitimate pursuit of the development of knowledge which will alleviate human suffering. Given that GSK had to go to court on Tuesday to protect its shareholders, what further steps, in addition to the legislation last year, will the Government take to ensure that life sciences research organisations are not intimidated out of existence in this country?
It is widely recognised that gene therapy and drug development offer the greatest potential for treatment of conditions such as cancer. There is frustration within the medical research community that the NICE review process for medicines and medically assisted technologies is laborious and long. Yet if one listens carefully, there is widespread agreement that NICE, although far from perfect, independent as it is, is absolutely necessary to the integrity of scientific development. The alacrity with which the Secretary of State gave in to the campaign for Herceptin several months ago, a drug for which Roche had not even applied for a licence, was alarming. It did enormous harm to the standing of NICE. In this review of best practice, what role will NICE have in gathering together the scientific evidence base and will this present an opportunity, once again, for the Government to support NICE and its efforts?
A number of noble Lords talked about the potential fracturing of research within the NHS because of the full-scale upheaval going on. We do not yet know whether PCT reorganisation and practice-based commissioning will have a beneficial or a detrimental effect. What steps will the Minister's department take, along with the Department of Health, to ensure that research, specifically in specialist areas such as neurology and audiology, do not slip away and become lost as the big medical issues with the high profile and the popular image take over what limited resources there may be.
Finally, I return to that Victorian building in Oldham. It is still there today, although it is part of bigger PFI premises. It is part of the Pennine Care NHS Trust which announced last week that 800 jobs are about to go in 400 hospitals, of which the Royal Oldham is one. I really wonder whether it would now be possible for a brilliant team, such as the one that was there in 1978, to appear, and with co-ordination, vision, flexibility and understanding, to produce such a momentous breakthrough as happened then. Whatever else comes from this reorganisation, I sincerely hope that we will remain a country in which brilliant scientists have the space and the wherewithal to do brilliant things.
My Lords, I am only too glad to echo the comments of other noble Lords in congratulating the noble Baroness, Lady Fritchie, on an excellent maiden speech and thanking the noble Baroness, Lady Hayman, for tabling a Motion on a subject of unusual importance. It is important not only for the well-being of patients but also, as we have heard, for any claim that we may have in this country to regard ourselves as a world-class force for progress in the medical sciences. There is so much to which we could point to validate such a claim: the standing of our universities in world league tables; the continuing keenness by pharmaceutical companies to maintain and build their research capacity in the UK rather than elsewhere; the vibrancy of our medical research charities, which account for at least 15 per cent of our R&D spend; the constant stream of medical advances which this country has pioneered over many years; and the NHS itself, as a platform for research. All these are rightly to be celebrated and nurtured.
I feel able, at the opposition Dispatch Box, to acknowledge that there are areas in which the Government can hardly be faulted. I refer to their commitment to increasing the medical research budget year by year in the MRC and NHS and in securing broad agreement on how best to encapsulate the ethical underpinning of research in recent legislation. In measuring how high this country jumps in terms of medical science and research, we are lucky enough to begin with the bar set high, with a shared purpose to achieve the same successful outcomes.
Ready as we may be to trumpet our successes, however, a debate such as this is, if nothing else, an opportunity to look closely at those aspects of our system that are working less well and where we may be falling short. The first issue I want to focus on is regulation. It is generally agreed by those in the research field, as well as on all sides in Parliament, that a strong regulatory framework for conducting basic and clinical research is indispensable. However, we are hearing from the medical community an ever-growing threnody that the burden of regulation has now reached the point where it is obstructively and unreasonably deterring doctors and university departments from initiating research programmes. The noble Lord, Lord Winston, has spoken about that today very eloquently, as he did on
There is the serious issue of multiple approvals for clinical trials, which, thank goodness, the Government look as though they are now addressing. Two years ago in this House we debated the Clinical Trials Regulations. We wondered then whether the persistence of the Minister, the noble Lord, Lord Warner, in trying to minimise the most burdensome effect of the directive would in practice prove fruitful. If we had doubts about that, we are now seeing them borne out.
Take cancer. Two months ago an editorial in the BMJ reported randomised trials of a new anti-cancer agent as follows:
"The Directive requires reporting of all suspected serious adverse events, regardless of whether they are caused by the underlying disease, chemotherapy or the investigational drug. Information on each such adverse event needs to be distributed globally to all investigators working on the molecule. The co-ordinating investigator has already received 219 faxes, each consisting of between two and 36 pages. The Directive also requires that each event is reported to local ethics committees, together with an ethical evaluation. So far these have been discussed in 14 sessions of the Tampere ethics committee".
That situation is being replicated up and down the country. The result is that the cost of conducting non-commercial clinical trials has risen dramatically. The business of managing authorisations requires more staff; insurance and indemnity costs go up; the cost of submissions to research ethics committees go up and so do the costs of pharmacovigilance. We get to the point where, for many investigator-initiated projects, the cost of regulation consumes the money allocated to do the research. If we are not careful, the flow of new therapies will simply dry up, especially those that, because of their complexity, pharmaceutical companies find unattractive.
The answer is not to throw money at these problems. I found myself, in common with others, bemused by the Chancellor's announcement that the budgets of the MRC and for NHS research were to be merged. The announcement was made without any prior consultation, and one has to wonder what lies behind it. The noble Baroness, Lady Hayman, set out several concerns, as did others. If it is intended as an oblique means of shifting significant money away from basic research and into translational research, I, with others, would want to sound a loud warning. Even if that is not the intention, it could be the effect. Translational research is vital, but we de-emphasise basic research at our long-term peril. We wish Sir David Cooksey well as he reviews these matters in the context of the strategy set out in Best Research for Best Health.
I want to touch now on an issue that I do not think has been mentioned. No science base worth its name is possible without children at school pursuing science subjects to A-level and through to university, and without a sufficient supply of science graduates to teach them. The warning signals have been plain for a number of years now that we are simply not getting enough children to take up science seriously. In the past 20 years the number of pupils taking A-level physics has declined by 35 per cent The supply of physics teachers is diminishing with alarming rapidity, and nearly a third of them are in their 50s.
What is to be done? The announcements in this year's Budget of a programme of recruitment of new science teachers and of extra money for schools science were, of course, decidedly welcome. But if we look at what has gone wrong with this part of the school curriculum, we have to confront some pretty stark and unpleasant truths. Last summer the Oxford and Cambridge RSA did a survey of teenage children about their views on science lessons. Ninety-three per cent of them said that they did not regard science or scientists as being "cool". Over half thought that science lessons were "boring and confusing". When Save British Science did a survey recently, it found that in more than three-quarters of secondary schools, science practicals had been cancelled, and that by far the most common reason given for that was the rowdy behaviour of pupils. In fact, bad behaviour was seen as the single biggest problem for the teaching of science subjects, far above lack of equipment or class sizes. That poses a question mark over standards of discipline maintained in the classroom, but there is another question mark over the content of the syllabus. Dr Martin Stephen, High Master of St Paul's, recently voiced his view that the attempts to make science GCSEs more relevant had left them "unchallenging and uninspiring". He said:
"The new GCSEs are to real science what baby food is to steak and chips. They will bore the pants off many students, not inflame them with a new love of science".
Dr Stephen is by no means alone in these opinions.
The message here is surely that more money for schools science, although very welcome, may not be the most important ingredient in the revival of science that we all want to see in this country. The danger is severalfold. A number of universities are making cutbacks in their science and medical departments. That not only leads to the erosion of particular disciplines in their own right but also has a damaging effect on the ability of a university to maintain cross-disciplinary excellence, which my noble friend Lord Colwyn did so well to mention, as did the noble Lord, Lord Bhattacharyya.
Pharmaceutical companies are finding it increasingly hard to source home-grown science graduates with good degrees. The key issue here is the quality of graduates. Funding from award councils that has nominally been allocated for teaching medical students is calculated on the number of students being taught, as opposed to any real measure of the teaching quality. The incentives to provide the high-quality teaching essential for research are therefore lacking. One manifestation of that is the shortage of clinical academics. I do not propose to spend time speaking about that because, serious as the problem is—and it is extremely serious—not too long ago we had a very fruitful debate on that very subject, led by the noble Lord, Lord Turnberg. If there is an overriding key message that I would pick out it is that universities must not just be places where students are taught; they must also be centres of academic excellence. Without fostering and maintaining those centres of excellence, we are into a downward spiral in which the business of attracting and retaining good people, both to learn and to teach, will become ever harder. Indeed, that was the theme of the excellent debate about universities initiated by my noble friend Lord Patten on
For our science base to thrive, and for the UK to hold its own internationally in that sense, the expertise of our university faculties, pursuing learning and inquiry for their own sake, must be the benchmark we use above all others to measure success.
My Lords, I am grateful to my noble friend Lady Hayman for introducing this debate. We all appreciate her great personal interest in and commitment to this area. I congratulate the noble Baroness, Lady Fritchie, on her excellent maiden speech. It had everything that we admire in this House—expert knowledge, clarity of thought, and passion—and we look forward to many similar speeches of such quality in the future. I am also very grateful to the other contributors to the debate. I was very moved by the speeches of the noble Baroness, Lady O'Cathain, and my noble friend Lord Acton setting out their personal experiences. It is important that people do communicate these messages, because at the end of the day that is enormously important in encouraging researchers and showing the public how important this area of research is.
The UK is a world leader in both industrial and academic medical research. The Government believe that it is a major national asset which should be strongly supported. That is why we have steadily increased funding to the Medical Research Council, whose budget has risen from £289.1 million in 1997–98 to £480.8 million in 2005–06, which represents an increase of 72 per cent I assure the noble Baroness, Lady O'Cathain, that we will continue to give full support to medical research in the future.
I echo a number of speakers in the debate who said that UK university research in this area has an outstanding record. We remain strong internationally in terms of achievement, productivity and efficiency. The latest report of the Office of Science and Innovation shows that in the fields of preclinical and health research we rank second only to the USA, with a 12 per cent world share of citations, and in the field of biological and clinical sciences we have a 10 per cent share of citations. As someone pointed out, for a country with 1 per cent of the world's population doing 5 per cent of the world's science, that is an extremely good performance.
It is also true that research funded by the MRC has led to some of the most significant discoveries and achievements of 20th century medicine. For example, Watson and Crick were based in an MRC unit in Cambridge when they made their discovery of the structure of DNA. Monoclonal antibodies have revolutionised biomedical research and sparked an international billion-pound biotechnology industry. The original techniques were devised in the MRC Laboratory of Molecular Biology in Cambridge. Again, it is clear that we have world-class research, but it is worth focusing on those two discoveries, because they have revolutionised medical research. They were both absolutely based on fundamental basic research, and one needs to always keep that relationship in mind.
Translating the results of basic research into direct clinical and economic benefits is also of key importance. The MRC's strategy for doing so ranges from support for experimental medicine to funding clinical trials and other population level studies. Translational research needs a vigorous exchange of ideas, methods, people and priorities between basic and clinical sciences, which the MRC actively promotes. In January 2006, it launched a call for centre grant applications to strengthen translational research in the UK. Some 22 applications were received, and the awards will be made in the autumn.
Collaboration with industry is another important area for the translation of basic science into economic and medical benefits. The MRC does this through MRC Technology Ltd, which is responsible for exploiting the intellectual property rights from research in MRC research establishments. Between 1987 and 2004, the MRC received more than £102 million in income from exploitation of its intellectual property rights and granted around 457 licences. The MRC's commercial income was £28.5 million in 2004–05 and expenditure on commercialisation was £9.3 million. This level of licence income is equivalent to 9 per cent of research expenditure in MRC institutes and units which, on the basis of the most recent comparative figures available, is more than three times the proportion achieved overall by US universities and around 15 times the level in UK universities. I am also glad that my noble friend Lady Hayman drew attention to the fact that the quality of our medical research is a key factor in helping to keep world-class pharmaceutical and biotechnology industries in this country.
We are rightly proud of the past achievements of the Medical Research Council and we want to build on those. We also want to build on another huge advantage that the UK has in the translation of research into the clinic: the National Health Service. The NHS has a key role to play in determining the future health and wealth of this country and the Government are determined to harness its capacity to make the UK the best place in the world for health research, development and innovation. The Government's new strategy for NHS research in England, Best Research for Best Health, aims to create a health research system that supports outstanding individuals, working in world-class facilities, conducting leading-edge research that is focused on the need of patients and the public. The NHS also provides researchers with potential access virtually to the entire population, through an integrated system of primary, secondary and tertiary care. This is a unique selling point for public sector researchers, charities and private sector organisations.
Acting on reports from the Academy of Medical Sciences and the Bioscience Innovation and Growth Team, the Government created the UK Clinical Research Collaboration in 2004. It is a partnership of organisations, bringing together the National Health Service, research funders, industry and other stakeholders to develop joint actions to support clinical research in the UK and exploit the potential of the NHS more effectively. The UKCRC has had a successful first 18 months and has shown that the Government, working in partnership with the pharmaceutical, bioscience and healthcare industries, can not only increase communication and co-ordination between key stakeholders, but make things happen. I am glad that my noble friend Lady Hayman drew attention to what I think is a success story.
More can be done, and at the time of the Budget, as noble Lords have mentioned, the Chancellor announced a single jointly held health research fund. The aim is to maximise the impact of the MRC's funded medical research and the Department of Health's R&D. It will build on the UK's world-class medical science base and recent developments such as the development of the UKCRC and the Government's new strategy for R&D in England, Best Research for Best Health. It has enormous potential.
As noble Lords have pointed out, deciding on the best institutional arrangements for public funding of health research is difficult. Sir David Cooksey will be leading the review which will advise Government on the best way to take this forward. Perhaps I may say to the noble Baroness, Lady Fritchie, that, knowing Sir David very well, too, I am sure that we shall see some new and energetic thinking, which will be conducted extremely well. The noble Baroness, Lady O'Cathain, was slightly optimistic about the date. I hate to be in the position of suggesting that it may be a bit later, but the timetable will be slightly longer than the noble Baroness suggested. However, I am sure that Sir David Cooksey will complete the task as quickly as possible. He launched the consultation on
I wish to make clear that there is no intention in this move to alter in any way the balance between basic and applied research. I say to the noble Baroness, Lady Murphy, that what we want to do is not to change the balance but to make the research more effective. At least some people feel strongly that National Health Service R&D has been used to fund all sorts of infrastructure issues and that it is sometimes hard to see where the actual research has been carried out. We think that we can make this research more effective. I am sure that it will be carried out on the basis of excellence and relevance, not on geopolitical grounds. I should also tell the noble Baroness that there is no plan to cut the £1.3 million. The Cooksey review will look at whether the totality of £1.38 million should be included in a single budget, or whether there is still a case for some of that remaining with the National Health Service and be very much focused on the policy issues that it needs to address.
There is certainly no intention of altering the Haldane principle. It is something that we all approve of—very strongly in my case. It is fundamental. However, when I asked my civil servants recently who Lord Haldane, the person who introduced the principle, was and where it was written down, no one was able to find out. The answer is that it is not Lord Haldane the scientist but Lord Haldane the Cabinet Minister. However, it is a principle that we all accept, and it is in the 1980 report on the machinery of government. It is a very good idea and we totally support it.
Another fundamental issue raised during the debate was the question of regulation. I agree with my noble friend Lady Hayman that we have to get better at a key aspect of this—that is, working in Europe to make certain that any regulation that comes from there is sensibly drafted so that it does not cause us problems.
My noble friends Lord Turnberg and Lord Winston talked eloquently about the restrictions that they feel are hindering research. The Department of Health is aware of this problem and I agree that there is an issue here. I shall be meeting my noble friend Lord Winston to see whether there is any way in which changes can be made to ensure that we get good regulation. We do not want to get rid of regulation—good regulation is fundamental—but there is a difference between regulation and bureaucracy. The latter achieves nothing other than to hold up important work that needs to be done.
I cannot agree with the noble Lord, Lord Colwyn, that our IP policies, or the Patent Office policies, are in any way holding up the exploitation of our research. They are very similar to those in the United States. We make certain that all the IP goes to the people who carry out the research, which is what happened in the Bayh-Dole Act in America. I know of no cases where it is felt that we have problems in that area.
The noble Lord, Lord Ramsbotham, raised the question of research into mental health problems in prisons. I am very glad to hear that in my absence my charitable trust, the Sainsbury Centre for Mental Health, is continuing to do good things. Unless things have changed in my absence, I assure the noble Lord that the charity is very keen to do research but it does so only if it leads to policy changes. Unless that has changed while I have been away, that will continue to be the case.
The noble Baroness, Lady Murphy, and my noble friends Lord Rea and Lord Parekh raised the important area of clinical excellence. This area has been neglected in the past but, due to some excellent work by Mark Wolpert of the Wellcome Trust, there is now a real focus on solving the problems there. One problem is the length of the training that people have to undergo if they are to do clinical research. They have to get the qualifications that a researcher would have—that is, a PhD—and then they need the clinical experience that a clinician would have. That means that only very late in their lives do people get to do any clinical research, and there are very uncertain career prospects after that. Mark Wolpert has done some excellent work on this and the issue is now being focused on. I think that we can raise it up as it is an area that has been neglected and we need to do something about it.
My noble friend Lord Parekh also raised some other important and interesting ideas concerning the clinical area. I shall certainly read in Hansard what he said and give it some thought.
My noble friend Lord Bhattacharyya raised the question of a council for technology, but I would be rather against that. We now have the Technology Strategy Board and the technology programme. Those are clearly focused on what they should be doing—that is, applied research and research carried out in collaboration with industry, with a clear focus on competitive advantage. It is very difficult to do both applied and basic research within one organisation. It is much better if they are carried out by different bodies as they are managed and evaluated in different ways.
The noble Baroness, Lady Warwick, raised the question of MRC money being on a UK basis and National Health Service money being on an English basis. That is exactly the kind of problem and snag that we have asked Sir David Cooksey to help us with. The noble Baroness also asked whether we could expect to see a greater increase in medical research in the comprehensive spending review. As she will know very well, there are two answers to that. If it were my decision, the answer would be "yes", but the official government response would be "wait and see".
My noble friend Lord Rea asked whether clinical researchers will continue to be funded by the NHS. I believe that discussions are taking place between the Department of Health and the Higher Education Funding Council for England to secure how best to make certain that that funding is made.
The noble Baroness, Lady Barker, raised the question of animal rights extremists. We have done a lot both on the legislative front and in terms of forming a special police unit under assistant chief constable Anton Setchell in 2004 to take a national view of the issue. I think that after some considerable time the unit is now beginning to get on top of this problem. A lot of prosecutions are now taking place. There is still a lot to do but the Oxford biomedical facility will be built. Is it encouraging to see young people taking a stand in favour of scientific progress. Scientists are now speaking up about the vital work they do, and ordinary individuals are signing up through the people's petition to express how vital they believe that work is.
The noble Earl, Lord Howe, raised a key question: the supply of young creative scientists. The position on young scientists in this country is much better. Indeed, it is very good, both compared with the past and compared with other countries. The question of people turning away from science and engineering is an almost universal problem. It includes Japan, Germany, South Korea, and so on. In this country, the figures show that the number of first degrees obtained in SET subjects grew by 43 per cent between 1994–95 and 2003–04. That includes very strong growth in subjects allied to medicine and biological sciences. The growth in PhDs in 2004 compared with 1994–95 is 88 per cent The situation at undergraduate level is rather good. Surprisingly the percentage of the total undergraduate population taking science degrees has gone up rather than down.
I agree that there is a problem at A-level. I do not think that that is all to do with disruption by pupils. The question of the qualifications of teachers is enormously important. Far too many young people are taught physics and chemistry by people who do not have relevant qualifications. We have taken some strong steps to change that in terms of conversion and getting new people in. We have taken another extremely important decision, which is to make certain that the very brightest children can do triple science, which has not always happened in the past and also appears to correlate with how well people do at A-level.
I was pleased that my noble friend Lord Haskel raised the question of knowledge transfer networks. We now have 18 such networks, which are doing extremely well in a diverse range of fields. We have always said that we do not have intermediate organisations for translating basic research into helping industry. We now have 18 in important modern areas, which are proving very successful.
This has been an important debate, which has highlighted both the strength of Britain's medical research and its contribution to society as a whole. This country's future medical research depends on making the best use of highly talented people and the unique potential of the National Health Service as a platform for clinical research to bring benefits to patients. The extra funds that the Government have given to medical research, the action that we are taking to improve our funding system and the translation of basic research into clinical and economic benefits demonstrate the Government's support for this great national asset.
My Lords, there remains a single moment for me to thank all noble Lords who have participated in today's debate, to echo the congratulations of the whole House to the noble Baroness, Lady Fritchie, on an outstanding maiden speech, and to comment perhaps on how timely is the proposal before your Lordships' House on setting up a committee on regulators. Perhaps I may even suggest that my noble friend Lord Winston should join it. I beg leave to withdraw the Motion for Papers.