Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Questions 100-119)

PROFESSOR GORDON MCVIE, PROFESSOR ANDREW MILLER AND PROFESSOR SIR PAUL NURSE

WEDNESDAY 16 JANUARY 2002

  100. ICRF, as I understood it, did mainly in-house research, although not exclusively, and CRC out-funded research. Would you like to tell us whether there will be any difference? How are you going to juggle these two previous existences? In other words, are you going to carry on in the same way or are you going to have a major change?
  (Professor Sir Paul Nurse) There are advantages with both types of funding, intramural and extramural. It is quite a complicated issue, which I can go into should you wish. We recognise in the new organisation the advantages of both. Indeed, the Government and Medical Research Council for the last 70 years have operated exactly in that way with a strong intramural programme with the Laboratory of Microbiology, National Institute of Medical Research and a very strong extramural programme through a response mode programme of project grants. We will continue in that way. What we have is, of course, the advantage of now looking at best practice on both sides, on both organisations. One of the problems when you have a single organisation that has been around for many years is it can get a bit ossified in how it operates and no doubt both of us could have done things better. Coming together has its disadvantages and can be a bit chaotic but has the advantage of re-looking at everything we do. We can now look at the cost-effectiveness of the different ways of funding and also the quality of work that is produced from the different ways of funding, and begin to look at our long-term strategies. In the short to medium term both streams will be maintained approximately at their present proportions because they are both working effectively, but one could imagine over the longer term we will look carefully at what we are doing and maybe make adjustments to make the best contribution that we can make to Cancer Research in the UK.

  101. I suppose it is too soon to be able to tell the Committee how soon we will see your first joint science programmes coming on stream?
  (Professor Sir Paul Nurse) We have, of course, in very general outline in thinking about the merger process, as to whether it was a good idea or not, thought a little bit about this but this now requires a major look at our strategy and this requires the bodies to do it. I have to tell you only this morning did we make decisions about the scientific executive boards. We only now have the chairs of our committees and so on in place. We are still to work this out, so my colleagues will forgive me if I am vague on what we are doing, but I imagine that we will over the next six months develop our combined scientific strategy and we will be using that to roll out our subsequent support of work after that. In the meantime, our previous strategies are not so different and we can really make a reasonable stab at a preliminary one and two year plan with what we have got in place. We hope to get benefits from this merger and benefits not only in monetary terms and total support but also the intellectual weight going into looking at strategy and that, I think, will take a little longer before we can see the fruits. I do not know if Gordon wants to add to that.
  (Professor McVie) A good example is that we each fund clinical units in the NHS, embedded in university hospitals, doing clinical trials together. You know about the National Cancer Research Institute and you may wish to ask about it.

Chairman

  102. Yes, we will.
  (Professor McVie) The network of trials is getting set up and it is no secret that, in fact, the leadership has come from our two organisations out there. The centres that are largely the ones that are active are already being supported by one charity or the other. They are funded in different ways, they have different ratios of core funding to clinical funding to lab funding on each site. This is going to be rationalised within about a month, I would think, and we will have far better clarity, far more leverage in terms of getting them to work within the grand plan of the NCRI. We will be better equipped, I believe, to achieve the target set by the NCRI of doubling the number of people in clinical trials. Really this is going to be just so much simpler, quite honestly, because it is post merger, it is just going to work.

Dr Iddon

  103. Could you perhaps tell us how the joint Directors-General will work? If it has been decided, and I assume there has been some discussion about it, how will the joint responsibilities apply?
  (Professor Miller) Perhaps I could start to do that and give an explanation why I am sitting between two very eminent cancer people.

Chairman

  104. This is SmithKline Beecham all over again.
  (Professor Miller) I am here for an interim period and my job is to be the merging mechanic, integration engineer, to help assist with the merger at a technical level. I am a scientist, however, and I have run large scientific laboratories, research laboratories. To me it is going to be very interesting how the two totally different mechanisms of funding to which you have alluded are brought together in a way that is significant. Funding research to do that properly has been a major problem always. How do you fund the unknown? How do you think of the unknown and try to choose who can go into the unknown better? It turns out the only way really to do it is to look at people, some people are better at research than others, and you watch them and if after ten years somebody has been doing it for ten years they are likely to keep doing it and you fund them and, on the other hand, sometimes as totally new, original things pop up outside the establishment. I think the two together are going to be able to fund a very strong laboratory which has not only got two Nobel Prizes but I hear today yet another European prize, not to Paul, not to Tim, but to Richard Treisman. Maybe you can say something about that.
  (Professor Sir Paul Nurse) This is the Louis Jeantet award that has just been given to a member of Cancer Research UK. It is the largest prize for biomedical research outside the Nobel Prize. We have got good people in Cancer Research UK.
  (Professor McVie) The answer to your question is we do not have a referee here, we have a mediator to help with the rest of the merger. We have not tackled the finance, the admin, the IT, a whole lot of things like that. The lead responsibility for science is with Paul and the responsibility for leading on the fund raising, communication, public affairs, including what we are doing now, lies with me.
  (Professor Miller) And both will sit on each other's committees, that is what I was really coming on to say.

Dr Iddon

  105. Thank you. Congratulations on the award that you have just announced.
  (Professor Sir Paul Nurse) I will communicate that.

  106. Well done. My next question is about applications for research grants that come to you from outside and I am sure that the people who apply for those will be a little anxious to know whether there are going to be any delays during the hiatus of reorganisation?
  (Professor Sir Paul Nurse) Perhaps I can pick that up. We are very conscious that the last thing we want to do is even sometimes at higher level of management things look pretty chaotic and we do not want that to translate on to the shop floor, so to speak, with scientists doing their work. We have made the decision to leave the funding mechanisms of the two old organisations in place so they continue their routine work until we have the new committees, the new boards and the new structures in place that will replace them. I told you that the highest level of the scientific executive board has only been put together today, we have to put that in place and it will take some months before we have the whole structure in place. I am not quite sure when. May at the earliest, maybe July or August, perhaps a little later. In a sense it does not matter overmuch, research is a long-term investment and we must get it right. If we rush into that and then find that we do not have the right address to send the grant applications in all hell will be let loose out there and we must avoid that. The answer is we are going to leave the old structures in place, put the new ones there and as soon as they are fully operational we will switch.

  107. My last question is probably going to be answered by the reply "not me, gov" because I am taking you back to 1923 when the two charities, as I understand it, split for the first time over their attitudes to the clinical applications of research. So, what has changed, except that we are in a different era?
  (Professor Miller) My understanding is that they did not actually split. There were a group of clinicians who felt that the then ICRF was not doing enough clinical research, perhaps over-emphasising basic research. I am not a clinician but it is clear that the clinical research and trials that Professor McVie has referred to are going to be one of the very strong things that this new charity will do. Another thing that I think we are already agreeing to emphasise is this so-called translational research, in other words consciously concentrating on trying to go from targets that become evidence from basic research and take that into the clinical.

  Mr Dhanda: I apologise for missing the first part of the meeting but what I have caught has been very interesting. I would like to ask you a little bit about the Cancer Plan. In the first year of it the Government's assessment of it has been quite positive.

Chairman

  108. Sorry, Professor McVie, I am told you wanted to say something on the last point?
  (Professor McVie) I just wanted to reassure Dr Iddon about the welfare, not just of clinical research in the new charity but prevention research which will not be necessarily of a conventional variety conducted in hospitals but actually conducted in primary care. We already have some intervention trials, for instance, with selenium in primary care settings throughout the country to see if we can cut down the risk of prostate cancer. I believe that is going to be a big emphasis. Thank you for allowing me to think about the answer to the National Cancer Plan.

  109. Are you happy with it?
  (Professor McVie) I think it is an ambitious plan and I think it is early days. I really think that most of the targets set are further down the line, they are three years, four years, five years. I think the soundings that we have had from our clinical units are positive. I think there is still some mystery about where some of the money is and whether the cheque got lost in the post or whether it has been absorbed like creosote into the fence post of the administration of the health service. I do believe that the direction is correct and there is beginning to be somewhat less cynicism, certainly amongst the oncologists who are employed by the two organisations. There are, however, major black spots and, of course, the Beatson Oncology Centre in Glasgow is the biggest. To lose four consultant oncologists in the space of four weeks would cripple any cancer centre. There is a real, real problem there. I would have thought seven-eighths of the resource has not yet got out there. Certainly the human resource is not yet in place that has been promised. Certainly the drug budgets are not yet up. There are machines ordered all over the country, including at the Beatson, new radiotherapy machines, but it is a six month installation time and you will be lucky if this time next year much has changed in terms of waiting times for even palliative radiotherapy in two or three of our major cancer centres around the country. That is all I feel we can say.

  110. Is the Beatson safe? Four consultants are hard to find.
  (Professor McVie) It has just been devastating. As you know, we have a major clinical academic unit, Cancer Research UK's biggest unit in Scotland at the Beatson Institute and Oncology Centre. I have been in close contact with the doctor, Adam Bryson, who has been parachuted in to try to help out and I have offered the help of the new charity, Cancer Research UK, and I shall be going to see him in the next week or two to see exactly what can be done in the short-term and perhaps also in the longer term. Our entire investment in translational medicine in the West of Scotland, which is about six or seven million pounds a year, is at risk here.

  Chairman: Could I encourage you to use the political process. Many of us would be glad to make a noise about what is happening there and I am sure the MPs in that part of the world would too, so please give us the chance and the bullets.

Dr Iddon

  111. I did not know about this, I must be out of touch, but can you tell us why there have been these four oncologists leaving at once?
  (Professor McVie) It has been total frustration, total loss of belief that the health trust would ever deliver what they had promised. The health trust have now been taken out of the loop by the Scottish Executive and this new u­bergauleiter, Adam Bryson, who is a medically qualified doctor, is now reporting directly to the Greater Glasgow Health Board because there is a complete lack of trust in the NHS Health Trust of North Glasgow. Everything was promised over a period of one, two, three years and nothing has been delivered, waiting lists have been doubling, patients have been dying on stretchers in waiting rooms. It has been awful.

  112. Have we retained oncologists in the UK or have they gone abroad, the brain drain?
  (Professor McVie) Three have left to other positions in the UK, one may have taken early retirement and the fourth one is unemployed, and that is the one I really worry about, if he was that angry.

Mr Dhanda

  113. You talked about resources of the Cancer Plan. Is the Cancer Plan perhaps a little too ambitious or are there parts of it that you feel may have been missed out?
  (Professor McVie) I think the major missing bit for us is the mention of cancer research in the National Cancer Plan. It does not get the headlines that I think it deserves, certainly after the work of this Committee at putting cancer research issues on the map. We have done our bit to try to weld our resources together and we are also functioning much more intimately with the Medical Research Council and the Departments of Health in the four countries in the National Cancer Research Institute. That is working. We are just perplexed that things cannot go fast enough. We feel that we have got our act together better than the people delivering the cancer care. I do not believe that these were not gettable targets given the resource. If the resource does not come along then in a couple of years' time we are going to be saying "great idea but there is still no football".

Chairman

  114. Where do you think the resource gets held up then?
  (Professor McVie) Predominantly training skilled people, such as radiographers, to run radiotherapy machines. We are 400 medical oncologists short, 200 clinical oncologists, we have not got an academic pathologist within a mile of most of these cancer centres, radiologists are stretched. We just have a major resource problem. It has been recognised by Government, there is no shadow of a doubt that the interaction with the Royal Colleges has been very productive and we have got a wishing list but you cannot find these people overnight when the previous Government had run down medical student intake and there really are not the people in the system to be coming out of the other end to attract into oncology.
  (Professor Sir Paul Nurse) It comes back to this focus on training, the care delivery. There is a real need for trained personnel, inward recruitment and to get people through the medical schools who will actually make a difference. I would really like to support what Gordon said about the lack of reference to research. We are only really going to ultimately lead to improvement by having a commitment to that and it was a pity that was not there. There are initiatives there that you cannot complain about, let us not be too mealy-mouthed. There are things like the National School Fruit Scheme that you may be aware of or breast screening extensions and the Cancer Services Collaboratives, for example. These are good but the major issue is one to do with resource, getting people out there to be able to actually treat this disease.

Mr Dhanda

  115. I was going to ask you whether you thought there was sufficient research ethos in cancer centres but I think you have answered that already.
  (Professor Sir Paul Nurse) We do not have an agreed policy but we can perhaps give our personal views. I do not think there is personally, no.
  (Professor McVie) I would agree. People are too busy. If you are sitting with 60 patients in your waiting room and it is half past four in the afternoon and after that you have then got to go and write a research grant to Cancer Research UK to get money to do an interesting bit of research, that is asking an awful lot of people.

Mr Hoban

  116. I would like to go back to the question about resources and staffing. You talk about training more people through clinical medical schools but what capacity is there in the system to allow people to retrain as cancer specialists or as radiographers? Is that feasible or are you waiting for the additional students to come through medical schools?
  (Professor McVie) I am not an expert in this area. The Colleges have got their hands on the data of the number of people in different pools. I am told there is a shortage of consultants in cardiology and in respiratory medicine and in rheumatology. I do not think we have just got a unique problem in oncology, it just happens that cancer research has been remarkably successful in the last ten or 15 years and we have got much more to offer and, therefore, the demand has suddenly risen there because there is far more opportunity to improve the outcome of patients with common cancers. As long as we were just making spectacular impacts in a cancer which only occurs once in every million young children, that was not going to stretch the health service, but when you suddenly find something which affects 48,000 colon cancer patients a year that really stretches your service. I think we have stretched things much more thanks to the success of cancer research. Retraining has not been a big deal in medicine and I think you are right to bring it up. What happened to all of the specialists in tuberculosis, for instance? Could they not be recycled into respiratory cancer doctors? I have often thought that they could be. Radiography is another shortage specialty and I do not think there will be very much to be gained in that other than what the Government is already doing, for instance, in nursing to try to get people back who have retired from nursing.

Chairman

  117. I know that you are a super-optimist but in your darker moments do you ever see that the public might turn off giving money to cancer research because the delivery process in hospitals is not there and they would say "what good is all this money, we might as well give it to supporting action against hunting foxes" or something?
  (Professor Miller) Could I make the point that I noticed was in your 2000 Report, and it is still the case, and it is a very simple one to me as a non-clinical person, namely the five year survival rate in this country is still very low compared with comparable countries in Europe, so something is wrong clearly, quite seriously.

  118. That is what I am trying to get at.
  (Professor McVie) We are lucky to live amongst the most generous people in Europe. Our generosity to charity, whether it is Christian Aid, Oxfam, Crisis, Shelter, Cancer Research UK, is phenomenal. It is interesting that our data suggested that there is a relationship to poverty and social deprivation and generosity within our community fund raising. I do not believe that people have yet become that cynical about the failure of the health service to deliver cancer care as good as you can get in France or in Holland or in Italy. However, they are certainly very supportive of us raising the problems with you and they say "That is your job. You know that you have developed a drug that works betters or a radiotherapy scheme that is better for prostate cancer. You are right to go out there and if we can help you with the local health trust by saying `Why have you not got the right kind of computer software on your radiotherapy machine?' then we will do that". I think that there may well be a trend for many of our supporters to take up arms themselves. There has been a growth of advocacy groups in this country, and some of them are sitting behind, as there has been in the United States and they have been effective. Maybe that is one avenue which will evolve in the next year or two.

  119. Putting the money in and the expectations they have got and we raise their expectations, where do you think they put the finger on to blame when it does not go right? When it comes their turn for a loved one to go into hospital or something, who do they blame do you think in your experience of talking to people? Do they blame the charities for not doing enough or do they blame Government? Government always gets blamed for everything. It would be interesting to know who the public in your experience of people who support you blame?
  (Professor Sir Paul Nurse) Maybe I can make a stab at this one. I think on the whole the charities do not get the blame, quite frankly. We do act as, if you like, some sort of policeman who is commenting independently and the public trust us. I think certainly it is aimed at the Government. We do have to be a bit careful, of course, because if we over-promise what we can deliver then cynicism may, indeed, set in.


 
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