Select Committee on Science and Technology Minutes of Evidence


Examination of Witnesses (Questions 740-759)

TUESDAY 25 MARCH 2003

DR DIANA DUNSTAN, DR PETER DUKES, DR PAT GOODWIN AND DR VAL SNEWIN

  740. What is the order of magnitude? Is it 100 per cent?
  (Dr Dunstan) On programme grants, we have had a difficult financial climate in the past year or so, but normally, if you ignore that, the award rate on programme grants that actually go to the Board is about 40 per cent. I would be surprised if the infections area was different to that, but it may be that a lot of those awards are in the areas we are very happy with, as I said before—HIV, AIDS, malaria and those kinds of areas—rather than ones that perhaps need to be built up.

Lord Patel

  741. Could you clarify that the 30 per cent success rate is overall or is it in communicable diseases grants?
  (Dr Goodwin) Those are the applications to the Infection and Immunity Panel, which covers communicable diseases but also some areas of basic immunology.

  742. That might depend on the number of applications you get?
  (Dr Goodwin) Yes, but there are quite a lot. I would say the majority is in communicable diseases.

Baroness Warwick of Undercliffe

  743. Is the 30 per cent then 30 per cent of alpha-rated projects?
  (Dr Goodwin) No, this is 30 per cent of everything. We fund all the high quality science on our panels.

  744. Is it the same for the MRC?
  (Dr Dunstan) At the moment, as you probably know, we are not even able to fund all the research at the upper end, which is international, leading edge work.

Baroness Emerton

  745. For the record, my background is nursing and nurse education. I am a previous chairman of a health trust. This question follows really from the previous one. Do you fund research in the full range of infectious diseases actively, including microbiology, clinical infectious diseases and epidemiology?
  (Dr Dunstan) Yes, we do.
  (Dr Goodwin) We do, too.
  (Dr Dunstan) We think in particular that we have to be careful that we do not fund things that would perhaps be better funded, say, by industry and that we do not fund needs-driven research that perhaps is best commissioned by the end user. We are quite careful about trying to draw lines in those respects. Otherwise, we fund right across the spectrum.

  746. Do you have any criteria in your portfolio for priorities?
  (Dr Dunstan) At the moment, the priorities that relate to infectious disease is work in Aids epidemiology, the TSEs, primary care, public health research and antibiotic resistance work. As I say, the Strategy Development Group will meet next week and one of its key topics will be developing an infections strategy. I think that will probably throw up some other areas.
  (Dr Goodwin) We fund across the whole range. We do not have any specific priorities in our general baseline funding schemes. We merely look at the applications that come in and fund the best quality research.

  747. And that covers it all?
  (Dr Goodwin) Yes, it covers it all.

Lord Patel

  748. To an extent, you did answer the supplementary that Lord Oxburgh asked about how you work with authorities, particularly the Department of Health, in identifying priority areas of research in communicable disease. We are now going to have the slightly different world of the Health Protection Agency. For the reasons we have established and, Dr Dunstan, you mentioned bio-terrorism, do you already have or are you looking at any plans as to how you might co-ordinate the work with the Health Protection Agency?
  (Dr Dukes) We have started discussions with Sir William Stewart, Shadow Chair of the HPA. That has been a very good lead-in. We have also been talking to the Interim National Director of R&D, Dr Charles Penn. These are fairly informal discussions at this stage, if you like, to map out the terrain over which we might talk. Clearly there are some plans within the HPA which are exciting for the way they might look more outward on the one hand and develop programmes between the four component parts of the HPA in a new way. We already have links with the component parts of the HPA but no doubt the new organisation will offer us new opportunities. The sort of thing that we might look together to talk to each other about, and perhaps work together with each other on, are new areas for the HPA like behavioural and sociological research, which maybe they have not been involved in before, and of course the Economic and Social Research Council can be brought into that discussion. The HPA has particular facilities which are national and world class; for example, GMP vaccine manufacture, animal testing, Category 4 laboratories, where there may be some synergies, if you like, in terms of using infrastructure more optimally. In relation to population data, there is a real wealth of surveillance data within the PHLS, and improving data flows between surveillance and epidemiology and other areas such as genomics and bioinformatics is another opportunity that could be exploited. We are already aware of work in relation to diagnostics and vaccines, where there will be opportunities for synergies. Finally, the shadow HPA has been talking to us about their early ideas in relation to training, improving critical mass and such like. If I could add one thing, which is that relations with the HPA and those kinds of opportunities will be one of the foci for discussion at this forthcoming strategy discussion that my colleague, Dr Dunstan, mentioned.
  (Dr Dunstan) There are lots of opportunities for the MRC in the future. We have appointed new directors for work in the Gambia and Uganda; that is, in developing countries. There will be appointments of new directors in key fields of infections over the next five or six years. We are opening up lots of opportunities and that is why it is particularly important to look at the strategy and work the relationships out so that we get the best out of them.

Lord Lewis of Newnham

  749. You talk about new opportunities. This obviously involves an amount of money. Are you able to get extra money or is this reallocation of moneys that you already have between these various headings?
  (Dr Dunstan) It is not finally decided but I have said that we are hoping that MRC will be able to put in for a spending review in 2004, a bid for money in human infectious disease. It may be that this will be jointly with, for example, the BBSRC because there are obvious links there, the ESRC because of their behavioural perception of risk type links, and maybe even other research councils as well. Because these things evolve, it may also be enveloped in a bid that is called Environmental Health, and infections will be a subsection of that. If that bid were successful, we would expect to have money, and whether it is new money or not or whether it is money that has been given to us within our baseline, actually focused on infections research. We would have to report on how we spent on infections. So there is a chance that we might have new money. This year, for example, we were allocated, as Lord Patel knows, £40 million over three years for stem cell research. The kind of bid we were thinking that human infections disease might need is £15 million, or something like that.

Lord Patel

  750. Is there a comment from the Wellcome Trust?
  (Dr Snewin) I would like to thank Dr Dukes for putting the HPA into context. The Wellcome Trust has quite a similar comment to make. Our Director has also had informal meetings with Sir William Stewart, the Shadow Chair of the HPA. The Trust is increasingly willing to work in partnership with other organisations, and that includes Government agencies and departments. Some examples are: the Synchrotron Diamond Project and Joint Infrastructure Fund and also the new national network for science learning centres. Regarding the Health Protection Agency and the Department of Health, we have stated in our written evidence to your Committee, which included our response to the Department of Health consultation on the HPA, that the Trust considers that there should be an opportunity for research into public health and infectious diseases in the UK to be enhanced. In order to facilitate the possible partnerships in the future, the Trust suggested that there might be a committee set up to advise the HPA on research, along with the Medical Research Council of course and other funders. More generally, the Trust has also agreed to facilitate a working group to discuss public health sciences in general and in particular public health professional structures. The first meeting of that working group will be held at the Trust this year.

Lord Rea

  751. Dr Dukes, you mentioned how the MRC may be funding projects which will help to improve surveillance. I wonder whether that is an MRC role rather than a Department of Health role? Is this not for the HPA itself? Is it not a more administrative and public health activity rather than the kind of research that the MRC is best fitted for?
  (Dr Dukes) I am sorry if I gave the impression that I thought it was MRC's role to conduct surveillance because clearly, as Lord Rea indicates, that is not our view. However, in terms of developing methodologies and developing the interface between, if you like, the routine side of surveillance and the more academic epidemiology side, there is probably more that can be done in ensuring that the data moves from the one side to the other side. It may be that surveillance can be informed by, if you like, developments in basic epidemiology as well as by laboratory-based tools.

Lord Rea: That clarifies it.

Baroness Finlay of Llandaff

  752. Some members of this Committee have expressed quite firm concerns about the reorganisation of the PHLA and the change to the HPA. You spoke quite positively about the way that you see opportunities coming. I just wondered if you felt that there were areas of current research that may be threatened by the reorganisation, or whether you felt overall optimistic, which was the message that came across.
  (Dr Dukes) We have not had that feedback ourselves directly from the research community. I cannot really help you further on that.

Lord Patel

  753. Is that feedback positive or negative?
  (Dr Dukes) We have had no negative feedback from the research community.
  (Dr Dunstan) No concerns have been expressed that it affects research.
  (Dr Snewin) Within the comments that we put into our written submission to your Lordships, the Trust expressed some concerns that public health funding should be protected under the new structure and that the proposed reallocation of funding to the NHS from current public health laboratories might potentially have an impact, especially on strain collections and links with academic researchers. We have brought that to the attention of the HPA in our response to them. As has been expressed in our written consultation, we consider that research structures should be set up within the HPA in a way to allow academic researchers to gain charity and other funding, so that research can flow easily between the public and academic research community in this area.

Lord Haskel

  754. The Committee recently visited a major hospital in Birmingham and there they stressed the importance of good practice in fighting infection - good practice in hygiene, personal hygiene, food hygiene, animal husbandry, this sort of thing. To what extent do the Medical Research Council and the Wellcome Trust have a role in supporting and identifying, and indeed implementing, best practice in this field of communicable disease prevention and control?
  (Dr Goodwin) In general we do not consider this is part of our remit, and so I hand over to Dr Dunstan.
  (Dr Dunstan) In terms of our health services research, then we are perfectly happy to fund applications that are "generalisable". We would not fund an application that was simply looking to solve a problem in one particular hospital. We would want the output to be potentially generalisable. Yes, we do, and we have quite a portfolio of that kind of work. In our general practice research framework it is used not simply by MRC for work but actually by other funders. They have done quite a lot of work on best practice in terms of disease prevention and treatment. Some of those studies have been very helpful to other practitioners. We do not have a role—the role belongs to NHS R&D—in what we call service delivery and organisation. There is a line drawn between MRC and the Department of Health and the NHS. However, it is perfectly possible, for example, for an NHS R&D funded project in that area to be part of a co-operative group that the MRC supports and to be one of the qualifying pieces of funding for that. If people wanted to come to us for work in infections and prevention, that would be a perfectly good way of doing it. Perhaps finally I could simply say that in the MRC Scientific Vision for the next 10 to 15 years one of the things that we need to develop, which has generally been welcomed, is something called a Health Implementation Research Centre. It may be a building; it may actually be a virtual centre. We are hoping to bring together expertise that will enable people not only to do better translational work and get better implementation, but actually to design their projects in the first place so that they can be better implemented and translated into practice. This is a gleam in our eye. We have talked actually not to the Trust yet but to some other funders which might be interested in this. I think there is a likelihood that although it will start small, it might be something that will be developed in the reasonably near future.

Lord Haskel: That would certainly fit in with the sort of thing we were hearing when we were in Birmingham.

Lord Oxburgh

  755. To go back to the Wellcome Trust, you said that this was not your responsibility. Is that because you believe this is excluded by the terms of the Wellcome will[1] or simply because your Governors have taken a policy decision not to cover this kind of work?
  (Dr Goodwin) The will can be interpreted quite broadly, but at the moment the Governors feel that they can be most effective by funding the basic research and some of the more clinical aspects, but not being involved in the implementation of best practice.

Chairman

  756. May I follow that up a little, again coming to clinical research? One of the areas in clinical medicine that is very important is antibiotic resistance. It is well known that it is difficult to get funding to look into antibiotic resistant causation and indeed the control of it, but would you, either the Wellcome Trust or MRC, look at antibiotic resistant proposals that maybe would not reach the high standard that you would want but nevertheless are of such importance that you would be willing to fund them or give them a fair wind amongst all the others?
  (Dr Dunstan) In response to our highlight notice, we have between 40 and 50 applications in antibiotic resistance. I have to say that most of them have not been of a high enough quality. We have funded about seven or eight of those but they have been fully funded. Perhaps I could add something else that I think is relevant to this, and it is certainly relevant to an answer I gave before. One of the other initiatives that MRC is taking jointly with the Department of Health through the Chief Medical Officer and with the ESRC is to look at patient safety research. In terms of best practice and preventing the development of antibiotic resistance, that kind of research actually could have quite a significant contribution in this area.
  (Dr Goodwin) As far as the Trust is concerned, we receive very few applications in that area at the moment but, as I indicated earlier, antimicrobial resistance and patient-orientated research are areas that the Trust is reviewing at the moment. The Governors will be considering those reports and they could possibly decide to do something more specific in those fields, but I cannot speak for what decisions they will make.
  (Dr Dukes) Just to clarify a point about giving things a fair wind, in an area in which we have issued a highlight notice to encourage the research community, such as antibiotic resistance, as long as the quality criteria are actually met, they do get more than a fair wind when they come up to Council in recognition of our partnership with the Department of Health and our wider national role.

Lord Lewis of Newnham

  757. Can I just take up this point on the standards that we are dealing with because at times of course there is a certain type of work which appeals very much to, say, the academic community as a whole as being very much in the forefront of the work. That, I imagine, is the sort of work that would appeal to you very much. But there is another type of work which is very much more routine in nature and which is very important indeed for the development of this but does not have quite the same cachet when it comes to the academic looking at these particular types of approaches. Who actually would fund that particular type of work? I am not suggesting for one moment you should do it. I know you have your set of criteria to deal with it but who would look at that because these are very important areas very often to look at?
  (Dr Dunstan) Perhaps I could say first that one of our research boards is in health services research and public health research. Some of that work is, I suppose, very applied and might not in some senses appeal to some academics in the way you describe. I think because we look at that in the round in that particular board that that particular board is able to make its recommendations to the Council for funding and it does get a very full and careful consideration. Indeed, we do fund a lot of work through that board. The MRC is able to fund quite a lot of applied work that way: clinical trials, epidemiological studies and real health service studies in various areas. Otherwise, I think we would expect PHLS, or the HPA in future, to do that kind of work. Some of it might also be done in connection with industry, I suppose, if they had an interest.

Lord Patel

  758. In your view, has that support of this kind of indirect research by the PHLS and other authorities been well done in the past?
  (Dr Dunstan) There may be gaps, I guess.
  (Dr Dukes) PHLS does sometimes come in to the MRC as an applicant or as one of a number of applicants and has achieved funding through MRC. That is indeed one way where we can actually address these areas where, if we were not careful, a gap might open up between our organisations.

Baroness Warwick of Undercliffe

  759. This rather follows on from what you have just been saying. You talked about the variations in quality. We have had quite a lot of evidence where support for public health research in the area of communicable disease control and particular research into quality control of diagnostics and interventions has not been adequately funded. What is your role in quality control? Do you have a role in quality assessment and, if not, perhaps you could tell us who does?
  (Dr Dunstan) We do not really have a role in that. I wonder perhaps whether NIBSC has a role in some areas of diagnostics. I have to say, I am not an expert in this. We would be very careful, I think, if we were doing a clinical trial, or any other kind of study, to make sure that the diagnostics that we used were appropriate and as good as possible because clearly otherwise it would undermine the whole of the project, but it is not really directly in the MRC's remit.



1   The Trust's governing document is now its constitution, adopted on 20 February 2001, which is a re-statement of the Trust's objects under Sir Henry Wellcome's will. Available to view at www.wellcome.ac.uk. Back


 
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