Examination of Witnesses (Questions 480-499)|
TUESDAY 4 MARCH 2003
480. The reason why there is this gap is that
this is a very risky area and there are a number of schemes whereby
you can share the risk with some government schemes, for instance,
the Small Company Guarantee Scheme, the Subsidised Nursery Units
and things like that. From what you are saying, do I get the impression
that you think these schemes have failed?
(Dr Reeders) I do not think they are focused enough
and I do not think they are targeted adequately. In my experience
and my understanding of them, they are not targeted to the highest
value added components of what we could achieve in this country,
which is development and technology, so I think any scheme that
is put in place should be really different. Do not just create
jobs, do not just create new companies. Create something that
really adds value, which leverages intellectual property. I think
you should target the schemes to people who want to develop intellectual
property to generate very high value added products, such as pharmaceuticals.
That is where I would target funds and that is what is really
needed. That is exactly what programmes like the United States
SBIR programme do. You have to write a grant at the very highest
level with specific commercial aims in mind and then you get federal
funding. The federal government in that case can target where
it puts it money depending on what it wants to achieve. For example,
if it wants to achieve enhanced vaccine programmes you could fund
(Dr Logan) I just wanted to come in there and say
a couple of things about the schemes that are in place at the
moment. The Loan Guarantee Scheme is very difficult to get. It
is not workable and every time we have gone for it we have been
told, "This is only applicable if the researcher does not
have any money", and we find that we still have a resistance
within universities to researchers putting their house up for
collateral. They do not see that they should have to do that,
so there is still an attitude thing there. The Loan Guarantee
Scheme is not feasible for this sort of research and actually
it is not enough money anyway. Smart Award is very good. That
has been very successful but we still need something before the
Smart Award to fill that gap, because the Smart Award is prototyping.
We have still got this gap before the prototyping where we have
got this kernel of an idea, we know there is something there,
but we need to do the trials. University Challenge has been very
patchy. In some areas it has worked extremely well, particularly
where we are seeing much more involvement now with the regional
development agencies, and in the areas where the funding and the
incubation is joined up so that the clinician has the opportunity
to go into an incubator and then a science park and has the funding,
it is all working extremely well. Yorkshire and Humberside are
a good example of this. As I say, it is very patchy and in other
areas the University Challenge has either been very risk averse
or perhaps has had people on the committees who are not necessarily
well enough equipped to make some of the right decisions. In an
example I was involved in at Bristol and Bath there were some
very bad decisions made at the beginning as people did not have
the experience. That brings us on to another issue. There is still
a lack of expertise in Universities in this area of identifying
from the universities which of these ideas are the ones that are
really going to work. You have got the technology transfer officers
who sometimes do not have the expertise to judge the winners,
so we are not being able to focus the funds we have as effectively
as we might do. As I say, the University Challenge has been a
bit patchy as well. We need a joined-up provision.
481. I am getting mixed messages between what
I hear from Dr Reeders and what I hear from Dr Logan, and I therefore
seek clarification. From what you said earlier on, Dr Logan, and
correct me if I am wrong, you implied that we have (or at least
you have in the universities you are involved with) researchers
whose research has got to a stage where it can now be converted
to a product and it is held in that gap, as Dr Reeders referred
to earlier, because there is no finance to convert it to a product.
You are suggesting that the systems that are in place, either
the loan grant or the University Challenge Grant, are not adequate
or are not at that level. On the other hand, Dr Reeders, what
you are saying is that if you have got a product which will go
to market there are plenty of venture capitalists out there who
will do it with you. Is it that there is no enterprise at the
university which will allow you to do that? What is it? To say
that we have researchers who have research which has come to fruition
and they cannot get it to the market sounds to me pretty dreadful.
You said you would give us examples.
(Professor Borriello) On that particular issue, and
I alluded to it earlier, there is frequently another gap and that
is a gap between the inventor's view of the marketability of their
potential product and the investor's view. Sometimes the lack
of apparent investment is not due to the fact that it is not available
but that the investors make the decision that it is not worth
investing in, either because the market is not there for the return,
although the product is good, or the product is not what the investors
perceive it would be on reaching market.
482. That is the real world though, is it not?
(Professor Borriello) That is the real world and that
is my point. You will hear differing stories but one has to get
underneath those stories and judge whether it was a potential
world leading product which they failed to secure funding for
because they did not know the system, or whether it was that it
was not actually a very good product and nobody wished to invest
in it. Both can fail to get to market. It is the first one which
should cause us concern, not the second one. The other point is
that I think one needs to differentiate between talking about
new technologies for communicable disease, surveillance, and control.
That would include diagnostics as well as therapeutics and I would
argue, maybe from a point of ignorance, that investment in therapeutics
is much higher and potentially easier to obtain than it is in
diagnostics because the returns on therapeutics, although the
risk is high, are equally high. In terms of diagnostics, the returns
are low and the risk is high and the market is very competitive.
Getting investment in new diagnostics in the UK or, I would suggest,
almost anywhere in the world, unless it is a spin-off of something
that somebody did not realise had great diagnostic potential,
something they did not purposely go to do, such as PCR, then I
suspect that that is the weaker link in the UK compared to therapeutics.
Everyone is into the new cancer drug, everybody is trying to develop
new vaccines, despite the risk. I do not think you would find
many people purposely setting out to develop new diagnostics in
(Dr Reeders) That is because there is a massive profit
differential between therapeutics and diagnostics. Therapeutics
is one of the last great bastions of super-profits in the world
and it is created by the bizarre fact of giving 17-20 years patent
life for composition of matter. You can create a drug and you
get 17-20 years of monopoly and you can charge whatever you want
for it because you are the only one allowed to sell it, and it
is incredibly profitable. Clearly, capital will go towards the
profit. Diagnostics are very difficult. They are much less profitable
and there are a lot of business model issues concerned with, for
example, diagnostic platforms. By and large diagnostics are mounted
on platforms run by a few major companies. What you are able to
make usually is a reagent that you can put on top of that platform.
The companies that control that platform are not always very willing
to let you compete, for example, with their products. The profitability
in diagnostics is very low and whether you are in the US or the
UK raising venture capital for diagnostics is very hard. Unless
some structural changes are made to the market somehow to affect
profitability, people will not put their money in diagnostics.
483. You mentioned that regulations often inhibit
in-house developments. Could you expand on that and say why these
regulations were introduced in the first place? Could you abolish
them and, if so, what would you put in their place?
(Professor Borriello) As I said, there is frequently
a penalty to be paid for improving standards. It is a value judgement.
If I give you a simple example with, let us say, the diphtheria
dipstick test for diphtheria toxin, where the market is small,
you would not get a major manufacturer to produce it although
you might get some charitable bodies to fund production for use
in the Third World. In the UK, let us say, the Central Public
Health Laboratory wished to make these kits. We could use them
within our own laboratory for diagnostics. We could probably get
them accredited so we retain our diagnostic accreditation, but
we would not be able to sell it to another legal entity or employing
authority without getting it kite marked as regulated by the In-Vitro
Diagnostics Directive. Doing that is costly both financially and
in terms of time. We would then have to ask the question as a
publicly funded body, is it in our interests to do this, which
is going to enable a few labs to have improved diagnostics, or
not? Do we just make sure everybody sends their material to us?
We would naturally opt for the second option, but the consequence
of that is that we are not pushing this technological diagnostic
484. What would your solution to this problem
(Professor Borriello) I am not sure there is a ready
solution unless, for example, the UK Government decided to set
up some small body which would take on that role for all these
so-called orphan diagnostics and would bear the cost of that and
be the regulatory body. We would give the intellectual property
to such a front body in return for that body making sure that
that technology was available to the maximum number of people,
and it would not be competing. There would be no cry of "foul"
from industry because they would not be interested in those mark-ups.
485. Dr Logan, how would SIMFONEC be classified
in that area? Would you not fit the bill?
(Dr Logan) I think there are still issues. That might
be one answer but we do have a situation at the moment where our
clinicians have to fill a number of roles and while merit rewards
are still based on RAE particularly, if we take our clinicians
and our researchers away from their pure research they cannot
do their pure science and they cannot get their number of publications
out per year, the income for their department goes down. If we
were going to have some kind of system like that, in order to
incentivise the researchers to become involved we would probably
have to have a different merit system within the university. Alan
Milburn has just written a letter about rewards for consultants.
I was just reading that on the website. He is actually saying,
"We will look at the contribution of consultants to the NHS",
and he is also talking about the research but there is nothing
in there about commercialisation of research. What I would say
is that even if those things were available, unless you incentivise
the researchers in some way and you find an income stream which
is not long term to the department, it is not going to be successful.
At the moment the departmental income is based on the RAE and
that is a real issue for us.
486. I am not sure that this is evidence based.
(Dr Logan) Yes, it is. I would refer you to the RAE
assessment exercise and subsequent funding allocations.
487. I am still employed in the NHS as an academic
and I still have my merit award. Nobody stops me from doing research
if I wish to.
(Dr Logan) Would you, if you were head of a department
in a university, want your key researchers to become involved
in the commercialisation process if it meant that they were going
to have fewer publications which could affect your income?
Lord Patel: Cyclacel is a good example. It is headed
by a key researcher who does research.
488. Dr Logan, you moved into the area I wanted
to ask about. When we were in the United States in January it
became very clear to us that the universities did a great deal
more to incentivise their staff to consider commercial development
and to be very proactive in doing it. It is part of their assessment,
part of the criteria, and it occurred to me to ask you to what
extent is that sort of thing being done in the UK? You have moved
on to the territory of the difficulty of the income of the department
but how would you propose that we moved nearer to the point in
this country when the United States has got where they are so
hot on these things that nothing seems to escape them?
(Dr Logan) I think that is a very good point. There
is a model. NICENT in Northern Ireland have changed their reward
system so that their researchers get promotion on the basis of
their record of commercialisation and integration with business.
I do not think that is happening in many UK universities at the
moment. Certainly, if I take somewhere like the University of
Bristol, where I was before, and the universities where I am now,
promotion is still linked to research and having a good research
record, so we need additional incentives. This is similar to the
issue of good teachers who did not get promotion in university
if they were not doing the research. We are hitting the same issue
again. The culture of enterprise is really there; it is beginning
to happen, but we could move it forward more quickly if we changed
the personal reward systems.
489. We have explored venture capital for new
diagnostics and new vaccines, and Dr Reeders suggested that we
had to raise the profitability. How would you do that? Is it the
case that there is market failure there?
(Dr Reeders) My favourite way of increasing profitability
is to reduce taxes in selective ways. Maybe this is a personal
point rather than an expert point but I do think that when governments
shovel money into things to try and stimulate them the productivity
of that money can be low. What always does incentivise people
is reduction in the taxes they pay, so I think there are ways
to reduce taxes on the profits of small companies, on the capital
gains of people that make money out of those small companies to
try and suck people into those kinds of ventures. That obviously
does not target communicable diseases specifically. Another major
area in the context of vaccines is to try and develop a process
of promoting vaccines. The problem with vaccines is that by and
large preventive vaccines are used when you do not have a disease.
If you have got a terrible headache you will go to the doctor,
you will take the pills, you will create a profit for the pharmaceutical
company, but the economic stimulus to prevent a disease is much
less than that. Because it is a public health matter rather than
an individual matter, governments do have to step in and promote
prevention. Right now only three or four of the world's top 25
pharmaceutical companies bother with vaccines at all, so vaccines
are a very neglected area and there is a potential to stimulate
vaccine development in particular for a range of infectious and
communicable diseases that really are not treated right now. Providing
perhaps a specific help with conducting clinical trials would
be one way to do it. Conducting clinical trials in naive, that
is, uninfected, individuals, is extremely expensive. Parents are
very reluctant to have their children inoculated with new experimental
vaccines and we do need a method to try and bring those vaccine
development candidates through. The pharmaceutical industry would
be very reluctant to do that because again it is an area where
there is not enough profit. There are therefore two very specific
things that can be done: in general reduce taxes and specifically
in the case of vaccines provide government support, perhaps through
the NHS or otherwise, to vaccine development. Vaccines were invented
in Britain. We have had a very good track record of developing
new vaccines, but the world wide markets are not sufficient to
stimulate new capital to go into the area.
490. Professor Borriello, any comments on that?
(Professor Borriello) Yes, particularly on vaccines.
I think it is quite telling that apparently it is true that the
world market in one single anti-ulcer drug is bigger than the
total combined market for every vaccine currently available. That
exemplifies the point you made about profitability. Coupled to
that is adverse publicity and high risk. I think something can
be done to protect vaccine companies who are producing products
for public health which is that if they have gone through all
the appropriate legislation and regulatory screening to become
a product that is sold it is difficult to see why they should
then be held liable for one adverse reaction which then destroys
the market and sometimes destroys the company. If, however, they
have been found to be fraudulent in obtaining such regulatory
clearance, then of course they should be held liable. I think
there is a pull-through in thinking from the tobacco industry
where they are saying, "You knowingly sold a product, even
if you did not know it was bad and even though it was legal".
That does cause fear in investors in things like vaccines, as
does the way potential adverse publicity is handled. It is not
handled very well in the UK. Having said that, it is not handled
very well anywhere in the world.
(Dr Reeders) I think that is a good point, that one
of the limitations in developing vaccines is fear of liability
because you are not treating a disease. If I give you a medicine
for a serious disease and you get a side effect, I can say, "Look:
I weighed the risks", but when I give a naive child a vaccine
and then they have an onset of a nasty side effect to prevent
a disease they never might have had, the sentiment in the public
is very much against that, and yet vaccines are matters of public
health and therefore I think the public should underwrite or in
some way protect companies that in good faith have problems with
(Professor Borriello) If I may raise one other point,
as companies increasingly move towards sub-unit vaccines or, now
increasingly, genetically engineered vaccines, so that one makes
a safe vaccine, so instead of attenuating a pathogen using passage
you attenuate it with a known attenuation using modern molecular
methods. Those increasingly are being given orally. Again, that
has advantages in not using needles and increasing the risk of
the spread of AIDS, etc, in Third World Countries, so oral is
better, but that means you excrete the organism. Now a new regulatory
body that people are having to go through is saying, do we release
genetically modified organisms into the environment? The problem
is that the bodies that deal with that are not used to dealing
with public health and they are not used to dealing with vaccines.
They are used to dealing with genetically modified crops, so there
is now a gap based on ignorance (in the nicest sense of the word)
between those trying to get some of these products up to market
and those who now find they have a role in saying whether or not
they can be used.
491. If somebody was sitting here from the Treasury
and they heard what you had said, their response would probably
be along the lines that more often than not if there is a failure
of the market in the private sector and then the government gets
involved it is rapidly followed by a failure in the public sector.
The objective is to try and get the market to work better, not
to get the public sector or government to be involved. Is there
no way in some of the things that you have been outlining of getting
the market to work better?
(Dr Reeders) I think the problem is that by and large
most vaccines are used for public health purposes. Typically,
an individual is vaccinated not to protect him or her but to protect
the public. For example, smallpox may be (hopefully not) a classic
case of this problem. The big advantage of vaccinating people
for smallpox is the protection of transmission in the public.
Individuals may not be prepared to pay for the general public
good. That has been true of diphtheria vaccine, for example, where
individuals said, "I do not care if there is a diphtheria
outbreak. I do not like to risk having some (unproven) side effect".
I think in general governments should not dabble in markets but
let the market dynamic work, unless there is a need to take a
public health standpoint. For example, car companies, left to
their own devices, would never make better roads. They might make
safer cars but there would be no incentive to make better roads.
Individuals would not buy safer roads; there would be no way to
do that. They will buy safer cars but the cars will go on bad
roads. Somehow we have to fix the roads if we are going to influence
road safety. Vaccines are a case par excellence where intervention
by the public for the good of the public has a place.
492. It would be interesting to hear about some
of the problems that might be involved in bringing, for example,
a diagnostic test to market but, more generally than that, can
you separately give us a glimpse of what new technologies might
in fact add to coping with infectious disease? We have heard about
the difficulties of bringing some of these things to market and
you have touched on the difficulties of the low profitability
of diagnostic tests and the difficulties associated with vaccines,
but what is there? One hears about a much broader spectrum of
possibilities, near-patient testing, for example, which could
have very significant public health implications, with the possibility
of off-the-shelf testing incentives, for example, in high street
pharmacies. What are the possibilities that we should be looking
at out there which might affect the infectious disease general
scene over the next decade and what are the problems associated
with implementing that?
(Dr Reeders) I tell you what: next time I get an upper
respiratory tract infection I would like to be able to go to a
pharmacy, grab a small diagnostic device, prick my thumb and know
that I have a viral infection and I do not need to go to the doctor
or to wonder if I have to take antibiotics. Ultra rapid point-of-care
testing has to have a huge value in avoiding people contacting
the health service when they do not need to but more likely for
general practitioners to be able to make triage decisions as to
whether to refer people or to give them antibiotics, which obviously
can have significant drawbacks from a public health standpoint.
(Professor Borriello) There are three big questions
in there. On near patient testing, certainly that is an area where
a drive to diagnostics has happened but it has happened for commercial
reasons. People who have produced therapeutics are keen to join
with diagnostic manufacturers to get a diagnostic that is sharp
and to couple it with their therapeutic. That is the main driver.
The advantages are as indicated: if a GP can do a throat swab
on a child between the ages of two and 15 and say it is a streptococcus,
he can give the appropriate antibiotic quickly, so it has application
there. Until very recently, the opportunities to pull through
near patient testing into general practice were low because they
were not the budget holder, but with the advent of primary care
trusts they are now the budget holder for diagnostics and can
commission their diagnostics and so there is a great opportunity
for that sort of testing to come into the market place. The influenza
near patient test is one that is on the market, but again that
is for a very good reason. It is because you can sell anti-flu
drugs. Will they reduce the burden or increase the burden on diagnostics
in main laboratories? They will probably increase it because most
GPs would want some sort of confirmation. Most patients who diagnose
themselves across the counter would probably want some confirmation.
They could be exceptionally useful in difficult-to-reach population
groups, particularly in the Third World and particularly, say,
in Australia with remote population, and that could also be true
in the Hebrides in the UK. It would also be true of drug abusers.
If you could couple a near patient test for Hep B and have a rapid
answer and then give them therapeutic vaccine instead of saying
to a drug addict, "Come back next week", then you would
have a public health advantage. The same could be true of immigration
services, rapid screening of particular infectious diseases, as
well as the veterinaries. These are not really near patients tests.
They are near target. The target could be a cow as much as a human.
There are implications also for surveillance. If the diagnostics
are made remotely you may not get feeding back of information.
That is something which has to be looked at.
493. We have heard previously that the market
opportunities here are not great because margins are small; on
the other hand there are various companies about but you only
have small volumes with them. Could I ask Dr Reeders whether he
sees opportunity here if this expands?
(Dr Reeders) Yes. We very actively look for exactly
this type of technology to invest in, high volume technology that
could be used by relatively unskilled people which generates high
volumes for something that people really care about where they
would be prepared, let us say, as a consumer or as a GP, to pay
three pounds to know the answer. We have not seen those technologies
yet and they have not been developed to my knowledge. There are
lots of people working on it but the significant breakthroughs
I think are not there at the moment.
494. There are a number of US patents in this
area and there are prototype devices for HIV over-the-counter
testing and TB and one or two others. You are familiar with these,
(Dr Reeders) I am familiar with many of them.
(Professor Borriello) There are many in the market
place in America and Japan. That is because the health funding
is different there and they are nearly all based on the original
pregnancy testing technology, so it is well proven, old technology.
495. Where the market has failed to develop
some of these, what can the public sector do to stimulate this?
(Professor Borriello) The other part of the key question,
apart from near-target testing, was also new technology diagnostics
and by that I am talking about normal diagnostic laboratories.
There are a number of problems there. One is that they are exceptionally
price sensitive. What a company might consider as not an unreasonable
cost per test a routine laboratory would see as exorbitant because
pathology as a whole is very poorly funded in the UK. Until they
can link good pathology services with bed occupancy turnover and
improved therapeutics, you will not get investment in that area
and that is going to have to be the trick in terms of securing
the funding to improve the pathology. Modernising pathology or
rationalisation of pathology is exceptionally slow in the UK.
It really still has not happened. There is all sorts of resistance
to that, mainly along professional lines. Where the new technology
can have a big impact is that you will get more rapid diagnosis
but the proof that that leads to improved patient care still is
not in the public domain. Where the real benefit has come and
where the evidence exists is where you have new technology that
can better characterise individual pathogens and type them, fingerprint
them; it is forensic microbiology. On that basis, when you are
involved, for example, in trying to get a company to withdraw
a product because you are saying that the botulism in their baby
food is the one that infected the child, to be able to say definitively,
"This is not a coincidence. This is the exact same strain",
that is exceptionally powerful and companies respond very quickly.
That technology has been used in product withdrawal at least three
times over the last two years where five years ago it would have
been much more difficult to prove. I will give you a very brief
anecdote. When we had the huge tinned salmon botulism outbreak
the company raised the possibility that the botulism came from
the can opener and got into the tin; it did not come from the
tin to the can opener. You have those trails of evidence problems
which new technology can start to unravel.
(Dr Reeders) There is one other issue which is adoption
of standards. One of the problems that companies face when deciding
how big a market is going to be is how fast adoption will be.
One of the problems in the UK particularly is that it is not clear
often what standards are going to be adopted by physicians or
the NHS, and therefore it becomes dangerous to enter the market.
In the US it is more regularised so often the professional bodies
or the government or the insurance companies or the fear of liability
will drive a certain behaviour and it will become rapidly adopted
and it will become uniform very quickly. Then companies can go
into that market knowing that the standard, say, is to swab a
child's throat for streptococcus and you will not be reimbursed
for the antibiotics if you do not do the swab, or whatever. One
of the things that would help in this country is more consistent
standards across the country for testing.
496. How do you think new technologies should
be evaluated and how do you think information about them should
be disseminated so that worthwhile ones are taken up and who do
you think should be responsible for those two things?
(Professor Borriello) There have to be two levels
of evaluation. First, there has to be the specialist laboratory
evaluation that under ideal conditions this product does have
this level of sensitivity and specificity and can cope with this
particularly problematic specimen, or not, whichever the case
is. There then has to be a proper field evaluation. That is an
area where having a network of NHS trust laboratories as well
as public health laboratories in the recent past under single
management (which is soon to disappear) has never properly been
utilised for field evaluations of diagnostics. That has been a
tremendous missed opportunity, but very frequently a diagnostic
or any new technology will have 98 per cent sensitivity and 99.99
per cent specificity and negative predicted and positive predicted
values which are very high, and in the field they are always about
65 per cent because you are taking it from a specialist evaluation
and putting it into the front line where you have got for example
a brand new MLSO, a training MLSO, an MTO who has not used it
before, it is four o'clock Friday afternoon, nobody has cleaned
the machine properly, those sorts of problems, so there is the
opportunity to have proper co-ordinated and regulated field evaluations
as well as the specialist evaluations which the Medical Devices
Agency undertakes in the UK and that opportunity still exists
but it does not happen. Pushing out information is much more difficult.
We have a good system for adverse events report but we do not
have a good system for collating and making publicly available
everybody's evaluations or having some proper analysis of those.
The fact that somebody has done an evaluation does not mean to
say that it was done properly or well. We do need to put guidance
out. The problem is, would certain companies cry "foul"
if you recommended that a particular product was not purchased
for a particular diagnostic, particularly if they already had
their kite marking from the In-Vitro Diagnostics Laboratory? There
are some problems but I do not think they are insurmountable.
Who should deliver it? Maybe the MDA in its new combined agency
role with the MCA or maybe it should be the Health Technology
Assessment Panel or some combination of these. It should involve
a full range of professionals. It should involve users, it should
involve the Veterinary Laboratories Agency, it should involve
the National Blood Agency, because they all have an interest in
diagnostics and shared experience.
497. Who makes the decision which new diagnostics
to adopt or not even after the evaluation is carried out. Is there
a co-ordinated strategy about that? Can you give me examples of
the new diagnostics? Some of them you mentioned, like diphtheria.
(Professor Borriello) What currently happens as far
as I am aware is that the decision as to whether or not to adopt
a particular diagnostic technology is a local one with the laboratory
director or the chief technician or chief technician equivalent
within the laboratory in response to information available and
also in response to opportunity. Have they suddenly been told
they have some capital and funding available for equipment? Which
companies have recently been round to talk to them or which meeting
did they go to when they saw something explained? It is a very
local decision with little possibility of going to a single repository
of greater sources of information and comparative data. How could
it be done? Possibly we do need a NICE equivalent for diagnostics,
impartial, with full professional involvement with everybody who
has an interest, making some sort of guidance.
498. NICE can do it itself, technology assessment.
(Professor Borriello) It could, absolutely. It would
not be able to do it for every single possible diagnostic available
or for every diagnosis one would wish to make but they really
should concentrate on high volume where it is important to make
accurate early diagnosis. An example of the problems would be,
let us say, the urinary antigen test for pneumococcus. It is only
£12 to £15 a test. Actually, that is a lot in the local
laboratory. Should they use that or should they use some generic
PCR approach or should they use an immunoassay platform or should
they use a black box. I do not know, but that is the sort of choice
that they are facing locally, not only when should they test but
also what test should they use. There is no guidance at all.
499. It is certainly correct that there is no
(Professor Borriello) No, there is no procurement
strategy. The NHS has a huge potential leverage in terms of getting
the best kits at the best price and also having a role in stimulating
appropriate evaluations. The body for the NHS is called PASA.
They have no role as far as I am aware in procurement of diagnostics
of any sort, including laboratory consumables. That has to change.