1. The NHS R&D Programme in England: Background and Progress Presentation to a meeting on The Need for Independent Biomedical Research, Roma, 3 November 2003 Dr Chris Henshall Director Science and Engineering Base Group Office of Science and Technology Honorary Professor London School of Hygiene and Tropical Medicine

2. Overview Public and private R&D Public and private R&D  R&D expenditure in the UK, Italy and USA  Why spend public money on R&D?  Why spend public money on biomedical and health R&D? UK systems UK systems  For health care  For research UK funding for biomedical and health R&D UK funding for biomedical and health R&D The NHS R&D Programme The NHS R&D Programme  Origins  Development  Present position Concluding remarks Concluding remarks

3. R&D expenditure in 2000 as %GDP GERD GOVERD HERD** BERD UK 1.83 0.22 0.38 1.20 Italy* 1.04 0.21 0.33 0.51 USA 2.70 0.20 0.37 2.04 GERD = Gross Expenditure on R&D GOVERD = Government expenditure on R&D HERD = Higher Education expenditure on R&D BERD = Business Expenditure on R&D *1999 figures ** 8%, 4% and 6% from business in UK, Italy and USA respectively

4. Why spend public money on R&D? Governments fund research for three reasons Market failure Market failure  Direct, private returns to business will not provide the incentives for business to fund all the research needed to underpin a prosperous, knowledge-based economy. Governments therefore support basic, strategic and applied research with public (as opposed to private) benefits To support the work of Government itself in policy and regulation To support the work of Government itself in policy and regulation  Government may need itself to develop the evidence base for policy and regulatory decisions To support innovation, effectiveness and efficiency in the delivery of public services To support innovation, effectiveness and efficiency in the delivery of public services  Government services need applied research just like any other business

5. Why spend public money on biomedical and health R&D? To support basic biomedical and clinical research to underpin commercial and non-commercial developments in health care (market failure) To support basic biomedical and clinical research to underpin commercial and non-commercial developments in health care (market failure) To provide and/or assemble the evidence base to support the formulation of policy for health and health care, and to support health and health care regulation (policy and regulation) To provide and/or assemble the evidence base to support the formulation of policy for health and health care, and to support health and health care regulation (policy and regulation) To provide the evidence base for innovative, effective and efficient delivery of those parts of the health care system that are publicly run and/or financed (public research for public services) To provide the evidence base for innovative, effective and efficient delivery of those parts of the health care system that are publicly run and/or financed (public research for public services)

6. Overview Public and private R&D Public and private R&D  R&D expenditure in the UK, Italy and USA  Why spend public money on R&D?  Why spend public money on biomedical and health R&D? UK systems UK systems  For health care  For research UK funding for biomedical and health R&D UK funding for biomedical and health R&D The NHS R&D Programme The NHS R&D Programme  Origins  Development  Present position Concluding remarks Concluding remarks

7. UK Health Care 60 million population 60 million population £1,000bn GDP £1,000bn GDP £56bn spent on National Health Service in England in 2002-03 £56bn spent on National Health Service in England in 2002-03 £3.5bn spent on private health care in the UK in 2002-03 £3.5bn spent on private health care in the UK in 2002-03 Spending on NHS in England planned to rise to £90bn in 2007-08 Spending on NHS in England planned to rise to £90bn in 2007-08

8. National Health Service (1) Treatment for all according to need, regardless of ability to pay Treatment for all according to need, regardless of ability to pay (Largely) free at the point of delivery (Largely) free at the point of delivery Funded through general taxation Funded through general taxation Funds allocated to 303 Primary Care Trusts (PCTs) in England through weighted capitation formula Funds allocated to 303 Primary Care Trusts (PCTs) in England through weighted capitation formula PCTs contract with hospitals to provide acute care PCTs contract with hospitals to provide acute care

9. National Health Service (2) 28 Strategic Health Authorities in England responsible for local management of NHS: strategy, planning, capacity, performance 28 Strategic Health Authorities in England responsible for local management of NHS: strategy, planning, capacity, performance Department of Health sets central policies and monitors overall performance Department of Health sets central policies and monitors overall performance National bodies undertake various functions, eg National bodies undertake various functions, eg  National Institute for Clinical Excellence  Commission for Health Improvement  Modernisation Agency  National Patient Safety Agency  Health Development Agency

10. Dual Support System for research The Education Departments fund the Higher Education Funding Councils (FCs) in England and the devolved administrations The Education Departments fund the Higher Education Funding Councils (FCs) in England and the devolved administrations  The FCs allocate research infrastructure funds (QR) to universities according to the volume and quality of their research The Office of Science and Technology (in the Department of Trade and Industry) funds the UK Research Councils (RCs) The Office of Science and Technology (in the Department of Trade and Industry) funds the UK Research Councils (RCs)  The RCs allocate funding to peer reviewed projects and programmes in universities and their own research institutes

11. Dual support funding 2003-2006 2003-042004-052005-06 QR*£1308m£1390m£1538m RCs total£1859m£1985m£2190m MRC£ 422m£ 451m£ 495m BBSRC£ 260m£ 283m£ 324m ESRC£ 94m£ 104m£ 120m EPSRC£ 465m£ 488m£ 543m NERC£ 257m£ 273m£ 298m PPARC£ 249m£ 265m£ 283m CCLRC£ 112m£ 122m£ 127m *figures provisional for some devolved administrations

12. Overview Public and private R&D Public and private R&D  R&D expenditure in the UK, Italy and USA  Why spend public money on R&D?  Why spend public money on biomedical and health R&D? UK systems UK systems  For health care  For research UK funding for biomedical and health R&D UK funding for biomedical and health R&D The NHS R&D Programme The NHS R&D Programme  Origins  Development  Present position Concluding remarks Concluding remarks

13. UK Health R&D Expenditure (2) Figures or estimates for 2002-03 (or 2001-02*) Industry£3000m Charities£ 640m* Medical Research Council£ 387m Higher Education FC£ 148m** Department of Health£ 62m** NHS: Support for Science£ 312m** Priorities and Needs£ 104m** Priorities and Needs£ 104m** **England only

14. Overview Public and private R&D Public and private R&D  R&D expenditure in the UK, Italy and USA  Why spend public money on R&D?  Why spend public money on biomedical and health R&D? UK systems UK systems  For health care  For research UK funding for biomedical and health R&D UK funding for biomedical and health R&D The NHS R&D Programme The NHS R&D Programme  Origins  Development  Present position Concluding remarks Concluding remarks

15. NHS R&D: origins House of Lords Report: Priorities in Medical Research (1987) House of Lords Report: Priorities in Medical Research (1987)  Biomedical and health policy research OK  MRC supports limited portfolio of health services research but cannot be expected to meet all the needs of a major state service  NHS needs to engage with biomedical research and to undertake more “operational research”  DH/NHS Director of Research and Development (DRD) DRD appointed and NHS R&D Strategy launched in 1991 DRD appointed and NHS R&D Strategy launched in 1991

16. NHS R&D: Principles Integration with NHS management and governance – NHS buying research for the NHS Integration with NHS management and governance – NHS buying research for the NHS Focus on issues of priority to decision makers in the NHS – patients; clinicians; managers; policy makers Focus on issues of priority to decision makers in the NHS – patients; clinicians; managers; policy makers Partnership with research community to Partnership with research community to  Identify research questions  Deliver the research  Make sense of the findings Primary, secondary and tertiary research Primary, secondary and tertiary research Training and capacity development Training and capacity development

17. NHS R&D: Evolution 1991-96 – Prof Sir Michael Peckham 1991-96 – Prof Sir Michael Peckham  Foundation; promotion; expansion 1996-99 – Prof John Swales 1996-99 – Prof John Swales  Consolidation; reorganisation 1999-04 – Prof Sir John Pattison 1999-04 – Prof Sir John Pattison  Further consolidation and reorganisation

18. NHS R&D: current position (1) NHS R&D Programme NHS R&D Programme  Around £70m pa of mainly “new” (post 1991) money  Programmes of commissioned research in Health Technology Assessment (HTA), Service Delivery and Organisation (SDO), and New and Emerging Applications of Technology (NEAT)  HSR training awards for medics (especially Primary Care), other clinicians and social scientists  Research synthesis and communication  Cochrane  CRD and network of review centres  Clinical Evidence  Responsive project grant funding under review

19. NHS R&D: current position (2) Funding for R&D in NHS hospitals Funding for R&D in NHS hospitals  Concerns about clinical research with introduction of internal market  “Declaration” of R&D spending in hospitals and primary care  Formation of R&D budget for hospitals  Some adjustments to allocations to reflect quality and volume; expansion of primary care  Intention to assign spending to NHS Support for Science and NHS Priorities and Needs Funding  Spends currently being revalidated as part of wider costing of hospital activities

20. NHS R&D: current position (3) Clinical research Clinical research  Extent and quality of NHS-led clinical research in hospitals still unclear  Some Regional DRDs established clinical research fellowships and other support for clinical and translational research in early years of NHS R&D Strategy, but the focus of the R&D Programme is now on health services research  Current reports from DTI Biotechnology Innovation and Growth Team and from Academy of Medical Sciences will point to continuing failings in translational research and trials and in the engagement of the NHS in these

21. NHS R&D: funding House of Lords said NHS should be a research- based industry and should spend more on “operational research” House of Lords said NHS should be a research- based industry and should spend more on “operational research” NHS R&D Strategy proposed target for NHS spend on R&D of 1.5% of NHS budget NHS R&D Strategy proposed target for NHS spend on R&D of 1.5% of NHS budget NHS spent £56b in 2002-03, and £416m on “R&D” NHS spent £56b in 2002-03, and £416m on “R&D” NHS budget set to rise to £90b in 07-08; R&D spending is static at best NHS budget set to rise to £90b in 07-08; R&D spending is static at best Challenge of strategic control over R&D funds in hospitals, which is the majority of R&D spend Challenge of strategic control over R&D funds in hospitals, which is the majority of R&D spend R&D Programme is currently around £70m of the £416m pa NHS R&D spend R&D Programme is currently around £70m of the £416m pa NHS R&D spend

22. Other funders MRC has funded clinical research trials and health services research for many years MRC has funded clinical research trials and health services research for many years MRC has continued to support trials and HSR as the NHS R&D Programme has developed, in close collaboration with the DoH and NHS MRC has continued to support trials and HSR as the NHS R&D Programme has developed, in close collaboration with the DoH and NHS  MRC HSR Collaboration  Expanded portfolio of trials, HSR and public health research  Spend of around £54m in 2001-02 on trials, public health and HSR Various clinical research initiatives Various clinical research initiatives Charities strong on basic research, with some clinical/translational research and some support for trials from CRUK, BHF and other “mission oriented” charities Charities strong on basic research, with some clinical/translational research and some support for trials from CRUK, BHF and other “mission oriented” charities

23. Overview Public and private R&D Public and private R&D  R&D expenditure in the UK, Italy and USA  Why spend public money on R&D?  Why spend public money on biomedical and health R&D? UK systems UK systems  For health care  For research UK funding for biomedical and health R&D UK funding for biomedical and health R&D The NHS R&D Programme The NHS R&D Programme  Origins  Development  Present position Concluding remarks Concluding remarks

24. Concluding remarks Most countries use public funds to support basic and clinical/translational research Most countries use public funds to support basic and clinical/translational research Some public needs for translational research and trials can be met by industry (eg submissions to regulators) Some public needs for translational research and trials can be met by industry (eg submissions to regulators) A balanced health system requires publicly funded translational, health services research and trials – depending upon the role government plays in directing and delivering the system A balanced health system requires publicly funded translational, health services research and trials – depending upon the role government plays in directing and delivering the system This publicly funded research needs international collaboration and coordination, with each country playing its role This publicly funded research needs international collaboration and coordination, with each country playing its role Within countries, this research needs to be carefully positioned in relation to the health service Within countries, this research needs to be carefully positioned in relation to the health service

25. Further information On DH and NHS R&D: On DH and NHS R&D:  www.doh.gov.uk www.doh.gov.uk On the Medical Research Council On the Medical Research Council  www.mrc.ac.uk www.mrc.ac.uk On government science funding policy and statistics On government science funding policy and statistics  www.ost.gov.uk www.ost.gov.uk From me From me  chris.henshall@dti.gsi.gov.uk chris.henshall@dti.gsi.gov.uk