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Health and Healthcare Technologies Event University of Bath

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1 Health and Healthcare Technologies Event University of Bath
Katie Finch Medical Research Council 12th May 2011

2 MRC mission Encourage and support research to improve human health
Produce skilled researchers Advance and disseminate knowledge and technology to improve the quality of life and economic competitiveness of the UK and worldwide Promote dialogue with the public about medical research

3 Recent achievements New therapies Clinical practice Diagnostics
MRC contribution to over 10% of global pipeline of therapeutic antibodies, including Humira®. Clinical practice Compression stockings have no effect preventing DVT in stroke patients: saves NHS £7m and 320,000 nursing hours a year; Use of CBT in social recovery of schizophrenia patients with psychosis; review of evidence of increased risk of cardiovascular disease. Diagnostics New cancer diagnostics based on test for minichromosome maintenance (MCM) proteins. Screening programmes Flexi-Scope bowel cancer screening to be rolled out over next four years. Vaccines MenAfriVac: 40¢ meningococcal meningitis vaccine received WHO prequalification in June 2010. Therapeutic antibodies: MRC inventions at LMB in late 80s, early 90s spawned therapeutic antibody market, estimated value $40bn and growing. About a dozen new mAbs currently in phase III trials. Clinical practice: An “intended consequence” of the MRC’s funding strategy is that we generate a solid evidence base to help regulators and advisory bodies make rational decisions. Compression stockings – CLOTS trials, University of Edinburgh, funded by MRC; Chest, Heart & Stroke Scotland; CSO; UK Stroke Research Network. Schizophrenia - Two MRC trial platform grants funded work referenced in a 2009 update to guidelines. Professor Fowler (University of East Anglia) led a trial on CBT in social recovery of patients with psychosis – positive results led to CBT recommended as an intervention for people with schizophrenia; Dr Osborn (UCL) reviewed evidence for adverse cardiovascular (CV) outcomes in people with severe mental health illnesses; NICE recommended all patients with schizophrenia be screened for CV risk factors. Cancer diagnostics - Minichromosome maintenance (MCM) proteins are characteristically expressed in the nuclei of cancerous cells (work by Nick Coleman and Ron Laskey at MRC Cancer Cell Unit); test for cervical cancer on the market, also being pursued for lung and bowel cancer. NOTE: Ron Laskey is chairing the session. Bowel cancer screening – announcement by David Cameron PM, 3 October. Screening programme based on Flexi-Scope test – its effectiveness was demonstrated by a 16-year trial funded by MRC, Cancer Research UK and NIHR. Single test reduced bowel cancer incidence by a third. MenAfriVac – WHO prequalification (June 2010) followed phase II trial part-funded by MRC which showed vaccine to be safe and to generate up to 20 times more antibodies than current vaccine. Protection from group A meningitis infection that periodically sweeps through sub-Saharan Africa every 8-10 years.

4 MRC funding MRC gross research expenditure - £758.2m in 2009/10.
279 new grants to researchers. £366 million on grants and training awards in universities and medical schools. £375 million for over 500 programmes in our research units and institutes. Over 4,500 publications in peer-reviewed journals in 2009. Licensing income receipts of £66.2 million: over £500 million total cash generated since 1998. People 4,000 people employed in our units, institutes and centres. Over 5,700 research active staff supported by the MRC. £78.2 million on training and career development: around 350 fellows and 1,500 postgraduate students.

5 UK Government Departments OSCHR
Partnership working UK Government Departments OSCHR Research community Patients and carers UK Clinical Research Collaboration MRC MRCT NIHR NHS International Public Universities Regulatory bodies Research councils Partnerships are key to achieving our strategic aims and objectives. NOTE: AMRC’s recent report ‘Ways and Means’ shows how the MRC lies at the heart of many interactions between medical research charities and other funders – MRC involvement can be pivotal in delivering the most impact from medical research funding. Because of the complex inter-relationships within science funding, we can achieve more by working with others. A great deal of research is now conducted on a scale that is not achievable by a single funding body (or country), for example, large facilities like Research Complex at Harwell (officially opened July 2010) , National Prevention Research Initiative (NPRI), UK Biobank, European and Developing Countries Clinical Trials Partnership (EDCTP). Relationships with industry and regulators to help translate scientific discoveries into applications: ie new drugs, therapies and diagnostics; prevention strategies; clinical practice; economic benefits. Learned societies Medical charities Industry Parliamentarians Policy-makers

6 Coordinated public sector health research strategy
HM Treasury DH BIS OSCHR Devolved Administrations NIHR MRC OSCHR achievements [taken from OSCHR’s written evidence and Sir John Bell’s oral evidence to the House of Lords Science and Technology Committee, 12 Jan 2010: A Shared Vision for UK Health Research – published vision means OSCHR partners develop strategies accordingly and know they are joined up with other public funders. Translational medicine – an initial focus of OSCHR, along with public health research, public health records research, methodology research and human capital. MRC and NIHR have divided up translational research where one or the other leads and spends on behalf of other organisations: Eg single call for Experimental Medicine. Looking ahead: Capability Clusters – Most advanced OSCHR programme for interacting with industry, providing a place where industry can go and do the most challenging bit of the development pipeline: early phase IIa projects to decide quickly whether a molecule is effective or not – requires a lot of scientific input. Comes out of the Office for Life Sciences but led by OSCHR and involving all partners. Industry very enthusiastic, pushing to see them developed. Collaboration Framework – Government-funded agencies and major charities have agreed to work within a single framework to ensure funding initiatives providing support for programmes in experimental medicine or cohort development, for example, fit within UK-wide strategy. Public health research – 2008/09: map of public health research funding in the UK. Eg MRC leading on Ageing and Addiction & Mental health; NIHR leading on Obesity and Infection. Fellowships survey published – part of OSCHR’s focus on capacity-building and ensuring the right mix of clinical specialties and academic research training for clinicians. Research Funding flow Policy input

7 MRC remit and partners MRC - basic research to early clinical trials
Underpinning and aetiological Prevention Detection and Diagnosis Treatment development and evaluation Phase 1 & 2 trials Basic research Discovery Preclinical Early Clinical Late Clinical HTA MRC EME BBSRC NIHR Medical Charities TSB

8 Strategy update

9 Research Changes Lives
MRC Strategic Plan Over the next five years the MRC aims to support medical research which increases the pace of the transition to better health. We will achieve this through: Strategic Aim One: Picking research that delivers Strategic Aim Two: Research to people Strategic Aim Three: Going global Strategic Aim Four: Supporting scientists

10 Research Changes Lives
1. Picking research that delivers: Setting research priorities which are most likely to deliver improved health outcomes Research priority theme one: Resilience, repair and replacement Natural protection Tissue disease and degeneration Mental health and wellbeing Repair and replacement Research priority theme two: Living a long and healthy life Genetics and disease Life course perspective Lifestyles affecting health Environment and health Strategic Aim One Picking research that delivers: Setting research priorities which are most likely to deliver improved health outcomes Research priority theme one: Resilience, repair and replacement Natural protection – to explore resilience to disease and degeneration, understanding how it may be exploited for new inventions that ameliorate disease processes Tissue disease and degeneration – to advance knowledge in the biology of ageing and degeneration of human tissue; to understand the mechanism and impact of chronic inflammation Mental health and well-being – to explore the relationship between mental health, wellbeing and resilience to disease processes Repair and replacement – to translate the burgeoning knowledge in regenerative medicine into new treatment strategies Research priority theme two: Living a long and healthy life Genetics and disease – to use genetics, imaging and biological indicators to understand predispositions for disease, and to target treatments to disease subtypes Life course perspective – to drive forward interdisciplinary research addressing health and wellbeing from childhood to older age Lifestyles affecting health – to determine the most effective strategies for tackling lifestyles that are detrimental to health Environment and health – to explore the impacts of changes in our environment on health and wellbeing

11 Research Changes Lives
2. Research to people: Bringing the benefits of excellent research to all sections of society Translation of research Regulation, ethics, governance and working with decision-makers Communication 3. Going global: Accelerating progress in international health research Partnerships and shaping the agenda Global health 4. Supporting scientists: Sustaining a robust and flourishing environment for world-class medical research Capacity Use of population-based data Research environment Strategic Aim Two Research to people: Bringing the benefits of excellent research to all sections of society Translation of research – to bring the health impacts of fundamental research to people more quickly Regulation, ethics, governance and working with decision-makers – to uphold and guide ethical research practice and the highest standards of research governance; to enhance the regulatory process by providing innovative approaches Communication – to enhance communication with the scientists, the public, policy-makers and partners Strategic Aim Three Going global: Accelerating progress in international health research Partnerships and shaping the agenda – to provide international leadership in partnerships which enhance the competitiveness of the UK knowledge and health base Global health – to support global health research that addresses the inequalities in health which arise particularly in developing countries Strategic Aim Four Supporting scientists: Sustaining a robust and flourishing environment for world-class medical research Capacity – to strengthen and sustain a skilled research workforce through targeted support for excellent training and the development of world-class research leaders Use of population-based data – to exploit fully the complexity and benefits of population-based data; to maximise sharing and linkage of data, and to develop data collection and storage Research environment – to provide a world-class research environment

12 Spending Review–key messages
Overall Science and Research resource budget maintained at 2010/11 levels in cash terms MRC resource expenditure will be maintained at 2010/11 level in real terms (~10% cash increase by 2014/15) £220m capital to MRC from DH budget for UKCMRI construction costs MRC capital budget reduced by 57%

13 Spending Review–Impact
Reform, Research Concentration, Economic Impact, Working in Partnership are all important themes on which we are expected to deliver All ROs are expected to manage demand Efficiency savings target for MRC: £53.3m by 2014/15, to be achieved in part by implementing Wakeham recommendations and pay restraint Both targets will be very challenging All MRC savings to be recycled into our science programmes

14 MRC Delivery Plan Strategic programmatic themes
Major activities that will rapidly deliver gains in health and wellbeing, together with increased economic impact. National capability Develop and sustain research infrastructure for delivering highest quality biomedical research, driving interdisciplinarity and engaging with partners. Cross-council and multidisciplinary priorities Lead on Lifelong Health and Wellbeing and work with other research councils on other priority challenges. Other government initiatives Translational medicine, NC3Rs, Stem cells, TSB Skills base Strengthen and sustain skilled research workforce, support future research leaders and respond to industry needs for well-trained researchers. Programmatic themes: Detailed on following slide. National capability: eg UKCMRI (with Wellcome Trust, Cancer Research UK, UCL), LMB, UK Biobank (with Wellcome Trust, Northwest RDA, DH, Scottish Govt), Methodology research. Cross-council programmes: LLHW (MRC lead), Living with Environmental Change and others; work with STFC re national and international facilities, particularly Diamond and ESRF; public engagement; RCUK international offices. Other govt initiatives: Translational: partner with TSB and OLS Clusters with stratified medicine and regenerative medicine highest priorities; investment in developmental pathway and developmental clinical studies; meeting needs of industry. NC3Rs: maintain joint contribution with BBSRC. Stem cells: see regenerative medicine in programmatic themes on next slide. TSB: Working with TSB is central to many MRC strategic funding initiatives. Skills base: PhD studentships – reduce numbers slightly but increased training support for each student so maintained investment overall; Fellowships – increase number of early and intermediate fellowships, sustain investment in senior fellows; Clinical research training – increase number of intermediate fellowships

15 Strategic programmatic themes
New frontiers in biomedical research Living a long and healthy life Health research is global Population health sciences Stratified medicine Regenerative medicine, stem cells and tissue repair Systems medicine Mental health and wellbeing Lifestyle and behaviour: obesity, addiction Healthy ageing International leadership Global health e-Health research Population-based cohorts Public health infections research 1. New frontiers: Strategic alignment with industry in research, training and translational investments; Joint working with TSB, NIHR and research councils in key areas of medical advance For example, the Inflammation and Immunology Initiative: £10m in two new research consortiums – collaborations between industry and academia following workshops in areas of COPD and rheumatoid arthritis; Strengthen drive toward novel therapeutic and diagnostic interventions. 2. Long and healthy life: Strategic investment in mental health; Strategies for tackling lifestyles that are detrimental to health such as obesity and addiction; Healthy ageing (For example, the MRC leads on Lifelong Health and Wellbeing: the cross-research council programme into healthy ageing); 3. Global: International leadership in partnerships – particularly South East and Southern Asia, and influencing the European scientific agenda; Working in partnerships to optimise funding to support global health research – trials (with DFID and Wellcome Trust), MRC units in The Gambia and Uganda, and partnership with Indian Council for Medical Research under the Global Alliance for Chronic Diseases. 4. Population health sciences: Optimise contribution of population health sciences to public health research (with NIHR and UK Health Depts, ESRC, Wellcome Trust and other funders); Exploiting the benefits of population-based data to inform development and implementation of public health policies (use of e-health records); Achieve an integrated response to emerging infectious diseases (with NIHR)

16 Training and careers Development of new postdoc collaborative fellowships with industry Sustain support for MRC early and intermediate fellowships Improve the attractiveness of MRC Senior Fellowships to the best candidates Potentially open up MRC studentships to excellent EU students in strategic skills shortages Survey: signals from students and early researchers

17 Translation What is it? - turning discoveries into clinical benefits, while maintaining the basic research that drives it. MRC’s translational strategy is: building on the MRC’s existing role in pushing forward basic knowledge to improve people’s health and wealth; strengthening the support and oversight of the translational processes. Basic medical research Prototype discovery and design Pre-clinical development Early clinical trials Late clinical trials

18 Translational research
Overall spend on Managed Programs to Increase to £50 M pa by 2014 (have allocated £47 M since 2008) Developmental Pathway Funding Scheme Developmental Clinical Studies Translational Stem Cell Research Committee Developing novel ways of supporting translational activities Enhance support for Experimental Medicine Maximising best use of resources and infrastructure Increasing the UK capacity/capability for translational research Developing novel ways of supporting translational activities Building on Devolved Portfolios and Translators Pilots Pre-competitive and collaborative approaches

19 Working with industry Widen our engagement and adapt to a changing innovation ecosystem Pharmaceutical Biotech Devices and diagnostics Research partnerships Explore and fund innovative models of pre-competitive and collaborative research partnerships Stratified Medicine and Systems Medicine agendas Regenerative medicine Health Sciences Collaborations, partnerships with TSB Opportunities for MRC to add value and provide leadership MRC leading for other research councils on engagement at policy level with Pharma companies

20 Funding

21 Roles of Boards and Panels
Primary decision making bodies on MRC funding Grants, Units and Institutes Ensure balance of portfolio is right for area of responsibility Shape strategy in their areas: directly, through Strategy Board and via interaction with Overview Groups Join up with other bodies to ensure seamless support for science Consider the impact and value of the research in their areas

22 Boards and Overview Groups
Strategy Board Molecular and Cellular Medicine Board Population and Systems Medicine Board Infections and Immunity Board Neurosciences and Mental Health Board Population Health Sciences Group Translational programmes Training programmes Translational Research Group Global Health Group Strategy Board: Sets top-level strategy, budgets and special initiatives Research Boards: Funding projects, programmes, units, assessing performance, strategy development and implementation Overview groups: Steering delivery and strategy, cross-board monitoring Executive Board (not pictured) ensures delivery Also not pictured: Wider cross-funder initiatives. Training and Careers Group

23 Types of Research Support
Question Driven Research grant Personal Support Driven Fellowship The project / programme The people The ‘place (s)’ The person The project The ‘place’

24 Which Scheme? Standard “response mode” grants Research grants
New investigator research grants Programme grants Strategic initiatives (Calls) Personal support – variety of fellowships Eligibility Awards to promote collaboration Between HEIs (Partnership grants) With industry (MRC Industry Collaboration Awards) Short awards for personal development Discipline hopping People exchange

25 Training and Careers Group
MRC Fellowship Panels Strategy Board Training and Careers Group Clinical Panel Clinical Research Training Fellowship Clinician Scientist Fellowship Senior Clinical Fellowship Non-Clinical Panel Career Development Award Senior Non-Clinical Fellowship Strategic Panels Biomedical Informatics Fellowships Panel Career Development Award in Biostatistics / Methodology Research / Economics of Health / Population Health Scientist Fellowships Panel

26 Senior Clinical Lectureship
MRC post doctoral fellowships Non Clinical, Clinical and some of Strategic Skill fellowships Senior Non-Clinical Career Development Award Yrs Post PhD -1 1 2 3 4 5 6 7 8 9 11 12 CRTF Clinical Lectureship Clinician Scientist Senior Clinical Lectureship Senior Clinical Population Health Science Bioinformatics, Biostats, Economics of Health NIHR ‘Walport’ Lectureships aligned with MRC clinical fellowship schemes Methodology Development Key:

27 Timelines Note deadlines
Process – is there an outline or pre-sub stage? Plan ahead – need apply 1 year in advance Process time for grants i.e. time until a decision usually 14 weeks (3 months) for applications declined at triage stage within 23 weeks for a funding decision by a Board/Panel (6 months) Start date is usually 6 months after funding decision

28 Lifelong Health and Wellbeing: A Strategy for Collaborative Ageing Research in the UK

29 The challenge of an ageing population
The UK’s population is ageing Life expectancy has increased by 30 years in last century Overall decrease in fertility rate Currently one in six people is over 65 this will rise to one in four by 2033 Over 85s are the fastest growing segment of the population Inequalities - life expectancy varies between UK regions by 14 years The Drivers Ageing is a major risk factor for disease and disability Increased pressure on public services, welfare, health and social care – current models are unsustainable Social and economic opportunities 29 29

30 Lifelong Health and Wellbeing (LLHW)
Current major cross-Research Council programme in ageing Strategic coordination of ageing research across the Research Councils Supports research targeting factors throughout life that determine health and wellbeing in older age LLHW Strategic Aims Develop interventions that lead to improved health and quality of life in older age Inform policy and practice including services and technologies to support independent living Increase capacity and capability in ageing-relevant research 30 30

31 LLHW Joint funding initiative
Funding partnership between five research councils and four health departments Support for multi-disciplinary research addressing factors that influence health and quality of life in older age Build capacity in multi-disciplinary ageing research community £30m commitment since 2008 to three LLHW phases 31 31 31

32 Strategy for Collaborative Ageing Research in the UK
Developed by Research Councils and UK Health Departments under LLHW programme – published September 2010 Purpose Identify opportunities for greater impact through cross-sector approaches Build on existing strengths Add value to initiatives and activities of individual funders Create new partnerships, across academic disciplines and stakeholder communities – Government, private and third sector Set priority areas for LLHW programme over CSR2011 32 32

33 Achieving good cognitive function and mental wellbeing in later life
Priorities for CSR 2011 Achieving good cognitive function and mental wellbeing in later life Promoting physical health in older age Extending healthy working lives Enhancing mobility and independence in an ageing population 33 33

34 Successful proposals Encompass the remit of more than one Research Council – creative multi-disciplinary approaches Not usually supported by individual funders Research excellence, impact and importance Robust methodology and design Add value to the programme Encourage stakeholder engagement and capacity building 34 34

35 you should start early’
‘If you want to age well, you should start early’ 35 35

36 36


38 Assessment Process (MRC)
(short-listed applications only) All short-listed applications are assessed by the Research Boards/Panels Applicants can respond to the reviewers comments (Grants) Discuss reviewers critique at interview (Fellowships) applications scored (1-10) feedback will be given on all applications reviewed by the Board/Panel

39 Assessment process (MRC)
Referee Assessment (all grant and fellowship applications) applications refereed – reviewers UK and International applications scored (1-10) Board/Panel Assessment (grants) Triage (shortlisting) allows Boards/Panel to focus on those proposals most likely to be funded decisions are made based on the views of the reviewers & Board/Panel members unattributed reviewers’ reports fed back to applicant Mention No fixed numbers or % for cut off point at triage (~30% of applications) Dependent on: number of applications submitted Funds available to award at that meeting Approx. x2-3 the value of applications that the Board can fund are assessed at the meeting – are flexible Note – take this approach since Research Organisations do not want to limit at source and cannot put such large numbers to Boards/Panels to review.

40 Core Assessment Criteria- Grants
importance scientific potential people and Track record environment research plans resources (justification; good value for money) ethical issues or risks to human participants appropriate use of animals Referees Triage Board

41 And finally… Review internally mentors for new applicants
Tip: get a second opinion, proof read & spell check MRC is looking for quality not quantity

42 Need & Potential for Impact
Remember… Your application will only be as strong as its weakest link Design Deliverability Need & Potential for Impact Ethics Resources

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