APPENDIX 45
Memorandum submitted by Professor Hilary
Thomas, Professor of Oncology, University of Surrey and the Royal
Surrey County Hospital
INTRODUCTION
1. I am a Professor of Oncology jointly appointed
between the University of Surrey, who pay five sessions of my
salary and the Royal Surrey County Hospital who pay six sessions
of my salary. The first five years of my post (which is currently
a five-year fixed-term post) my salary for the National Health
Service has been funded entirely by a local charity entitled Guildford
Undetected Tumour Screenings (GUTS). I believe that my review
is relevant to the Committee as an academic working in the National
Health Service environment who is attempting to establish a research
base in the area of the treatment of cancer. My specific research
focus is translational research which I believe is relevant to
the terms of reference adopted by the Committee. I will respond
to those specific areas outlined in the terms of reference where
I feel I have a relevant contribution to make.
ADEQUACY OF
THE OVERALL
RESOURCE
2. I have just returned from the American
Association for Cancer Research. This is arguably the highest
quality and best attended forum for cancer research in the world.
It is very clear both in terms of the low representation of the
United Kingdom and the resources spent on cancer research in this
country that we fall perilously behind our colleagues in Northern
America and also Europe. Indeed with the very high application
rates per grant awarded currently I have been actively advised
to obtain funding both in Europe and America in preference to
the UK.
EFFECTIVENESS OF
THE ORGANISATION
AND CO-ORDINATION
OF UK CANCER
RESEARCH
3. Having been a Professor for the past
18 months I have a limited experience of attempting to obtain
funding from the country's National bodies. I had the good fortune
to be funded by Imperial Cancer Research Fund myself for four
years between 1990 and 1994 when I undertook my PhD. Although
the Cancer Research Campaign has a small amount of funds available
for grants the vast majority of its funds are already committed
to centres for which it provides core funding. Furthermore the
resources available to the MRC are also heavily committed and
grants for cancer research from the MRC are few and far between.
It is also clear that such grants are more likely to be obtained
by large groups collaborating so that the initial hill of establishing
a critical mass is a very steep one to climb.
UK NATIONAL CANCER
INSTITUTE
4. My impression is that the major protagonists
for a UK National Cancer Institute are the potential beneficiaries.
Speaking as somebody from a small institution which is attempting
to establish a core cancer research base resources poured into
a national central institute would amplify one of the existing
problems—where core funding has been present in an institution
for decades, it often results in institutional complacency which
is not conducive to the production of competitive high-quality
research. Whilst the National Cancer Institute in America is an
excellent example of such a body, within the States it is perceived
as a low-status, low-funded group and because of the far greater
industry funding of cancer research it is no longer held in the
esteem and cache as in the past. Given the low level of National
funding in the United Kingdom I believe it would be an inappropriate
diversion of resources to spend large sums of money on a physical
landmark rather than enhancing the quality of research more broadly
be making a higher proportion of money available on a competitive
basis. It would be virtually impossible for a UK National Cancer
Institute to compete internationally without a dramatic increase
in resources and in the current climate this is likely to be at
the expense of other institutions so that the overall quality
in the UK would fall behind.
CONDITIONS REQUIRED
TO ENSURE
INDUSTRIAL INVESTMENT
IN DEVELOPMENT
AND CLINICAL
TRIALS OF
ANTI-CANCER
DRUGS
5. This is an area particularly close to
my heart. At the present time the lack of infrastructure and understanding
within the NHS about both the importance of clinical trials and
their potential as an income stream is greatly under-utilised
and underexploited. The extremely slow and laborious Multi-Centre
Research Ethics Committee which was introduced specifically to
expedite the process of ethical approval has in fact delayed the
whole process and resulted in a lack of competitiveness in the
UK which has meant work has gone to other countries. Interestingly
there has been a dramatic rise in the number of trials performed
in the Eastern block because they are not only more competitive
financially but also more responsive and pro-active.
SUITABILITY OF
THE UK WITH
THE PARTICULAR
REGARD TO
THE ETHICAL
APPROVAL PROCESSES
6. This point is addressed in the paragraph
above.
COST BARRIER
TO INDUSTRY,
UNIVERSITIES AND
RESEARCH INSTITUTES
OF TRIALS
OF NEW
DRUGS AND
TREATMENT
7. I am not aware of any cost barriers.
I believe that the UK can be competitive, our problem is manpower
and relatively few institutions have the necessary staff to enable
trials of the new therapies to be co-ordinated. It is quite feasible
for any National Health Service Oncology Centre to undertake clinical
trials but resources are needed to develop an infrastructure which
can deliver the necessary quality for us to compete internationally.
STATUS OF
RESEARCH AMONGST
NHS CLINICAL ONCOLOGISTS
8. It is my perception that research is
not highly valued within the body of the oncology community. This
may be at least in part a function of the very high workload of
most NHS Clinical Oncologists who spend much of their working
week fighting fires and become disillusioned and jaded too early
to enable them to continue with a research interest in spite of
their best intentions on initially being appointed as consultants.
THE APPLICATION
OF NHS R&D FUNDS
TO CLINICAL
ONCOLOGY RESEARCH
9. I have limited experience of this but
am conscious of a very marked contrast between the distribution
of the sums to my former institution (Hammersmith Hospital, part
of Imperial College Science and Medicine) and my new institution,
The Royal Surrey County Hospital, which is a District General
Hospital with a Cancer Centre. It is unfortunate that the distribution
of resources which was initially encouraged through the Culyer
report has not yet been possible but I am optimistic that over
the next two to three years changes will be effective where sums
are allocated in direct proportion to the work and the quality
of the work undertaken.
10 April 2000
| 
