APPENDIX 3
Memorandum submitted by The Royal Academy
of Engineering
The Royal Academy of Engineering comprises the
United Kingdom's most eminent engineers of all disciplines. The
Academy's objectives may be summarised as the pursuit, encouragement
and maintenance of excellence in the whole field of engineering
to promote the advancement of the science, art and practice of
engineering for the benefit of the public. The Academy aims to
take advantage of the wealth of engineering knowledge and experience
that its Fellows possess. The interdisciplinary character of The
Academy's membership provides a unique breadth of expertise with
which to further all forms of engineering.
By promoting a multi-disciplinary approach,
The Academy is able to overcome traditional barriers and to demonstrate
the interdependence of different areas of expertise in the efficient
use of modern technology and engineering. Emphasis is also placed
on the importance of well-informed communication between engineers,
Government, research establishments, industry, public services
and academia.
The evidence which follows represents a collation
of personal views from Fellows of The Royal Academy of Engineering.
It cannot reflect the views of all contributing Fellows nor those
of The Academy as a whole.
1. THE COSTS
AND OUTPUTS
OF THE
EQUAL INITIATIVE
In terms of the costs and outputs of the EQUAL
initiative, Fellows note that there is a shortage of information,
both on the internet and in more traditional communication media.
It is suggested that a network might be created to increase awareness
in the general population and specifically within the academic
community.
2. THE EFFECTIVENESS
OF THE
INITIATIVE IN
CONFRONTING THE
CHALLENGES OF
AN AGEING
POPULATION
Fellows note that the aims of EQUAL are immense.
It is debatable whether a topic of this size can be covered coherently
within one initiative. To make the initiative more effective,
Fellows suggest that relevant science policy outputs (such as
those from the "Ageing Population" Foresight Panel)
should be timed to feed into the launch or re-assessment of the
EQUAL initiative.
3. THE DEGREE
OF SUCCESS
OF THE
INITIATIVE IN
MEETING ITS
AIMS
The lack of information regarding EQUAL in the
public domain makes it difficult for Fellows to comment on the
degree of success of the initiative in meeting its aims. This
appears to be an important area with significant room for improvement.
The clarification of the aims and objectives of EQUAL is another.
4. THE ROLE
OF THE
OFFICE OF
SCIENCE AND
TECHNOLOGY IN
CO-ORDINATING
THE INITIATIVE
Fellows are largely supportive of the OST as
a channel for co-ordinating this activity. It is suggested that
such co-ordination should impact in a practical way, across the
Research Councils once EQUAL has clear aims and objectives. In
any event, Fellows see very little evidence that such co-ordination
exists. It is felt that the relatively low profile of EQUAL and
this lack of co-ordination is having a negative influence on the
public perception of support for the elderly. If EQUAL aims not
simply to increase access to health care for the elderly, but
to create new types of health care and living environments for
the ageing population, then it is important that academia and
the public are made aware of this. Support for the OST is not
universal; some Fellows point to the lack of specific funding
for EQUAL and assert that without dedicated funding—and
hence a new channel for the distribution of funding—the
objectives of EQUAL will not be met.
5. TO WHAT
EXTENT HAS
THE ROYAL
ACADEMY OF
ENGINEERING BEEN
INVOLVED IN
THE EQUAL INITIATIVE?
The Royal Academy of Engineering is concerned
about the EQUAL initiative and has been involved in work which
has been supportive of its aims through its recent studies in
the fields of Biomaterials and Biomedical Engineering.
For example, The Royal Academy of Engineering
report, "A Review of the UK Research Base in Biomaterials"
(August 1998) recommended that research funds should be increased
"to support a balanced portfolio of research. In recognition
of its importance, it is recommended that about 15 per cent of
biomaterials funding be allocated to basic, curiosity-driven research,
the remainder being divided between short and medium term programmes,
giving priority to those programmes which meet the recommended
criteria and are in line with the objectives of the Government's
EQUAL initiative."
The report goes on to highlight the opportunities
that arise with these challenges. "With the current trend
towards an increasingly ageing population, there is the potential
for a real consumer-orientated market in medical equipment for
the elderly. Comprehensive designs are required to support the
lifestyle of the ageing population, for example to improve mobility,
avoid trauma and reduce dependence. Such designs will lead to
a better quality of life and are directly relevant to the Government's
EQUAL initiative."
In addition, the recent report from The Academy's
UK Focus for Biomedical Engineering, "Medical Engineering:
A Field with Potential" (June 1998) identifies the following
areas as ripe for research:
A. HOME
MONITORING
Improved monitoring methods are required with
a wider repertoire of characteristics so that a comprehensive
range data can be effectively monitored remotely. Less obtrusive
and more reliable sensors are required, particularly for use in
wearable devices. Such developments are already taking place in
the UK in the area of sensors which can be implanted beneath the
skin to monitor blood-sugar levels to control diabetes, a condition
which has been estimated to cost the NHS £2 billion a year.
Provision for wide-scale development of such novel systems, from
prototype to commercial product, must be available. Research into
the processes and care systems that can be used to provide local
continuous monitoring. Such work is essential to address the deterioration
in the physical condition of elderly people living alone that
is sometimes associated with the non-compliance with prescribed
medication and treatment regimes.
B. REHABILITATION
Rehabilitation of the elderly and others, such
as children and other people affected by injury or disease is
a wide field requiring research to:
— Provide a new generation of prosthetic
devices. This requires the development of improved, compact energy
storage systems.
— Improve orthoses. This is particularly
relevant to those required after trauma, surgery or joint and
neuromuscular disease.
— Help avoid the problems arising from
immobility. Such problems include circulatory disorders or the
formation of pressure sores. A great deal of work has already
taken place in the university sector to model the effects of forces
on the formation of pressure sores, so providing potential solutions
to their formation.
— Produce novel techniques for assisting
patients suffering from incontinence.
— Improve augmentation of impaired
sensory function.
— Create robots and remote control
systems. Such systems are required to assist people in their homes.
— Develop the application of electrical
stimulation to improve function in neuromuscular disorders and
in patients with spinal cord injuries. In the longer term, techniques
providing direct access to sensory and motor nerves will remain
a research objective.
6. HAS THE
EQUAL INITIATIVE IDENTIFIED
AND SUPPORTED
THE MOST
APPROPRIATE RESEARCH
AREAS FOR
CONFRONTING THE
CHALLENGES OF
AN AGEING
POPULATION?
Fellows do not have sufficient information on
EQUAL initiative outputs to be able to make judgements about the
identification and support of EQUAL research areas. However, it
has been suggested that it might have been appropriate to launch
the EQUAL initiative with a smaller-scale, short-term project,
to alert the community and prepare it for a larger scale programme
in the future. The concentration of effort is believed to be a
prerequisite for an effective programme, which is envisaged to
encompass engineering research and "infrastructural"
research into social systems and the experiences of the elderly.
Aspects of the latter research elements could be addressed and
prioritised by involving groups such as Age Concern (specifically,
their "Debate of the Age").
7. IS RESEARCH
IN THIS
AREA RECEIVING
SUFFICIENT GOVERNMENT
FUNDING?
EQUAL is held to be a most important initiative.
Current funding levels are seen to be inadequate to meet the immense
research challenges of extending quality life. Fellows state that
this funding shortfall needs to be addressed. It is suggested
that the Government's commitment to taking up the challenges of
the Ageing Population could be made much more explicit by identifying
new money and targeting specific funds into this area. At present
the Government is perceived to be following the practice of identifying
an area as important and then passing on advice to the funding
and decision-making bodies.
It is suggested that without new and dedicated
money, the aims and objectives of EQUAL will not be met, as it
is extremely difficult for a peer-reviewed grants committee of
a research council or other body to positively discriminate in
favour of technology for the elderly disabled. Indeed, some Fellows
reflect that the competition for funds from initiatives such as
EQUAL and Foresight is a constraining factor in many research
areas. It is therefore felt that the important philosophy of this
initiative requires new mechanisms—and possibly new channels—to
be put into place for the prioritisation and distribution of EQUAL
funds. If decisions are made inside or outside of the Office of
Science and Technology, they need to be taken by those without
vested interests.
8. TO WHAT
EXTENT HAS
EQUAL STIMULATED RESEARCH
IN NEW
AREAS?
With the dearth of available information about
EQUAL, Fellows of The Royal Academy of Engineering see little
evidence that the initiative has stimulated research in new areas;
rather, researchers have been encouraged to change the way that
they present their research. It is noted that the presentation
of a new `spin' on old activities is not what the EQUAL initiative
was intended to achieve. Hence, although EQUAL might be high on
the national agenda, EQUAL objectives are not receiving attention
in a practical way. It is noted that it is possible that it is
still too early to detect the influence of outputs from such an
initiative.
9. WHAT ARE,
OR SHOULD
BE, THE
KEY AREAS
OF RESEARCH
FOR THE
EQUAL PROGRAMME?
The Royal Academy of Engineering has identified
a number of key EQUAL research areas in the fields of Biomaterials
and Biomedical Materials, which are described in the response
to question 5. In addition, Fellows identify a number of other
priority areas for research:
— Research projects to explore and
address the issue of discrimination in NHS healthcare provision.
It is noted that treatments that may dramatically improve the
quality of life of the elderly (eg heart surgery, immediate physiology
treatments after a stroke) are often withheld. A programme to
change the attitudes of managers and clinicians within healthcare
would therefore yield significant benefits.
— Activities that research and highlight
the importance of preventative medicine for future generations
of elderly.
— Research programmes to explore the
social issues—as well as the health issues—which contribute
to extend quality life for retirees (eg loneliness versus physical
ailments). The interaction between health and social factors is
well illustrated by the influence of housing type and quality
for the elderly, which also requires research.
This advice for the prioritising of research
areas to address EQUAL objectives comes with one proviso; that
engineers, scientists and social scientists are not restricted
in their areas of research to those which have been specified
by Government. Politicians should trust the scientific and engineering
community and lead not by dictat but by encouragement.
January 2000
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