Examination of Witnesses (Questions 100-119)
PROFESSOR GORDON
MCVIE,
PROFESSOR ANDREW
MILLER AND
PROFESSOR SIR
PAUL NURSE
WEDNESDAY 16 JANUARY 2002
100. ICRF, as I understood it, did mainly in-house
research, although not exclusively, and CRC out-funded research.
Would you like to tell us whether there will be any difference?
How are you going to juggle these two previous existences? In
other words, are you going to carry on in the same way or are
you going to have a major change?
(Professor Sir Paul Nurse) There are advantages with
both types of funding, intramural and extramural. It is quite
a complicated issue, which I can go into should you wish. We recognise
in the new organisation the advantages of both. Indeed, the Government
and Medical Research Council for the last 70 years have operated
exactly in that way with a strong intramural programme with the
Laboratory of Microbiology, National Institute of Medical Research
and a very strong extramural programme through a response mode
programme of project grants. We will continue in that way. What
we have is, of course, the advantage of now looking at best practice
on both sides, on both organisations. One of the problems when
you have a single organisation that has been around for many years
is it can get a bit ossified in how it operates and no doubt both
of us could have done things better. Coming together has its disadvantages
and can be a bit chaotic but has the advantage of re-looking at
everything we do. We can now look at the cost-effectiveness of
the different ways of funding and also the quality of work that
is produced from the different ways of funding, and begin to look
at our long-term strategies. In the short to medium term both
streams will be maintained approximately at their present proportions
because they are both working effectively, but one could imagine
over the longer term we will look carefully at what we are doing
and maybe make adjustments to make the best contribution that
we can make to Cancer Research in the UK.
101. I suppose it is too soon to be able to
tell the Committee how soon we will see your first joint science
programmes coming on stream?
(Professor Sir Paul Nurse) We have, of course, in
very general outline in thinking about the merger process, as
to whether it was a good idea or not, thought a little bit about
this but this now requires a major look at our strategy and this
requires the bodies to do it. I have to tell you only this morning
did we make decisions about the scientific executive boards. We
only now have the chairs of our committees and so on in place.
We are still to work this out, so my colleagues will forgive me
if I am vague on what we are doing, but I imagine that we will
over the next six months develop our combined scientific strategy
and we will be using that to roll out our subsequent support of
work after that. In the meantime, our previous strategies are
not so different and we can really make a reasonable stab at a
preliminary one and two year plan with what we have got in place.
We hope to get benefits from this merger and benefits not only
in monetary terms and total support but also the intellectual
weight going into looking at strategy and that, I think, will
take a little longer before we can see the fruits. I do not know
if Gordon wants to add to that.
(Professor McVie) A good example is that we each fund
clinical units in the NHS, embedded in university hospitals, doing
clinical trials together. You know about the National Cancer Research
Institute and you may wish to ask about it.
Chairman
102. Yes, we will.
(Professor McVie) The network of trials is getting
set up and it is no secret that, in fact, the leadership has come
from our two organisations out there. The centres that are largely
the ones that are active are already being supported by one charity
or the other. They are funded in different ways, they have different
ratios of core funding to clinical funding to lab funding on each
site. This is going to be rationalised within about a month, I
would think, and we will have far better clarity, far more leverage
in terms of getting them to work within the grand plan of the
NCRI. We will be better equipped, I believe, to achieve the target
set by the NCRI of doubling the number of people in clinical trials.
Really this is going to be just so much simpler, quite honestly,
because it is post merger, it is just going to work.
Dr Iddon
103. Could you perhaps tell us how the joint
Directors-General will work? If it has been decided, and I assume
there has been some discussion about it, how will the joint responsibilities
apply?
(Professor Miller) Perhaps I could start to do that
and give an explanation why I am sitting between two very eminent
cancer people.
Chairman
104. This is SmithKline Beecham all over again.
(Professor Miller) I am here for an interim period
and my job is to be the merging mechanic, integration engineer,
to help assist with the merger at a technical level. I am a scientist,
however, and I have run large scientific laboratories, research
laboratories. To me it is going to be very interesting how the
two totally different mechanisms of funding to which you have
alluded are brought together in a way that is significant. Funding
research to do that properly has been a major problem always.
How do you fund the unknown? How do you think of the unknown and
try to choose who can go into the unknown better? It turns out
the only way really to do it is to look at people, some people
are better at research than others, and you watch them and if
after ten years somebody has been doing it for ten years they
are likely to keep doing it and you fund them and, on the other
hand, sometimes as totally new, original things pop up outside
the establishment. I think the two together are going to be able
to fund a very strong laboratory which has not only got two Nobel
Prizes but I hear today yet another European prize, not to Paul,
not to Tim, but to Richard Treisman. Maybe you can say something
about that.
(Professor Sir Paul Nurse) This is the Louis Jeantet
award that has just been given to a member of Cancer Research
UK. It is the largest prize for biomedical research outside the
Nobel Prize. We have got good people in Cancer Research UK.
(Professor McVie) The answer to your question is we
do not have a referee here, we have a mediator to help with the
rest of the merger. We have not tackled the finance, the admin,
the IT, a whole lot of things like that. The lead responsibility
for science is with Paul and the responsibility for leading on
the fund raising, communication, public affairs, including what
we are doing now, lies with me.
(Professor Miller) And both will sit on each other's
committees, that is what I was really coming on to say.
Dr Iddon
105. Thank you. Congratulations on the award
that you have just announced.
(Professor Sir Paul Nurse) I will communicate that.
106. Well done. My next question is about applications
for research grants that come to you from outside and I am sure
that the people who apply for those will be a little anxious to
know whether there are going to be any delays during the hiatus
of reorganisation?
(Professor Sir Paul Nurse) Perhaps I can pick that
up. We are very conscious that the last thing we want to do is
even sometimes at higher level of management things look pretty
chaotic and we do not want that to translate on to the shop floor,
so to speak, with scientists doing their work. We have made the
decision to leave the funding mechanisms of the two old organisations
in place so they continue their routine work until we have the
new committees, the new boards and the new structures in place
that will replace them. I told you that the highest level of the
scientific executive board has only been put together today, we
have to put that in place and it will take some months before
we have the whole structure in place. I am not quite sure when.
May at the earliest, maybe July or August, perhaps a little later.
In a sense it does not matter overmuch, research is a long-term
investment and we must get it right. If we rush into that and
then find that we do not have the right address to send the grant
applications in all hell will be let loose out there and we must
avoid that. The answer is we are going to leave the old structures
in place, put the new ones there and as soon as they are fully
operational we will switch.
107. My last question is probably going to be
answered by the reply "not me, gov" because I am taking
you back to 1923 when the two charities, as I understand it, split
for the first time over their attitudes to the clinical applications
of research. So, what has changed, except that we are in a different
era?
(Professor Miller) My understanding is that they did
not actually split. There were a group of clinicians who felt
that the then ICRF was not doing enough clinical research, perhaps
over-emphasising basic research. I am not a clinician but it is
clear that the clinical research and trials that Professor McVie
has referred to are going to be one of the very strong things
that this new charity will do. Another thing that I think we are
already agreeing to emphasise is this so-called translational
research, in other words consciously concentrating on trying to
go from targets that become evidence from basic research and take
that into the clinical.
Mr Dhanda: I apologise for missing the first
part of the meeting but what I have caught has been very interesting.
I would like to ask you a little bit about the Cancer Plan. In
the first year of it the Government's assessment of it has been
quite positive.
Chairman
108. Sorry, Professor McVie, I am told you wanted
to say something on the last point?
(Professor McVie) I just wanted to reassure Dr Iddon
about the welfare, not just of clinical research in the new charity
but prevention research which will not be necessarily of a conventional
variety conducted in hospitals but actually conducted in primary
care. We already have some intervention trials, for instance,
with selenium in primary care settings throughout the country
to see if we can cut down the risk of prostate cancer. I believe
that is going to be a big emphasis. Thank you for allowing me
to think about the answer to the National Cancer Plan.
109. Are you happy with it?
(Professor McVie) I think it is an ambitious plan
and I think it is early days. I really think that most of the
targets set are further down the line, they are three years, four
years, five years. I think the soundings that we have had from
our clinical units are positive. I think there is still some mystery
about where some of the money is and whether the cheque got lost
in the post or whether it has been absorbed like creosote into
the fence post of the administration of the health service. I
do believe that the direction is correct and there is beginning
to be somewhat less cynicism, certainly amongst the oncologists
who are employed by the two organisations. There are, however,
major black spots and, of course, the Beatson Oncology Centre
in Glasgow is the biggest. To lose four consultant oncologists
in the space of four weeks would cripple any cancer centre. There
is a real, real problem there. I would have thought seven-eighths
of the resource has not yet got out there. Certainly the human
resource is not yet in place that has been promised. Certainly
the drug budgets are not yet up. There are machines ordered all
over the country, including at the Beatson, new radiotherapy machines,
but it is a six month installation time and you will be lucky
if this time next year much has changed in terms of waiting times
for even palliative radiotherapy in two or three of our major
cancer centres around the country. That is all I feel we can say.
110. Is the Beatson safe? Four consultants are
hard to find.
(Professor McVie) It has just been devastating. As
you know, we have a major clinical academic unit, Cancer Research
UK's biggest unit in Scotland at the Beatson Institute and Oncology
Centre. I have been in close contact with the doctor, Adam Bryson,
who has been parachuted in to try to help out and I have offered
the help of the new charity, Cancer Research UK, and I shall be
going to see him in the next week or two to see exactly what can
be done in the short-term and perhaps also in the longer term.
Our entire investment in translational medicine in the West of
Scotland, which is about six or seven million pounds a year, is
at risk here.
Chairman: Could I encourage you to use the political
process. Many of us would be glad to make a noise about what is
happening there and I am sure the MPs in that part of the world
would too, so please give us the chance and the bullets.
Dr Iddon
111. I did not know about this, I must be out
of touch, but can you tell us why there have been these four oncologists
leaving at once?
(Professor McVie) It has been total frustration, total
loss of belief that the health trust would ever deliver what they
had promised. The health trust have now been taken out of the
loop by the Scottish Executive and this new ubergauleiter,
Adam Bryson, who is a medically qualified doctor, is now reporting
directly to the Greater Glasgow Health Board because there is
a complete lack of trust in the NHS Health Trust of North Glasgow.
Everything was promised over a period of one, two, three years
and nothing has been delivered, waiting lists have been doubling,
patients have been dying on stretchers in waiting rooms. It has
been awful.
112. Have we retained oncologists in the UK
or have they gone abroad, the brain drain?
(Professor McVie) Three have left to other positions
in the UK, one may have taken early retirement and the fourth
one is unemployed, and that is the one I really worry about, if
he was that angry.
Mr Dhanda
113. You talked about resources of the Cancer
Plan. Is the Cancer Plan perhaps a little too ambitious or are
there parts of it that you feel may have been missed out?
(Professor McVie) I think the major missing bit for
us is the mention of cancer research in the National Cancer Plan.
It does not get the headlines that I think it deserves, certainly
after the work of this Committee at putting cancer research issues
on the map. We have done our bit to try to weld our resources
together and we are also functioning much more intimately with
the Medical Research Council and the Departments of Health in
the four countries in the National Cancer Research Institute.
That is working. We are just perplexed that things cannot go fast
enough. We feel that we have got our act together better than
the people delivering the cancer care. I do not believe that these
were not gettable targets given the resource. If the resource
does not come along then in a couple of years' time we are going
to be saying "great idea but there is still no football".
Chairman
114. Where do you think the resource gets held
up then?
(Professor McVie) Predominantly training skilled people,
such as radiographers, to run radiotherapy machines. We are 400
medical oncologists short, 200 clinical oncologists, we have not
got an academic pathologist within a mile of most of these cancer
centres, radiologists are stretched. We just have a major resource
problem. It has been recognised by Government, there is no shadow
of a doubt that the interaction with the Royal Colleges has been
very productive and we have got a wishing list but you cannot
find these people overnight when the previous Government had run
down medical student intake and there really are not the people
in the system to be coming out of the other end to attract into
oncology.
(Professor Sir Paul Nurse) It comes back to this focus
on training, the care delivery. There is a real need for trained
personnel, inward recruitment and to get people through the medical
schools who will actually make a difference. I would really like
to support what Gordon said about the lack of reference to research.
We are only really going to ultimately lead to improvement by
having a commitment to that and it was a pity that was not there.
There are initiatives there that you cannot complain about, let
us not be too mealy-mouthed. There are things like the National
School Fruit Scheme that you may be aware of or breast screening
extensions and the Cancer Services Collaboratives, for example.
These are good but the major issue is one to do with resource,
getting people out there to be able to actually treat this disease.
Mr Dhanda
115. I was going to ask you whether you thought
there was sufficient research ethos in cancer centres but I think
you have answered that already.
(Professor Sir Paul Nurse) We do not have an agreed
policy but we can perhaps give our personal views. I do not think
there is personally, no.
(Professor McVie) I would agree. People are too busy.
If you are sitting with 60 patients in your waiting room and it
is half past four in the afternoon and after that you have then
got to go and write a research grant to Cancer Research UK to
get money to do an interesting bit of research, that is asking
an awful lot of people.
Mr Hoban
116. I would like to go back to the question
about resources and staffing. You talk about training more people
through clinical medical schools but what capacity is there in
the system to allow people to retrain as cancer specialists or
as radiographers? Is that feasible or are you waiting for the
additional students to come through medical schools?
(Professor McVie) I am not an expert in this area.
The Colleges have got their hands on the data of the number of
people in different pools. I am told there is a shortage of consultants
in cardiology and in respiratory medicine and in rheumatology.
I do not think we have just got a unique problem in oncology,
it just happens that cancer research has been remarkably successful
in the last ten or 15 years and we have got much more to offer
and, therefore, the demand has suddenly risen there because there
is far more opportunity to improve the outcome of patients with
common cancers. As long as we were just making spectacular impacts
in a cancer which only occurs once in every million young children,
that was not going to stretch the health service, but when you
suddenly find something which affects 48,000 colon cancer patients
a year that really stretches your service. I think we have stretched
things much more thanks to the success of cancer research. Retraining
has not been a big deal in medicine and I think you are right
to bring it up. What happened to all of the specialists in tuberculosis,
for instance? Could they not be recycled into respiratory cancer
doctors? I have often thought that they could be. Radiography
is another shortage specialty and I do not think there will be
very much to be gained in that other than what the Government
is already doing, for instance, in nursing to try to get people
back who have retired from nursing.
Chairman
117. I know that you are a super-optimist but
in your darker moments do you ever see that the public might turn
off giving money to cancer research because the delivery process
in hospitals is not there and they would say "what good is
all this money, we might as well give it to supporting action
against hunting foxes" or something?
(Professor Miller) Could I make the point that I noticed
was in your 2000 Report, and it is still the case, and it is a
very simple one to me as a non-clinical person, namely the five
year survival rate in this country is still very low compared
with comparable countries in Europe, so something is wrong clearly,
quite seriously.
118. That is what I am trying to get at.
(Professor McVie) We are lucky to live amongst the
most generous people in Europe. Our generosity to charity, whether
it is Christian Aid, Oxfam, Crisis, Shelter, Cancer Research UK,
is phenomenal. It is interesting that our data suggested that
there is a relationship to poverty and social deprivation and
generosity within our community fund raising. I do not believe
that people have yet become that cynical about the failure of
the health service to deliver cancer care as good as you can get
in France or in Holland or in Italy. However, they are certainly
very supportive of us raising the problems with you and they say
"That is your job. You know that you have developed a drug
that works betters or a radiotherapy scheme that is better for
prostate cancer. You are right to go out there and if we can help
you with the local health trust by saying `Why have you not got
the right kind of computer software on your radiotherapy machine?'
then we will do that". I think that there may well be a trend
for many of our supporters to take up arms themselves. There has
been a growth of advocacy groups in this country, and some of
them are sitting behind, as there has been in the United States
and they have been effective. Maybe that is one avenue which will
evolve in the next year or two.
119. Putting the money in and the expectations
they have got and we raise their expectations, where do you think
they put the finger on to blame when it does not go right? When
it comes their turn for a loved one to go into hospital or something,
who do they blame do you think in your experience of talking to
people? Do they blame the charities for not doing enough or do
they blame Government? Government always gets blamed for everything.
It would be interesting to know who the public in your experience
of people who support you blame?
(Professor Sir Paul Nurse) Maybe I can make a stab
at this one. I think on the whole the charities do not get the
blame, quite frankly. We do act as, if you like, some sort of
policeman who is commenting independently and the public trust
us. I think certainly it is aimed at the Government. We do have
to be a bit careful, of course, because if we over-promise what
we can deliver then cynicism may, indeed, set in.
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