Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 120-139)



  120. Absolutely.
  (Professor Sir Paul Nurse) As a single organisation we can take a responsible approach to that and I think it is something we need to act as, that is Cancer Research UK should act as the major source of independent information about cancer within the UK. That is another new initiative that we will do. We have both been doing it separately but we see ourselves as the gold standard to which the public will look. Furthermore, we can act as the focus for work in the rest of the world, looking at best practice in the rest of the world, and I think this is a major new initiative. I wonder if I could take the opportunity, since I am speaking, of going back to an earlier question about personnel and the limitations and the problems there. I would just like to bring up another issue which I think is of real concern. Often the interface between basic research and understanding and the clinic works through the pathologist. There is a real difficulty with shortages of pathologists at the moment, it is absolutely dire. That is now compounded with all the fall out as a consequence of Alder Hey which is now making this sort of research very difficult to actually manage. I think this needs to be brought to your attention because it is possible that some of the knee jerk reactions as a consequence of Alder Hey, if not properly handled and managed, will lead to real difficulties, I think, in the future in carrying out this sort of research. I think it is something one should be aware of.

Dr Turner

  121. Can I just add a rider to that? Do you think that the difficulty that has been experienced in the Medical Laboratory Scientific Service, especially with recruitment because until last year starting salaries for graduates were less than £8,000—
  (Professor Sir Paul Nurse) Disgraceful.

  122. Is this a major contributory factor to the problem you have just outlined?
  (Professor Sir Paul Nurse) It is an utter disgrace. Utter disgrace. Nothing more to be said.


  123. You do not want to add to that in more vehement terms, Professor McVie?
  (Professor McVie) I do not have the vocabulary that my colleague does.

Dr Turner

  124. I am sure both Gordon and Paul will remember that one of this Committee's most cherished recommendations in its report that we are reviewing was the National Cancer Research Institute. We were looking to this to improve the co-ordination of cancer research efforts in the country and expand upon them and stimulate expansion. How effective do you think it has been so far?
  (Professor McVie) Chairman, I have hinted that I am pleased with how we have got on.
  (Professor Sir Paul Nurse) I think we are actually pretty optimistic. It got us all together. It is virtual, let us make that quite clear. It is not bricks and mortar. It has put together databases on what is going on. That has allowed certain holes, or will allow holes, to be recognised. This is, of course, of great interest to us too. We have had some early successes. For example, an initiative funded mostly by Cancer Research UK—it has to be said—with a major contribution from the MRC and Government funding on prostate cancer which was identified as a shortfall, so that was very good. I think I can say, and both Gordon and myself sit on this, it has been a very good atmosphere in this grouping. It is tackling the problems and it is a shift, and maybe even will turn out to be a seismic shift in the way that Government works with charities. Normally they are really rather separate and what we have here is a proper single umbrella with different bodies as equal partners who are actually tackling the real problems. I think it could be very good and certainly it started reasonably well.

  125. That is very reassuring to hear although there appears to be some impression—it was conveyed to us that there is some impression—that it has not yet had a great impact out there in the country.
  (Professor McVie) Sure.

  126. Do you feel that there needs to be anything done to raise the profile of the Institute to increase its impact?
  (Professor McVie) It has only had a director for three months, I think. I think we all attended the press launch and there was one member of the press there. It was not the hottest potato on that day.

  127. We love it.
  (Professor McVie) Basically I think it has proven its capacity to react to a situation quickly. The prostate cancer story was remarkable. We had identified this big gap across the country in prostrate cancer research funding. We decided what the priorities were. We issued a call for application for project grants. We got the grants in. We peer reviewed them internationally and we awarded the grants within six months. Now, the Medical Research Cancer has never ever achieved that in its entire history and that was driven by the fact of this process. Sitting at the table is also the Department of Health. The attendance has not always been spectacular from one or two of the devolved governments but I think they are catching on now that this is very, very important. The reason we are not seeing very much at the sharp end yet is because it takes a little while for things to filter down through the research pipeline to the patient. I think also the important issue which we debated, and you quite frustratingly failed to debate in the United States, was the pharmaceutical industry's contribution. They are now sitting there and they are active and if anybody is the specialist in getting something to the consumer it must be they. I think it is just a little bit early. I am really quite confident that we can make an impression on delivery of cancer care because we have everybody there and they are all committed and they are all paying up.
  (Professor Sir Paul Nurse) You mentioned profile. Do remember, you see, we are all constituent bodies so in actual fact what you are going to see on the street is funding from Cancer Research UK, which is probably two thirds of the spend of the MRC or the Department of Health. In fact, in some ways, by setting it up as a virtual Institute, it will never have, I would say, a very high profile, but that does not mean it does not make a difference.

  128. Obviously both your organisations separately are major players. Do you think you will have increased clout now that you have joined forces? By the way, you have not shown us the ring.
  (Professor Sir Paul Nurse) Ah. We will not exchange until the 4th February, we are being coy. Of course, it has got to make a difference. We have not emphasised this yet but I think this is a really important shift because we are now the biggest grouping. We will have considerable influence and we can really, I think, have a major impact on what the Government is doing here. We are coming in, we are working in collaboration, we are not in a competitive situation, that is the nice thing about this, yet we have our clear agendas. I think this is one of the real benefits of having Cancer Research UK: the ability to influence Government research spend and to lobby them over issues that really matter. In this respect, of course, we may find ourselves working together more in the future than perhaps in the past. I am talking about your body and ours.

  129. You have rightly pointed out, Sir Paul, that the Institute is a virtual construct. In fact, we did suggest that there should be a physical presence. We were never suggesting replication of Bethesda, a little ambitious, but at least some small physical centre for administrative purposes. Are you happy that it is evolving or being set up on a virtual basis? Do you think that there would have been perhaps extra advantage and focus to have been gained by having a physical centre, however modest?
  (Professor Sir Paul Nurse) If it is going to remain as its present role, that is the new money that is going into it in the sense of running it is relatively small, we are paying two-thirds of the total but it is relatively small sums, then it could have its own bricks and mortar or it could be located, as it is at the moment, in the MRC or go into Cancer Research UK. I am personally rather relaxed about it. If, on the other hand, very significant funds were going to go through this route, and I mean very significant, we are talking about tens of millions— This new institute we are opening up in Cambridge for 300 workers, which is not that big, Lincoln's Inn Fields where I come from is 500, that will cost about £15 million to run a year. If we are going to make something big these are tens of millions of pounds. Then, of course, there might be a need for a physical presence but otherwise it is just going to confuse, I think, because it will look rather silly, if I may suggest, compared with the major institutes from Cancer Research UK. Unless the Government, because that is where the only money can come from if it wants to re-badge it, is going to put in 20 million or something, I do not think it makes much sense. Of course, if you can persuade them to put in 20 million we would be delighted to work with them.


  130. Wait until they have sorted the railways and a few other problems.
  (Professor Sir Paul Nurse) Or we can run it for you if you wish.

Dr Turner

  131. When we were taking evidence for the report I think some of us felt a bit hesitant about the commitment to cancer research on the part of the Medical Research Council, we felt that they were not really quite pulling their weight. They are the host organisation as far as staffing is concerned and such physical accommodation as the Institute has. Are you totally happy with the MRC as the host? Do you think it is the most appropriate host organisation for the institution?
  (Professor McVie) The plan is, in fact, for the chairmanship to rotate. My understanding is that the secretariat will move with the chairman. I think the Medical Research Council took the first chair and it will rotate in a year and a half's time. I think that would seem to even things up. I think that is a good solution pro tem. The other possible source of a lot of money could be the Department of Health because it would make a lot of sense, in my view, for the Department of Health to take this early warning that we are able to produce in terms of things coming down the line from the lab to the clinic and fast tracking it and evaluating that and so on. I cannot think of a better structure to do it than within the National Cancer Research Institute. In fact, there could well be a lot more money coming in to the right hand end of it, evaluating the care delivery bit, in the future rather than the MRC. I share your hesitation about the wholeheartedness of the Medical Research Council's commitment and I derived great amusement from seeing how they managed to sell the added money they have put into cancer research from a variety of interesting illustrations, which I have no doubt they tell the cardiac people is also for cardiac research. I would very much like to see us blazing a trail in terms of establishing a fast track mechanism for getting research findings into the health service. No fast track exists, it never has done. It was built as if there would never be any research that mattered but now there is lots of cancer research that has delivered and is getting stuck in the system.

  132. Do you think that the institute is going to be able to deliver this for the first time?
  (Professor McVie) I think so. The framework is there.
  (Professor Sir Paul Nurse) The MRC Executive has been very supportive of this and that is very good. The criticism that they do not do enough for cancer research is, quite frankly, out of the existence of us. If there are priorities and they see the charitable sector is picking it up, one suspects it will not always get to the top of the agenda. Having said that, there has been very considerable support for this and there is support for making these cancer research initiatives work. If you have such a powerful body as ourselves I suspect that it is only human nature that they will tend to back off a little bit.


  133. And, Professor McVie, a National Cancer Act to give it some official backing, do you think?
  (Professor McVie) We did not quite see eye to eye, my partner and me, last time. We have not had time amongst our merger discussions to sit down and discuss the benefits of a National Cancer Act. My view is entirely unchanged from a year and a bit ago, I do believe a National Cancer Act would be an excellent idea. I think that the country needs clear positioning on things like tobacco and things like lifestyle links to illness, not just cancer. The obvious mechanism for extra funding for specific bits of cancer research is from Government straight to the National Cancer Research Institute. The mechanism for distributing the money is now there. The MRC have indeed come on board and we are sharing the Trials Committee work and the deliberation and the peer review, it is all working out fine. Now we have the receptacle for any more money that Government could, through a National Cancer Act, as they do in the United States, vote directly for something that constituents want.
  (Professor Sir Paul Nurse) As always, Gordon is very persuasive. I had reservations. I come to it perhaps more as a basic scientist. So much medicine, different types of medicine, cardiology, cancer, whatever, is underpinned from a similar understanding in biologies that my concerns were we might distort too much by separating one part of it away from the rest of the medical research initiatives in the country and I was bothered, although I would be rather happy to see it in the cancer field, that we might then see a whole spate of these things because the same logic could equally be applied elsewhere and that might cause problems. However, this will be a very interesting point for us to debate and I certainly would not say that my position is entrenched, and of course I know very much there are strongly held opinions among this Committee as well, or certain Members of this Committee. I think this is something that we have to talk about with our organisation and perhaps will be happy to discuss with you at a later date.

  134. I think there is a Mental Health Act, for example, is there not?
  (Professor Sir Paul Nurse) There is a Mental Health Act. What I am thinking of here is the major diseases. If we end up with one for each we have got to take that on board before just taking it piecemeal. Maybe there is a case for it, maybe we should do that, but I think that is the natural, logical implication of doing that. We have to be aware of it before making that step.

  Chairman: That is for the future obviously. We will keep the pressure on.

Mr Hoban

  135. Can we talk about the National Cancer Research Networks. There are 32 that have been set up across England. What difference, if any, have they made to your work?
  (Professor McVie) They have not made much difference yet because they are starting within our centres and we are doing the work anyway. The great advantage of the network is going to be that it will involve all cancer centres, I think there are 34 in total, in England which are not yet linked into the trials network, they are not able to put patients on to cancer trials because they do not have core funding from Imperial Cancer Research or the Cancer Research Campaign. I think that when that has all happened, and I believe we are half way there to getting the 34 sorted, then we will have a really major force for getting patients on to clinical trials and we know that they will do better on clinical trials. At the present time we have not noticed much difference because we have just started doing this. I think it will come very good and probably another year will be needed to get that right. The background work done under Peter Selby's leadership for the trials network has been terrific. He has just stepped down as the Clinical Director of Research at the Imperial Cancer Research Fund. The translational network, the centres have not yet been announced but I know which ones they are and they have already got funding from Imperial Cancer or the Cancer Research Campaign and they are being co-ordinated by David Kerr. Again, that work is going on fine and they are ahead of their deadlines and their targets. That is all fine. This is early days. I see these as mechanistic tools with which you do the work. That is what they are, they are infrastructure. Clearly it is very welcoming to see the Department of Health sharing some of the infrastructure costs of doing clinical trials and that should lessen the burden on us. Again, we have not noticed that burden lessening to date. We have yet to see lowering of the costs of doing clinical trials in those centres but we will be taking that up with the National Cancer Research Institute.

  136. What level of funding do you expect or would you want the Government to make to meet some of that infrastructure cost and research cost?
  (Professor McVie) The total budget, I think, will have to grow probably three or four fold within the next two or three years as these centres come on line. I think the priming budget was enough, I think it was about ten million for the whole thing.
  (Professor Sir Paul Nurse) Twenty.
  (Professor McVie) I think that was probably enough to get the translational centres and the trial centres linked up. I cannot believe that these networks should not be the sort of paradigm for other kinds of trials in cardiac medicine and in Alzheimer's and in a variety of other things. I think what they are doing there they should be looking to do for all the other disease types where research trials are being carried out. I think this is the first time out, and it will probably be a little bit more expensive. I think the Government could save money by making each hospital share the infrastructure, the data managers, the statistical inputs, the hardware and so on for different kinds of trials. I think you are looking at considerably escalated costs over the next four or five years. We will certainly be doing our bit to share those costs. We have committed ourselves to partnership and I think that is only proper. We have to wait and see whether that all materialises.
  (Professor Sir Paul Nurse) If this works, this network, then we would double the numbers of cancer patients in trials. This is a very significant increase, of course, it would be higher than any other country, far higher than the US, just to make this absolutely clear. But, of course, what it will lead to, and this is of course what we are trying to see, is more higher quality clinical research, trials research. That will require extra money to carry out that work. What Gordon is referring to is the fact that if we now have a good network which will catalyse this work there will be demands on us to provide that money to do those trials. Now those demands may be very high, higher than we can meet, and it could be that when we are looking in succeeding years that we are not just simply looking at the infrastructure supports which have been put in place now, but the money to support trials. We have, of course, committees that look at this, we will be working with the MRC. I see that is where there is going to be a pressure point and the need that Gordon is referring to is the ability to fund new trials within the network.
  (Professor McVie) Mr Hoban, the system does work because we have tested it in Wales. The Campaign with the Welsh Assembly has shared the cost 50:50 of setting up a Welsh Cancer Trials network. This national network is only England, there is a Scottish Cancer Trials and a Welsh one. It is very confusing because it is buried in the National Cancer Research Institute which is UK. In Wales over three years we have seen the doubling of the number of patients in clinical trials and we have site visited them with the Welsh Assembly about seven or eight months ago. We have each agreed to double again the funding of that network, it has been so successful. We know it works and it is now really getting the English network up and running and functioning. I think this is really imaginative.

  137. We talked earlier about smaller charities and the involvement of those charities in cancer research. What role do you see small local charities playing in the very centres to be set up as part of the National Cancer Research Network?
  (Professor McVie) In the Cancer Research Campaign we have already merged with two smaller charities regionally based, one is in Newcastle and one is in Bradford. The local fund raising mechanism has been kept in place to fund young talent spotted coming through the system either in the laboratory or in the clinic. It is very difficult getting on to the bottom of the research ladder whether you are a clinician or whether you are a scientist. Getting the first money is very difficult. Knowing the best people, Andrew Miller talks about the importance of getting young talent, well, how do you know who they are? They are all right once they have a track record but how do you get the track record? In Newcastle we have set up fellowships with the money raised there for young people to come in and once they have established some sort of track record then they are more likely to compete and win money from Cancer Research UK. I think there are local initiatives, also, such as funding trials nurses where they do not exist, information nurses where they do not exist, data managers, the right kind of options and opportunities for local charities to plug into the system and I am sure that will happen.

  138. Are you concerned that your merging might crowd them out of the National Cancer Research Centre?
  (Professor McVie) No.
  (Professor Sir Paul Nurse) I think we will help them actually. One of the problems with smaller charities is often there is a lot of enthusiasm and commitment locally but often they find difficulty in making the proper assessment of the quality of work they are supporting. That is a very, very serious issue. I think we, as Gordon has already mentioned in an answer to an earlier question, can help there by providing the proper reviewing procedures. Personally, I feel that rather than crowding them out we will be able to help make a more effective operation. There is a real risk that the smaller charities may waste money by not funding the best research. That is a very serious problem. What we have to do is to be able to work out ways of working with them so they do not feel threatened, because they have major contributions to make in addition, but where they are supporting the quality work that is needed if they are going to really make an impact.

Bob Spink

  139. Mark Hoban's earlier questions on networks and clinical trials leads me on to the area that I would like to explore, the core issue of cancer registration. The GMC's guidance on confidentiality has caused severe problems for cancer registration, data collection and the ethical approval of cancer research. Has that impeded any of your research programmes and, if so, what can we do about that?
  (Professor Sir Paul Nurse) As you know, this is a major issue. It is concerning our researchers, our epidemiologists. I am getting lots of lobbying and there are lots of other bodies who are lobbying about this issue too. I am afraid I am not a sufficient expert to say specifically myself what is now required. What I am aware of is that there is quite a lot of confusion out there and it is not quite clear what the present situation in fact is. We have to be very careful about this because we have opportunities with cancer registries which can be thrown away by legislation which does not take account of all the needs. I am answering the question rather vaguely because I am afraid I am not on top of it but this is an important issue and we must not get it wrong.
  (Professor McVie) Chairman, I do not think the position has changed one bit really, in fact it has just got worse because of the GMC's intervention with a completely muddled and-ill-informed, ill-researched position. I think we are verging on chaos. I still believe, as I did the last time, that you are correct. I think you said that the Government should introduce legislation to include the registration of cancer as a legal requirement. I totally support that. We will do all we can to help in that area. This is one of the single biggest threats to the whole business of evaluation of whether either cancer research works or cancer care works. It is as simple as that, it could be devastating.

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