House of Commons - Science and Technology

Select Committee on Science and Technology First Report

II FUNDING

Research Funding

THE COMMITTEE'S REPORT

6. The Committee's Report was highly critical of the inadequate level of government funding of cancer research. Charity funding of research has over the years been substantially greater than state funding. The Committee's Report found that in 1998 -99 the two main charities alone spent £125 million; the Government had contributed £112 million through the Medical Research Council (MRC), the Higher Education Funding Council for England (HEFCE) and the Department of Health (DoH). In 1998-99, £63 million was given by the Department of Health to cover indirect costs to the NHS arising from R&D which had been funded by charities, industry or the MRC.[12] The MRC awarded £28.5 million to cancer research and another £30 million to "basic research of direct relevance to cancer". HEFCE funded cancer researchers within universities; the exact percentage of HEFCE money spent on cancer research was not clear. The Committee's Report concluded "there will always be calls for the Government to spend more money on research. We believe that the evidence we have received in this inquiry fully justifies such calls".[13] It recommended that "the Government should increase funding for direct support of cancer research to at least a level to match that provided by research charities. We recommend annual expenditure dedicated to cancer research of at least £200 million per annum at current prices, not including funds from NHS R&D or the Higher Education Funding Councils".[14] If all the Committee's recommendations had been adopted, annual Government spending on cancer research would have been around £380 million.[15]

GOVERNMENT'S REPLY

7. The Government's Reply broadly accepted the need for increased Government funding of cancer research. It laid out the research spending commitments for 2000-01 to 2003-04. The Science Research Infrastructure Fund was to receive £1 billion to build on the £750 million Joint Infrastructure Fund (JIF), which had been jointly funded with the Wellcome Trust. JIF had contributed to several cancer research projects, including equipment for the new Centre for Translational Research in Cambridge. £250 million was to go to the Research Councils to fund research, primarily in genomics. In addition, the Government promised to spend £20 million per annum for three years from DoH, on cancer research infrastructure, and £4 million extra on prostate cancer research.[16] The new funding was intended to bring Government spending on cancer research up to the level of voluntary sector spending by 2003. The figures for projected Government spending following these increases included funding from HEFCE and the Research Councils. The Committee had recommended that any Government spending total should exclude spending by these bodies.

REAL LEVEL OF EXPENDITURE

8. When we asked Sir John Pattison, Director of NHS Research, Analysis and Information, whether the Government's spending commitment was being met, he told us "it looks to us, on a first pass, as if the charitable sector input and the Government sector input are about the same".[17] We asked the representatives of the two largest charities whether they agreed with this assessment. Professor Gordon McVie, Director General of the Cancer Research Campaign said "it is the most creative accounting that I have come across for a very long time".[18] Professor Sir Paul Nurse, Director General of the Imperial Cancer Research Fund told us "what they have done is had a look at some of the other research activities, for example in the BBSRC [Biotechnology and Biological Sciences Research Council], they have badged what could be said to be generic research into biology and biomedical work, and re-badged that as cancer [expenditure]".[19]

9. The Department of Health memorandum states that Governmental annual spending on cancer in 2000-01 is close to £190 million. Of that sum, £83.8 million is funding from the Department. This includes not only direct costs, but support for the indirect costs to the NHS of research carried out by charities and the research councils. The other £104.2 million is funding from the MRC, HEFCE, and the other Research Councils.[20] We sought a further breakdown of this total. Dr Russell Hamilton, Director of Research and Development, NHS Executive South West, provided these details for us in evidence:[21]

Table One: Government spending on cancer research, 2000-01

Funding Agency
Spending Total (in £ millions)
Details

Department of Health (DoH)
73.2
NHS support for projects funded by the Research Councils and charities

DoH
5.2
NHS R&D

DoH
2.7
Policy Research Programme

DoH
1.4
public health programmes

DoH
1.2
Non-Departmental Public Bodies programmes

DoH
0.1
remaining funding

National Assembly for Wales 2.8

Department of Health, Scotland 8.6

Department of Health, NI 1.0

Medical Research Council 58.0 estimated

Higher Education Funding Council for England 26.0 £26 - £30 million estimated (£26 million used)

Biotechnology and Biological Research Council 6.3

Engineering and Physical Sciences Research Council 3.5

Economic and Social Research Council 0.043

Total
190.1

Source: Figures given to the Committee[22]

We have received breakdowns of the Department's funding laid out in Table One. The Policy Research Programme funding is directed towards the evaluation of cancer screening programmes, clinical trials for screening and funding for the Childhood Cancer Research Group. The public health programmes are the Small Area Health Statistics Unit and the Public Health Radiation Research programmes. The non-departmental public bodies involved are the National Radiological Protection Board and the Centre for Applied Microbiology and Research.[23]

10. A large part of the NHS funding goes on indirect funding for research. We note that in the figures provided above, £73.2 million is labelled "NHS support for projects funded by others". In oral evidence Sir John Pattison told us "you need to look at the indirect costs of supporting this research as well as the direct costs; and the indirect costs are at least as large as the direct costs of doing a piece of work in the National Health Service, sometimes larger".[24] We accept that indirect costs must be taken into consideration. We recognise the difficulty faced by the Department of Health in separating funding which can be labelled cancer research from cancer services and other clinical research. NHS Trust accounts would need to isolate NHS money spent on direct cancer research in order to make the necessary comparisons with voluntary sector spending.

11. In the course of this inquiry we have found the attitude of the Department of Health to the provision of financial facts and figures highly frustrating. We have been forced to ask several times for breakdowns and clarification of spending. We remain to be convinced by some of the figures given. The Department of Health has given no information as to how the totals of those other than for the Department itself were calculated. Where there is some indication of how figures were arrived at, the explanation lacks credibility: for example the figure of £6.3 million for the Biotechnology and Biological Sciences Research Council is based on "a database search using cancer related terms".[25] We recommend that the Department of Health publish annual figures for their expenditure on cancer research, detailing exactly where money is spent. We are not convinced that the £190 million which the Government claims to be spending on cancer research is really being spent on cancer research alone.

12. We asked the Minister for Public Health if the increase in Government spending were simply a re-badging exercise. She told us "when we made the commitment to match the money spent by the charities, we certainly never accepted that the charities were spending double what was being spent by the NHS. When we did the first assessment of the kind of ballpark calculations of what was being spent on cancer, I thought at the time that we would need to increase the investment to match the money being spent by the charities, but we were at that stage very clearly planning to increase the spending by at least another £20 million a year as part of the cancer research networks, and the rough estimates that we had when we first looked at this was that additional money would take us up beyond matching the spend by the charities".[26] There remains a suspicion that at least some of the increase in spending is merely the result of rebadging.

13. We are surprised by the Minister's assertion that charities were not spending twice what the Government was in 1998-99. In its Reply to the Committee's Report, the Government did not query the figures used in the Report. Indeed, it stated "the Government accepts the Committee's basic premise". [27] The Department reached an estimate of charitable funding of £180 million in 2000-01 by "[taking] information from the web sites and newsletters; [using] the Association of Medical Research Charities handbook; and [making] other enquiries by telephone and email to the relevant charities".[28] There is no indication of how it was decided which the "relevant charities" should be. We note that the Association of Medical Research Charities (AMRC) considers the expenditure of cancer charities in England and Wales from 2000-01 to be nearer £250 million. This represents the funding provided by 250 registered cancer research related charities, excluding unregistered charities such as the Institute of Cancer Research and other university-based funds or those administered by the MRC. The AMRC has details of the actual research expenditure of 130 of these charities; the total for these alone is £200.3 million. In addition to the 250 registered cancer research related charities, there are 43 NHS Charitable Funds and 42 general charities which also give funding for cancer research.

14. Whatever the exact level of Government and charitable funding of cancer research, and irrespective of which is the greater, it is clear that the Government is still far from spending as much as is needed. The Committee's Report recommended that the Government should spend at least £200 million per annum on cancer research, excluding funds from NHS R&D or the Higher Education Funding Councils.[29] The Government still has a way to go to achieve this target.

Cancer Plan funding

NEW FUNDS

15. Cancer care is inextricably linked to cancer research. The NHS Cancer Plan covered them both. The Committee's Report found that "there is widespread agreement that the poor state of the infrastructure for cancer treatment and research in the NHS is a serious barrier to clinical research. The Government must act quickly to address this through investment in the necessary staff, training, equipment and buildings".[30] It was not possible to isolate the amount spent on supporting cancer care in the overall NHS budget as so much of the expenditure overlapped with other clinical spending. This remains the case. The Cancer Plan promised by 2003-04 new government funding for cancer of £570 million[31] and asserted that this would fund almost 1,000 new consultants in the six major cancer specialities by 2005-06 and buy over 300 new pieces of diagnostic and therapeutic equipment.

CONCERNS ON FIRST TRANCHE OF FUNDING

16. We find that a major concern of those cancer specialists working in NHS trusts was the deployment of the first tranche of this new funding - £280 million in 2000-01. Several memoranda suggest some of that money has been used for purposes other than that intended. Professor James Malpas, President of the Association of Cancer Physicians, for example, told us "the perception is that it is being purloined by the Trusts to reduce their debt".[32] Professor McVie told us "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".[33] He added "I would have thought that seven-eighths of the resource has not yet got out there".[34] Professor Mike Richards, the National Cancer Director, acknowledged "I have heard a lot of concerns from around the country that the money is not getting through", adding that "the arrangement for next year is a lot stronger".[35]

17. We asked the Minister if she was aware of these concerns. She told us "we know that there has been concern from some areas about making sure that the money gets through to the front line in order to deliver those improvements".[36] When we asked about action taken to monitor the spending of Cancer Plan money, she told us "we have made it very clear that this investment was allocated to them to improve cancer services, and that this is what we expect to see happen and they will need to account for the investment at the end of this financial year. At this point we will be in a position to see where the money has been used and what decisions have taken place at each local level".[37] We then asked the Minister if she considered it completely honest with the public to announce funds for cancer care which might then be lost in NHS Trusts' coffers. She replied "we are clear that we have made additional investment available for cancer to the NHS and we also have clear targets that we expect them to meet as a result. We will monitor the situation and look very carefully at what this looks like at the end of the year and look forward to what we need to put in place to make sure we deliver cancer improvements we have set out in the National Cancer Plan".[38]

18. We are surprised that there is no clear mechanism for tracking these funds until the end of the financial year. It would be to the advantage of the NHS to have effective information systems in place to allow the production of accurate interim financial statements. We are unsure what the attitude of the DoH will be in future towards those trusts found to have misspent Cancer Plan funds. It is unclear how next year's funds will be protected. The increase in cancer care funding, often quoted over recent months, may not be reaching those who are relying on it to deliver the Cancer Plan. We are seriously concerned at the apparent ease with which Trusts can redeploy such funds if they choose. We consider it dissembling to allocate funding to cancer care, with great publicity, without taking even the simplest precaution to ensure that it reaches the intended areas. It is vital that end-of-year accounts for 2000-01, when eventually published, reveal exactly where Cancer Plan funds were deployed, and that Trusts be made answerable for any cancer funding spent on other services or financial requirements.

12 HC 332, para 16 Back

13 HC 332, para 120 Back

14 HC 332, para 134 Back

15 HC 332, para 146 Back

16 Cm 4928, paras 4,5 Back

17 Q 42 Back

18 Q 143 Back

19 Q 143 Back

20 Ev 19-20 Back

21 Q 159 Back

22 Ev 49 Back

23 Ev 49-51 Back