APPENDIX 43
Memorandum from Professor Adrian Newland,
Royal College of Pathologists
1. The MRC's remit of strengthening Clinical
Research is an important one in the current climate. This is particularly
crucial, at a time when Academic Medicine is under acute pressure,
with the loss of over a third of the lecturer posts, and professorial
vacancies approaching 80. It is increasingly apparent that research
should not only be basic, but needs to link in with the clinical
research undertaken in teaching hospitals, with a significant
element of translational research, with more focused clinical
goals. The stated aim of the proposals of the MRC for the National
Institute of Medical Research, in increasing the number of Clinician
Scientists with closer clinical links, will help achieve this.
It is clear that a major lead in this area from the MRC will send
an important message to the Government and to the academic community.
2. There are a number of potential options
for the relocation of the site at Mill Hill. Of course, it should
be considered as to whether Mill Hill should remain as the main
academic site, but it is clear that, over the last few years,
although producing some reasonable research, has rather lost its
way, and has become isolated from the main academic community,
and has provided less of an academic lead, as would have seemed
appropriate for an institution of this size and importance.
3. The option of re-providing the development
on a single site, in association with an academic clinical institution,
is attractive. This would retain the intra-institutional interactions
currently seen at Mill Hill, but would have the added value of
clinical links.
4. The single site would be the preferable
option; however, if this is not viable on cost grounds, then consideration
could be given splitting the institution into smaller coherent
elements, and placing these where they would get added value.
It would, however, have to be considered whether the loss of interaction
between the units is important, and this would, of course, have
to be considered following an assessment of to what degree and
with what success this currently occurs. It would have to be considered
whether this loss would be offset by the value of placing the
units within institutions most likely to enhance their value,
and would, of course, bring other additional links into play.
5. There needs to be considerable flexibility
in considering the future of the NIMR and its research direction.
Flexibility is the key, as in an envolving research environment,
priorities change, and there needs to be an ability to adapt and
exploit these. This however, would occur on the background of
an established research direction, with appropriate technology
that would not differ much from the current areas of research.
Although Cancer is widely supported in academic research, there
could be value in adding the Cancer agenda into the research themes,
but the actual direction should be left to a new Director, with
his advisory team.
6. The importance of the proximity of a
teaching hospital cannot be overestimated, as the development
of strong clinical links in achieving the strategic remit of the
MRC, is vital. In order to properly exploit translational research,
close links with a hospital would be important in developing the
contacts and having the discussions that make such a transition
possible. In addition, in order to increase the number of Clinical
Scientists, which is the stated aim of the project, to attract
them and use them most efficiently, such close clinical links
are crucial. This would be difficult to achieve on a remote site.
7. An important role of the renewed institute,
particularly with its potential increase in size, would be to
be involved in the training of clinical academics, and could be
the focus of the development of the National Training Numbers
for Academics Scheme currently being considered by the Academy
of the Royal Colleges.
8. A major role of the institution would
be by acting as a focus for training clinical and non-clinical
scientists. Co-ordinating key areas of biomedical research is
also important, as by having appropriate areas of expertise, it
would be possible to flexibly respond to any sudden new developments.
This can be illustrated by our inability to react and exploit
the few cases of SARS in the UK when they occured, which was unlike
some of our European counterparts.
9. The development of the new institution
should not be at the expense of basic scientists, but there should
be an increase in Clinical Scientists, while maintaining those
basic scientists with whom they would work and interact. The increase
in numbers would take into account movement into newer areas such
as Cancer.
10. The management of the new institution
would be crucial and it will be key to attract a Director of international
standing, with enough scope to direct the institute, but with
an influential scientific advisory board, who can shape the elements
of the institute over time. If the institute is to achieve excellence
in a number of areas, then there needs to be a strong advisory
board, although it is clear government by committee is rarely
successful, and there needs to be a strong director to lead and
shape the institution. It goes without saying that there needs
to be a strong professional team to take the scientific aims forward.
11. The institute, as it currently stands,
has become relatively insular, and isolated from clinical progress
and translational research, and has not been the leader that would
be anticipated for an institute of its size and reputation. A
renewed institute with strong clinical links, is crucial for the
development of academic research and in supporting academic medicine.
In order to achieve, this co-location with a research active hospital
is vital. This could be on one site, if such can be identified,
or, as a secondary option, could be on more than one site, alongside
one or more universities and their associated hospitals. However,
this would not be the preferred option.
12. The MRC has made a bold attempt to reinvigorate
the research output from the NIMR, which has understandably met
opposition from internal vested interests. There is an element
of complacency in the response to this, and the committee needs
to make a bold attempt to support this development and allow this
exciting endeavour to be taken forward. This can only be to the
benefit of academic medical research in this country.
17 November 2004
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