APPENDIX 66
Memorandum from Professor Hindmarsh and
Dr Dattani, University College London
We write to submit our views on the role and
future for the National Institute for Medical Research (NIMR),
which is under consideration by the Medical Research Council (MRC).
Both of us have been affiliated with the Institute over the last
20 years and have been more closely involved over the last six
years as researchers on the Mill Hill site and more recently over
the last two years as Visiting Workers. The involvement of Mill
Hill over the last 20 years in the research that we have undertaken
in clinical practice has been invaluable and has led to a massive
expansion in our understanding of disease processes. This has
placed our unit at the forefront of the evaluation and treatment
of paediatric endocrine disorders and a similar beneficial relationship
exists in other clinical areas such as cardiology, gastroenterology
and immunology. We believe our experience as researchers and clinicians
qualifies us to comment on the proposals made by the MRC regarding
the direction for the NIMR.
1. THE CASE
FOR RETENTION
ON THE
MILL HILL
SITE
We believe that the National Institute for Medical
Research as currently constituted at Mill Hill provides for the
United Kingdom a unique constellation of scientists and supporting
staff, which covers a breadth of scientific disciplines and specialities.
This close proximity of working is to be commended and directly
parallels models used by successful industries such as BMW's Munich
Engineering Centre and DaimlerChryslers Technology Centre in Michigan.
Mill Hill exemplifies what organisational researchers have known
for a long time, that the frequency of communication between co-workers
decreases dramatically as the physical distance between them increases
(1).
This observation is true when considering basic
science interactions but, paradoxically, a moderate separation
works to a considerable advantage when we consider the interaction
of clinical workers with the Mill Hill site. This stems from the
fact that there is a tendency in many UK Academic settings for
clinical researchers at all levels to become entangled with service
delivery within the National Health Service (NHS). The distance
between NHS site and Mill Hill is far enough to ensure that this
potential conflict of interest does not take place so that the
time that is dedicated for research is exclusively dedicated to
that task, but close enough to allow easy and regular contact.
This dissociation of immediate demands of clinical practice from
a period of uninterrupted focus on basic science is advantageous
to the clinician who then gains access to the extensive animal
facilities and expertise on the Mill Hill site, the exposure to
numerous and different basic science concepts from the vast array
of special interest groups on the site and the tremendous infrastructure
at Mill Hill with respect to lab support and higher technologies.
We believe that the separation of the clinical
practice from the basic sciences is most beneficial in reality
because it enforces the protection of clinicians' time to spend
on research. This insulation also engenders a spirit of independence
of thought, which leads to the generation of intense, original
and fruitful collaborations. This differs from the current concepts
often promulgated within universities where dependence within
a smaller grouping is fostered because of the competitive nature
for internal funding within an institution. This internal competition
simply does not exist at NIMR and is a major reason for their
collaborative culture. In addition, we do not view their current
location as impeding the influence of basic science on clinical
practice and vice versa as the attendance of ourselves and many
others from the fields of cardiology, gastroenterology, virology
and infectious diseases over the years have testified. Rather
with this integrated approach and close liaison, both groupings
have strengthened their standings within the basic science and
clinical science communities.
2. THE DISADVANTAGES
ASSOCIATED WITH
CESSATION OF
NIMR AT MILL
HILL
One of the major arguments that has been put
forward for the move of NIMR from the Mill Hill site is that it
would allow them to integrate more with clinical practice. Several
of the arguments against this have been rehearsed above, but less
frequently mentioned are the many specific disadvantages to the
current science of such a move. Any movement of NIMR to central
London would lead inevitably to fragmentation of the resource
as it now stands, because no single site in central London or
within the University of London is capable of absorbing the number
of scientists, support staff and facilities that go with NIMR,
whilst protecting its freedom to interact with multiple clinical
sites in the UK. We believe any such move would in practice lead
to fragmentation of the existing groupings in attempts to embed
them with the much less interdisciplinary culture in the Universities,
and at considerably increased cost.
Further, we believe that any movement into central
London, leaving aside the property cost considerations and relocation
expenses, is likely to be problematic in terms of ensuring staffing
of the Institute in whatever form it would ultimately take. The
evidence from the public service sector recruitment and in particular
non consultant recruitment in the NHS points to London being seriously
disadvantaged, because of the cost of living and travel associated
with the area. Longer commuting times are hardly conducive to
long out-of-hours working typical of NIMR staff, and it will be
more difficult to recruit and retain lower paid ancillary staff
who also play a key role (eg trained animal staff). We question
the wisdom of taking this risk.
A question mark would also hang over the provision
of the large animal facilities that are currently available on
the NIMR site. Relocation of these facilities to central London
would need careful consideration because the facilities would
be far more expensive to rebuild in central London than to maintain
at Mill Hill, would become very vulnerable to outside adverse
interest cf the experience in Oxford, would require extensive
expenditure on security and would probably not be cost effective.
Their existing location has not prevented them from providing
much valued specialised animal support services for many central
London Institutions including our own.
The final point is that this large Institution
if moved whole would then become part of already large and unwieldy
organisations whose components are already distributed miles apart.
Two situations could follow. In the best case scenario, NIMR might
continue to operate as an independent Institute within another
institution in which case nothing would have changed from the
status quo other than a large waste of money. Alternatively,
the pursuit of integration with clinical specialties would likely
lead to fragmentation into science disciplines, and the unique
culture of mutual interdependence across all scientific field
would be lost. There are very few large scale functional entities
within Universities that match the scale of integrated activities
and collaborations across the Divisions at NIMR.
3. CURRENT ARRANGEMENT
Continuing with the Mill Hill option allows
the Medical Research Council and NIMR to contemplate more practical
ways in which they can improve and increase their contribution
to clinical academic medicine in the United Kingdom, which is
thought to be in crisis (2).
In its present guise NIMR with its physical
separation from the day to day demands of the NHS provides an
ideal opportunity for several tiers of scientific clinician working.
First, by creating junior research positions with focused time
periods away from clinical commitments the organisation could
help lay the foundations for the rediscovery of academic medicine
by generating a cadre of highly trained scientific clinicians
who would first be able to develop their own work programme and
then maintain NIMR links through the next two stages. The second
phase could be to build upon these participants in a highly structured
and disciplined environment, by creating the equivalent of some
tenured track posts linking NIMR with different clinical Institutions.
The final stage would be to develop a working bond with the scientific
clinicians who are allied to NIMR with the creation of scientific
clinician leaders who are based predominantly on the NIMR site
but who can interact with the clinical fraternity. We know that
NIMR leaders are keen to increase the number of clinically trained
scientists running programs at Mill Hill. With proper and sustained
funding, and appropriate agreements with the relevant NHS trusts,
such opportunities would be highly prized within the academic
clinical community. Finally, if the MRC wish to contribute to
the revival of Academic Clinical Medicine in the UK they should
consider the creation, in partnership with the NHS, of Clinical
Research Centres to undertake the detailed patient evaluation
and clinical studies that are the essence of translational research.
4. CONCLUSIONS
We believe that the proposed move of NIMR from
the Mill Hill site in pursuit of imagined improvements in clinical
translation will do more harm than good, and risks damaging their
unique scientific environment that is necessary to generate translatable
discoveries in the first place. We believe that a more modest
focussed investment on translational training and research at
Mill Hill, together with separate investments in clinical units
in several institutions, closely linked to the NIMR, would be
much more likely to produce in practice the enhanced interactions
between NIMR scientists and the clinical world that the Medical
Research Council desires.
REFERENCES
(1) Allen T J. Communication Networks in
R&D Labs. R&D Mangement 1971; 1: 14-21.
(2) Clark J, Tugwell P. Who cares about
academic medicine? BMJ 2004; 329: 751-2.
Dr Mehul Dattani
Reader in Paediatric Endocrinology
Professor Peter Hindmarsh
Professor of Paediatric Endocrinology
22 November 2004
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