Select Committee on Science and Technology Written Evidence


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.


  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.


  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.


  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.


  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.


  (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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