House of Commons - Science and Technology

Select Committee on Science and Technology Written Evidence

APPENDIX 69

Memorandum from Dr E F Gevers, National Institute for Medical Research

We are clinicians in early stages of our careers and we currently work, or have worked in the recent past, as scientists at the NIMR, some of us combining our research with clinical sessions in teaching hospitals in London. The following represents the unanimous view of all the clinicians currently working at the NIMR We believe that moving the NIMR to a hospital/HEI site in central London would not be advantageous and we therefore would like to submit the following as evidence for the inquiry into the future of the National Institute for Medical Research.

1. TRANSLATIONAL RESEARCH

1.1 The need to ensure translation of basic science into clinical research to benefit clinical practice and healthcare in the UK is widely recognised, but this is a multistage process. Early translational research bridges basic scientific findings to human physiology and pathophysiology (for example: effects of gene mutations found in human diseases in mouse models) whereas late translational research involves the implementation and evaluation of promising diagnostic or therapeutic discoveries in clinical practice. The former requires the best environment for fundamental scientific discoveries with good links to the relevant academic clinical specialists. Late translation (experimental/physiological studies involving patients, clinical trials and epidemiological studies) primarily requires the best environment for patient centred research. The MRC's proposal implies that these two activities would be best served by being combined on a single site in central London. We have seen no evidence presented for this. We have worked both medically and scientifically on sites where patient care and research were combined and have not experienced added value of the combination. We believe this is more likely to result in a compromised unfocussed solution for the NIMR that is sub-optimal for its science in the longer term.

1.2 The current NIMR already engages in early translation, with collaborations in 50 different clinical centres, with suitable collaborators and appropriate well-described patient populations. In early translational research, little patient material is required, and the specialist knowledge and expertise of the clinical partner is far more important than its physical proximity. Key features are the exchange of ideas, a raised clinical awareness of scientists and the scientific training of clinicians. As clinician scientists in training at NIMR, we would welcome an expansion of capacity for early translational activities, done in a way that does not compromise the primary focus of the Institute in pursuing fundamental understanding in the biomedical sciences. It is the excellence and concentration of the multidisciplinary NIMR science environment, and the insulation from clinical demands that its location affords, that attracts clinicians here, rather than to the many university science departments already embedded on a hospital campus. In our experience, the separation of the NIMR from our hospitals is a simple and practical solution that protects our precious research time and improves our productivity, whilst being close enough to move between clinical work and science work in a planned fashion.

1.3 The UK needs more individuals trained in both science and medicine for the improvement of translational research. Such clinician-scientists can ultimately work entirely as clinicians or as scientists, or both. Currently, training in both fields is given little official recognition or encouragement, and is usually organised by a few highly motivated individual clinicians and scientists using ad hoc funding. We believe this discourages many medical students from taking this career path risk even though a clinician-scientist training is essential if we are to improve our translational research capacity. We believe research training in the NIMR could be integrated with advanced clinical training in the best teaching hospitals, but to capitalise on this investment in training, it is essential to follow through with a structured career development plan. This must include protected research time and specific funding opportunities, for the clinician-scientist to put his/her translational training into practice. This will require communication between the MRC, the clinical training authorities (Royal Colleges etc) and the NHS Trusts and is not something that moving NIMR will solve.

1.4 At a more senior level, most current consultant contracts have a set number of clinical sessions per week, which leaves little or no time for science. The next generation of clinician-scientists would possibly be better employed on joint appointments with research institutes like the NIMR, rather than solely by the NHS, whose main goal is to provide clinical services. There would be value in making more senior appointments at the NIMR to clinically practicing scientists, to strengthen research appropriate translational opportunities in specific areas. However, simply introducing more clinicians into NIMR will not automatically achieve increased translational results, any more than moving scientists en masse onto a single hospital campus.

2. LOCATION OF THE RENEWED INSTITUTE

2.1 All are agreed that the NIMR should remain as a national centre of excellence in biomedical science, building translational research capacity on top of its fundamental discovery science. Early translation requires partnership with clinical consultants keen to collaborate, and who are best placed to provide clinical knowledge, expertise, and appropriate patient material. In our view, this will rarely benefit from immediate physical proximity to a single clinical Institution, which will not be the best partner for all clinical disciplines.

2.2 Relocation of NIMR to a single hospital/HEI is bound to lead to the perception of the Institute as "belonging" to that partner, restricting in practice the range of contacts. NIMR scientists would not be encouraged to approach clinical specialists in "competing" Institutes who may in fact be better partners for their research than the particular local clinical specialists on site. In reality, both the Institutions invited to bid for the NIMR are in fact large conglomerates with clinical departments quite widely dispersed, so the physical proximity argument for clinical interactions does not stand much scrutiny in this case. In our experience, there is no guarantee that communication between clinicians and scientists is any greater when the hospital and research institute are in different buildings on the same extended campus. A better way to improve this communication would be to organise meetings for scientists and clinicians which focus on specific organ systems and diseases, and NIMR could well develop this role.

2.3 The current location of the Institute has many advantages. It is in an area that is attractive and affordable to live, so that a local community of scientists, clinician-scientists and support staff exists naturally. Social contacts and out of hours working in the laboratory are commonplace and the MRC can take advantage of significantly lower salary costs and better recruitment of support staff. Furthermore, the existing site presents many possibilities to expand and build new facilities. There are many ways in which investment at Mill Hill could improve on facilities currently lacking (conference facilities, visitor accommodation) and we believe this would be far more cost effective than relocating the Institute to central London which would cause real disruption, loss of key support staff at huge financial cost, for imagined benefits.

3. MANAGEMENT OF THIS PROCESS

We have made our views known, via interviews with the management consultants about our views on translational research in the renewed NIMR, and spoken and written representations to the Task Force and to Professor Blakemore in response to minutes of the Council Meeting and recommendations of the Task Force. These views arise from our direct experiences coming from university and hospital environments to work at the NIMR, but it is not clear whether they, or responses of most scientists and clinicians who responded to FIS and Task Force consultation exercises, have been taken into consideration. MRC should think again about the real opportunities for NIMR's contribution to translational research and training on the Mill Hill site.

Dr Laura Andreae, MA MBBS MRCP PhD

National Institute for Medical Research,

Division of Neurophysiology

Dr Ross Breckenridge, MRCP PhD

National Institute for Medical Research,

Division of Developmental Biology/Specialist Registrar in Clinical Pharmacology

University College Hospital, London

Dr Evelien Gevers, MD PhD

National Institute for Medical Research,

Division of Molecular Neuroendocrinology/

Honorary Specialist Registrar in Paediatric Endocrinology

Great Ormond Street Hospital/Middlesex Hospital, London