Memorandum submitted by the British Heart
Foundation (FC 35)
1. INTRODUCTION
1.1 The British Heart Foundation (BHF) is
the nation's heart charity and we welcome the opportunity to submit
written evidence to this inquiry. The BHF is the largest funder
of cardiovascular research in the UK and an active member of the
Association of Medical Research Charities (AMRC). Between April
2008 and March 2009 we invested over £145 in cardiovascular
research every minute—a total annual investment of over
£78 million. We fund more than half of all university-based
cardiovascular research in the UK, with BHF-funded researchers
and projects at centres in over 30 cities across the UK.
1.2 Our research portfolio extends from
fundamental laboratory-based molecular, biological and genetic
studies to large-scale clinical trials of novel and existing preventive
and therapeutic interventions. We support research through infrastructure
awards for buildings and equipment, project and programme grants
for research staff and consumables and, most importantly, research
training and career posts for basic and clinical scientists, from
PhD students through to research professors.
2. GENERAL COMMENTS
2.1 It is clear that the next government
will need to make decisions about where to make cuts in public
spending in light of the current economic climate. We believe
that where this occurs, it is essential that the effects on medical
research within the UK are kept to a minimum. Medical research
is fundamental to the UK economy, in terms of the societal and
economic benefits that result from the investment made, as an
employer of the UK workforce and as part of the UK's competitiveness
internationally.
2.2 Research has a crucial role in improving
standards in healthcare, with the potential to provide innovative
approaches to prevention and treatment and achieve step changes
in the quality of care.
2.3 We believe that there are three key
areas that must be reinforced in order to maintain and strengthen
medical research in the UK:
— sufficient support for charity-funded
research must be provided by the Higher Education Funding Councils
(HEFCs);
— the UK research environment must be sufficiently
facilitative for both basic and clinical research; and
— academic research careers must be sufficiently
supported to ensure future sustainability of the UK research base.
3. DECIDING WHERE
TO MAKE
CUTS IN
SCIENCE SPENDING
3.1 There have been substantial developments
in both diagnosis and medical treatment that have steadily increased
survival for those with heart and circulatory disease. Some of
the most ground-breaking and important achievements in heart health
research over the past 49 years have been made thanks to work
supported by the BHF. The charity sector as a whole also makes
an enormous contribution to medical research. The Association
of Medical Research Charities (AMRC) estimates that 70% of all
funding from its members goes to higher education institutions,
and medical charities as a whole fund approximately 14% of all
university research. We believe that any decisions on science
funding should take this significant contribution into account.
3.2 The Government currently allocates public
funds for research through the dual support system, providing
two clear streams of funding to both the HEFCs and the research
councils. In England, as part of the quality-related (QR) grant
provided to universities through the Higher Education Funding
Council for England (HEFCE), a separate element has been provided
since 2006 in the form of the Charity Research Support Fund (CRSF).
Similar streams of funding are also in place in other nations
of the UK. The CRSF aims to cover the gap in the full economic
costs incurred from charity-funded research, and as a result helps
charities such as the BHF to assist universities in attracting
researchers of the highest calibre, and conduct research of the
highest quality.
3.3 In 2004 the Government made a commitment
to the financial sustainability of research, working together
with all funders towards fully funding research in UK universities.
Progress has been made, with a report earlier this year showing
that almost all measures of sustainability amongst higher education
institutions have improved in recent years.[20]
3.4 However, a pressing concern is the uncertainty
surrounding the adequacy of the current level of funding of the
CRSF, and the future of the fund beyond 2010-11. The uncertainty
over both of these issues impacts on the confidence of researchers
to seek funding from medical research charities and on universities'
enthusiasm for hosting charity-funded research. Many within the
medical research sector are concerned that the CRSF will not reach
its intended 2010-11 target of £270 million from its current
£194 million total, and current evidence also suggests that
some researchers are already being discouraged from applying to
charities for funding.[21]
We believe that further reform is needed to place charity funded
research on a level playing field with research funded from other
sources, and to provide long-term reassurance to charities, universities,
and researchers.
3.5 We believe that the Government should
conduct a comprehensive review of the level of funding needed
beyond 2011 to effectively support the substantial investment
made by medical research charities. In particular, funding must
be set at a level which allows universities to recover full economic
costs for charity-funded research at a comparable level to the
costs they can recoup from research funded by Research Councils.
The Government should also work with higher education institutions
to ensure that universities, researchers and other funders are
aware of the CRSF, and that charity research is not adversely
affected.
3.6 The £135 million reduction announced
in the HEFCE grant letter in December 2009, together with the
£600 million cut to higher education and science funding
announced in the 2009 Pre-Budget Report, is a concern to the research
sector. While fuller details of these announcements are yet to
emerge, it is vitally important that the CRSF is not reduced as
a result. This would have an extremely detrimental effect on both
universities and charities and, more importantly, on the pioneering
research funded by medical research charities.
4. ESTIMATING THE
ECONOMIC IMPACT
OF RESEARCH
FOR QR FUNDING
4.1 The Research Excellence Framework currently
under development has proposed that the impact of research be
given a significant weighting of 25% in the overall assessment
of research. While we fully understand and support HEFCE's view
that the impact of research is important, it is clear that there
are substantial difficulties in assessing and scoring this in
a robust manner.
4.2 The development of medical research
from basic science to clinical benefit is a process that occurs
over a substantial period of time before the full effects are
realised. This is estimated to take around 17 years on average,
but can be as high as 25 years before healthcare benefits emerge.
4.3 Cardiovascular disease is the UK's biggest
killer, with the costs of healthcare alone amounting to over £1.7
billion each year.[22]
There is therefore a great need to invest in research seeking
to improve cardiovascular health in the UK. The real benefit of
medical research is in the impact that it has on health gains
to the population. A 2008 report estimates that every £1
invested in cardiovascular medical research produces benefits
that are worth 39p every year thereafter in perpetuity.[23]
In other words, the cost of research is recouped through social
gain within three years of making the investment, and it continues
to pay such dividends every three years thereafter.
4.4 Similarly, public investment in medical
research has a substantial impact in triggering future investment
by industry. A 2009 report estimates that a £1 increase in
extra public medical research can lead to an increase in private
pharmaceutical industry research and development spending in the
range of £2.20 and £5.10.[24]
4.5 Research funds can be distributed either
in response to demand from the research community, so called bottom
up or response-mode funding, or it can be pre-specified by the
funder for specific initiatives—top down funding. Most `breakthroughs'
in medical research (eg monoclonal antibodies, stem cells, cell
cycle genes) have evolved from investigator-led, curiosity-driven
research (bottom up), in which the UK has played a leading role.
A recent report from the House of Commons Innovation, Universities,
Science and Skills Select Committee highlighted the importance
of basic research in the debate on strategic science funding,
citing cardiovascular research as a prime example where basic
research has led to substantial translational benefits. Some of
the key advances in cardiovascular medicine have resulted from
a substantial amount of research carried out in non-medical departments,
such as chemistry, physics and engineering.[25]
4.6 It is for these reasons that it is crucial
that basic science in particular continues to be strongly funded
in the UK. Whilst there are times when a top down approach can
stimulate new research activity, it also runs the risk that funds
can be allocated to projects (the best applications for the initiative)
that would not have succeeded in open competition against other
scientific proposals. Thus, funds are diverted away from high
quality bottom up research towards poorer quality top down research.
Therefore, it is crucially important that in any new funding arrangements
there are sufficient funds for investigator-led, hypothesis driven
research. Consequently, it is essential that the research budget
should not be susceptible to short-term political considerations,
and that Haldane principles must apply at all times. It is also
important that the balance between basic and translational research
must also be retained. Without basic research into mechanisms
of disease, where the UK is highly competitive internationally,
there will be no new findings to translate into better drugs or
treatment.
SUSTAINABILITY OF
THE RESEARCH
BASE
5.1 A separate issue, connected to the overall
sustainability of UK research, is the number of science graduates
willing to consider a research-based career. The Government has
identified improving the supply of scientists as a key objective
within the ten-year science and innovation investment framework.[26]
However, the BHF is concerned in particular about the attractiveness
of cardiovascular research to academic scientists. Public funders
have committed resources to research training, and there has been
considerable reform of the system to make it easier to embark
on such careers, but it is unclear whether these measures are
sufficiently effective. Training and retaining a new generation
of basic science and clinical researchers is paramount to future
public health.
5.2 The BHF has recently surveyed our own
researchers on the research career pathway and the environment
for cardiovascular research in the UK. While the vast majority
felt the UK was an excellent environment to carry out cardiovascular
research, we have found that there are a number of key concerns
that are felt within both basic and clinical science that are
discouraging current researchers from pursuing a long-term career
in academic research. Whilst these include issues relating to
competitiveness of salaries and career structure, the uncertainty
of future funding means that some lack the confidence and security
to pursue a career in academic research.
5.3 The Government has a key role to play
in helping to ensure that the UK research environment has a sustainable
supply of talented, motivated scientists, to ensure that the UK
continues to be a global leader in research. Consideration should
therefore be given to the impact that any cuts in the research
budget will have on the aim to ensure that the UK has a strong
supply of scientists, engineers and technologists.
CONCLUSION
— The BHF makes a substantial contribution
to research into cardiovascular disease across the UK. We are
dependent on not only the generous donations provided by members
of the public, but also on the support provided by Government
to universities, and more broadly on an environment facilitative
of research.
— Ensuring that sufficient, long-term support
is given to universities for charity-funded research should be
a priority. The Government must review and commit to charity research
support funding beyond April 2011.
— Medical research provides societal and
economic benefits to the UK. The full extent of healthcare benefits
from basic research can take up to 25 years to be fully realised,
and so caution must be applied in any move towards impact assessment
through the proposed Research Excellence Framework.
— Stable funding is a key incentive in
ensuring basic and clinical scientists continue careers in research
and help to sustain the future research base.
— If you would like further information
about this response, please contact Joseph Clift, Policy Officer,
at cliftj@bhf.org.uk or on 0207 554 0156. We would be pleased
to discuss any of these issues further with the Committee.
Professor Peter Weissberg
Medical Director
British Heart Foundation
January 2010
20 Research Councils UK and Universities UK (2009)
Review of the Impact of Full Economic Costing on the UK Higher
Education Sector. Back
21
Breast Cancer Campaign (2009) Full economic costing: the effects
on charity-funded research. Back
22
www.heartstats.org Back
23
Health Economics Research Group, Office of Health Economics, RAND
Europe (2008). Medical Research: What's it worth? Estimating the
economic benefits from medical research in the UK, Back
24
Office of Health Economics, Alzheimer's Research Trust (2009)
Forward Together: Complementarity of public and charitable research
with respect to private research spending. Back
25
Innovation, Universities, Science and Skills Committee (2009)
Putting Science and Engineering at the Heart of Government Policy. Back
26
HM Treasury (2006) Science and innovation investment framework
2004-2014: next steps. Back
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