Examination of Witnesses (Questions 740-759)|
TUESDAY 25 MARCH 2003
740. What is the order of magnitude? Is it 100
(Dr Dunstan) On programme grants, we have had a difficult
financial climate in the past year or so, but normally, if you
ignore that, the award rate on programme grants that actually
go to the Board is about 40 per cent. I would be surprised if
the infections area was different to that, but it may be that
a lot of those awards are in the areas we are very happy with,
as I said beforeHIV, AIDS, malaria and those kinds of areasrather
than ones that perhaps need to be built up.
741. Could you clarify that the 30 per cent
success rate is overall or is it in communicable diseases grants?
(Dr Goodwin) Those are the applications to the Infection
and Immunity Panel, which covers communicable diseases but also
some areas of basic immunology.
742. That might depend on the number of applications
(Dr Goodwin) Yes, but there are quite a lot. I would
say the majority is in communicable diseases.
Baroness Warwick of Undercliffe
743. Is the 30 per cent then 30 per cent of
(Dr Goodwin) No, this is 30 per cent of everything.
We fund all the high quality science on our panels.
744. Is it the same for the MRC?
(Dr Dunstan) At the moment, as you probably know,
we are not even able to fund all the research at the upper end,
which is international, leading edge work.
745. For the record, my background is nursing
and nurse education. I am a previous chairman of a health trust.
This question follows really from the previous one. Do you fund
research in the full range of infectious diseases actively, including
microbiology, clinical infectious diseases and epidemiology?
(Dr Dunstan) Yes, we do.
(Dr Goodwin) We do, too.
(Dr Dunstan) We think in particular that we have to
be careful that we do not fund things that would perhaps be better
funded, say, by industry and that we do not fund needs-driven
research that perhaps is best commissioned by the end user. We
are quite careful about trying to draw lines in those respects.
Otherwise, we fund right across the spectrum.
746. Do you have any criteria in your portfolio
(Dr Dunstan) At the moment, the priorities that relate
to infectious disease is work in Aids epidemiology, the TSEs,
primary care, public health research and antibiotic resistance
work. As I say, the Strategy Development Group will meet next
week and one of its key topics will be developing an infections
strategy. I think that will probably throw up some other areas.
(Dr Goodwin) We fund across the whole range. We do
not have any specific priorities in our general baseline funding
schemes. We merely look at the applications that come in and fund
the best quality research.
747. And that covers it all?
(Dr Goodwin) Yes, it covers it all.
748. To an extent, you did answer the supplementary
that Lord Oxburgh asked about how you work with authorities, particularly
the Department of Health, in identifying priority areas of research
in communicable disease. We are now going to have the slightly
different world of the Health Protection Agency. For the reasons
we have established and, Dr Dunstan, you mentioned bio-terrorism,
do you already have or are you looking at any plans as to how
you might co-ordinate the work with the Health Protection Agency?
(Dr Dukes) We have started discussions with Sir William
Stewart, Shadow Chair of the HPA. That has been a very good lead-in.
We have also been talking to the Interim National Director of
R&D, Dr Charles Penn. These are fairly informal discussions
at this stage, if you like, to map out the terrain over which
we might talk. Clearly there are some plans within the HPA which
are exciting for the way they might look more outward on the one
hand and develop programmes between the four component parts of
the HPA in a new way. We already have links with the component
parts of the HPA but no doubt the new organisation will offer
us new opportunities. The sort of thing that we might look together
to talk to each other about, and perhaps work together with each
other on, are new areas for the HPA like behavioural and sociological
research, which maybe they have not been involved in before, and
of course the Economic and Social Research Council can be brought
into that discussion. The HPA has particular facilities which
are national and world class; for example, GMP vaccine manufacture,
animal testing, Category 4 laboratories, where there may be some
synergies, if you like, in terms of using infrastructure more
optimally. In relation to population data, there is a real wealth
of surveillance data within the PHLS, and improving data flows
between surveillance and epidemiology and other areas such as
genomics and bioinformatics is another opportunity that could
be exploited. We are already aware of work in relation to diagnostics
and vaccines, where there will be opportunities for synergies.
Finally, the shadow HPA has been talking to us about their early
ideas in relation to training, improving critical mass and such
like. If I could add one thing, which is that relations with the
HPA and those kinds of opportunities will be one of the foci for
discussion at this forthcoming strategy discussion that my colleague,
Dr Dunstan, mentioned.
(Dr Dunstan) There are lots of opportunities for the
MRC in the future. We have appointed new directors for work in
the Gambia and Uganda; that is, in developing countries. There
will be appointments of new directors in key fields of infections
over the next five or six years. We are opening up lots of opportunities
and that is why it is particularly important to look at the strategy
and work the relationships out so that we get the best out of
Lord Lewis of Newnham
749. You talk about new opportunities. This
obviously involves an amount of money. Are you able to get extra
money or is this reallocation of moneys that you already have
between these various headings?
(Dr Dunstan) It is not finally decided but I have
said that we are hoping that MRC will be able to put in for a
spending review in 2004, a bid for money in human infectious disease.
It may be that this will be jointly with, for example, the BBSRC
because there are obvious links there, the ESRC because of their
behavioural perception of risk type links, and maybe even other
research councils as well. Because these things evolve, it may
also be enveloped in a bid that is called Environmental Health,
and infections will be a subsection of that. If that bid were
successful, we would expect to have money, and whether it is new
money or not or whether it is money that has been given to us
within our baseline, actually focused on infections research.
We would have to report on how we spent on infections. So there
is a chance that we might have new money. This year, for example,
we were allocated, as Lord Patel knows, £40 million over
three years for stem cell research. The kind of bid we were thinking
that human infections disease might need is £15 million,
or something like that.
750. Is there a comment from the Wellcome Trust?
(Dr Snewin) I would like to thank Dr Dukes for putting
the HPA into context. The Wellcome Trust has quite a similar comment
to make. Our Director has also had informal meetings with Sir
William Stewart, the Shadow Chair of the HPA. The Trust is increasingly
willing to work in partnership with other organisations, and that
includes Government agencies and departments. Some examples are:
the Synchrotron Diamond Project and Joint Infrastructure Fund
and also the new national network for science learning centres.
Regarding the Health Protection Agency and the Department of Health,
we have stated in our written evidence to your Committee, which
included our response to the Department of Health consultation
on the HPA, that the Trust considers that there should be an opportunity
for research into public health and infectious diseases in the
UK to be enhanced. In order to facilitate the possible partnerships
in the future, the Trust suggested that there might be a committee
set up to advise the HPA on research, along with the Medical Research
Council of course and other funders. More generally, the Trust
has also agreed to facilitate a working group to discuss public
health sciences in general and in particular public health professional
structures. The first meeting of that working group will be held
at the Trust this year.
751. Dr Dukes, you mentioned how the MRC may
be funding projects which will help to improve surveillance. I
wonder whether that is an MRC role rather than a Department of
Health role? Is this not for the HPA itself? Is it not a more
administrative and public health activity rather than the kind
of research that the MRC is best fitted for?
(Dr Dukes) I am sorry if I gave the impression that
I thought it was MRC's role to conduct surveillance because clearly,
as Lord Rea indicates, that is not our view. However, in terms
of developing methodologies and developing the interface between,
if you like, the routine side of surveillance and the more academic
epidemiology side, there is probably more that can be done in
ensuring that the data moves from the one side to the other side.
It may be that surveillance can be informed by, if you like, developments
in basic epidemiology as well as by laboratory-based tools.
Lord Rea: That clarifies it.
Baroness Finlay of Llandaff
752. Some members of this Committee have expressed
quite firm concerns about the reorganisation of the PHLA and the
change to the HPA. You spoke quite positively about the way that
you see opportunities coming. I just wondered if you felt that
there were areas of current research that may be threatened by
the reorganisation, or whether you felt overall optimistic, which
was the message that came across.
(Dr Dukes) We have not had that feedback ourselves
directly from the research community. I cannot really help you
further on that.
753. Is that feedback positive or negative?
(Dr Dukes) We have had no negative feedback from the
(Dr Dunstan) No concerns have been expressed that
it affects research.
(Dr Snewin) Within the comments that we put into our
written submission to your Lordships, the Trust expressed some
concerns that public health funding should be protected under
the new structure and that the proposed reallocation of funding
to the NHS from current public health laboratories might potentially
have an impact, especially on strain collections and links with
academic researchers. We have brought that to the attention of
the HPA in our response to them. As has been expressed in our
written consultation, we consider that research structures should
be set up within the HPA in a way to allow academic researchers
to gain charity and other funding, so that research can flow easily
between the public and academic research community in this area.
754. The Committee recently visited a major
hospital in Birmingham and there they stressed the importance
of good practice in fighting infection - good practice in hygiene,
personal hygiene, food hygiene, animal husbandry, this sort of
thing. To what extent do the Medical Research Council and the
Wellcome Trust have a role in supporting and identifying, and
indeed implementing, best practice in this field of communicable
disease prevention and control?
(Dr Goodwin) In general we do not consider this is
part of our remit, and so I hand over to Dr Dunstan.
(Dr Dunstan) In terms of our health services research,
then we are perfectly happy to fund applications that are "generalisable".
We would not fund an application that was simply looking to solve
a problem in one particular hospital. We would want the output
to be potentially generalisable. Yes, we do, and we have quite
a portfolio of that kind of work. In our general practice research
framework it is used not simply by MRC for work but actually by
other funders. They have done quite a lot of work on best practice
in terms of disease prevention and treatment. Some of those studies
have been very helpful to other practitioners. We do not have
a rolethe role belongs to NHS R&Din what we
call service delivery and organisation. There is a line drawn
between MRC and the Department of Health and the NHS. However,
it is perfectly possible, for example, for an NHS R&D funded
project in that area to be part of a co-operative group that the
MRC supports and to be one of the qualifying pieces of funding
for that. If people wanted to come to us for work in infections
and prevention, that would be a perfectly good way of doing it.
Perhaps finally I could simply say that in the MRC Scientific
Vision for the next 10 to 15 years one of the things that we need
to develop, which has generally been welcomed, is something called
a Health Implementation Research Centre. It may be a building;
it may actually be a virtual centre. We are hoping to bring together
expertise that will enable people not only to do better translational
work and get better implementation, but actually to design their
projects in the first place so that they can be better implemented
and translated into practice. This is a gleam in our eye. We have
talked actually not to the Trust yet but to some other funders
which might be interested in this. I think there is a likelihood
that although it will start small, it might be something that
will be developed in the reasonably near future.
Lord Haskel: That would certainly fit in with the
sort of thing we were hearing when we were in Birmingham.
755. To go back to the Wellcome Trust, you said
that this was not your responsibility. Is that because you believe
this is excluded by the terms of the Wellcome will
or simply because your Governors have taken a policy decision
not to cover this kind of work?
(Dr Goodwin) The will can be interpreted quite broadly,
but at the moment the Governors feel that they can be most effective
by funding the basic research and some of the more clinical aspects,
but not being involved in the implementation of best practice.
756. May I follow that up a little, again coming
to clinical research? One of the areas in clinical medicine that
is very important is antibiotic resistance. It is well known that
it is difficult to get funding to look into antibiotic resistant
causation and indeed the control of it, but would you, either
the Wellcome Trust or MRC, look at antibiotic resistant proposals
that maybe would not reach the high standard that you would want
but nevertheless are of such importance that you would be willing
to fund them or give them a fair wind amongst all the others?
(Dr Dunstan) In response to our highlight notice,
we have between 40 and 50 applications in antibiotic resistance.
I have to say that most of them have not been of a high enough
quality. We have funded about seven or eight of those but they
have been fully funded. Perhaps I could add something else that
I think is relevant to this, and it is certainly relevant to an
answer I gave before. One of the other initiatives that MRC is
taking jointly with the Department of Health through the Chief
Medical Officer and with the ESRC is to look at patient safety
research. In terms of best practice and preventing the development
of antibiotic resistance, that kind of research actually could
have quite a significant contribution in this area.
(Dr Goodwin) As far as the Trust is concerned, we
receive very few applications in that area at the moment but,
as I indicated earlier, antimicrobial resistance and patient-orientated
research are areas that the Trust is reviewing at the moment.
The Governors will be considering those reports and they could
possibly decide to do something more specific in those fields,
but I cannot speak for what decisions they will make.
(Dr Dukes) Just to clarify a point about giving things
a fair wind, in an area in which we have issued a highlight notice
to encourage the research community, such as antibiotic resistance,
as long as the quality criteria are actually met, they do get
more than a fair wind when they come up to Council in recognition
of our partnership with the Department of Health and our wider
Lord Lewis of Newnham
757. Can I just take up this point on the standards
that we are dealing with because at times of course there is a
certain type of work which appeals very much to, say, the academic
community as a whole as being very much in the forefront of the
work. That, I imagine, is the sort of work that would appeal to
you very much. But there is another type of work which is very
much more routine in nature and which is very important indeed
for the development of this but does not have quite the same cachet
when it comes to the academic looking at these particular types
of approaches. Who actually would fund that particular type of
work? I am not suggesting for one moment you should do it. I know
you have your set of criteria to deal with it but who would look
at that because these are very important areas very often to look
(Dr Dunstan) Perhaps I could say first that one of
our research boards is in health services research and public
health research. Some of that work is, I suppose, very applied
and might not in some senses appeal to some academics in the way
you describe. I think because we look at that in the round in
that particular board that that particular board is able to make
its recommendations to the Council for funding and it does get
a very full and careful consideration. Indeed, we do fund a lot
of work through that board. The MRC is able to fund quite a lot
of applied work that way: clinical trials, epidemiological studies
and real health service studies in various areas. Otherwise, I
think we would expect PHLS, or the HPA in future, to do that kind
of work. Some of it might also be done in connection with industry,
I suppose, if they had an interest.
758. In your view, has that support of this
kind of indirect research by the PHLS and other authorities been
well done in the past?
(Dr Dunstan) There may be gaps, I guess.
(Dr Dukes) PHLS does sometimes come in to the MRC
as an applicant or as one of a number of applicants and has achieved
funding through MRC. That is indeed one way where we can actually
address these areas where, if we were not careful, a gap might
open up between our organisations.
Baroness Warwick of Undercliffe
759. This rather follows on from what you have
just been saying. You talked about the variations in quality.
We have had quite a lot of evidence where support for public health
research in the area of communicable disease control and particular
research into quality control of diagnostics and interventions
has not been adequately funded. What is your role in quality control?
Do you have a role in quality assessment and, if not, perhaps
you could tell us who does?
(Dr Dunstan) We do not really have a role in that.
I wonder perhaps whether NIBSC has a role in some areas of diagnostics.
I have to say, I am not an expert in this. We would be very careful,
I think, if we were doing a clinical trial, or any other kind
of study, to make sure that the diagnostics that we used were
appropriate and as good as possible because clearly otherwise
it would undermine the whole of the project, but it is not really
directly in the MRC's remit.
1 The Trust's governing document is now its constitution,
adopted on 20 February 2001, which is a re-statement of the Trust's
objects under Sir Henry Wellcome's will. Available to view at