Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 488 - 499)



  Q488  Chairman: Good afternoon and welcome to the Committee. Many thanks for taking the time to join us this afternoon. That is very much appreciated, as is also the written evidence with which you are associated either individually or on behalf of the organisations you represent. These written papers have been circulated and we have made good use of them, as you might discover in the process of the discussion to follow. You are now online and this is going out via the internet directly. Perhaps I can start with a general question and you can introduce yourselves at the same time. Can I ask about the research councils, because you see them and must watch them quite carefully as the alternative providers and, in some cases, the main providers of research money. They have spoken to us about the priority they say they attach to research on the scientific aspect of ageing. I wondered whether you had seen that priority in action. Are they attaching priority? Is the volume of research about right or at about the level you would expect to complement what you also are involved in? Are the research councils doing enough? Are there gaps or problems of coordination? This is just an opportunity to reflect on the volume of research starting initially with what the councils are responsible for and whether they are providing sufficient priority and drive.

  Dr Goodwin: James Goodwin. I am Head of Research for Help the Aged, which is a large international charity which supports research into all aspect of ageing. We have good working relationships with all the research councils. We also have a formal relationship with the National Collaboration on Ageing Research which is funded by the research councils and with its successor, the New Dynamics of Ageing. We are very well placed to get a good perspective on the whole range of these services and across the four research councils which are researching ageing. Generally speaking, my view is that the funding levels for the research councils are low in comparison with the research councils' spending generally and also with international estimates of research. For example, my estimate of ageing research funded by the research councils is only about ten per cent of their total research. In some cases, it is as low as two per cent and in some cases—for example, the Medical Research Council—it is much higher than that. In terms of volume of funding, we consider it to be quite low. The central issue is not just funding at the present time but the fact that there has been no sustained core funding in the history of core funding for ageing over the last 30 years, which they have in the United States. If we compare the research councils investment on ageing, they have a sustained budget for the last 30 years but the current budget is about $994 million. If we compare that with the £12 million going into the New Dynamics of Ageing, one can see straight away that there is quite a discrepancy there.

  The Committee suspended from 3.44 pm to 3.54 pm for a division in the House   Q489Chairman: In terms of what you said quite specifically I wanted to ask whether the National Collaboration on Ageing Research is a great loss. How do we know that the new organisation will do better what it was meant to do, because the research councils have pulled the financial plugs on this?

  Dr Goodwin: When people ask me what are the main priorities for ageing research, my answer is not that it is academic priorities which we must decide in terms of where to go—for example, should there be research into pensions or technology in older people? They are more strategic and they would be the lack of investment in ageing research, the fragmentation in ageing research and the absence of strategic direction. The National Collaboration on Ageing Research provided some of their areas and in terms of its demise now those functions will be that much more difficult. The National Collaboration on Ageing Research did succeed in producing a multidisciplinary approach, although by many that is perceived to be a vehicle for the EPSRC, to promote their areas. That is not a view that I entirely share. In terms of what the research councils expect, they expect these days good discipline, good research in discipline and interdisciplinary research as well. Both have to be provided. Now that the NCAR has faded, we need to look at alternative bodies to provide strategic direction. That is one of the recommendations I made in my written evidence. At the moment, the only body to do that would be the Funders' Forum on ageing research of which Help the Aged of course is a leading member. In terms of gaps in ageing research, it appears to me from our international experience that where you have a high order of strategic direction the issue of gaps recedes to some extent. We also have to look at the relationship between gaps in research that we perceive and research capacity at present in the research universities. For example, if we identify a gap in the biology of ageing, there might not be the capacity in the universities in the first place by which to exploit that, so we need to identify that relationship. We need to consider deficiency of funding so there may not necessarily be a gap. There might be a deficiency of funding in which we need to build capacity. Finally, it is method as well as area. We need to involve older people more in the research process itself and we need to think about translation aspects. In geriatric research, geriatric medicine, consultants now have had their training reduced and they therefore do not have to do any research. This is an issue that was raised by the European Academy of Medicine for Ageing. It appears to me that there are fewer and fewer academics involved in geriatric research and therefore that makes translation from evidence to practice that much more difficult. These are all general areas on gaps which we should consider before we identify some of the academic areas.

  Dr Nowell: Ian Nowell from Age Concern England. I am responsible for a division within Age Concern which is innovation and strategy. Age Concern has a federal structure so in England we have over 400 independent Age Concerns. Our approach to research is somewhat different. Age Concern England plays a lead role on public policy in terms of ageing and older people. Our interest in research is very much along that public policy agenda. We are looking at research which is making an impact on policy and in terms of practice. Our interaction with the research councils is probably not as extensive in terms of Dr Goodwin's and Help the Aged's level of interaction. In terms of gaps, some of those gaps are about services that local Age Concerns are providing that are impacting on older people on a day to day basis. We are particularly interested in looking at the impact of preventative low level services. The gut feeling is that they are important. They do have an impact. It is producing sufficient evidence base to have an impact in terms of commissioning bodies and policy. There are areas where we are seeing big gaps. Age discrimination is now of particular interest. We are certainly looking at age related prejudice. We have done some work with the University of Kent. That whole area of stereotypes, the development and the impact seems to have a great deficiency in terms of research. Mental health is another area of particular interest to us which I think we highlighted in our written response to the Committee. We passionately support research into policy and practice. We support the interdisciplinary approach in terms of research and we very much welcome the New Dynamics of Ageing programme, building on the Growing Older programme, giving a real collaboration between the research councils and a real opportunity to have the different disciplines coming together in a way which will have an impact on older people.

  Professor Souhami: Robert Souhami, Cancer Research, UK. Your original question was, were the research councils attaching priority to ageing research, and on that question I need to step slightly to one side because Cancer Research UK does not have an opinion on the funding of ageing research in its general sense. What we are concerned about obviously is cancer as a disease affecting the ageing population. If we look at the pattern of research into cancer as it affects an ageing population, both in terms of the therapeutics and the social aspects of cancer such as screening, quality of life and so on, the answer is clearly that both Cancer Research UK and its partners do not invest enough specifically into the questions of cancer as it affects an ageing population. The reasons for that are quite complex and you will probably want to explore them in a while. There is within the UK a very successful forum where the funding partners get together. That is the National Cancer Research Institute. In the National Cancer Research Institute, the major funders of cancer are sitting and discussing the questions of research priorities in cancer. Cancer Research UK is there, the Department of Health is there, the Medical Research Council, the Leukaemia Research Fund, Wellcome and so on. There is now a national forum for considering issues which relate to research priorities as they affect cancer. We have a pretty good idea of where those therapeutic and other priorities are. If you were to look at the generality of funding in cancer and say, "How much of that is specifically devoted towards therapeutic and other aspects of cancer as it affects an elderly population?" the answer is a very small proportion. If you were to look abroad, particularly to the US, to see whether cancer as a disease of the elderly is picked out as a specific area for focused research funding, you would find more in the US than in the UK or in other European countries.

  Q490  Chairman: If my colleague, Lord May, were here I know he would want to ask two supplementaries. We have spoken about the quantity of research. What about the quality? Do you have any views about what is happening in this country? The additional supplementary is: if the quality is, however you assess it, high, low or indifferent, how is that measured and are there any relevant bibliometric measures?

  Dr Goodwin: It is well recognised internationally, and Help the Aged has profound international collaborations in ageing research. Some of the best ageing research in the world is conducted in the United Kingdom. Without naming names, if you went to the United States they could pick out five or six leading researchers. That similarly applies to Europe. That is notwithstanding the fragmentation of ageing research in the United Kingdom. The kind of quality measures that we go for are those which are acceptable to the academic community in terms of high impact publications in peer review journals, the acquisition of national and international funding, awards of objective, academic merit and progress. The United Kingdom in those areas performs very well in terms of ageing research. What worries me greatly however is the sustainability of capacity in ageing research. That is exemplified by an exercise in which Help the Aged has just been engaged, which is to raise £20 million for a single ageing research project. We had 32 bids of outstanding international merit for those and we were only able to fund one. The combined worth of those was £420 million and £20 million leaves the other £400 million under-funded. There is good quality research in the United Kingdom, but it is the question of sustaining capacity with adequate funding and strategic direction.

  Dr Nowell: It is not so much the quality of the research but how the research results are used. There is a great deficiency in terms of the dissemination of the results. In terms of the impact on practitioners and on organisations such as ourselves, we would welcome a far greater emphasis on more thought, more resources, in terms of the dissemination of the results that have been produced and the bringing together of different results to address the issues. The participation of older people and part of the quality is, how much impact is it having? How much are they engaged? How much are they valuing the research which is involving them in many instances?

  Q491  Lord Turnberg: On the business of cancer research networks, there is a model for getting good research done in places where there are good researchers and applying it to practice, which is something you were talking about. Do you think that is a good model for research into ageing? Do you think it is a good model to apply or to try?

  Professor Souhami: It is difficult to give a general answer. The cancer research networks specifically are dealing with therapeutic research. In so far as there is general therapeutic research to be done into problems of ageing, comorbidity and the way in which it is managed, yes, it has been a very successful model for cancer. Cancer has a curious advantage there though. It will be interesting to see how the other networks set up under the UKCRC umbrella fare. The curious advantage for cancer is that before the networks were set up it was already true that over 60 per cent of all the therapeutic trials in the United Kingdom were in the field of cancer. The reason why it has been the case for the last 40 or 50 years that cancer has been so concerned about therapeutics is because of the nature of cancer treatment. It is difficult, complicated, expensive and toxic treatment. There has always been a very strong desire amongst cancer clinical researchers to assess the value of what they do. That has been a very strong motivation for these networks working well. It is now the case in the UK that therapeutic research of that kind is thoroughly embedded. I guess the answer to your question is, for cancer, for therapeutic research, it has been an excellent, palpably successful model. In so far as those things could be translated to research, therapeutic or other clinically related research questions in ageing, it is certainly a model to consider.

  Q492  Lord Soulsby of Swaffham Prior: With respect to research capacity, what is the situation with respect to the flow of people like research students, post-doctorals, senior and junior fellowships in the field of cancer? Is it adequate?

The Committee suspended from 4.09 pm to 4.18 pm for a division in the House

  Professor Souhami: Yes. The mechanism of flow is adequate. The numbers of people involved are not yet adequate, particularly in some shortage areas such as in radiation research and in surgical research into cancer and gynaecological research into cancer. I am talking about clinical research now. This is not a problem unique to cancer. The question of manpower shortage generally at the clinical level in therapeutic research in cancer is an important one and depends very much on the specialties one is talking about. As far as fundamental research in cancer is concerned, on the whole that works pretty well. I do not think at the moment there is a funding crisis which prevents people of real talent being able to be supported in the basic cellular pathology of cancer. I hope I do not sound complacent about this but at that level funding does not seem to be the problem. At the clinical end, there are problems in getting people through into high class clinical research.

  Dr Goodwin: In terms of ageing research specifically, if I look across the portfolio of researchers in the United Kingdom, very few enter gerontology. Most of them train in other disciplines and they come to ageing after that. The special initiatives of the research councils have served to attract such individuals into research on ageing. For example, SAGE, ERA, EQUAL and so on. The aim from that therefore was that these researchers should become more senior and move into response funding. This has often proved difficult. Because we have stop/start funding of research in terms of ageing, it is very difficult to maintain a flow of research, undergraduates, graduates, post-doctoral fellows and so on. In four years, in spite of a huge effort from ourselves, we have funded 16 PhDs, 21 fellows and 12 large, post-doctoral programmes in excess of half a million each. That is indicative of the expense of this and the difficulty made by the absence of strategic coordination of funding.

  Q493  Baroness Walmsley: Dr Goodwin and Dr Nowell, could you explain how your organisations promote research into the scientific aspects of ageing? Could you also say to whom your organisation is accountable and where the money comes from? Does it mainly come from individuals, from companies or from grant awarding bodies?

  Dr Goodwin: We have four main priorities by which we promote research. They are by directly funding research, by influencing the direction of research nationally, by international collaborations and, fourthly, by promoting dissemination. In terms of funding, we fund between £3 million and £4 million a year in all issues of scientific ageing. We have just completed a £20 million major gift appeal which is going to the University of Edinburgh and we core fund the University of Oxford's Institute of Ageing. In terms of influencing, we have a formal working relationship with the National Collaboration on Ageing Research. We play a leading role in the Funders' Forum. We work closely with government departments, in particular the Department of Health, the Department of Work and Pensions, less so with the DTI Office of Science and Technology. We have many influences across members of the Department of Health and planning initiatives through Poverty Action in the DTI. Internationally, we are members of the Research Agenda Committee of the United Nations. We are consultant advisers to the International Association of Gerontology and the European Academy of Medicine for Ageing, and in the USA we have working relationships with the Alliance for Ageing Research and the American Federation of Ageing Research.

  Dr Nowell: In terms of our approach to promoting research, it is partly commissioning research and that is to inform our public policy work, our development of services for older people through local Age Concerns. We very much look to influence the agenda of research through partnerships working for academic institutions and through some of the professional bodies, the British Society of Gerontology in particular, the BGS as well and other bodies. We also look to participate, disseminate and support conferences, working very closely with the BSG. We have been partnered jointly working with them to engage older people in their annual conference which we felt was important and is quite an interesting approach. We are also looking to develop and disseminate information about the experiences of older people themselves. We will commission work on the economic contribution that older people bring. It is not all doom and gloom. Older people make a very valuable contribution to their communities, both through paid employment and through a whole range of unpaid activities. In terms of accountability, for Age Concern England it is the National Council on Ageing. It brings together local Age Concerns, over 100 national bodies including Help the Aged, a member of our National Council on Ageing, but also professional bodies, retirement organisations and national bodies. That produces our board of trustees. On funding, our resources which are commissioning research that we are interested in, supporting the partnership work not particularly a huge amount of money and in effect that is part of our core budget. That would come through our fund raising, our trading activities, which would generate unrestricted income through which we will support those areas of activity. That is the overview.

  Q494  Baroness Walmsley: What about companies? Do you not get any money from companies?

  Dr Nowell: We will attract money from corporates in terms of developing. Say, for example, we have a strategy of technology in older people. That is very much about developing internet taster sessions through local Age Concerns. The money from Microsoft, Cable & Wireless, BT and other corporates will be used not for research in the classic sense. It will look at evaluation and what impact it is having. If that is constituting research, in that sense, yes, we will get some money from corporates but very much focused in Age Concern England on working with and supporting local Age Concerns.

  Q495  Lord Drayson: You do not see any interest from companies doing applied research to better understand the use of their technologies, their products, for the older market place?

  Dr Nowell: In terms of the interest in the market place and universal design, for example, the interest is not that huge. I do not think there is an awareness of what the opportunities are of engaging with the 50-plus population. We have established an Age Concern research service which is to get a better understanding through qualitative and quantitative tools of the aspirations, the attitudes, the needs and desires of the 50-plus population. I think the business world is incredibly slow in responding to those opportunities. We have a real battle because the digital divide is not a temporary feature. Once all the baby boomers come through, that is it. The impact on people who are not engaged is going to be so great in terms of services that the problem is far greater. In terms of numbers, we are not convinced that that challenge is going to go away, but the development of products designed for that 50-plus population, both hardware and software, is not impressive.

  Q496  Baroness Finlay of Llandaff: This question is for Professor Souhami. It relates to cancers and their relationship to age and comorbidity. I would like to ask how much research CRUK is supporting on the problems associated with comorbidity. We know that life expectancy is going up. The incidence and prevalence of cancer are going up. We know that DNA damage is associated with ageing and liver disease. How much priority research that crosses the boundary or the non-boundary between the two is occurring, how much it is being supported?

  Professor Souhami: Taking comorbidity first, I have given Mr Collon the statistics which back up what you are saying to show just how big the problem is in terms of the cancer problem in the over 70s and how that is going to grow. There are already 140,000 cancers occurring each year in the United Kingdom over the age of 70. There is no doubt that the relative survival diminishes greatly particularly in the over 80 age group. The issues of comorbidity, and the research done into it, are slightly complex. The way in which therapeutic trials are set up inside the United Kingdom, and indeed in other countries in the world, usually puts an upper limit to the age of inclusion in trials, simply because of the toxicity of some treatments. The question that you are interested in, though, is how many studies and how many therapeutic investigations are done specifically to put therapeutic questions which are applicable to an elderly population rather than the generality of cancer patients. The answer is very, very few, both in this country and in other countries. Partly that is an opportunity question, how many therapeutics one has which have low toxicity and where existing comorbidities will not be important for patients. There are not that many treatments that are out there that you can easily give to people who may have heart disease, diabetes or vascular disease. Just the same, that is not the complete explanation. Part of the explanation is simply that therapeutics of cancer in the elderly have not been a high priority in most developed countries in the world. Getting the age of inclusion into therapeutic trials up above 65 to 70 has been a slow process. Getting it from 70 up to 75 will also be a slow process as people have to adjust their mentality and think that there are trials which can be done which should include patients of this age. Much of the research that is being promoted in the US on therapeutics of cancer in the elderly is to ask exactly the questions that you are asking: what are the stumbling blocks which prevent the design and execution of therapeutic studies in an elderly population with cancer? Is it a question of comorbidity? Is it a question of late presentation? Is it a question of doctors and health care professionals who do not think about things in the right way? The truth is we do not know the answer to that in different settings. Within the UK, those questions are just as unanswered as they are in other populations. There is a big gap there.

  Q497  Baroness Finlay of Llandaff: Given the large burden of disease which is there, what is CRUK doing about addressing that, because that burden is going to get greater over time?

  Professor Souhami: Correct. At the moment, there is no concerted plan of any of the funding partners to alter the way in which therapeutic studies are being created and engendered inside the United Kingdom. In my view—and in the view of many people inside CRUK—it is not because of a cultural bias; it is simply that people have not placed this as the highest priority in their cancer therapeutics—the NCRI and the funding partners of the NCRI could well make this one of their priorities for considering research gaps inside the United Kingdom in exactly the same way as they have done with quality of life research in the United Kingdom in cancer, and radiation oncology research in the United Kingdom in cancer. There is an opportunity there for the funding agencies to reconsider the kinds of therapeutic questions they wish to see addressed. You put your finger on an extremely important point, in my judgment. You ask secondly about the question of the interface between the biology of cancer, the biology of ageing and DNA damage and repair. There one is on slightly stronger ground. The lifetime exposure to DNA damaging agents does not start or stop at a particular age so the question of DNA damage and the repair mechanisms that are responsible for keeping your DNA undamaged are applicable at whatever age you are looking at. The issues of whether or not there is a decreased efficiency in repairing DNA damage and the other cellular processes which are important in the emergence of a cancer as you get older are very under-funded in the UK, not because of an objection to funding such studies; it is simply a question of whether we have available model systems and scientists who are thinking about those problems in the UK. If you look across the Atlantic to the US, you find exactly the same problem. There is quite a difficulty in knowing whether or not there are separate problems to be addressed in cell biology of ageing with respect to cancer that are quite different in nature from the cancer problem generally. Although we do fund research directly applicable in cell biology of ageing and other cellular processes that are equally applicable to cancer and ageing, they are general cellular processes which are important generally to cancer rather than specifically because they are motivated towards an ageing population of cancer patients.

  Dr Goodwin: If I could add some support to that argument, there are two issues related to your question on comorbidity. One is to better understand the ageing process. We know from research over the last 20 years that ageing is the biggest single risk factor for age related diseases. If we answer the question how does ageing predispose us towards disease, we can produce the mechanisms which will produce the interventions. Secondly, in terms of translational research, it comes back to the question of adequately trained and adequate numbers of geriatricians in research such that they understand the translatability of evidence into practice.

  Q498  Baroness Hilton of Eggardon: If we could return to the organisations that support you and look at government departments, I wonder what your relationship is with various government departments. We have heard from them how they view this whole issue. Do you have good contacts? Are they receptive to your point of view, and what more could be done in this respect?

  Dr Nowell: We have a range of good contacts with a range of government departments on topics which are of mutual interest, very much set by their policy agenda which often coincides with our policy agenda. In many instances, it is a positive process. There are challenges, particularly when there are cross-departmental initiatives. The joining up may be there with us but it is often missing within government. For example, the strategy for ageing which has been developed and is about to appear at any moment has been quite challenging for us to have a coherent input into that kind of process. Some of the experience we have had working very closely with the Department of Health, the Department for Work and Pensions has been very positive, and working with a number of other parts of government as well. The only bit that we have found a little more challenging is to look at where their research interests and agendas are before the commissioning stage. That we have with some departments but I do not think with sufficient.

  Dr Goodwin: Relationships between government departments have improved considerably over the last number of years on the formal and the informal level. In terms of the formal level, we work closely with members of the Funders Forum in terms of clear discussions about the issues on the scientific agenda which we should be addressing to avoid duplication and over-investment or even under-investment. In terms of our special relationships, we work particularly closely with the Department of Health, the Department for Work and Pensions and, to a lesser extent, the Department of Trade and Industry. In terms of achieving the strategic levels of spending and the direction, that is a lot more difficult and somewhere where there is scope for improvement.

  Dr Nowell: One area which is important is the interaction at a regional level with those regional bodies, the development agencies, assemblies and government offices. We have, with the English Regions Network, developed a dual region for all ages and if we are looking at the impact of changing demographics on regional strategies we have found that to be a very productive way of getting ageing onto agendas at regional and sub-regional level.

  Q499  Baroness Hilton of Eggardon: There is no problem about access to government departments?

  Dr Goodwin: We have always found them to be generally very responsive in terms of the information those government departments would like to have, in terms of the issues in the report in relation to older people and so on. That is a reciprocal arrangement as well because we like to discuss with the departments—and we do—what their priorities are for scientific research on ageing. That is something which we find increasingly easy.

  Professor Souhami: As far as CRUK is concerned, all our money comes from the public. The science spend this year will be about £210 million. There is not a question of having to work with other people to raise money. There is an extremely important issue about how research fits in and whether research findings are then easily taken up by the National Health Service. One has to say that the relationships with the Department of Health and other government structures are very good. I would not like to have to deal with some of the problems they have to deal with. On the issue of availability of cancer treatments when they are new, have come forward and we take part in their development, it is always very important for us to make sure that organisations like NICE and so on are seeing the evidence for what it is. On the whole, there is plenty of opportunity to put your point of view. I do not think that presents a particular problem for us.

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