Volume 1
Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology.
- Great Britain. Parliament. House of Lords. Science and Technology Committee.
- Date:
- 1995
Licence: Open Government Licence
Credit: Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology. Source: Wellcome Collection.
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![4.11 Dr Green suggests two further possibilities (Q607). First, purchasers might establish a mutual insurance scheme, to share the cost of rare and complex cases. Secondly, specialist centres must ensure that purchasers know what special services they can provide and what sort of patients they are particularly keen to receive for research purposes. He is against designated research beds (Q623), “because I would like to see research-active hospitals having a...total commitment to the research ethos throughout the hospital”. Sir Leslie points out (Q916) that, in a “cost-per-case” system, such as pertains in the USA, the economic disincentive against extra-contractual referrals would disappear. 4.12 The CDMS put it to us (Q126) that there is no such thing as a “referral for research purposes”. Patients are referred to specialist clinics because they will receive there the best available care; the fact that, once there, they provide a resource for research, is a consequence rather than a cause. The Associaton of Young Medical Scientists (AYMS) makes the same point: “Research centres of excellence are also clinical and service centres of excellence, and emphasis on the latter must be maintained” (p319; cp BMA Q1375, Conference of Colleges QQ911, 914). According to the UKCCCR, “Several studies have shown that there is a survival advantage if [cancer] treatment is given in a specialist centre”. Accordingly Professor Rona MacKie FRSE proposes another approach to sustaining patient flows: “The onus is on academic centres to prove their approaches to therapy are to the patients’ benefit” (Q1050). Professor Trimble of Belfast (Q700) puts the dark side of this argument: if patients are not referred and consequently receive less than the best available treatment, “a few cases of litigation will probably solve this problem...but that will take a few years”. 4.13 Several witnesses (Council of Deans p74; MRC p46; ARC p413) accuse the Culyer report of ignoring these issues. The Culyer report deals with extra-contractual referrals in paragraphs 3.42-44. It proposes that it should be possible for the NHS R&D budget, at national or regional level, to support extra-contractual referrals for research purposes - though admitting that the primary reason for a referral may not always be easy to determine. The AMRC welcomed this proposal, subject to the details of implementation (Q225). 414 Professor Culyer himself told us, “I regret that we did not give more time to addressing the issue of tertiary referrals, as it perhaps has given the impression we saw no problem there. In fact that was not our view, and I think the question of tertiary referrals is very important, but it is also very complex; it seems to me that it is a matter to be given the highest priority by the new CRDC” (Q504). He suggested that the answer to the problem would involve “a more planned approach to the location of major centres of tertiary referral”, taking account of critical masses and “surrounding research and teaching synergies”; and might involve a role for a figure analogous to the new NHS Director of Trials. 4.15 Professor Peckham (QQ11-12, p383) acknowledged that there may be a case for central funding in this area. But he pointed also to “a broader issue, which is about reconciling the conduct of research with the future organisation of health services” by finding, for instance, new ways of conducting trials without concentrating patients in a single centre. Sir Miles Irving (Q1275) similarly sees scope for taking research out into the district general hospital; this can have “an enormous influence in stimulating interest within those hospitals in the whole research exercise”. Queen’s University of Belfast reckons, “The way forward is to collaborate with general practice and undertake research in the community” (p222). As Professor Maggie Pearson, a Professor of Health and Community Care and a member of the Task Force, put it (Q502), “Just as people talk about the money following the patient, clearly the R&D also ought to follow the patient”. However Professor Pearson went on to admit that this is “not an easy issue”; she cited the cost and complexity of research liaison, and the underdeveloped state of research capacity in general practice, nursing and the professions allied to medicine (see Appendix 10). 4.16 Weagree that research can follow the patient, but only up to a point. Multi-centre trials are a familiar research tool, and can no doubt be taken further, particularly with the assistance of information technology. Clinical teaching is making more use than hitherto of peripheral hospitals and the primary sector, and research opportunities in such settings will no doubt expand. However](https://iiif.wellcomecollection.org/image/b32219337_0001_0037.jp2/full/800%2C/0/default.jpg)
