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NHMRC

Professor Sally Davies

Professor Sally Davies is the Director General, Research and Development at the Department of Health, United Kingdom. She is responsible for implementing the 'Best Research for Best Health' strategy that was published in January 2006. Her expertise is in health services research. In this vodcast, she discusses the implementation of this strategy and future directions for research in the UK.

Professor Sally Davies: I've got a simple message. This isn't for scientists, this journey; this is for all of us. And it's for the department of health service too. And as I am a paid up member of the department of health and therefore one of you, I thought I'd take you on a romp through the rollercoaster that I'm living. And I do it through the questions that I asked when I started just under three and a half years ago. At that point I'd inherited an antique system with £550 million given historically to hospitals to do research that, though I never admitted it publicly, at that point was not spent on research, and clearly that money was falling in purchasing value as the service began to eat into it to deliver the things it needed to.

So I started by asking a number of questions, including: Did the department of health have a role? What was its role? And we were in the midst of a change from the Department of Health Care to the Department of Health and Health Care. But we also recognised we have a role in UK plc in the generation of wealth and our position internationally, so you could help about health diplomacy, but you can talk about biotech and a number of issues there. 'Could we deliver on our mission without the evidence?' I asked. And clearly I had that age-old debate: Could we just use everyone else's evidence and get on with the business? And the answer is, maybe you can deliver boring health care that way, but we will not shift the paradigm to a preventive and personalised system without playing in the game of research.

So then you have to ask: So what's that role? And clearly it's understanding disease, providing the evidence for interventions; and as people pricked up their ears in the health service and the department of health I'd say, 'Yes, and have you noticed that our medical research council is not giving us the evidence we need. It's not telling us whether cognitive behavioural therapy works for depression as well as the latest tablets'—which, by the way, for mild to moderate, it does. It's not doing that sort of study. We can't rely on others. We have to make sure we have that evidence. Who else is going to research models of care? Who else is going to look at what the public want, how they're behaving, some of the social research about obesity, that sort of thing. In fact, I've been positioning research as a domain of quality. How can we deliver high-quality services without research? And this UK plc bit that goes forward.

So why would we want quality? Well, it speaks for itself. You only have to look at the front pages of newspapers. But it's not only about evidence. There's a lot of work in industry, but it seems to hold true in the health care sector that if you have a research active organisation, then they absorb new research, they become more innovative. You, if you don't play in this with your health services, will have a very boring health service. Now I can't bear boredom. But more importantly, it will be old-fashioned. It won't deliver what you as policy makers want it to.

For us, the clinical academics are the leaders of our system. And I could give you all the evidence about that and research active hospitals recruit better, they retain better. And what about the data? Well, you need it for quality, you need it for audit. We need it for research. We all need it, let alone the slipstream effects and the evidence that those doctors active in research deliver better care for their patients across the board. So I hope I'm persuading you as to why we should play in that field. And we had a number of reports published in October 2004 which said not only that the NHS should play, but it had a unique advantage, just as you do, a public system, internationally, about what we could do.

My predecessor was asked by ministers to set up—it's dreadful but it's what it says on the tin—the Research for Patient Benefit Working Party, on which I had the privilege to sit, looking at what we should do to help the NHS and take it forward. I took over the role from him just after that, and at that time I had a budget, at that time as I say historical, of about £550 million, and I persuaded ministers that we needed to have radical change and actually take control of research in the NHS, in part to give it back to researchers and scientists, in part to make sure that what we needed was delivered.

So I went out on the road and consulted and debated and built the case for change, and debated with everyone the role of government funding in health research. It's clearly to fund infrastructure, clearly to develop the people capacity, to fund—and this is a term that came from our Treasury, so I use it; I'm the Director of Market Failure Research. It's a great title, isn't it? It means we fund research we need for the service that no-one else would. So we have to do that.

But we also have a role that's broader than just the health service, and that we must never lose, as well as regulations, governance and systems. We did a study through the UK Clinical Research Collaboration Board, which I have the honour of chairing, which we set up as a result of that Research for Patient Benefit Working Party I won't go into, about what was funded by the public sector in research. Suffice it to say the left-hand end is basic; the right-hand end is clinical, moving to applied. Clearly we were not funding sufficiently in the clinical and applied. Now, whatever I say should be taken against a background that we must sustain that basic research. It is the bedrock of advance for the future. But that doesn't mean we shouldn't develop the other bit effectively.

Finally, before I show you what we do or did and are doing, I asked the question not only about the barriers and the incentives, but, you know, if we're going to make change, how do I take ministers with me. I need to think what they want from it. Well, clearly they want what the ministry wants—improved health and care. They want to develop our knowledge economy and the UK plc, but what they also needed was some recognition for what they were doing. We were putting £550 million into the system as NHS R&D—you'll notice I've rebranded us as the National Institute of Health Research. Why? Because no publication recognised our funding. No-one was proud of getting our money. Ministers kept saying, 'Well, we get no thanks. They don't seem to notice us. So why should we go on funding it?' So we had to find a way of making sure that researchers gave that recognition to the money so the money could be grown to deliver what we wanted. So there I was—that's a narrow inlet—when I got a phone call that we had managed to take our proposed strategy out for public consultation. So, thank you to the Whitsundays—it was a great holiday. To know that that document had got out there.

We did a three-month public consultation to take forward what we were doing. In that consultation, we discussed the challenges in delivering for patients, and it was the historical funding which I've talked about, the lack of incentives, the fact that applied research and clinical research is considered to be second-class and the issues about capacity and the fact the NHS was playing for clinical academics, but then it had actually no call on them and no way of developing what they were doing and working with them. And we conceived a health research system, again with patients and public at the centre, which could be put into the health system and was based on having infrastructure, people, the faculty, research to support market failure and other developments translation that the NHS needed to play, and systems. And we took that forward into a new strategy published two years ago this month in 2006. But before publishing it, my minister took it through the Cabinet so it became government policy, not just 'Sally's strategy'—this is government policy, very powerful in taking it forward.

Now you can just imagine me with this and everyone saying 'Great, you've got government support, but actually it's too difficult. You won't manage it.' Now I never got to the bottom of that one, whether it was too complicated, whether it was because I was female, whether I was an upstart or what, but clearly the view was that although this was a great plan, it was not doable. And none of it is rocket science, but it all needed to be rolled out in different ways. And the way we've done it, not quite standard DH practice in England, was by project management. And on the day that strategy was launched, we launched a new website, NIHR.ac and that had 16 implementation plans, total transparency, what each plan was trying to do, what the milestones were, what the timetables were, updated every six months, so the next update will be in February, and now we've got 30 plans, and my team, who are absolutely wonderful, have delivered it. Whenever people say, 'What are you doing? We don't know,' I tell them to do like me and read the website. And that was enough to immediately get out of our then Chancellor of the Exchequer, now our prime minister, the fact that we'd got a strategy, we'd planned it and we were doing it by project management, an extra £100 million to take it forward, more money into the system.

And basically we set some visions for the future that we wanted the NHS to be recognised as an international centre of research excellence; we want the best people; we want ourselves to fund research to improve health and care; we've got to have good systems; and clearly I'm very concerned about being sound custodians of the money. Two years later the Prime Minister wrote the forward for a report published two weeks ago on what we've delivered in that two years. I just want to show you some of it, not only starting off the NIHR—and this is all on the web, so I don't have to go through it all—dedicated facilities for experimental medicine, the clinical research facilities, the engine for developing new treatments in translational medicine, all across Britain, developed in partnership with the Wellcome Trust, developed in partnership with Research UK, with us putting in £30 million a year to making sure they work.

Networks—not tea and bickies clubs for academics, which are all too common, but managed networks, performance managed, to take forward putting patients into studies for public sector trials and for industry too on a cost recovery and visible profit. And you can see the top one is the mental health research network and that as the network kicked in, recruitment picked up. The bottom one is the cancer research network. Can you see the percentage of patients put in public sector trials? Now 12 per cent of cancer patients go into public sector trials, more than any country—not only telling us what we need to know, actually delivering best care by protocol to patients. Cancer docs are no longer doing just what they fancy—they're doing the best.

What else can I show you? There's so much there, I can't go through it all. But we are setting up in Britain—and you're doing very similarly in some ways here—Connecting for Health, a national program for IT that will hold records from cradle to grave, from primary care through to the most specialist. We now have a program within Connecting for Health called the Research Capability Program to try and prepare that program to deliver the data that will make a real difference to public health research in the future. Think of all that data that we can collect.

So there I was chugging along, storming along, whatever way you want to look at it, when actually the Chancellor was rather taken with this and said, 'Couldn't we get all of the public sector health research to be a bit more zingy and really more modern and going forward?' So he asked Sir David Cooksey, a well-known former venture capitalist, to do a review with the aim of speeding up translation of basic biomedical research and benefits for patients, increasing the volume of applied health research, and again this thing about harnessing the potential of our health service. David came back, saying, 'We have strong basic research; we must sustain it. We need to develop our translation.' We have to build on the strategy we had, highlighting this issue about research culture and the service, for all I'm battling, this is a long-term change management strategy. I'm systems reengineering the department of health. In the NHS I'm process reengineering and change managing. Gosh, the skills I'm having to learn as a doc. I didn't know any of this four years ago, I can tell you, and I'm learning every day, which makes it fun. We have insufficient translation in the NHS. And he also got into the drug development model. What he gave us—because he recommended it to the then chancellor, now our prime minister—is ring fencing of our funds and the opportunity to bed in our latest comprehensive spending review for significantly more money.

He also set up an umbrella group that I rather wish he hadn't, because it's yet more paperwork and time consuming for me, known affectionately as OSCHR, the Office for Strategic Coordination—on bad days I say 'control'—of Health Research, which works with us in the Department of Health, with the Department for Innovation, Universities and Skills (DIUS). Science hangs off that. Our Medical Research Council hangs off DIUS. Our virtual institute that I have set up and am running, the National Institute of Health Research, hangs off that, to try and make it all coordinated. And we've been working very well through that. And clearly you will have noticed that we're branding for success to try and take up that recognition, NIHR, leading to pride, and people now wanting to play with us and be part of it. And through the comprehensive spending review I now have a budget rising to over a billion. So actually my program budget is the biggest in the Department of Health now. So from being a little silo R&D that was kind of doing all right but kind of dying off on the vine, we're now the most booming, dynamic directorate of the lot. And it's great fun. You've got to enjoy work, otherwise why bother to do it. Look how much money we've got and what good we can do for the nation with this—delivering better services, transforming health care, translating advances from basic science right through. And the Medical Research Council got a very nice settlement too—it goes up to £720 million by the end of it. And we're very careful to position—and I'm not going to go through it but out of the blue-grey in the middle—each of our programs within the whole of the health service and how it all fits together, and we provide the evidence base and the evidence synthesis for things like our National Institute for Health and Clinical Excellence, our National Institute for Innovation and Improvement and everything.

So that was, as I promised you, an absolute romp through the journey we're going on. What I wanted to do was to try and persuade you that it is worth as a department espousing research and getting into the business. If you don't, your health services will be left behind. If you don't, you will have no say about how it goes forward. It will be done to you. And you might not like the outcome for your nation and your public might not respect you for opting out. Please go with it. Thank you.