Health fails to bring in cheque

October 27, 2000

London has a valuable patient base, so why isn't the capital profiting from medical research funding? Martin Ince asks.

It ought to be a dream match. Britain's biggest group of medical researchers meets Britain's biggest crowd of sick people. So why is London not a world magnet for medical research funding? Last week Sally Davies, research director for the National Health Service in London, gathered more than 100 experts from London and beyond to ponder this problem.

Davies's budget of about £260 million makes up the huge majority of NHS research spending. It pays both for NHS participation in externally funded research and for research into NHS priorities such as primary care. And although this money is rarely remarked on, it equals almost 70 per cent of the national spending of the Medical Research Council.

One of the reasons this money is spent in London is because of its "patient base", the polite term for the capital's sick. Davies, a specialist in sickle cell disease, points out that of all British cities, only the capital offers a pool of sufferers from this condition that is large enough to provide sound research results. The same is true of many others. Another participant in the meeting, Ken Fleming, head of medical sciences at Oxford University, says that the small population of the Oxford area is one of the most direct advantages London has over his department.

This advantage, coupled with London's highly rated medical schools, ought to make London the first port of call for super-rich drugs companies in need of hard data from drug trials in the race to get new pharmaceuticals to market.

Tadataka Yamada, chairman of research at SmithKline Beecham, points out that a best-selling drug has sales of £1 billion a year, nearly £3 million a day. At that price, companies are happy to pay well for trials that bring success closer. London's medical academics are good, he says, and the present government's support for research and innovation is a plus point, but it is the NHS that makes it unique.

However, the NHS is not good at making the most of its patient assets, being poor at recruiting them to trials, producing low-quality data too often, and being adept at creating unpredictable add-ons to the bill. According to Mark Walport of Imperial College School of Medicine and Hammersmith hospital, better coordination of London as a research centre is endangered by pressures from academe and the NHS. New health authority boundaries, he says, endanger the flow of patients on which the system depends. And the research assessment exercise pits departments against each other when their position on the world stage demands collaboration. Even the regular meetings of the deans of London's five medical schools have foundered for lack of common ground on how to work together.

The amount of money being spent in London by the NHS, the MRC and the big medical research charities suggests that despite these drawbacks, the capital still has quality and critical mass.

But even the most fascinating patient group is useless as a research subject unless it is possible to make use of it. Capital cities have young, mobile populations, with lots of movement on a local, national and world scale.

Many speakers point to the need for better databases on Londoners and their health as the vital step towards presenting the city as a world centre for health trials. But there is more to success than simply piling up data. Pharmaceuticals companies will not use data for which patients have not given informed consent. This has already arisen as an issue in Iceland, where a commercial firm has rights to a database that Icelanders have to opt out of rather than into. London is the opposite of Iceland - far bigger and more diverse - but the same issue arises if it is to attract significant pharmaceuticals trials. Some of the problems of gathering data may be solved by the current programme of computerising NHS patient records, but there are no short cuts on consent.

London is also slower than other biomedical centres, including Oxford and Cambridge, at turning its expertise into new businesses, partly because of the cost of staff, buildings and other essentials.

Karin Duncker of the New York Biotech Association, an expert on the problems of biomedical innovation in a major city, told the meeting that her group has been facing the same problem. New York, like London, has major universities with big-name medical schools and a finance centre to rival the City of London. But the financiers, she said, "would rather invest money in south San Francisco" than in a start-up company a walk from their desks. New York also lacks incubator space for start-up companies, something else in short supply in London by comparison with Oxford and Cambridge.

Working parties in both cities are looking at solutions to this problem, but in the US they are doing so in a healthier overall context. "Research spending by the National Institutes of Health is hurtling up," Duncker says.

By contrast, NHS research spending in London is under pressure for diversification to other regions, and other funders will react badly if London's medical schools are unsuccessful in the forthcoming RAE. Some are already regarded as attracting too few genuine research stars and spreading themselves too thinly.

However, the fact that the NHS accounts for 6 per cent of the London economy and spends £7 billion a year there, plus £500 million for the private health sector, means that powerful players have a strong interest in getting it right. The Greater London Assembly has no direct health role but is taking an interest. Davies and others hope this will involve pressing for funds rather than attempting to take control.

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