SPECIAL ARTICLE * ARTICLE SPECIAL
Health and medical research funding in the United Kingdom R.A. Heacock, PhD, DSc, FCIC, FRSC(UK) M any countries are confronting challenges in the health field similar to those in Canada that are generating ever-increasing needs for research-based information to develop future programs and policies. Therefore, the agencies that support this research, such as Canada's National Health Research and Development Program (NHRDP),'.2 must ensure that the available funds are used optimally. To consider how other countries approach this problem it is useful to assess their successes and failures in a Canadian context. Although Canada and the United Kingdom have many geographic differences, the similarities in traditions and systems of government and in the long history of support by government and private industry of health and medical research make the United Kingdom a useful starting point for comparison. This article is based on discussions held with UK government officials and academics in 1987 and 1988 as well as more recently obtained information. Health research in the United Kingdom, as in most Western countries, is carried out with support from both the public and the private sectors. The major government agencies concerned - the Medical Research Council (MRC), the Department of Health (DOH) and the Scottish Home and Health Department (SHHD) - have in-house programs and fund university research. As in Canada, indirect costs of university research are also a government responsibility, basic funding being provided through the Department of Education and Science (DES); some research-related hospital and patient-care costs are absorbed by government through the health care system. In the private sector health research funding is available from medical research charities, trusts and foundations. Some, such as the Wellcome Trust and
the cancer charities, provide significant amounts (45% and 25% of the total charitable funding respectively) and are thus influential. The relative contribution of the charities has increased markedly in recent years to as much as or even more than the MRC contribution.3-6 In Canada the national voluntary health organizations provide about 25% of the total funding. UK industrial (pharmaceutical and medical devices) expenditures on applied health research are significant; they are mostly in-house, but substantial amounts (possibly as much as $200 million per year) are spent in universities. Gross British expenditures on pharmaceutical industry research and development were about $1.3 billion in 1987. The morale of the scientific community in the United Kingdom is currently quite low; the reasons include funding levels that have not grown as fast as research costs, despite a DES report of 16% growth in real terms since 1979, and the perceived lack of government understanding or appreciation of science. As a 1988 House of Lords report stated: "Morale among medical researchers is low because of the impression, right or wrong, that the Government believes that research does not matter; if this impression is not corrected it will have disastrous effects."4 The almost entirely academic University Grants Council, which presided over government university funding, has been replaced by the new University Funding Council (UFC), with significant industrial representation; this change has caused some apprehension in the academic community. What it means in practice is unclear,7 but the UFC may decide to "contract" with the universities for predetermined courses of action, the "per student" block grants becoming a thing of the past. Concentration of the
Dr. Heacock is director general of the Extramural Research Programs Directorate, Health Services and Promotion Branch, Department of National Health and Welfare, Ottawa, and is responsible for the Canadian National Health Research and Development Program.
Reprint requests to: Dr. R.A. Heacock, Extramural Research Programs Directorate, Health Services and Promotion Branch, Department of National Health and Welfare, Ottawa, Ont. KIA IB4 -
For prescribing information see page 862
CAN MED ASSOC J 1990; 142 (8)
811
research components of the cash transfers in selected universities may be one outcome. Some observers fear a few "elite" universities will emerge, many others evolving into little more than "teaching factories"; some have already seen strong trends in this direction, the process being effectively aided by the UFC's selection exercise. In 1987 the Advisory Board for the Research Councils (ABRC), which advises the UK government on civil science, including the allocation of funds among the research councils and the other recipient bodies, recommended a higher education system based on three types of institution: one with a substantial research component, another offering research at an MSc level and the remainder teaching essentially undergraduate studies.8 The recommendations were not well received and will probably not be executed.
MRC The British MRC was established in 1920 with a mandate to promote a balanced development of medical and related biologic research; it evolved from the Medical Research Committee, founded in 1913 to administer funds provided for medical research under the 191 1 National Insurance Act. Like its Canadian counterpart, the MRC is neither a government department nor part of one. Although it receives most of its funding through the DES, it may also receive funds from other government departments, international agencies and the private sector. (The Canadian MRC receives its budget directly from Parliament and not through a government department.) However, the British MRC, unlike the Canadian MRC, sustains a significant in-house research effort. The operation of the facilities and the administrative costs account for about 53% of the council's budget. The MRC also funds university research (projects and programs) as well as individual studentships and fellowships. The British MRC is strongly committed to excellence in research; several of its establishments have attained international pre-eminence. Eight scientists have been awarded Nobel prizes for work done in the MRC Laboratory of Molecular Biology, in Cambridge. The MRC's 1989-90 budget is $379.4 million, about 90% ($352.7 million) of which is being provided from the DES. The remainder comes from other government departments and agencies, National Health Service (NHS) area health authorities, the World Health Organization and private sources. The MRC received a $6 million "once-only" injection of funds late in 1988 to replace outdated equipment; this year's allocation is significantly higher than 1988-89's, at $320 million. However, most of this year's increase seems earmarked for new initiatives 812
CAN MED ASSOC J 1990; 142 (8)
and will not alleviate the erosion of the MRC's "research purchasing power", which has resulted from years of budget underindexing. The Canadian MRC grants and awards budget for 1989-90 was $197 million, which indicates comparable expenditure per capita expenditure on medical research. The UK research councils are required to prepare annual 5-year corporate plans. The MRC's 1989 plan,9 although maintaining the basic commitment to excellence in research, indicates an evolution of corporate thinking toward a mixed problem-driven and science-driven approach to priority-setting. In addition, the MRC will seek increased cooperation with industry, the medical charities and international organizations and more income from nongovernment sources. A strategy committee has been created to identify areas in which both increased and decreased future efforts are warranted. The MRC had been the United Kingdom's lead agency for AIDS (acquired immune deficiency syndrome) research since 1983. However, by 1987 its traditional reactive role was insufficient to ensure needed research, so the AIDS Directed Program was started as a problem-driven priority, with designated funds of $29 million over 3 years. This marked a departure for the MRC, commissioning research in addition to operating in its classic responsive mode. The program operates with central direction; priority is given to research into vaccines and drug therapy as well as the molecular biology of HIV (human immunodeficiency virus). Additional funds have since been approved. The increased effort in health services research is another problem-oriented priority. The MRC entered this field in 1981 as a result of an agreement signed with the health departments; funds previously transferred to the departments'0 were returned to the council."I'2The MRC plans to expand its support for health services research (currently $6 million per year) in collaboration with the health departments and the Economic and Social Research Council (ESRC). Annual meetings with the health departments keep the MRC informed of departmental priorities, which can be considered when policy is
formulated. The MRC is one of the five British research councils that may carry out in-house research, support university research, fund some international scientific activities and provide support for individual research trainees. (The other four are the Science and Engineering Research Council, the Agricultural and Food Research Council, the Natural Environment Research Council and the ESRC.) The councils, which all exhibit a different style of operation, receive their budgets through the "science vote" of the DES; the ABRC advises on the allocation of funds among them (about $1.6 billion in 1989-90).
Total UK government research and development expenditures in 1988-89, including those for defence, civil departments, the research councils and universities, were considerably higher, at $9.8 billion. There has been much discussion recently on the need to reorganize the present five-council structure, which dates from the mid- 1 960s. A 1989 study commissioned by the ABRC,'3 in response to concerns about the distribution of biology research funds between several councils and the perceived inability of the councils to collaborate, has recommended that the present system be replaced by a single national research council; this new council would incorporate the ABRC and comprise six semiautonomous operating divisions, including one for medical sciences.'4
ESRC The ESRC's objectives are to identify, and fund research into, priority economic and social issues, to ensure the widespread and effective dissemination of research results and to maintain a national social sciences capability.'5 The ESRC, which has traditionally been more problem-oriented than the MRC, has two principal approaches to funding: (a) the three research development groups, in which areas such as industry, the economy and the environment, human behaviour and development, and society and politics are identified and research proposals invited; and (b) the research grants scheme, in which applications for funds to research any topic in the council's mandate are considered. The ESRC has a major ($3.8 million) 3-year AIDS research initiative into social and behavioural consequences of HIV infection. Additional funds are expected this year for some new initiatives related to aging. Despite its smaller 1989-90 budget of $64 million the ESRC is more involved in health-related research than its Canadian counterpart, the Social Sciences and Humanities Research Council (SSHRC), whose 1989-90 budget is $75 million; the ESRC has recently established a working group to determine strategy for health-related research. In addition to supporting specific sociohealth research projects and social sciences postgraduate students in health-related areas, the ESRC jointly funds some research units with the DOH, the MRC and the SHHD.
DOH
concluded that its research is broadly policy oriented and not directed toward the research needs of the NHS, which are quite different from those of ministers and the departmental administration. Since 1988 a part-time chief scientist has been appointed; he has advisory but no longer has (as did his predecessors) executive responsibility for departmental research. In addition, a committee has been established to set research priorities, which currently include AIDS, effectiveness of acute care services, transition to community care, consumer attitudes to health and social services, influence on lifestyle, evaluation of the effectiveness of social programs, health personnel (human resources in the NHS), child care and primary care. The total 1988-89 DOH research budget was approximately $42 million, of which about $30 million was for health research, personal social services research and social security research, mostly being conducted extramurally. The balance was for information technology research, the Biomedical Engineering Centre (aids for the disabled), NHS building research, and equipment and supplies research. The DOH supports approximately 34 research units and university-based programs in the applied health sciences as well as individual projects. The small grants scheme has been terminated; however, unsolicited research proposals are still considered in the context of overall research priorities, and attempts are now made to direct these applications to one of the research councils. The regional small grants scheme, which is administered and funded locally (about $20 million per year) in the NHS regions, is still in operation. The DOH jointly funds some research activities with both the MRC and the ESRC.
Health Education Authority (HEA) The HEA, a special health authority within the NHS, leads and supports the promotion of health in England.'6 It assumed the functions of the former Health Education Council in 1987 and was given responsibilities for AIDS health promotion and health education later that year. HEA's responsibilities, which parallel those of the Health Promotion Directorate of the Department of National Health and Welfare in Canada, include health promotion research. HEA's research is intended to provide a research and evaluation base to maximize the effectiveness of its own programs. Of the total 1988-89 budget of $43.6 million $4.8 million was spent on research and evaluation.
Formed in 1988 by splitting the Department of Health and Social Security, the DOH has interests in SHHD many areas of health research. Its approach was Scotland spends more per capita on health than criticized in the 1988 House of Lords report,4 which CAN MED ASSOC J 1990; 142 (8)
813
other parts of the United Kingdom. The SHHD, which is responsible for the NHS in Scotland, has its own budget and is independent of the DOH. The SHHD has no responsibilities for social security; pensions and social work are the responsibilities of the departments of Social Security and Scottish Education respectively. Although the MRC is responsible for biomedical and clinical research across the United Kingdom, the SHHD, through its chief scientist's office, has independent policies in many areas of research, particularly health services research. Its work is guided by six committees: the chief scientist's committee, which handles such items as broad policy issues and budgets, and five supporting specialist committees, which deal with health services research, clinical and biomedical research, medical equipment research, evaluation of medical and scientific equipment and health service supplies, and research into equipment for the disabled. The chief scientist's position at the SHHD is part-time, as it is at the DOH. The Biomedical Research Committee also assesses applications to the Scottish Hospitals Endowments Research Trust, which represents the consolidation of endowment funds of many Scottish hospitals before the NHS was established, in 1948. The interest on the fund, about $1 million per year, is used to support medical (mostly biomedical) research in Scotland; the fund might be compared to Physicians Services Incorporated Foundation in Ontario, the funds of which came from the private sector before government health plans were established. Recent SHHD research priorities include health care of the elderly, misuse of alcohol and drugs, mental illness and handicap, multiple deprivation in relation to health, alternative patterns of care, senile dementia and equipment for the disabled. Priority is also given to the dissemination and implementation of research results. The SHHD's 1988-89 research budget was $9.6 million. About one-third of the funds supported eight research units, six of which are oriented toward health services research; the balance was allocated to the six committees mentioned previously. The Scottish Health Education Group, a separate agency, supported by the Common Services Agency of the SHHD and part of the NHS in Scotland, is responsible for health promotion, including research (research expenditures are about $0.5 million per year).
Health and Safety Executive (HSE) The HSE is a statutory body appointed by the Health and Safety Commission, which is concerned with occupational health and safety in the United Kingdom. The work of the HSE requires considera814
CAN MED ASSOC J 1990; 142 (8)
ble scientific input. In addition to the in-house activities of the Research and Laboratories Division, the HSE has an extramural research program. Interestingly, the practice of transferring research council funds to the health departments,'0 which had failed in the case of the Department of Health and Social Security, appears to have succeeded in this case. The funds have not been returned to the MRC for direct administration. The HSE has a current extramural research budget of $2.8 million, 30% of which is spent on contracted research in MRC facilities. The HSE has a committee that decides on research priorities; all funded extramural research must satisfy the specialists within the HSE or be approved through external peer review, whichever is more appropriate. Also, the research must be relevant to the work of one of the divisions of the HSE. A broad spectrum of disciplines important to occupational health and safety is covered.
Conclusion Canada and the United Kingdom have many similar programs to support health and medical research, but the private sector (industries, charities, trusts and foundations) plays a relatively larger role in funding in the United Kingdom. However, with regard to the public sector, there is no British equivalent to the substantial research funding provided by the provinces. Many of the same questions preoccupy researchers and administrators in the two countries: What are appropriate funding levels? Should priorities be set with a science-driven or a problem-driven approach, or both? How should the research results be disseminated and applied? However, considerable overlap exists in the priorities (e.g., AIDS, aging, drug and alcohol abuse, and the delivery of care) that have emerged in both countries. The 1988 House of Lords report4 stated that there was insufficient research related directly to NHS needs and proposed the establishment of a national health research authority within the NHS to address this issue. However, there has been no official government response, and the prospects for the establishment of such a body appear poor, particularly since the early 1989 white paper on the NHS paid little attention to research.'7 Health services research and public health research seem to be served more effectively in Canada through the NHRDP and some provincial programs; however, the SSHRC is much less active in socioeconomic health research than the ESRC is in the United
Kingdom. Although the 1980s have not been good years for research in the United Kingdom, improvements are beginning.'8 The 1989-90 budgets for the re-
search councils contain significant increases over expected levels, representing an actual increase of about 11%. Funding of the first new Interdisciplinary Research Centres,'9 including three involved with medical research, has been announced. New funds are available to support these centres, the programs of which will be more tightly managed than is usual for university research; the research must be related to a central theme, be interdisciplinary and be prepared to seize innovative opportunities rapidly. A new clinical research initiative is under way, although perhaps not on the scale originally envisaged. The future is brighter, but UK researchers may have to accept some concentration of resources. The recent proposal to change the present research council structure drastically will undoubtedly be resisted. The medical research community can be expected to oppose the MRC's demise; the ESRC fears that the funding available for social science research could become marginal under a single national research council. One recent commentary on behalf of the MRC strongly decried what its author referred to as a marxist approach to research administration.20
Addendum
research councils for some research infrastructure costs (excluding academic salaries and building costs). In addition, universities are being encouraged to increase their income from research contracts.
References 1. Heacock RA: The NHRDP: providing support for health care researchers. Dimens Health Serv 1987; 64: 9-12 2. Idem: Forty years of federal support for public health research through the Department of National Health and Welfare. Can J Public Health 1989; 80: 101-104 3. Connor S: The flickering candle in the laboratory. New Scientist 1987; 114(1562): 30-32 4. Priorities in Medical Research: Report by the House of Lords Select Committee on Science and Technology, HMSO, London, 1988 5. Smith R: Is research to be privatized? Br Med J 1988; 296: 185-188 6. Idem: The funding of medical research: going up or coming down? Ibid: 267-270 7. Inscrutable UFC [E]. Times High Educ Suppl 1989; July 28 8. A Strategy for the Science Base: a Discussion Document Prepared for the Secretary of State for Education and Science
by the Advisory Board for the Research Councils, HMSO, London, 1987 9. Medical Research Council Corporate Strategy 1989, Medical Research Council, London, 1989 10. Lord Rothschild: A Framework for Government Research and Development, HMSO, London, 1971 11. McLachlan G (ed): Five Years After: a Review of Health Care Research Management after Rothschild, Oxford U Pr, Oxford,
1978 The UK government has now responded to the House 12. Kogan M, Henkel M: Government and Research: the Rothof Lords Report4 and has decided not to accept the schild Experiment in a Government Department, Heinemann recommendation to create a national health research Ed, London, 1983: 38-139 authority. Instead, a chief of research and development 13. Morris R: Review of the Research Councils' Responsibilities for Biological Sciences, Advisory Board for the Research will be appointed within the DOH to advise the governCouncils, London, 1989 ment on various research issues and to take on special face abolition threat. New Scientist 1989; responsibilities with regard to the research needs of the 14. Research councils 24 123 (1673): NHS. 15. Economic and Social Research Council Corporate Plan, The proposed single UK National Research Council 1988/93, Economic and Social Research Council, London, will not materialize either. Instead, the ABRC will have 1988 been reconstituted on Apr. 1, 1990, as a leaner body, with 16. Working for Health, Health Education Authority, London, 1988 a more explicit mandate to improve coordination and 17. Working the Patients, HMSO, London, 1989 cooperation among the various councils. R: Being bullish about medical research. Br Med J The UFC will be more selective in the distribution of 18. Smith 1989; 298: 544-545 funding among the universities. A consultation exercise is 19. Three new interdisciplinary research centres. Ibid: 550-551 in progress to shift the boundary within the dual support 20. Perutz M: The new Marxism. New Scientist 1989; 123 (1673): system, with funds to be transferred from the UFC to the 73-74
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Health and medical research funding in the United Kingdom R.A. Heacock, PhD, DSc, FCIC, FRSC(UK) M any countries are confronting challenges in the health field similar to those in Canada that are generating ever-increasing needs for research-based information to develop future programs and policies. Therefore, the agencies that support this research, such as Canada's National Health Research and Development Program (NHRDP),'.2 must ensure that the available funds are used optimally. To consider how other countries approach this problem it is useful to assess their successes and failures in a Canadian context. Although Canada and the United Kingdom have many geographic differences, the similarities in traditions and systems of government and in the long history of support by government and private industry of health and medical research make the United Kingdom a useful starting point for comparison. This article is based on discussions held with UK government officials and academics in 1987 and 1988 as well as more recently obtained information. Health research in the United Kingdom, as in most Western countries, is carried out with support from both the public and the private sectors. The major government agencies concerned - the Medical Research Council (MRC), the Department of Health (DOH) and the Scottish Home and Health Department (SHHD) - have in-house programs and fund university research. As in Canada, indirect costs of university research are also a government responsibility, basic funding being provided through the Department of Education and Science (DES); some research-related hospital and patient-care costs are absorbed by government through the health care system. In the private sector health research funding is available from medical research charities, trusts and foundations. Some, such as the Wellcome Trust and
the cancer charities, provide significant amounts (45% and 25% of the total charitable funding respectively) and are thus influential. The relative contribution of the charities has increased markedly in recent years to as much as or even more than the MRC contribution.3-6 In Canada the national voluntary health organizations provide about 25% of the total funding. UK industrial (pharmaceutical and medical devices) expenditures on applied health research are significant; they are mostly in-house, but substantial amounts (possibly as much as $200 million per year) are spent in universities. Gross British expenditures on pharmaceutical industry research and development were about $1.3 billion in 1987. The morale of the scientific community in the United Kingdom is currently quite low; the reasons include funding levels that have not grown as fast as research costs, despite a DES report of 16% growth in real terms since 1979, and the perceived lack of government understanding or appreciation of science. As a 1988 House of Lords report stated: "Morale among medical researchers is low because of the impression, right or wrong, that the Government believes that research does not matter; if this impression is not corrected it will have disastrous effects."4 The almost entirely academic University Grants Council, which presided over government university funding, has been replaced by the new University Funding Council (UFC), with significant industrial representation; this change has caused some apprehension in the academic community. What it means in practice is unclear,7 but the UFC may decide to "contract" with the universities for predetermined courses of action, the "per student" block grants becoming a thing of the past. Concentration of the
Dr. Heacock is director general of the Extramural Research Programs Directorate, Health Services and Promotion Branch, Department of National Health and Welfare, Ottawa, and is responsible for the Canadian National Health Research and Development Program.
Reprint requests to: Dr. R.A. Heacock, Extramural Research Programs Directorate, Health Services and Promotion Branch, Department of National Health and Welfare, Ottawa, Ont. KIA IB4 -
For prescribing information see page 862
CAN MED ASSOC J 1990; 142 (8)
811
research components of the cash transfers in selected universities may be one outcome. Some observers fear a few "elite" universities will emerge, many others evolving into little more than "teaching factories"; some have already seen strong trends in this direction, the process being effectively aided by the UFC's selection exercise. In 1987 the Advisory Board for the Research Councils (ABRC), which advises the UK government on civil science, including the allocation of funds among the research councils and the other recipient bodies, recommended a higher education system based on three types of institution: one with a substantial research component, another offering research at an MSc level and the remainder teaching essentially undergraduate studies.8 The recommendations were not well received and will probably not be executed.
MRC The British MRC was established in 1920 with a mandate to promote a balanced development of medical and related biologic research; it evolved from the Medical Research Committee, founded in 1913 to administer funds provided for medical research under the 191 1 National Insurance Act. Like its Canadian counterpart, the MRC is neither a government department nor part of one. Although it receives most of its funding through the DES, it may also receive funds from other government departments, international agencies and the private sector. (The Canadian MRC receives its budget directly from Parliament and not through a government department.) However, the British MRC, unlike the Canadian MRC, sustains a significant in-house research effort. The operation of the facilities and the administrative costs account for about 53% of the council's budget. The MRC also funds university research (projects and programs) as well as individual studentships and fellowships. The British MRC is strongly committed to excellence in research; several of its establishments have attained international pre-eminence. Eight scientists have been awarded Nobel prizes for work done in the MRC Laboratory of Molecular Biology, in Cambridge. The MRC's 1989-90 budget is $379.4 million, about 90% ($352.7 million) of which is being provided from the DES. The remainder comes from other government departments and agencies, National Health Service (NHS) area health authorities, the World Health Organization and private sources. The MRC received a $6 million "once-only" injection of funds late in 1988 to replace outdated equipment; this year's allocation is significantly higher than 1988-89's, at $320 million. However, most of this year's increase seems earmarked for new initiatives 812
CAN MED ASSOC J 1990; 142 (8)
and will not alleviate the erosion of the MRC's "research purchasing power", which has resulted from years of budget underindexing. The Canadian MRC grants and awards budget for 1989-90 was $197 million, which indicates comparable expenditure per capita expenditure on medical research. The UK research councils are required to prepare annual 5-year corporate plans. The MRC's 1989 plan,9 although maintaining the basic commitment to excellence in research, indicates an evolution of corporate thinking toward a mixed problem-driven and science-driven approach to priority-setting. In addition, the MRC will seek increased cooperation with industry, the medical charities and international organizations and more income from nongovernment sources. A strategy committee has been created to identify areas in which both increased and decreased future efforts are warranted. The MRC had been the United Kingdom's lead agency for AIDS (acquired immune deficiency syndrome) research since 1983. However, by 1987 its traditional reactive role was insufficient to ensure needed research, so the AIDS Directed Program was started as a problem-driven priority, with designated funds of $29 million over 3 years. This marked a departure for the MRC, commissioning research in addition to operating in its classic responsive mode. The program operates with central direction; priority is given to research into vaccines and drug therapy as well as the molecular biology of HIV (human immunodeficiency virus). Additional funds have since been approved. The increased effort in health services research is another problem-oriented priority. The MRC entered this field in 1981 as a result of an agreement signed with the health departments; funds previously transferred to the departments'0 were returned to the council."I'2The MRC plans to expand its support for health services research (currently $6 million per year) in collaboration with the health departments and the Economic and Social Research Council (ESRC). Annual meetings with the health departments keep the MRC informed of departmental priorities, which can be considered when policy is
formulated. The MRC is one of the five British research councils that may carry out in-house research, support university research, fund some international scientific activities and provide support for individual research trainees. (The other four are the Science and Engineering Research Council, the Agricultural and Food Research Council, the Natural Environment Research Council and the ESRC.) The councils, which all exhibit a different style of operation, receive their budgets through the "science vote" of the DES; the ABRC advises on the allocation of funds among them (about $1.6 billion in 1989-90).
Total UK government research and development expenditures in 1988-89, including those for defence, civil departments, the research councils and universities, were considerably higher, at $9.8 billion. There has been much discussion recently on the need to reorganize the present five-council structure, which dates from the mid- 1 960s. A 1989 study commissioned by the ABRC,'3 in response to concerns about the distribution of biology research funds between several councils and the perceived inability of the councils to collaborate, has recommended that the present system be replaced by a single national research council; this new council would incorporate the ABRC and comprise six semiautonomous operating divisions, including one for medical sciences.'4
ESRC The ESRC's objectives are to identify, and fund research into, priority economic and social issues, to ensure the widespread and effective dissemination of research results and to maintain a national social sciences capability.'5 The ESRC, which has traditionally been more problem-oriented than the MRC, has two principal approaches to funding: (a) the three research development groups, in which areas such as industry, the economy and the environment, human behaviour and development, and society and politics are identified and research proposals invited; and (b) the research grants scheme, in which applications for funds to research any topic in the council's mandate are considered. The ESRC has a major ($3.8 million) 3-year AIDS research initiative into social and behavioural consequences of HIV infection. Additional funds are expected this year for some new initiatives related to aging. Despite its smaller 1989-90 budget of $64 million the ESRC is more involved in health-related research than its Canadian counterpart, the Social Sciences and Humanities Research Council (SSHRC), whose 1989-90 budget is $75 million; the ESRC has recently established a working group to determine strategy for health-related research. In addition to supporting specific sociohealth research projects and social sciences postgraduate students in health-related areas, the ESRC jointly funds some research units with the DOH, the MRC and the SHHD.
DOH
concluded that its research is broadly policy oriented and not directed toward the research needs of the NHS, which are quite different from those of ministers and the departmental administration. Since 1988 a part-time chief scientist has been appointed; he has advisory but no longer has (as did his predecessors) executive responsibility for departmental research. In addition, a committee has been established to set research priorities, which currently include AIDS, effectiveness of acute care services, transition to community care, consumer attitudes to health and social services, influence on lifestyle, evaluation of the effectiveness of social programs, health personnel (human resources in the NHS), child care and primary care. The total 1988-89 DOH research budget was approximately $42 million, of which about $30 million was for health research, personal social services research and social security research, mostly being conducted extramurally. The balance was for information technology research, the Biomedical Engineering Centre (aids for the disabled), NHS building research, and equipment and supplies research. The DOH supports approximately 34 research units and university-based programs in the applied health sciences as well as individual projects. The small grants scheme has been terminated; however, unsolicited research proposals are still considered in the context of overall research priorities, and attempts are now made to direct these applications to one of the research councils. The regional small grants scheme, which is administered and funded locally (about $20 million per year) in the NHS regions, is still in operation. The DOH jointly funds some research activities with both the MRC and the ESRC.
Health Education Authority (HEA) The HEA, a special health authority within the NHS, leads and supports the promotion of health in England.'6 It assumed the functions of the former Health Education Council in 1987 and was given responsibilities for AIDS health promotion and health education later that year. HEA's responsibilities, which parallel those of the Health Promotion Directorate of the Department of National Health and Welfare in Canada, include health promotion research. HEA's research is intended to provide a research and evaluation base to maximize the effectiveness of its own programs. Of the total 1988-89 budget of $43.6 million $4.8 million was spent on research and evaluation.
Formed in 1988 by splitting the Department of Health and Social Security, the DOH has interests in SHHD many areas of health research. Its approach was Scotland spends more per capita on health than criticized in the 1988 House of Lords report,4 which CAN MED ASSOC J 1990; 142 (8)
813
other parts of the United Kingdom. The SHHD, which is responsible for the NHS in Scotland, has its own budget and is independent of the DOH. The SHHD has no responsibilities for social security; pensions and social work are the responsibilities of the departments of Social Security and Scottish Education respectively. Although the MRC is responsible for biomedical and clinical research across the United Kingdom, the SHHD, through its chief scientist's office, has independent policies in many areas of research, particularly health services research. Its work is guided by six committees: the chief scientist's committee, which handles such items as broad policy issues and budgets, and five supporting specialist committees, which deal with health services research, clinical and biomedical research, medical equipment research, evaluation of medical and scientific equipment and health service supplies, and research into equipment for the disabled. The chief scientist's position at the SHHD is part-time, as it is at the DOH. The Biomedical Research Committee also assesses applications to the Scottish Hospitals Endowments Research Trust, which represents the consolidation of endowment funds of many Scottish hospitals before the NHS was established, in 1948. The interest on the fund, about $1 million per year, is used to support medical (mostly biomedical) research in Scotland; the fund might be compared to Physicians Services Incorporated Foundation in Ontario, the funds of which came from the private sector before government health plans were established. Recent SHHD research priorities include health care of the elderly, misuse of alcohol and drugs, mental illness and handicap, multiple deprivation in relation to health, alternative patterns of care, senile dementia and equipment for the disabled. Priority is also given to the dissemination and implementation of research results. The SHHD's 1988-89 research budget was $9.6 million. About one-third of the funds supported eight research units, six of which are oriented toward health services research; the balance was allocated to the six committees mentioned previously. The Scottish Health Education Group, a separate agency, supported by the Common Services Agency of the SHHD and part of the NHS in Scotland, is responsible for health promotion, including research (research expenditures are about $0.5 million per year).
Health and Safety Executive (HSE) The HSE is a statutory body appointed by the Health and Safety Commission, which is concerned with occupational health and safety in the United Kingdom. The work of the HSE requires considera814
CAN MED ASSOC J 1990; 142 (8)
ble scientific input. In addition to the in-house activities of the Research and Laboratories Division, the HSE has an extramural research program. Interestingly, the practice of transferring research council funds to the health departments,'0 which had failed in the case of the Department of Health and Social Security, appears to have succeeded in this case. The funds have not been returned to the MRC for direct administration. The HSE has a current extramural research budget of $2.8 million, 30% of which is spent on contracted research in MRC facilities. The HSE has a committee that decides on research priorities; all funded extramural research must satisfy the specialists within the HSE or be approved through external peer review, whichever is more appropriate. Also, the research must be relevant to the work of one of the divisions of the HSE. A broad spectrum of disciplines important to occupational health and safety is covered.
Conclusion Canada and the United Kingdom have many similar programs to support health and medical research, but the private sector (industries, charities, trusts and foundations) plays a relatively larger role in funding in the United Kingdom. However, with regard to the public sector, there is no British equivalent to the substantial research funding provided by the provinces. Many of the same questions preoccupy researchers and administrators in the two countries: What are appropriate funding levels? Should priorities be set with a science-driven or a problem-driven approach, or both? How should the research results be disseminated and applied? However, considerable overlap exists in the priorities (e.g., AIDS, aging, drug and alcohol abuse, and the delivery of care) that have emerged in both countries. The 1988 House of Lords report4 stated that there was insufficient research related directly to NHS needs and proposed the establishment of a national health research authority within the NHS to address this issue. However, there has been no official government response, and the prospects for the establishment of such a body appear poor, particularly since the early 1989 white paper on the NHS paid little attention to research.'7 Health services research and public health research seem to be served more effectively in Canada through the NHRDP and some provincial programs; however, the SSHRC is much less active in socioeconomic health research than the ESRC is in the United
Kingdom. Although the 1980s have not been good years for research in the United Kingdom, improvements are beginning.'8 The 1989-90 budgets for the re-
search councils contain significant increases over expected levels, representing an actual increase of about 11%. Funding of the first new Interdisciplinary Research Centres,'9 including three involved with medical research, has been announced. New funds are available to support these centres, the programs of which will be more tightly managed than is usual for university research; the research must be related to a central theme, be interdisciplinary and be prepared to seize innovative opportunities rapidly. A new clinical research initiative is under way, although perhaps not on the scale originally envisaged. The future is brighter, but UK researchers may have to accept some concentration of resources. The recent proposal to change the present research council structure drastically will undoubtedly be resisted. The medical research community can be expected to oppose the MRC's demise; the ESRC fears that the funding available for social science research could become marginal under a single national research council. One recent commentary on behalf of the MRC strongly decried what its author referred to as a marxist approach to research administration.20
Addendum
research councils for some research infrastructure costs (excluding academic salaries and building costs). In addition, universities are being encouraged to increase their income from research contracts.
References 1. Heacock RA: The NHRDP: providing support for health care researchers. Dimens Health Serv 1987; 64: 9-12 2. Idem: Forty years of federal support for public health research through the Department of National Health and Welfare. Can J Public Health 1989; 80: 101-104 3. Connor S: The flickering candle in the laboratory. New Scientist 1987; 114(1562): 30-32 4. Priorities in Medical Research: Report by the House of Lords Select Committee on Science and Technology, HMSO, London, 1988 5. Smith R: Is research to be privatized? Br Med J 1988; 296: 185-188 6. Idem: The funding of medical research: going up or coming down? Ibid: 267-270 7. Inscrutable UFC [E]. Times High Educ Suppl 1989; July 28 8. A Strategy for the Science Base: a Discussion Document Prepared for the Secretary of State for Education and Science
by the Advisory Board for the Research Councils, HMSO, London, 1987 9. Medical Research Council Corporate Strategy 1989, Medical Research Council, London, 1989 10. Lord Rothschild: A Framework for Government Research and Development, HMSO, London, 1971 11. McLachlan G (ed): Five Years After: a Review of Health Care Research Management after Rothschild, Oxford U Pr, Oxford,
1978 The UK government has now responded to the House 12. Kogan M, Henkel M: Government and Research: the Rothof Lords Report4 and has decided not to accept the schild Experiment in a Government Department, Heinemann recommendation to create a national health research Ed, London, 1983: 38-139 authority. Instead, a chief of research and development 13. Morris R: Review of the Research Councils' Responsibilities for Biological Sciences, Advisory Board for the Research will be appointed within the DOH to advise the governCouncils, London, 1989 ment on various research issues and to take on special face abolition threat. New Scientist 1989; responsibilities with regard to the research needs of the 14. Research councils 24 123 (1673): NHS. 15. Economic and Social Research Council Corporate Plan, The proposed single UK National Research Council 1988/93, Economic and Social Research Council, London, will not materialize either. Instead, the ABRC will have 1988 been reconstituted on Apr. 1, 1990, as a leaner body, with 16. Working for Health, Health Education Authority, London, 1988 a more explicit mandate to improve coordination and 17. Working the Patients, HMSO, London, 1989 cooperation among the various councils. R: Being bullish about medical research. Br Med J The UFC will be more selective in the distribution of 18. Smith 1989; 298: 544-545 funding among the universities. A consultation exercise is 19. Three new interdisciplinary research centres. Ibid: 550-551 in progress to shift the boundary within the dual support 20. Perutz M: The new Marxism. New Scientist 1989; 123 (1673): system, with funds to be transferred from the UFC to the 73-74
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