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The NHS Commissioning Board Draft Mandate and patients in health research

The Shard went up (officially).  And the NHS Commissioning Board Draft Mandate came down from on high.  All on the same day.  Add the odd torrential downpour with its associated misery and these could be Biblical times.

I have come to the conclusion that it is my fate to be locked away somewhere remote and with an intermittent phone signal when such momentous events occur.  On this occasion I was taking part in the Third NIHR Experimental Medicine Research Training Camp; a three-day residential meeting where over 60 NIHR doctoral students were learning the art of science communication.  By their own confession they were taken out of their comfort zone.  No more so than when they had to test their ideas in front of our excellent lay advisory panel.  It forced them to think differently, to re-interpret their knowledge and expertise from a public and patient viewpoint.  But the outcome in terms of their plans and ideas was superlative.

So what about the NHS Commissioning Board Draft Mandate from the point of view of public and patient involvement in research?

Unsurprisingly most attention has been drawn to page 26 of the Mandate headed’Promoting growth, research and innovation’ which looks at the role of the Board in promoting research by:

  • Working with research funders
  • Improving adoption and spread of new technologies
  • supporting patient participation in research

Objective 17 and associated Annex B set out more precisely how this will be achieved and measured.  The commitment to measure increasing patient recruitment is important.  It is my view that this data should not only be about participation rates (already available through the clinical research networks), but also the extent to which patients are being offered the opportunity to take part in research  (a possible role for the Care Quality Commission (CQC) through its annual patient survey).  Together, these measures would tell us much about the extent to which the NHS is realising its duties in terms of research and patient choice.

For what it is worth, my own view is that the real game-changer in the Mandate when it comes to participation, falls within the ‘Choice Framework’ set out in Annex D.  For this begins to set – for the first time and in some detail – the expectation that patients should be offered the opportunity to take part in relelvant and appropriate research as part of their care and treatment.  It gives them and us license to challenge the system to make that choice a reality.  As will the reviewed and renewed NHS Constitution when it comes out in draft form this autumn.  Or I hope it will anyway!

The less satisfying aspect of the Mandate is the weakness of its statements on public involvement – as National Voices has already pointed out.    In fact, it is very poor indeed.  I already have a growing sense of unease over the new corporacy which may be creeping over some Clinical Commissioning Groups (CCGs) as they tackle the issue of public involvement.  A number of CCGs are clearly in the search for those with specialist expertise and skills, as opposed to finding those who can reflect and articulate the patient voice.  Others, on the other hand, are doing their best to get it right.  But it is difficult to get a cohesive picture of what is happening because the signals are intermittent and often broken-up.

So I would say this.  It is important that we respond to the consultation on the Mandate to support and strengthen its statements about patient choice and research.  But equally important is to hear people’s experiences about what is happening with public involvement locally, good and bad.  For we must make the case that, in order to meet its objectives, the NHS Commissioning Board has to ensure a better foundation for public involvement than it has thus far.

Only if we provide space for patients to challenge the system will we see improvements in the way that care and treatment is provided and people’s choices honoured.

Government consults on Healthwatch membership

The Government last week launched a public consultation seeking views on the membership of Healthwatch England.

Healthwatch England will be the ‘consumers champion’ under the NHS reforms. It will be what they call a ‘statutory committee’ of the Care Quality Commission (CQC) and is expected to be up and running by the autumn. Many, including National Voices, have argued that it should be an independent body.

In the consultation,the Department of Health asks for views on how large the Healthwatch committee should be, how people should be appointed to it(including whether they should be elected), and what sort of experience they should have. It says that they should have a background in active patient and public involvement.

The document is quite helpful in describing where Healthwatch fits into the overall scheme of things. There will be local Healthwatches as well. And a key issue will be ensuring that these local bodies form a strong network. Also, that they have a strong link to the England committee. We have singularly failed to achieve this aim with previous incarnations of patient and public involvement forums, beginning with Community Health Councils in the 80/90s or their successors including ‘LINKS.’

As an aside, you might wish to read Angela Rippon’s interview in the Sunday Times today. She is now a Vice-Chair of the Patients Association (paywall).

I’ve got a pile of irony to do tonight – from Scottish independence to NHS reform

On my train journey from Edinburgh this morning, I listened to a BBC Radio Scotland phone-in about the implications of Scottish independence.  The intricacies of a possible de-coupling from the UK are fascinating – from the economy to people’s pensions, to the NHS.

I’ve yet to read an article written specifically about the pros and cons from a medical research or science point of view.  But this is a good overview of the economic issues as recently appeared in the Financial Times.  In terms of the day-to-day, though, I wonder just how much more of a difference formal ‘independence’ will make in some areas.

For the irony is that, for a good few years, the forums I am involved in have become well-versed in encompassing the devolved administrations and their points of view as if they are wholly independent.  The discussion and negotiations are not always easy.  Sometimes – well, quite often actually – colleagues look jealously upon the enlighted approach they are taking.  But the upshot is that broad agreement is reached sooner or later and the various partners left to their own devices to how it is implemented.  So the real issue is not about de-coupling.  Rather it is how to ensure these different approaches remain linked to everyone’s benefit.

While away, I have intermittently followed the latest blows being traded over NHS reform. Mike Birtwhistle from MHP has blogged insightfully about the various politics behind the stance, or should I say different stances, of the medical professions.

How ironic it is that the Royal College of Physicians – who brought the BMA to heel to create the NHS in 1944 – is now being pressued by the BMA to ‘save the NHS.’  Or so the BMA would have us believe.  The relationship between the two has never been an easy one.  My sense is that the survival instincts of the Colleges – which are even greater than that of our own political parties – will come out on top.  They will want to stay at the negotiating table come what may.

Meanwhile, the irony is that life with the NHS reforms goes on.  Chris Ham, Chief Executive at the King’s Fund, wrote a blog last week which was much quoted for only one aspect, his comments about what the aforementioned medical professions and their latest salvos.

His other main observation was that, while the politics rev up again, the reforms continue apace in other ways, regardless of and without little need of legislation. And many, including Royal Colleges, position themselves rightly and astutely to ensure the reforms benefit their respective constituency – note this from the Royal College of Paediatrics and Child Health (RCPCH) about the new Children’s Forum. 

In other sectors – medical research for instance – the debate during the parliamentary stages has been highly relevant, important and constructive.  Much has been gained and much is still on the table.  Its cross-party support can only be helpful as we reach the final stages of the legislative process.  The potential impact on how the NHS supports research in the future is significant.  So, for some, I am sure, it would be ironic if this gain were to fall along with the Bill.  At the very least it would supposedly leave things in a bit of a pickle.  But I doubt very much that will be the outcome, one way or the other.

If you wish to get up to speed with the latter debate ahead of the Report Stage of the Bill in the House of Lords have a look at the ever-comprehensive analysis on Becky’s Policy Pages.

 

Manning and crowd weigh in on NHS reforms at the eleventh hour

Goodness me the nation’s health must be in peril if the Royal Colleges have kicked off their slippers and downed their pipes to emerge like Dad’s Army into the affray about the NHS reforms.  All seems to rest now on those of their number who reside in the Upper House.  How peculiarly English but ultimately unsatisfactory that it should come to this.

In the run up to today’s Second Reading debate of the Health and Social Care Bill, the hyperbole on both sides has been difficult if not impossible to avoid. Reading the papers feels more like a downhill ski slalom than an intellectual pursuit. 

And yet, while I wish I could buy into the Independent’s middle-ground opinion that what we have witnessed with the NHS reforms is simply a failure of communication, I do feel as though a lot more is at stake than this.  Heartwarmingly for me, it would seem a lot of people share this view on both sides of the debate.

It is with feelings akin to almost parental dismay that I recently learned that Julia Manning, Director of the right-leaning think-tank, 2020health.org, now blogs regularly for the Daily Mail.  The ‘right’ badly needs a radical if not impactful voice on science and I hope 2020health.org will earn its stripes in due course.  But Julia’s Daily Mail blog rather shot itself in the foot yesterday by saying – and I paraphrase – ‘we must not stop the Health and Social Care Bill because all the changes are underway anyway and everything will be in limbo.’  Her broadside simply served to underline how undemocratic the approach to the NHS reforms feels.  And her unfair swipe at Evan Harris lacked tabloid panache.

Alternatively you could dip into or gorge upon The Guardian’s running commentary on the whole saga, including their live text-feed thingy of what is being said by whom right now.  What would we do without the Guardian’s obsessive compulsive approach to these things?  I have come to the conclusion that its editorial staff grew up on and rather miss the days when news junkies used to watch ceefax page 102.  Occasionally, however there is a peach of an insight such as the one earlier today by Tony Blair’s former health adviser, Paul Corrigan.

If you wish to watch unadulterated coverage of the debate you can go to the parliamentlike.uk webcam here

Meanwhile the GPs just keep on answering those surveys including the latest one from the Royal College of General Practitioners in which only 4% of their number believe that the NHS changes will result in better patient care.  Not far away 84% of members of the Royal College of Psychiatrists want the Bill withdrawn – this after a group therapy session before which the level of despair was much greater.  But it is a wonder that our medical colleagues have any time for patients given the number or surveys they are filling out.

If you want some of the serious stuff then Becky’s PolicyPages are their usual reliable self with the gen on the research concerns.  But the penultimate word goes to National Voices (Ovarian Cancer Action has just become a member) with their five calls to Peers as the Bill heads for the vote.  National Voices’ briefing to the Lords highlights five further changes the patient lobby wants to see:

  • a definition of individual patient involvement
  • commissioners taking advice from expert patients
  • a statutory duty of candour
  • strengthening HealthWatch England
  • local HealthWatch organisations electing members of HealthWatch England.

I’m off to dinner in the Barry Room .

 

 

 

NHS reforms to face a tough round of Peer review this autumn

We are a nation that no longer knows when to put its rubbish bins out.

So I reflected, as I dragged our two overflowing wheelie bins back to their usual place. To be fair to Bromley Council, it’s not that they fail to pick-up our rubbish; just that no one can quite predict what sort of rubbish they are going to collect in any given week.

I won’t bore you with the details. Suffice to say that some months ago they changed the system of waste collection here – successfully ‘piloted’ with local residents I should add – so that various items would be picked-up on alternate weeks. Well, for the life of me, I and my neighbours have got it wrong at least 40% of the time. I wouldn’t mind that much but after hours toiling over separating tetra packs from the New Scientist it does get a bit irritating to see the bin men and women dump it all together in the back of a dustcart. As my mother would say – and she is usually right about most things: ‘it all goes down one way.’ But I do wonder if I am part of some sort of rather wicked observational study.

Such episodes in life do however serve as useful metaphors for larger trends at work. In this case, perhaps, it is the passing of what was once certain, fixed, reliable. Now I just sound like John Major don’t I?

Anyhow, enter stage centre-right, the NHS. September is upon us after another crummy August and our politicos have quickly rejoined battle over the health service reforms. The Sunday Times front page from yesterday suggesting that overseas companies are being primed to run hospitals (or should that be the other way round) left me unsettled to say the least.  Notwithstanding the so-called ‘Listening Exercise’ prior to the summer, it really does feel as if the tectonic plates are shifting beneath the NHS and fast.

The BBC Online has a good overview of where the battle lines have been draw if you wish to look deeper and I wish that I had been able to attend this evening’s Stempra briefing and discussion on the Bill – perhaps someone will post a comment giving us a sense of what happened. 

But I was struck by the passage in the BBC piece about the anticipated forensic scrutiny of the legislation when it gets to the House of Lords.  Heavens knows it needs it.  When I was a little closer to these things than I am now it was well-known that Peers were getting together regularly to examine and prise apart the Bill in preparation for its stages there.

This is the thing.  If you are into your pure politics then I suspect you will be attracted by the likely rough and tumble during the party conference season and in the House of Commons come October.  If, however, you are looking to throw your weight behind the forces that might ensure the reforms are changed for the better then I encourage you to assist our Peers in every way you can with good evidence and good briefing.

Otherwise, it will not be that the NHS fails to treat people in the future, rather that none of us will be able to predict which patients it will treat in any given week in any given part of the country.

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PS: Apologies that the links are to ‘home pages’ but I can’t seem to use anything other than the WordPress recommended links on this computer.

Rising cancer rates and the NHS reforms…plus NIHR and ‘impact’

I suspect you have seen today’s news bulletins covering Macmillan Cancer Support’s report predicting a significant rise in the number of people who will get cancer. To quote the opening lines of their statement today:

Cancer rates are increasing at such a rate that research shows 42% of people who die in this country will have had a cancer diagnosis. And for most of them (64%), it is cancer which causes their death.

Macmillan calls for better services and support for those with cancer. Fergus Walsh on his BBC blog emphasises the need for people to take more personal responsibility for their health. Cancer Research UK has been quoted as also emphasising the prevention message saying that half of all cancers could be prevented by better diet, stopping smoking etc. They are all right of course. As is also the message that we need to continue to fund cancer research if we are to ultimately secure new and ever-better treatments.

Similar comments were made yesterday at the excellent All-Party Parliamentary Group on Cancer hearing about the impact on cancer of the NHS reforms. I am sure that some rule to do with Chatham Docks prevents me from directly reporting the comments by the panel – Peter Johnson from Cancer Research UK, Jennifer Dixon from Nuffield, Heather Nathan (patient) and Dr Steve Field (GP and Chair of the NHS Future Forum) – or audience. But hopefully their insights will be appropriately incorporated in the final report of the Group on Commissioning expected later this year.

For the moment then, just two thoughts of my own:

It is pretty evident that for many patients – and not just those with cancer – the opportunity to benefit from new treatments and trials is often dependent on their own strength, determination and gall. It should not be like this. There is still a gaping need for better information to be provided and for patients to be better supported by health professionals and others on their patient journey to remove the element of ‘chance’ in their care.

We need to overcome this notion that somehow research is outside the remit of service commissioning or commissioners. It has to be integrated with the decision-making that sits behind such activity. While the changes to the Health and Social Care Bill which will mean new duties on GPs etc with regard to promoting and using research are good news, how we ensure this happens in practice is the unanswered question as yet.

In the closing stages of the meeting the panel were asked to identify the one significant challenge and opportunity arising out of the reforms. The challenges ranged from ‘money’ to safeguarding continuous patterns of care for people. The opportunities include the development of IT systems that enable better care, to developing a more responsive system.

And if there is one positive from Macmillan’s report today it is perhaps that the increasing numbers of cancer patients will mean a greater pull on the system to meet their needs better.

…and in other news:

I was delighted to see the following statement on NIHR’s website about the fact that NIHR funding will be considered alongside Research Council funding in the Research Excellence Framework (REF) in 2014. The new guidance also states that applied and practice-based research must be assessed on an equal basis with other types of research. This will ensure full recognition for the clinical and applied research which NIHR funds. In other words it is a strategically very important news.

NHS reforms latest

I’ve got a sneaky feeling that Andrew Lansley might be going to Cornwall on holiday giveh his overtures to the region about how the new funding allocations for the NHS will no longer penalise the county. And this is how The Guardian reported Andrew Lansley’s speech to the NHS Confederation yesterday.

Back to the Future on NHS Reforms

Here’s the BBC report on how the Health and Social Care Bill will now be scrutinised following the changes announced a few weeks ago. I think other reports have mentioned people’s criticisms of it going back to the committee stage for only ten days in all.

‘Scroll down’ for clinical trials

To begin with, here’s more on that Pfizer story about use of mobile phone technology etc in clinical trials. It seems to have piqued an interest among many of you anyway.

Also on the subject of clinical trials, I was rather perplexed by this story running out of the NHS Confederation this morning. I’m delighted that the NHS Confederation are at last exercising their PR might in the name of research – it must have something to do with Mike Farrer’s move there as CEO. As you may know, he was previously the chief executive at the North West Strategic Health Authority which led the hallowed ‘NW Exemplar work on clinical trials.

The overall message of the piece about regulation standing in the way of clinical trials is also good. But I am sure the data/evidence they have put forward to support it, passed its sell-by-date a long time ago. If you look at the latest metrics for trials put out by the NIHR Clinical Research Network (CRN) Co-ordinating Centre, one gets an alternative and more up-to-date picture of an improving situation.

Much work is still to be done though.

The really striking bit in yesterday’s MORI survey by the Association of Medical Research Charities (AMRC) was that showing the degree to which patients would be willing to assist in research by participating in trials (72%) or letting researchers access their confidential records (80%). But you have to scroll down the page to see these results.

A bit like we expect patients to ask their GPs to do if they want to turn their willingness to take part in research into action. I am sure I saw an academic paper a few weeks ago which heralded the 39% or equivalent GP practices that were active in recruiting patients for trials in Eastern England. All I could think of was…what about those people living in the catchment areas of the other 61%. Perhaps their GPs still use scrolls instead of prescriptions.

So grist to our mill in making sure the Health and Social Care Bill supports the things that are already being done by NIHR and others to change this.

Cameron’s High Five

A reminder that David Cameron will be making five pledges on the NHS in a ‘keynote’ expected this week (possibly tomorrow (Tuesday)). Things like..there will be no privatisation, and an end to waiting lists etc.

The Economist’s ‘Leviathan’ blog - which is always worth a look – takes a rather derogatory view of the Prime Minister’s five-a-day prescription, calling it mood music.

I read it as a sortof high-five to the NHS to rebuild confidence. But it will be the stuff between the lines that we’ll need to look out for, since this will hint at the conclusions drawn after the recent ‘listening exercise.’

Flying in the face of an interregnum

As a self-confessed member of the worried well, I ask that people think carefully before they throw strange words at me.  Particularly on the day of a regular visit to my ‘prescription-happy’ doctor.

A colleague asked me this morning how my interregnum was going.  It  sent me into a momentary panic.  Is it treatable I wondered anxiously?  Then I asked myself if I’d been asleep longer than I thought during which time there had been an overnight interregnum akin to other moments in history such as the Spanish Inquisition.

Finally I realised she was referring to my being between two jobs – I start at Ovarian Cancer Action on Monday.  Phew.

The final days of the Department of Health’s listening exercise have seen a last minute flurry of submissions.  I read on BBC News Online that over 15,000 comments have been made and 750 letters received by some poor official who only three months ago had an empty in-tray. The Association of Medical Research Charities’ (AMRC) submission on behalf of the charity sector can be found here – and very good it is too.  Elsewhere the King’s Fund has kept up its usual pace of incisive criticism with a report on accountability in the proposed new NHS set-up.

Indeed, accountability is a theme that has resonated strongly in these final days.  Mark Walport, Director of the Wellcome Trust, referred to it in his Times article yesterday.  The Daily Telegraph reports this morning that the inclusion of patients and the public in the management boards overseeing GP consortia, is likely to be one of the key recommendations that the NHS Future Forum chaired by Steve Field will make when it reports to the Cabinet shortly.

That has to be right.  There seems to be an inherent contradiction between Big Society politics and the NHS reforms if the public are not to be given greater access and opportunity to influence and shape how health care is delivered in their neighbourhood.  Of course, that’s always assuming you believe in the Big Society mantra.

But I do understand the difficulties for the Government in getting the composition of these bodies right given the equally understandable clamour from all and sundry to be represented.  I see the nurses are the latest to make their pitch today.  However, patient and public representation should be one of those ‘red lines’ for charities and the voluntary sector on which we should not give way in the months ahead.

If you are planning a holiday around developments with the NHS reforms then you may wish to take a look at the Financial Times article today which speculates about the timetable from here onwards.

Not long now before we’ll find out how much of its original plans the Government decides to alter or whether it is intent on flying in the face of its own self-imposed interregnum. 

Footnote:  By the way, I heard an interesting bit of ‘Whitehall’ news last week which is that the Office for the Strategic Co-ordination for Health Research (OSCHR) has moved offices from its HM Treasury base (its home for the last few years) and is now located in the Department of Health.  Happy to be corrected if I am wrong.

Back to First Principles with the NHS Reforms

The word on the street is that the Coalition Government is going back to first principles in its review of the proposals in the Health and Social Care Bill. 

As each day passes, the ‘natural break’ begins to feel more like gardening leave for a piece of legislation that was supposed to be one of the Government’s flagship Bills.  At the moment it looks possible that the Bill will be re-committed in the autumn.  I assume that this will push back the timing on the ‘second session’ of parliament legislation as well – this second Bill is significant to health research because it will deal with changes to the way in which research is regulated. 

So, from a flying start earlier in the year, it feels that the whole thing is becoming akin to a set of roadworks – the bollards are omnipresent as is the hole in the road and the queue of traffic but not much else is visible in terms of progress. 

Still we should be pleased that the Government is at least prepared to radically re-think its plans.  This week, you may have seen, 40 charities issued a statement urging there to be a stronger patient voice in the plans (quick plea to press officers – if you are going to issue something to the media, please make it available on your website the same day, I could not find it on any of the charity websites I checked).

And Cancer Research UK also held a very well attended briefing for MPs and others on the research aspects of the Bill. 

This is going to run and run and run…

International clinical trials day and a bit of mopping-up

It is International Clinical Trials Day today and The Cochrane Library has worked with the UK Medical Research Council’s Network of Hubs for Trials Methodology Research to produce a set of new podcasts about clinical trials – well worth a listen.

There was a conference in Vienna this morning organised by the European Clinical Research Infrastructure Network (ECRIN) (Yes, you’ve missed that), and it is perhaps worth reminding everyone that there is an excellent information leaflet and booklet on clinical trials that was produced by the UK Clinical Research Collaboration (UKCRC) some years ago with AMRC’s help.

Some local research centres are also doing special awareness days to highlight their work – for instance, this one in Bath.  And I thought this was a rather nice milestone being reported by the Leeds Cancer Research UK Centre to mark the day – it has recruited 2,000 patients to trials in its first year of operation. 

And if, like me, you intend to hold a roundtable debate with your family this evening about the way forward for the clinical trial you might wish to use this as fodder.

Yesterday while I was at the INVOLVE meeting saying goodbye to its current Chair, Sir Nick Partridge, Mike Rawlins (Chair of the Academy of Medical Science’s Review of Research Regulation), John Bell (President of the Academy) and Mark Walport (Director of the Wellcome Trust) were giving a press briefing on their concerns about the impact of the Health and Social Care Bill.  Mark Walport was on The Today programme this morning

But if you are in danger of going to sleep, have a look at Anaesthesia UK and read the comments made in a speech by Professor Michael Rees, Co-Chair of the BMA’s Medical Academic Staff Committee, about how the NHS reforms are the latest in a long line of recent develops which now threaten to destablise ‘medical academia.’ 

The Today programme reported that the Department of Health had issued a statement saying the Wellcome Trust’s fears were unfounded.  I doubt that very much indeed.  Anyway, we’ll be going at the issue again in a week or so with some added oomph.

Finally, my deepest apologies to Y-Touring for not getting to their special film showing of ‘Mind the Gap.‘  I was mopping-up loose ends and frayed strands.

Department of Health about to have a Field day taking calls, I believe.

The NHS seems to be dominating my life this week.  Quite apart from the news headlines, it has involved two visits to the doctors and a blood test so far ..but I am on the mend I am pleased to report.  All I can say is, a 45 minute wait for a blood test and excellent advice from my GP surgery receptionist (the real power in the NHS as you all know) leads me as usual to a personal conclusion about how good the service is.  The conundrum is why we are all so easily convinced that it is not by the time we get home.

In the meantime, as you know, I have a blue and yellow phone in my lounge.  This is so I can take direct calls from the Coalition Government Ministerial team at the Department of Health about pressing issues of state (and, yes, I have a red phone as well before people accuse me of bias!).  Now that ‘The Killing’ is over I have found I have more time than ever to provide wise counsel.

So I was pleased that my suggestion of a summit (mentioned in this blog a few days ago) has been so speedily (part) adopted as reported in the FT online this afternoon. It says that a number of ‘expert panels’ will look at the reforms with a fresh eye.  But can anyone tell me why there isn’t one on research?  Perhaps the phone went out at that moment in the call, I can not remember.  Anyway, the Department of Health news release is here.  The whole exercise is being called the NHS Future Forum and is going to be Chaired by Birmingham GP, Steve Field.

Looking at the strands, I absoluteoly get the first three.  However, the fourth (about health professionals advice influencing patient care) seemed a little thin although it is hard to tell fully without seeing the terms of reference. 

So I was going to call the Department when I realised that, as it was set-up some months ago, I can only take incoming calls from them.  I’ll let you know when it can make outgoing calls as well as part of the new Department listening exercise.

NHS reforms, research and 'localism'

I really would encourage you to read this morning’s article in The Guardian about the impact of the NHS reforms on doctor  expertise and research.  Its the first article that I’ve seen thus far which really conveys the message about health research that AMRC has been trying to put across and on which we anticipate stepping up our activity as the Health and Social Care Bill heads into the Lords.

It also feels like a significant piece because of the intervention of the President of the Royal College of Physicians, Sir Richard Thompson.  This is the profession’s voice as opposed to the ‘union’ voice as articulated by the British Medical Association (BMA).

At our Science Communication Awards on Tuesday night I got into quite an interesting conversation with some of our guests about the possible implications for research of an NHS reform package which is essentially as much about greater ‘localism’ as it is about establishing a regulated market.

One of the perennial concerns that AMRC often has to deal with is that of small local charities raising money for research taking place at their local hospital or by a doctor who perhaps cared for a loved-one.  It is not the raising of funds that is necessarily the problem.  Indeed, it is important that we do not deter such local passion and conviction.  No, it is the fact that such money is being raised and then distributed in a parochial way; that such local charities very rarely use independent external review (peer review) to ensure they are funding the best science.

That is why – knowing also that administering peer review is not easy or without associated costs – we try our hardest to encourage such organisations to buddy-up with other charities that do have such systems in place or find some way of routing funds to research charities while retaining some sort of footprint on it.

Who is to say that in the new NHS, we might not see GP consortia actively encouraging such local charity connections in the name of ‘so-called research’ – superficially beneficial but in the long-term pretty disastrous.

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