One good thing about sleepless nights in this weather is the opportunity to catch up on your reading.

In the wee small hours of this morning I decided to read a report entitled ‘Bursting the Biomedical Bubble’ authored by Richard Jones and James Wilsdon and published by the excellent Nesta just two weeks ago. It has been covered extensively in The Guardian, The Times Higher, and the Lancet among others. It’s the talk of the town so to speak. Well, Whitehall, Westminster and London’s medical mile at least.

The basic argument in the report is that biomedical research funding is out-of-kilter with the nation’s future needs. Funding has been skewed towards a highly medicalised model of health, is concentrated in London, Oxford and Cambridge, and is besotted by things like biotechnology and pharmaceuticals. The authors say the creation of the UK Research and Innovation (UKRI) is a golden opportunity to put things right.

‘Hoorah!’ I hear you say, and well you might. It’s an excellent report. It’s well-written as well.  By two authors who know their stuff and demolish the status quo in biomedical research with some aplomb, marshalling the evidence over the hilltops and into battle like a scene from one of those ‘Lord of the Rings’ films. Anyone who was frustrated if not angered by the smug self-satisfaction of the Life Sciences Industry Strategy and the resurgence of academic self-interest should read this report. There are sensible allies out there.

Yet (there’s always a yet, isn’t there?) there were places where I thought Jones and Wilsdon could have sharpened their pencils just that little bit more. Because while their analysis is powerful, I am not sure their prescription for the future is pointed enough to burst the so-called bubble.

The number one issue I have with report is that it could have more strongly challenge the leadership and governance that has presided over the creation of this biomedical bubble in the first place.  The same voices and interests continue to dominate decision-making in health research. Until they make space for other voices including patients, carers and the public decisions will follow an all too predictable pattern.  Finding itself in the classic situation of over-promising and under-delivering public trust will fade away. A sentiment that will be felt politically and financially.

Few would disagree with the report’s view that the UK is a world-leader in ‘public engagement.’ Nor would they disagree with its sentiment that public engagement is overdue radical reform and needs reinvigorating.  Read the BMJ editorial published this week and authored by Paul Wicks, Fi Godlee, Tessa Richards and me about patient rights and roles that challenge existing research hierarchies.

They pleasingly refer to examples of other nations such as the Netherlands where the science hierarchy has been brave enough to involve citizens in thinking about the research questions of the future.  But, again, I think they could have advocated more strongly for public engagement to be integrated into the whole fabric of how research is conducted. As we have learnt at the NIHR, cultural change only comes about by integrating the public voice in every aspect of an organisation’s/system’s strategic and operational decision-making.

And while a National Institute for People-Powered Research sounds a lot of fun (yes please!) I am not sure it would lead to the scale of change necessary. Just as building a new members-only sports centre in London W1 wouldn’t improve the nation’s fitness levels.

Finally, I hope it’s trust in UKRI to think out of the box and tackle public engagement head on is justified. After all ,UKRI only devoted a couple of pages to it in its strategic prospectus – a fact that doesn’t inspire confidence.

But these are perhaps picky observations. This is a good report that in most respects pulls few punches. It was worth the sleepless night that’s for sure. Perhaps the point is that we all now need to join James and Richard in sharpening our pencils if we are to burst the biomedical bubble for the better.