Taking a collaborative approach to researchBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7495.810 (Published 07 April 2005) Cite this as: BMJ 2005;330:810
The UK Clinical Research Collaboration has just launched a new initiative to encourage more doctors into research. Dr Liam O'Toole, who is heading up the organisation, talks about its goals
“Igniting our potential” is the incendiary slogan of the still infant UK Clinical Research Collaboration (it is just one year old). The man responsible for lighting the blue touch paper, or at any rate holding the match-box, is the organisation's acting chief executive, Liam O'Toole. He wants the NHS to be a global leader in medical research. His mood is bullish. “There's an enormous amount of goodwill,” he claims. “Everyone's facing in the same direction and wants to roll their sleeves up and sort it out.” No dissenting voices? None that Dr O'Toole is aware of.
The collaboration is run by a board of about 20 appointees, who represent the key players in clinical research, including the Medical Research Council, the Wellcome Trust, the Department of Health, the National Institute for Clinical Excellence, the Association of the British Pharmaceutical Industry, the Association of Medical Research Charities, and the Academy of Medical Sciences. The government has pledged an increase in funding to meet the costs of new research.
Dr O'Toole's confidence is probably justified because the problem that the collaboration was created to tackle, the under-performance of clinical research in the United Kingdom, has for years been a niggling preoccupation for all concerned. In its 2003 report, Strengthening Clinical Research, for example, the Academy of Medical Sciences said that “there is now a substantial gulf between basic discoveries and converting such discoveries into innovations that directly benefit patients or prevent diseases.” It concluded, “Put simply, clinical research has not kept pace with the advances in basic scientific discovery and this disadvantages patients.”
As Dr O'Toole sees it, “We have this great organisation in the UK, the NHS, which should be a fantastic environment for clinical research. But we've only been scratching the surface of that potential.”
Why? A whole series of obstacles, he says, from the structure of individual researchers' careers to the very infrastructure of the NHS itself. Take just one issue, the place of clinical research in an NHS district general hospital. The prospect of having their staff involved in research is not one that thrills all chief executives. Their job, after all, is to run institutions that exist to apply knowledge, not to acquire it. Research may be seen as an enterprise that drains resources, offering little in return. Kudos is fine, but it does not balance the books.
For more district general hospitals to welcome clinical trials, their management will need to be assured that the extra cost of research nurses, data managers, and the like will not have to be met out of existing budgets. The collaboration has been formed to tackle issues such as this. “We have representation from the NHS,” says Dr O'Toole. “We have the strategic health authorities, the NHS Confederation.”
Judging by the list of its partners, the collaboration has got just about everybody, in fact, including the key organisations that pay for or run research—government, industry and medical charities, and NHS management. “The risk was that in a year's time we would produce a glossy report making recommendations about change to no one in particular. There are lots of those out there already. We've got the people around the table who can actually effect change.” One way of looking at the role of Dr O'Toole and his colleagues is as the glue that helps to bring the partners together and hold them there.
Part of Dr O'Toole's confidence in the new body comes from his experience of running the organisation on which it is modelled, the National Cancer Research Institute. Set up in 2001, this was a response to the self evident observation that cancer research in Britain would benefit from some coordination. The speed with which it produced results surprised everyone, says Dr O'Toole. “The Cancer Research Network doubled recruitment into cancer trials. We managed to do the first ever analysis of how all the funding, government and charity, was spent. This showed not only where the money was going but, perhaps more importantly, where it wasn't.”
The best way for the UK Clinical Research Collaboration to build on this experience and to extend it to other conditions was much debated. “Should we go for a comprehensive infrastructure underlining all areas of clinical research? Or should we take it in bite sized chunks?” In the end it opted for caution and chose to focus on, in addition to cancer, mental health, diabetes, stroke, Alzheimer's disease, and medicines for children. A comprehensive system remains the long term goal.
With his experience of the cancer network, Dr O'Toole was the obvious choice to get the new organisation up and running. But he is still described as “acting” chief executive: whether he will continue is yet to be decided. He would clearly like to.
Dr O'Toole, now aged 45, has a degree in zoology and a doctorate in endocrinology, and has spent time doing post-doctoral research. So why did he quit research? “I got very stimulated by planning experiments and by interpreting the results.” It was just the bits in between that lacked appeal. The move from doing research to organising and managing it was a logical step.
New bodies set up to administer (or, as they prefer to say, facilitate) research rather than doing it should not count on the automatic support of the workers in the laboratory or at the bedside. So Dr O'Toole is keen not to overplay the role of the organisation itself. “What we didn't want to do was create an enormous bureaucracy in which we had representation from every stakeholder but all we did was sit around a table and talk.”
Currently housed in a few rooms at the top of the MRC's prestigious central London headquarters, the collaboration's offices announce their identity with a handwritten paper notice taped to the outer door, although this is evidence less of organisational modesty than of recent arrival. More important is the list of email addresses of the key personnel. Only half work at the MRC; the rest are located within the organisations that make up the collaboration.
It remains to be seen whether this new body will replicate the success achieved in the oncology community, in which there was already a more established culture of clinical research. “In other areas the challenges are greater,” Dr O'Toole admits. “But cancer does give us a model of working in partnership and a taste of what can be achieved.”