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Why the next government needs to support clinical research – for our health and the NHS

Joe Kiely
by Joe Kiely | Opinion

12 February 2024

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A scientist carrying out clinical research in the lab.

Our latest survey of the UK’s clinical research workforce suggests there could be trouble ahead. But it also tells us how policymakers could reestablish the country’s position as a global biomedical leader. Together with our Longer, Better Lives manifesto and programme for government, it can guide us to a healthier, wealthier Britain. Joe Kiely, one of our policy advisors, talks through the findings. 

On 5 March 2020, doctors in Reading recorded the UK’s first COVID death. They knew what was happening; they just didn’t have a way to treat it. Case numbers had doubled in two days, and they were only beginning to climb.  

UK research climbed higher. Planned, approved and launched within weeks, the Oxford RECOVERY trial went on to become the world’s biggest trial of potential COVID treatments, recruiting tens of thousands of patients across almost 200 NHS sites.  

By summer, thanks to RECOVERY, the UK became the first country in the world to identify that a steroid called dexamethasone could help treat people with severe COVID. Just a year after the trial launched, that discovery had saved an estimated 1 million lives around the world, including 22,000 in the UK. 

COVID was an unprecedented situation, and it would be tricky to launch trials for diseases like cancer so quickly. Still, Professor Martin Landray, who co-led RECOVERY, could already see the bigger picture. The UK generated the evidence for dexamethasone because a focus on clinical research had been integrated across the NHS. If we held on to that, we could make slow and bureaucratic NHS trials a thing of the past.  

“I think RECOVERY has set a new standard for what can be delivered,” Landray said, “and not just for pandemics. It would be a travesty if we went back to a situation where it takes years sometimes to get a trial off the ground.” 

Our latest survey of the clinical research workforce suggests there’s a risk that Landray’s worst case scenario becomes a reality. According to almost three-quarters of respondents, it’s become more difficult to deliver research in a timely manner in the last 18 months.  

Relearn the lessons of the COVID trials. Stop sinking us in pointless bureaucracy.

- A response to our survey from a clinical academic or scientist

The decision facing the next government

In early 2022, we warned that the UK was at risk of falling behind its competitors without strong intervention. Our fears were confirmed by the Association of the British Pharmaceutical Industry later that year. There had been a 44% drop in the number of patients recruited to industry trials between 2017 and 2021. Thankfully, the Government responded swiftly, commissioning Lord O’Shaughnessy to provide recommendations to improve the clinical trial environment. It was time to stop the rot. 

Since then, the government has made steady progress across key areas. The backlog of clinical trials waiting for regulatory approval has been cleared. The number of people taking part in industry clinical studies is rising. And promising activities from the Government’s 10-year, UK-wide clinical research vision, which was informed by lessons learned during COVID, are beginning to make a difference. 

Still, that vision will barely be three years old by the next election, leaving the winning party with a decision to make: keep building momentum, bringing potentially life-saving medical advances to patients more quickly, or fall further behind other countries, and watch patients lose out.  

That’s one of the most consequential choices any government could face. It’s why rebuilding the UK’s global position in biomedical research is the first of the 5 missions laid out in Longer, better lives, our manifesto for cancer research and care. The accompanying programme for government sets out the measures and commitments that the next government should make to help prevent 20,000 cancer deaths a year by 2040.

Our survey findings, published today, build on the manifesto and give a clear insight into the issues that are most important to clinical researchers.  

Although COVID cases are no longer filling wards, nearly half of respondents felt more frustrated and fatigued in the 18 months leading up to the survey.  

For many of them, it’s proving too much. Almost a third are now more likely to quit. Without intervention, an exodus of talent could materialise rapidly. Almost 6 in 10 potential leavers told us they are thinking about quitting within 2 years.  

I have been constantly fighting for academic time due to clinical pressures… Personally I feel more and more that if I wish to continue with my career plans I will have to do this from outside the UK or give up clinical training, which pains me to say.

- A response to our survey from a junior doctor

But it’s only doom and gloom if we allow it to be. Our findings also lay out what policymakers and NHS leaders can do to make Landray’s vision – and a healthier, wealthier Britain – a reality. 

The public are on board as well. Our polling shows that 4 in 5 UK adults believe that healthcare staff should have time dedicated for research, even when the health service is under pressure. 

The place of clinical research in the NHS

Nonetheless, there’s currently nowhere near enough capacity for or prioritisation of research within the NHS. A lot of this ultimately boils down to the wider pressures facing the health service, which nearly 4 in 5 clinical researchers described as a substantial or extreme barrier. 

Fund the NHS properly so that NHS employees have the time and head space to conduct and participate in research.

- A response to our survey from a consultant

Helpfully, as well as incentivising staff to stay in the NHS, a focus on research can actually help reduce pressures by bringing in money and improving care. RECOVERY is a good example here. As well as finding drugs that worked against COVID, the trial quickly stopped doctors wasting time and money – and possibly endangering patients – with treatments that didn’t.  

An infographic explaining The case for protecting research time in the NHS.

And yet these benefits are still not properly recognised across the NHS, where research is often seen as an expendable ‘nice-to-have’.  

Our survey shows this is driven by a lack of accountability for research at senior levels of the health service. Nearly 6 in 10 of all respondents – and 64% of healthcare professionals (HCPs) – said this is a substantial or extreme research barrier. Similarly, 56% of all respondents – and 61% of HCPs – stated that research and its benefits lacked visibility within the health service.   

As research is part of health service business the health service needs to actively embrace it – not create barriers against it or treat it like an optional extra. It’s all transforming lives for patient benefit and we need to be on the same side.

- A response to our survey from a research nurse

As long as research remains under-resourced and underappreciated within the NHS, clinicians won’t have the protections they need to get involved in it. And the situation is only getting worse. Almost half (46%) of surveyed HCPs telling us they had less time for research in the 18 months prior to the survey.  

We’re yet to see evidence that policymakers want to change this. Neither the Government’s response to the O’Shaughnessy review nor Labour’s announcements on life sciences include any commitment to increase dedicated research time in health service staff job plans. Given the economic and health benefits such a change could bring – and its popularity among the public  it needs to become a priority.

Learning from what’s come before

We understand that today’s pressures, staff shortages, and weak research culture make this challenging to implement. But, when it comes to clinical research, we’ve proved we can achieve tough things. 

Facing up to our other health challenges means recommitting to the lessons learned during COVID. We need strong and ambitious political leadership to drive an integrated approach to clinical research across the NHS. 

Alongside protecting research time in job plans, that approach has to include measures to cut the time it takes to set up clinical studies, improve the visibility of research and its benefits, strengthen accountability among NHS senior leaders and reduce the wider pressures on the health service.  

An infographic detailing how an interconnected policy response can unlock the benefits of clinical research.

We’ve seen some promising steps so far, but maintaining the UK’s long-term position as a world-leading destination to conduct clinical research will take more.  

Our survey describes these issues in more detail, and our Programme for UK Government provides the plan to do something about them.

Joe Kiely

Joe Kiely

Joe is a policy advisor in Cancer Research UK’s science policy team.

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