CSO Health Research Strategy

CHAPTER 3 - TARGETED DEPLOYMENT OF RESOURCES (AND INFRASTRUCTURE)

3.1 CSO invests a total of £68m per annum in Scottish research, representing a significant investment from the taxpayer and the Health Directorates in medical research. It is therefore important that these funds are deployed in an efficient and transparent way. However it is also important that all such investments are reviewed regularly against competing demands for funding and are not considered ring-fenced for any particular discipline or geographical area.

3.2 The need for regular review has been emphasised by the need to invest in new or emerging technologies to allow Scotland to remain at the forefront of medical research. In recent years the importance of Stratified Medicine as a means of transforming the way the NHS diagnoses disease and provides care has been recognised as an important area in which research is essential, while the capacity to transform the way the NHS operates through informatics is only now beginning to be realised. For this reason CSO needs to ensure that it has an acceptable balance of longer-term commitments and flexible funds to deploy as new priorities and initiatives emerge. At present there is an imbalance towards the longer-term. CSO will therefore free up a proportion of its budget to be deployed in support of new initiatives.

Question 10: What proportion of CSO funding should be available for deployment in new research initiatives relevant to the NHS? In what areas should CSO seek to disinvest to free up resources?

3.3 To ensure existing investments remain a priority and have a suitable focus we propose a number of reviews of long standing areas of investment. Proposals for the review of existing areas of investment are set out below.

Response Mode Grants

3.4 CSO funds research projects throught its two response mode funding commitments. At any one time around 100 CSO funded studies are active with a value of around £15m. Early findings from ResearchFish evaluation database suggest that CSO grants generate a considerable volume of additional activity. It is certainly true that CSO grants are highly valued by the research community and demand has never been higher.

3.5 Over the last 2-3 years we have taken steps to streamline the structure and administration of our response mode funding, and the changes have delivered efficiencies for applicants as well as for the Office. We are currently exploring the adoption of a new grants system that will deliver further efficiencies. However such is the demand for CSO grants, only one out of every five is able to be funded.

3.6 In terms of the type of research CSO funds, we currently focus our funding on early-phase development, pilot and feasibility studies that will equip researchers based in Scotland with the evidence needed to develop convincing high quality applications to the larger UK-wide funding streams. In the CSO Experimental and Translational Medicine Research Committee, for example, 50% of applications were for between £150k and £224k with 33% of applications at or around £225k upper limit. 17% of applications were for under £150k. However given the significant investment of over £8m per annum that CSO contributes to the NIHR NETSCC funding streams (such as HTA and EME) to allow access for Scottish researchers, the question arises as to whether any of the applications CSO has funded could equally or more appropriately have been considered by the NETSCC schemes. CSO will explore with NETSCC the interface between our two funding streams to ensure the focus of CSO grants is both clear and complementary.

3.7 CSO will also explore the possibility of raising the upper limit for applications from its current value of £225,000, although a significant increase in the grant funding limit within the same or reduced annual budget would raise issues of future viability of the Committees.

Question 11: Is the focus of the CSO response mode grant schemes adequately defined and understood by the research community? Should there be a narrower focus to complement and avoid overlap with other funding streams Scottish researchers have access to? What is a realistic upper level for CSO grants to allow worthwhile projects to progress?

NRS Strategic Investments

3.8 Chapter One referred to the important role CSO funding plays in supporting NHS studies. Since April 2008 CSO has been investing an additional £10m per annum in NRS Infrastructure. Phased in over three years, this budget was allocated to the Health Boards in Grampian, Greater Glasgow and Clyde, Lothian and Tayside to ensure that new staff were in place both to support current NHS research needs and deliver our ambitions for the future. Critically, CSO allowed the Boards to determine the specific areas in which to deploy the new staff to best meet CSO's strategic aims. Now that these investments have been in place for some time, it is appropriate to review the effectiveness of these investments and the extent to which they are contributing to our national ambition.

3.9 Given the range of functions covered by the NRS Infrastructure investment, it is clear that the underpinning infrastructure will be determined by the needs of current research activity, while for more speculative investments (eg biorepositories, safe havens) detailed metrics are required to assess how well the Health Board investments are delivering tangible research benefits relative to the funds deployed. With clinicians indicating that there are still unmet needs to support ongoing studies (e.g. research nurses) there may also be a need to assess the prioritisation of the resources. The paramount priority for deployment of resources in CSO Funding Agreements with the Health Boards is supporting current studies; we will ensure this principle is clearly applied across all our investments, with funding being redeployed where necessary.

3.10 The aforementioned £10m infrastructure allocation was delivered as a redeployment of resources already allocated to Health Boards for NHS Programmes of research. Those Programme funds often had little relationship to the scale of the wider research activity in those Boards and as a consequence the deployment of these resources has been seen as inequitable by those Health Boards who were relatively underfunded. From 2016 CSO will revise the allocation of underpinning infrastructure funds to ensure a more equitable deployment of resource based on activity.

3.11 With the current NRS Infrastructure contracts terminating in March 2015 it is also important to review the impact of specific infrastructure investments rather than make broad judgements covering the totality of the resource deployed.

3.12 CSO therefore intends dividing the NRS Infrastructure allocation into specific areas of investment, with each area being managed as a distinct budget. Under this arrangement, underpinning infrastructure deployed to support current needs (such as research nurses) will be managed and assessed separately from strategic investment for the future (such as national networks of biorepositories and health informatics 'safe-havens').

3.13 Such an arrangement will facilitate a phased approach to the review and contracting for NRS Infrastructure investments, rather than the full £50m investment over the 5 year period being evaluated en bloc. This will ensure any movement of funds is incremental. It will also ensure that the anticipated outputs from each area of investment can be properly projected and measured. Early priorities for such review are the £1.1m per annum investment in NRS Biorepository network, and the £0.9m per annum investment in safe havens.

3.14 For NRS Biorepositories, CSO is keen to ensure than an appropriate emphasis is placed on the creation of a network for the supply of tissue for non-commercial and industry research, with resource deployed on a scale proportionate to that output. Collection and retention of human tissue that is unlikely to be required for research purposes is both costly and unethical. To date there has been little focus on matching resource to anticipated need, while the ongoing collection, storage and management of tissue creates increasing pressures on limited CSO resource and expectations for continuing funding.

3.15 With stratified medicine assuming greater prominence we anticipate an upturn in demand, but whether that will focus on the provision of fresh tissue or utilise the investment in stored tissue, and on what scale, is yet to be determined. It is important that this demand is properly assessed and matched with investment. A review of the NRS Biorepository opportunities and investments will be conducted in the course of 2014-15.

3.16 Likewise, the rapid development of health and bio-informatics research infrastructure in Scotland, following the launch of e-DRIS and the development of the Farr Institute, requires us to ensure that the NRS safe havens investment is suitably targeted towards a national network and adding value. We anticipate that a fully functioning network of NRS safe havens will be a valuable resource, both in its own right as a vehicle through which research quality data can be accessed and as a resource that will support Farr research activity. Income will flow from activity associated with both these routes and will therefore be a proxy for demand. Given the stage of development of Farr, and the need to have clear governance and independent inspection arrangements in place for the safe havens, CSO recognises that an early review similar to that for Biorepositories would be premature. A review of the NRS Safe Haven opportunities and investments will therefore be conducted in the course of 2016-17.

CSO Core Funded Research Units

3.17 CSO invests in six Units:

• The Health Economics Research Unit
• The Health Services Research Unit
• Institute of Hearing Research
• Social and Public Health Sciences
• The Nursing, Midwifery and Allied Health Professions Research Unit
• Scottish Collaboration for Public Health Research and Policy

3.18 The Units' chief role is as centres of excellence for research disciplines that are central to Scotland's health needs. Total investment in Units represents £3.9m or 5.8% of CSO's annual expenditure. Each Unit enjoys an effective working partnership between the CSO and the Units' host institutions, and in three cases the Units are co-funded with the Medical Research Council. All Units are subject to a quinquennial review ensuring a strategic "fit" with CSO's priorities; a parallel scientific review is intended to ensure that their work contributes to the Scottish Government's strategy and purpose.

3.19 Given the scale of this investment, CSO needs to ensure that the relevance of each Unit to CSO's Strategic direction is regularly reviewed and assessed against the funds deployed. Similarly there is a need to ensure that the areas of work undertaken within the Units are a priority for CSO or Scottish Government colleagues. Finally, Units provide different functions such as undertaking research in areas of strategic need, providing policy advice and capacity building. These are quite different functions, possibly requiring different scales of investment over varying periods.

3.20 The CSO Units are an important investment and our intention to review their strategic fit and purpose is not through any discontent with their performance; however to review all other major areas of investment and omit the Units would not be sensible. CSO will therefore conduct a strategic review of Unit purpose and funding in the course of 2015-16.

Question 12 - What should determine the creation and continued funding of a CSO unit? Should any new unit have a plan for CSO funding to be time limited?