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COMMENT ON THE RECOMMENDATIONS OF THE WILLS COMMITTEE
23 April 1999

General comments

The Academy congratulates the Wills Committee on the thoroughness and comprehensiveness of the Strategic Review of Health and Medical Research. It is particularly insightful and paints an exciting vision for Australia's health and medical research future. It is strongly endorsed by the Academy and Government is encouraged to act swiftly to grasp the momentum and unity of purpose generated by the Committee's recommendations. While the bench-marking against international development in this sector is very comprehensive and the spectrum of recommendations from the Review is very broad, there are several major points which are of fundamental importance to achieving the vision articulated by the Committee. These are:

• An effective doubling of the NH&MRC budget over the next five years with continued higher levels linked to the achievement of agreed health and economic outcomes over the next five to ten years. It will be important that such outcomes are agreed upon by the range of stakeholders and defined realistically. As indicated below, the Academy believes the evaluation of these outcomes is best done as part of a general review analogous to the present Review. The practical achievement of this process will also be very dependent upon implementation of the recommendation to appoint a full time professional group of leadership and management within the NH&MRC.

• Although the Review contains numerous important recommendations aimed at enhancing the involvement of industry in Australian health and medical research, the single most important recommendation is for Government to implement a capital gains tax regime in the area of venture capital support to ensure an adequate flow of capital to new biotechnology enterprises. In the absence of effective implementation of this recommendation, progress in this very important area will only be marginal.

• The Review clearly articulates the necessity for developing an effective approach to the provision of infrastructure for research activities. The recommendation that equitable mechanisms for infrastructure funding be linked transparently to the level of competitive peer-reviewed grants, is desperately needed to help eliminate the historical, inadequate, and extremely complex arrangements that have arisen over the past decades.

• The recommendations focussed on improving the quality of Australia's investigator-initiated peer-reviewed research are particularly important, especially the emphasis on removing current barriers to the mobility of research workers and their funding between institutions, and the encouragement of the formation of larger multidisciplinary investigator-initiated research programs and networks.

• The recommendations associated with the necessity for developing a more effective priority-setting program and process address a very important and difficult set of issues which can only be effectively managed through implementation of the recommendations related to an enhanced NH&MRC management structure.

Comments on specific recommendations

2.1.1 Reinforce individual investigator-initiated, peer-reviewed research, appropriately fund competitively selected research projects, and remove barriers to mobility of researchers and their funding between institutions, including block funded institutes.

Two of the core recommendations under this heading (fully funding projects and paying true salary costs) are unexceptionable and should not be controversial given the proposed increase in NH&MRC funding. It should be stressed, however, that salaries for more junior research staff come from one-line grants and adjustments for real salary costs for such staff are also necessary if the value of each individual one-line grant is to be maintained. The proposed portability of grants between institutions and into and out of block-funded institutes, when taken together with the proposed break-up of block funding into a core facility grant (a Director's grant) and multiple project and program grants, will lead to the development of a real market for research groups such as that which developed in the UK with the introduction of the Research Assessment Exercise. It will become possible for institutions to recruit high profile groups but whether Institutions benefit from this will depend on their capacity and willingness to enter the market place.

2.1.2 Where appropriate, encourage larger, multi-disciplinary, investigator-initiated projects, research programs and networks.

The proposal to shift from small three-year grants to larger five-year grants is sensible given the proposed increase in NH&MRC funding which it is hoped will maintain grant success rates in the range 25-30%. The Review's strong support of the Network grant system needs to be tempered by the knowledge that the NH&MRC has yet to run a single round of these. The guidelines for Network grants (published in 1998) require financial input from Government, industry and research institutions. The conditions may suggest that the objects of encouraging collaboration and of supporting applied R&D have been confused.

2.2.4 Improve research career development to create opportunities for, and reward the best researchers.

The aim of this recommendation, namely to create real career structures for high quality research workers, is laudable and is strongly supported by the Academy. Nevertheless the proposal to increase the number of research workers entering the career stream at junior levels and to reduce their promotional opportunities by placing quotas on the number of available senior positions is probably unworkable and certainly will not encourage talented research workers to enter and stay in research careers. It should be noted that such a pyramidal staffing structure does not exist in research-active University Departments - the concept of a fixed established quota of Professorial and Associate Professorial positions in Departments in which Senior Lecturer positions are the career grade does not and could not operate in research-active departments. As a particular example, a research-active Department (unnamed) at one of the G8 Universities (unnamed) employs 15 Academic staff: these include 7 full Professors, 3 Associate Professors, 3 Senior Lecturers, and 2 Associate Lecturers. While the Department concerned would like to appoint more younger staff, it has no wish to dispense with the services of its very productive senior staff. For the same reason, no Department would wish to lose the services of an NH&MRC-funded Principal Research Fellow merely because there was no quota place available for their promotion to Senior Principal Research Fellow. The Academy believes strongly that promotion on merit must continue to be available for all productive research staff funded by the NH&MRC and that the problem of senior staff who become unproductive should be dealt with directly by use of appropriate performance management procedures.

The Academy believes that means need to be explored whereby research staff can follow dual careers in partnership either with a University or with industry. This would require the University or the industrial partner to join with the NH&MRC in making conjoint appointments at relatively junior levels and allowing such staff to work full-time at research during their most productive years whilst having the opportunity over time to develop other skills of particular value to the partners. Some of these staff would slowly transfer into roles in which research was no longer predominant; others would remain in research and should be able to feel confident that promotion was always possible when merit could be demonstrated.

3.4.2 Disseminate knowledge widely to practitioners, managers and the community to build understanding and bring pressure to adopt best practice.

The Academy does not support the proposal that research findings should be presented to decision-makers prior to their acceptance for publication in peer-reviewed journals although it accepts that the assessment of IP implications have to be dealt with before publication. Whilst acceptance for publication by a high quality, peer-reviewed journal is not a cast-iron guarantee that research findings in a particular study are repeatable or true, the process does filter out papers in which the data are internally inconsistent, are based on poor methodology, or are inconsistent with current knowledge. The Review's proposal would remove even this limited safeguard.

5.1.1 Appoint as full-time Chief Executive Officer an eminent scientist with leadership and management skills to lead and reshape the NHMRC to realise its full potential as the peak body for health and medical research. 5.1.2 Support the major NHMRC functions with full-time senior managers with strong research or health care backgrounds and dedicated, research-literate secretariat staff while retaining the Office within the DHAC. 5.1.3 Provide governance and advice needed in the context of these full-time management initiatives by recasting the roles and composition of the Council, the Council Executive and the Committees. 5.1.4 Strengthen NH&MRC obligations and linkages to the DHAC and other health departments and bodies through formal agreements. 5.1.5 Assess NHMRC's administrative funding in the light of this reorganisation, the roles of the NHMRC envisaged by this Review, and relevant international benchmarks.

The Academy supports the proposals contained in Section 5.1 (1-5) very strongly, but it wishes to point out that high quality specialist administrators are as difficult to recruit, train and retain as high quality scientists. They are also very expensive. Given that the aim of funding research is to produce good quality science, care will need to be taken to ensure that the administrative structure is appropriate and not larger than is necessary to achieve the laudable aims expressed in this section.

5.2.1 Involve the community in the research process and communicate about the role, benefits and results of research, consequences of new fields such as genomics, and ethical issues.

The report suggests that allocations for disease-related or organ-based streams should be influenced by community involvements in the decision making and/or priority setting processes. Whilst community input is valuable and should be sought, the Academy believes, as the report goes on to say, that resource allocation should still be based ultimately on excellence and innovation, as assessed by peer-review. The Academy supports the concept of defining broad research areas that are to be given some priority in funding, but ample scope must always be left to identify and fund high-quality proposals in all areas of medical sciences. Predicting the future will be no easier for those funding medical research than for planners in other walks of life. Would the elimination of gastric ulceration due to Helicobacter have been designated in advance as a priority area for Australian medical research?

5.2.2 Develop an effective, cohesive voice in the research sector for communication to politicians and policy-makers.

The Academy believes that the Australian Society for Medical Research is already fulfilling this role and could be assisted to develop it further, perhaps in collaboration with the Australian Academy of Science and other relevant bodies.

5.3.1 Increase government investment in contestable NHMRC funding by an average of 15% per annum over the next five years, under specific conditions, and invest immediately in several priority initiatives required to drive reforms.

The Academy supports the proposals in principle but is concerned that the funding could suddenly be withdrawn after 5 or 10 years according to whether as yet undefined criteria to do with financial benefits and improved health outcomes have been met or not. The Academy believes that a more broad-ranging review of research funding, such as that embodied in the present Wills Review, should be conducted periodically, say every 7 years. These Reviews would attempt to identify which funding policies had been successful and which had not, and to reshape policy accordingly. Assessing outcomes in terms of financial benefit and improved health should be attempted but these may prove difficult to define and to attribute to particular research programs. Treating gastric ulceration by treating Helicobacter infection improved health outcomes everywhere, not just in Australia. Improvements in health outcomes due to advances in medical research have to be assessed in global terms.

5.3.3 Develop a coherent approach to infrastructure funding for research.

The Academy is concerned that these proposals seem dependent on the willingness of State Health Departments to surrender control of that part of their discretionary budget that they allocate for support of research infrastructure. Since it seems inherently unlikely that all State jurisdictions would agree to such a proposal, the Academy feels that developing an alternative strategy to deal with research infrastructure needs should be developed so as not to hold up implementation of other proposals.