Women and Equalities Committee
Oral evidence: Female genital mutilation (FGM), HC 296
Wednesday 1 July 2026
Ordered by the House of Commons to be published on 1 July 2026.
Members present: Sarah Owen (Chair); Dame Nia Griffith; Christine Jardine; Kim Leadbeater; Kevin McKenna; Richard Quigley.
Questions 48 - 78
Witnesses
I: Baroness Merron, Parliamentary Under-Secretary of State for Women’s Health and Mental Health, Department of Health and Social Care; Professor Lucy Chappell, Chief Scientific Adviser, Department of Health and Social Care, and CEO, National Institute for Health and Care Research; Professor Ramani Moonesinghe, National Clinical Director for Perioperative and Critical Care, NHS England.
Witnesses: Baroness Merron, Professor Lucy Chappell and Professor Ramani Moonesinghe.
Q48 Chair: Good afternoon and welcome to the Women and Equalities Committee. Today we are holding an oral evidence session to follow up on our report on female genital mutilation, which will probably be referred to as FGM throughout the course of this session. We will hear from Baroness Merron, Parliamentary Under-Secretary of State for Women’s Health and Mental Health, Professor Lucy Chappell, chief scientific adviser at the Department of Health and Social Care and CEO of the National Institute for Health and Care Research, and Professor Ramani Moonesinghe, national clinical director at NHS England. Welcome to you all and thank you for coming.
The first question is to Lucy on reconstructive surgery. Are you happy for me to call you Lucy?
Professor Chappell: Please do, yes.
Chair: Excellent. You accepted this Committee’s recommendation that the Government fund a trial for reconstructive surgery for FGM survivors, yet both applicants to the research call—experts in the field of reconstruction and support for FGM survivors—were rejected. Applicants were told only that the funding opportunity may be “possibly readvertised”. Following our invitation to attend this Committee you wrote to us stating that you now intend to continue to take this funding forward. Why did the NIHR not inform applicants that it still intended to fund a reconstructive surgery trial rather than simply issuing a rejection letter?
Professor Chappell: The NIHR seeks to fund high-quality, impactful research that is really going to have an impact, particularly for groups like this who are typically under-represented in research. We would very much have liked to take one or both forward but we had an independent committee who assessed it and recommended that we should think again about it. We have since held a workshop with both sets of applicants and very much encouraged and supported them—going further than we usually do to work with the applicants—to get a fundable application. Your report called out the many difficulties with this particular topic because it is much more multidisciplinary, and working with patient groups is so critical. This is psychosexual expertise and surgical expertise, and it is a pretty uncharted area. We have taken a very proactive approach and have already held that workshop. We are reopening and going straight to a full call so that we will then move forward.
Q49 Chair: It is interesting that you said you have taken a proactive approach. You have taken a proactive approach now; you were not proactive before. The simple rejection letter said that it might “possibly” be readvertised. There was no offer to work with the applicants previously when it came to the rejection of these bids. You talked about under-represented groups in research. This is obviously an area where there are hugely under-represented groups. You said that you have gone above and beyond. That is something I would expect your organisation to do, particularly with under-represented groups. That is not extraordinary; it should be part of your job.
Professor Chappell: You are absolutely right. We have all those services available to our applicants and the huge majority of applicants—even in really contentious topics—usually use those as they prepare an application. It is unusual for us to go back and work with the applicants to this extent, because services such as our NIHR research support service are freely available and very well advertised, and applicants, who typically come from research-intensive universities, will know how to do that both within their institutions and with NIHR services. Even in topics like this—we regularly have topics that involve under-represented groups, where we have a whole suite of resources—it is unusual for us not to be able to take one of those forward. Of course, in hindsight, we could have framed our letters better. Of course we can think about that, but you do not always know how you are going to frame those next steps at the point when a committee is sending out a decision.
Q50 Chair: In terms of the political steer, it was very clear that the Government had allocated the funding for this research.
Professor Chappell: Yes.
Chair: Both my Committee and the Department of Health and Social Care were very clear that there is a political and moral need for this work to continue. This is not the first time we have had a similar conversation about trials not reaching a certain standard that you have decreed. We have seen pots of funding sitting that have been allocated by Governments of various political stripes, and we have had these conversations about what your organisation is doing to work with researchers to improve the process of you getting the money out of the door to make a difference to people’s lives. The funding call stated that applicants were expected to include co-applicants with lived experience. These are hugely traumatised individuals. To what extent did you consider the impact on FGM survivors when taking the approach that you did?
Professor Chappell: This is the view of the independent committee. Just to give you a flavour without going into the details of the applications, there was a recognition that approaching this from a purely psychosexual or surgical approach was not going to give us the right application to take forward, so putting that pause in also gives the opportunity to try to bring groups together. We really respect the lived experience and what that means but we think that often the solution is to bring people together in a workshop and give them the opportunity to create the best application. If you are going to take an application of this sort forward and support the community, it is essential that it is done with the best team; otherwise, we are heading into a trial that will not address the needs of the women and will not give the evidence that would actually change guidelines.
Q51 Chair: When did you decide to take that workshop forward?
Professor Chappell: I could look and get back to you with a written answer. You have mentioned other times when we have taken a pause and asked, “What did we see? What are we trying to get to? What is the bridge?” It will be a bespoke package, to say—I am being slightly hesitant because there are details about the applications that I am not able to share in public that meant we needed a considered approach, particularly in terms of whether we were going to bring the two applicant groups together or push on. That has been some of the discussion, which is why we wanted to make sure we got the approach right, mainly because—you are absolutely right—if you go out to particularly the lived experience groups and get it wrong it does not help the experience of research.
Q52 Chair: Looking back at the approach that you have taken, do you think you would perhaps have offered more support during stage 2 of the application process to ensure applicants met the required criteria?
Professor Chappell: There were circumstances, with two competing applications, where we felt that before progressing with stage 2 we needed to explore whether it was better for the community to bring the groups together. We sometimes do that where we see complementary expertise in two separate applications and we think it may be better for the research to explore whether they would come together. Sometimes they will and sometimes they will not; that is their choice. We cannot make them come together, but we can work with them to say, “We really understand”—and the Committee report has made this very clear—“that you need a multidisciplinary, comprehensive approach.” It was because we wanted to continue with it but do it in the best way that we could. We knew that we were going to continue to readvertise it. I think the letter has not made that clear—I accept that.
Chair: No. It says, “Possibly readvertised”.
Professor Chappell: We do have some other options for whether we readvertise or go through different routes. There are cases where if we do not think the right expertise is there, we sometimes do development work or look at our infrastructure. We have a suite of options available. If you have advertised once and not got the right standard then you can ask, “What would lead us to a successful application?” Just doing a readvertisement of the same thing may not lead to a different result unless you have done some work. As much as anything it is about taking a step back and asking, “Is there other expertise we can draw on? Are there other routes we should consider that may still reach the applicants and those with lived experience?” It should not be a one-size-fits-all, particularly if you have had a not-successful application.
Q53 Chair: Were any of these unsuccessful applications reassessed—as I have pushed for with other areas of your work that have been unsuccessful in getting money to where it is needed in healthcare research—independently from your committee?
Professor Chappell: Yes. They are already—
Chair: Was there any other work about the decision that you had taken that—
Professor Chappell: They are already assessed independently and that is the way. They then go to the programme director and, if necessary, to the scientific director for alternative scrutiny. I should say that the huge majority—well over 99%—of our applications go smoothly. We have a very high application rate, as do many Government funders at the moment. I am conscious that you are seeing the ones where it has not gone smoothly and we constantly ask whether that process can improve.
Chair: This is really important because, as we have heard, this is a hugely under-represented group of women who are highly traumatised. Other countries are light years ahead of us in reconstructive surgery and offers of reconstructive surgery for FGM survivors, and in complications in terms of maternal health, too, because many of them only present when they are giving birth. This is why I am asking why extra work was not done at the beginning of this and why, when they were rejected, it took a long time for them to understand that there would be support for them to reapply.
Q54 Richard Quigley: You went through a process of bids and you say it went to the committee and it did not meet the threshold of high-quality research. How do you assess that threshold? Are there metrics? Is it inputs or outputs? It just seems like a process that is guaranteed to fail.
Professor Chappell: As I say, it is a highly successful process used by pretty much every Government funder around the world, and the huge majority of our funding calls—
Q55 Richard Quigley: How did you make the decision in this case? What level was not met?
Professor Chappell: It will be assessed on multiple levels: usually scientific quality, deliverability, impact for patients and public, and value for money.
Q56 Richard Quigley: So the bidders had that framework in front of them. They knew what you wanted.
Professor Chappell: Our application guidance is extensive and these are typically from experienced applicants; it will not be their first call. We like to have a pool of maybe 12 applicants and successful applications will typically come from people who have deep experience in the field and know how to put together a successful application.
Q57 Richard Quigley: When the bid failed, were they given the reasons why it failed?
Professor Chappell: They will be given specific written feedback and then, as I have said, we will normally reconsider the best way to get a successful application and our routes. I know that the programme director has been looking at this with the consultant adviser to the programme asking what we could do. As I say, the complication in this case was there being two groups and wanting to explore whether it was the right thing to bring them together. Professor Moonesinghe has a parallel experience from her NHS England role as to how to bed this in the services, and what the services look like at the moment. Our reading has emphasised how the importance of psychosexual alongside surgical means that if you do not have the right teams and package in the application then pushing them forward to stage 2—it is a bigger cliff edge to not fund at stage 2 than to get it right at stage 1. Sometimes it is reparable between stage 1 and stage 2; sometimes it is up to us to take a pause.
Q58 Chair: You said that ideally you like to have 12 applicants. In an area like FGM, that is not realistic.
Professor Chappell: No, no—not ideally. I am saying you may have—you have who is right for the team. You say, “Who provides care for women with FGM?” For example—
Chair: No one at the moment.
Professor Chappell: Well, there are multidisciplinary teams.
Professor Moonesinghe: We can perhaps talk about that.
Chair: Not in Northern Ireland there aren’t.
Professor Chappell: But there are FGM clinics.
Professor Moonesinghe: There are FGM clinics.
Chair: Okay. I am going to pass on to Kevin to ask about evidence for reconstructive surgery.
Q59 Kevin McKenna: Before I start, I have to declare an interest because Professor Moonesinghe and I worked very closely for quite a long time at UCLH in critical care and post-anaesthetic care. We have been at NHS England together but not in the same team. I just want to flag that up.
I would like to talk a bit more about the evidence and the evidence base and how we get to an evidence base. Both the World Health Organisation and the Royal College of Obstetricians and Gynaecologists have stated that the evidence around clitoral reconstruction is weak and limited. Given the UK’s position in biomedical research, its strengths, and the opportunities that we have because of the nature of our population, why have we not led the global efforts to get a decent evidence base?
Professor Moonesinghe: Thank you, Kevin. I think this alludes to some of the things that Lucy was talking about in her statement just now. The care of people with FGM has to take a holistic approach, which includes primarily the psychological assessment and delivery of psychological care to these patients, and then alongside that, consideration of surgical interventions where those interventions have a strong evidence base. As you know, we do provide deinfibulation surgery but at the moment—as you have said already—there is no evidence for clitoral reconstruction. That is interesting because we do some clitoral reconstruction-type surgery for different indications. For example, patients who have had vulval cancer may have it, but this is a completely different clinical context.
There is a statement in the Committee’s report that we must have the surgical expertise in this country because we provide surgery for women who have had vulval cancer and for gender reassignment, for example. However, when I talk to clinical colleagues who are experts in this area, including in surgery, they tell me a slightly different story, which is that if you are doing gender reassignment surgery it is a completely different context from treating a woman who sadly has been scarred as a result of FGM. Even in the case of vulval cancer, where of course there will potentially be some scarring from surgery and radiotherapy, it is a completely different age group and the psychological needs are very different.
All this points towards the fact that we need evidence generated from research that takes a holistic approach to the treatment of people who have suffered FGM. The evidence is really weak and I have reviewed quite a lot of it. A scoping review published a while back cited 40 studies. They were very low quality indeed: small case series and no randomised trials. A lot of them came from the same author group, which is often a bit of a red flag when looking at evidence, because of course those types of evidence are potentially biased.
You ask why we are not leading the charge on this. Lucy has given her answer about how we are trying very hard through the NIHR to commission research that will answer the right question in an absolutely rigorous way and give us a complete answer for the patients we want to help.
Baroness Merron: There have been three NIHR-funded areas of research relating to FGM. I am happy to send the details, but I will briefly give the headlines. The one that came to an end most recently was in March 2025, and that was about improving specialist services. Another was a qualitative study exploring the views of survivors, health professionals and male partners. The other one, which is from some years ago, is about improving care, and that is more of a qualitative one.
I say this not as a clinician but from a ministerial point of view: as I know you know, we follow the Haldane principle. We set the strategy but the decision has to be made through the independent group, which is peer-reviewed. Obviously I can only respond to the advice that is given and the situation that is presented. I am not ducking the question, but while FGM comes in my brief, research does not; that is for Minister Preet Kaur Gill. I understand the Committee’s line of questioning and the challenge and I think it will be helpful—as was the report before—to drive things forward. But at the end of it all, as I know colleagues know, if we do not have the research—and I think it begs the question, “Why don’t we have the right research applications?” But we want to fund the research; that is our wish. We do not believe there is enough evidence and we absolutely want to get it right. I want to establish that commitment to the Committee.
Q60 Kevin McKenna: The WHO slightly shifted its recommendation last year to a conditional recommendation for clitoral reconstruction. Has the Government or the NIHR taken that into account and maybe changed on an ad hoc basis?
Professor Moonesinghe: It made a conditional recommendation but recognised the fact that the evidence it was basing it on was of extremely low quality. We have a different threshold for considering evidence when we commission services in the UK. We do not have anything that would reach the threshold of commissioning. This is not about cost; this is about potential risks. We do not know the potential harms associated with this type of surgery either. That is the reason why just following the WHO recommendation, which was a conditional recommendation, as you said, based on weak evidence, would not fit with our general approach to how we commission services and deliver healthcare.
Q61 Kevin McKenna: What potential harms do you think there could be from this sort of surgery given that we know quite a lot about other forms of genital reconstruction?
Professor Moonesinghe: It is the specific context of the women who have endured this terrible harm. It is that holistic package. The surgery is very unlikely to be sufficient in and of itself—that is all I am saying. It has to be parcelled up with psychological support as well. My colleague at UCLH who runs the only paediatric FGM service in the UK says that when her patients, who are usually in their teens, come to her, they have disclosed it often as a result of asylum applications and so on, and they are not psychologically ready for anything interventional. They need to be supported from a psychological perspective first before anything can be considered. That is lived experience. There are case studies that they have written up demonstrating the lived experience of running a service like that. What I am saying is that the circumstances for which you would have clitoral reconstruction after vulval cancer surgery, for example, are quite different from this context, and we cannot just move evidence from that place over to this.
Q62 Chair: Professor Moonesinghe, what are the dangers and the increased trauma levels of doing nothing for patients who we know suffer huge health complications including pain, incontinence, difficulty with fertility, and serious complications at birth? Why is doing nothing a more suitable option than perhaps taking forward some reconstructive surgery?
Professor Moonesinghe: I am going to caveat what I am about to say by saying that I am not a gynaecologist or a surgeon, but my understanding is that the deinfibulation procedure is the procedure that is indicated for patients who sadly have had type 3 FGM and are the most likely to have problems with urination, menstruation, childbirth and so on. That intervention is available for people who have those physical problems.
As I say, I am not a subject matter expert, but when it comes to clitoral reconstruction my understanding is that it is usually more for psychosexual harm and so there is a big psychological element to the support that these patients can be offered, which is offered in FGM clinics that are running across the UK and in the English NHS. The psychological support-first approach seeks to address some of those challenges. Of course it will not necessarily help with pain or physical problems such as problems with urination and so on, but my understanding is that deinfibulation is the main intervention to help with those because of the type of harm they have endured.
Professor Chappell: You might also ask if it would be appropriate to offer clitoral reconstruction surgery without an evidence base. If we look at the track record of where previous gynaecological surgery has not adequately had a good evidence base—whether it is mesh or other areas—we can say that you have to get the evidence base as to the benefits and the harms and present it to the women. It is clear from the literature that when you present the options women do not always go ahead. On the approach to considering reconstructive surgery, you have to ask what the right offer is and even what the right surgery is. As Ramani was saying, if our understanding of clitoral reconstruction surgery comes from groups of women who have not had FGM, that is not the appropriate evidence base to say, “Now we know what to do surgically.” Given the different types of FGM and what they have been through, these women deserve more than ever that we ensure that we are doing the very best possible.
Q63 Kevin McKenna: I suppose the thing is that because, obviously, this is typically migrant women—women from underserved communities full stop—notwithstanding all the issues around medical misogyny and all the layers of that, and the fact that quality is important, not moving this forward at an accelerated pace shows a lack of care for these underserved communities. What would you say to that?
Baroness Merron: I would say that we have a duty to everybody—I know the Committee and its individual members would absolutely share this—about safety, effectiveness and cost. That is just a standard application, as I know the Committee is aware, and it applies in this situation. I do not want to say that we have an extra duty of care in this regard, but I do think that where we are speaking about groups who are more exposed and more vulnerable, in the way that you describe, we have an absolute duty to support them and ensure that the care offered is all the things I have just described, and that they have the information available in the way that they need it and want it, and in the right place.
Professor Moonesinghe: I will add that the NHS provides the care that it provides to people irrespective of their status in terms of recourse to public funds. If somebody is disclosed as having FGM and there is an intervention available on the NHS, they will get it. That access is open to everyone irrespective of migrant status and so on.
Baroness Merron: I really do emphasise the point that was made when we were talking about deinfibulation: that absolutely is available, as well as the support that goes with it, not least of all through our 24 FGM support clinics that give very specialist support and a range of services and can be accessed through self-referral. It is really important to me that you do not have to go through hoops to get there.
Professor Chappell: The only other thing to add is that we know there are treatments and surgeries available in other countries that do not always have the same evidence base that the NHS and NICE expect. NICE is held up as an international standard for assessing evidence. We can think of a number of different types of surgery, such as cervical fusion surgery and spinal surgery for Ehlers-Danlos. In my area, when I see the treatments offered to women seeking fertility treatment abroad, they are offering treatment to women at a very vulnerable time of their lives and the evidence base can sometimes be minimal or absent. There is the importance of getting the evidence at a pace and with an appropriate approach, but it is important that we do not cut corners.
Q64 Kevin McKenna: Is that true for countries like France, Germany and Australia, all of which offer reconstruction in these circumstances? Are they operating under very different medical guidance and decisions? Have you had discussions with clinical bodies in countries such as France, Germany and Australia about this?
Professor Chappell: We are aware that there are some surgeons operating. That would typically be, in some countries, depending on their healthcare system and how you access the healthcare. In any country, depending on the private and the public healthcare system, we know there are countries offering it. It depends on whether it is in national guidance, and the WHO guidance is very clear on where we do have evidence, but being very explicit about low-quality evidence. If you go to the papers and you see that there are single case studies, that is not sufficient for the NHS to commission a service. We are doing that step, and we are seen as global leaders by taking forward the trial, to say, “What is the evidence?” If a woman needs to ask a doctor, “What are the outcomes?”, we cannot quote it from the literature.
Q65 Kevin McKenna: Do you know why licensed and registered medical facilities and practitioners in those countries are offering these surgeries? What evidence base are they using?
Professor Chappell: I have a list of all sorts of treatments—stem cell treatments for neurological diseases, cancer immunotherapies, fertility treatments, spinal surgery—which are offered in other countries and they will be doing their evidence synthesis. Our evidence synthesis—and really clearly, if you look at the WHO one—is saying, “We do not have a body of evidence and we do not have trials,” which are typically seen as the way to provide a sufficient level of evidence. We do not know what the outcomes are following these surgeries, and I think those women deserve that level of evidence.
Q66 Richard Quigley: Would you say France, Germany and Australia have healthcare systems that are good, average or below average compared to the NHS?
Professor Moonesinghe: Of course they have good health systems.
Q67 Richard Quigley: We know that women who are victims of FGM travel to places like France and Germany for reconstructive surgery. Are we saying they do not know what they are doing, or we do not understand what they are doing with that surgery, or we do not agree with the surgery? I am struggling to understand why a healthcare system in Europe, just over that stretch of water, which by your own admission is good, offers surgery and we do not.
Professor Moonesinghe: We can only reiterate what we have said, which is that the evidence is the evidence. It has been sourced from all over the world; we are not limited to evidence available in the United Kingdom.
Q68 Richard Quigley: Is this a self-imposed handbrake based on a system that has always existed, or is there something I am not understanding?
Baroness Merron: I spoke about Ministers setting strategy. I welcome the fact you have explained it in that way but I would not say there is a handbrake. I would say we are trying to resolve the issue through evidence, which we feel should come from the research that the Committee has rightly pressed us to do. We are seeking to get the evidence, the research and the trials in the right place. I definitely would not recognise a handbrake.
Q69 Richard Quigley: How would you explain to a victim of FGM who is looking at places like France and Germany why we are so far behind in terms of time?
Baroness Merron: From my perspective, the way the national health service is funded, run and so on is unique to the United Kingdom. All healthcare systems will be run in different ways. The thing I always focus on is the point that in commissioning services, which is where the Committee would like us to get to, we are back to clinically effective, cost-effective and safe. We have our standards, our way of doing it and our expectations in terms of research. I am not aware that we are an outlier in this way, but we have a particular issue here with a lack of evidence on an intervention, which, as was explained by my colleagues, does not stand alone. Surgery can be part of the answer but it is not necessarily the full answer. For some, even with surgery available, it will not be the right treatment for them, although in terms of opening fused scar tissue, which is a different intervention, that is absolutely available because it is clinically effective, cost-effective and safe.
Q70 Richard Quigley: Is the NHS having to manage patients who have been abroad for surgery and come back? What is that looking like? Are there additional procedures?
Baroness Merron: I asked that very same question—exactly so.
Richard Quigley: What was the answer?
Professor Chappell: There is medical tourism for surgery and treatments that are available in the NHS where people might make a choice to go abroad, and there is medical tourism for treatments that are not available in the NHS. Ramani, I don’t know whether you want to pick up from the NHS England side what we know about it.
Professor Moonesinghe: We do not have any specific data about the specific group of patients who are FGM survivors that have gone abroad for surgery. We do not have any specific data about complications when they come back.
Q71 Richard Quigley: We talk a lot about evidence. Are we collecting evidence of what has happened to patients who have been abroad? I am struggling. It feels like we are doing the same thing every day and expecting a different answer the following morning; no one is taking their foot off the brake. Correct me, Chair, if I am wrong, but it just feels like we are not progressing. I understand why—
Professor Chappell: We will have applications back in October. They will be assessed. They are going straight to stage 2, so we will not make them go back to the start, and we anticipate making an award because we are wrapping so much support around these applications. We have heard loud and clear. It is still right that you get a study—that we fund a study—that will get the answers that you are looking for.
Baroness Merron: And we want that to happen.
Q72 Richard Quigley: If you had a magic wand, going back to this process, what would you have done differently in these applications?
Professor Chappell: Given that under 1% of these calls come back with the decision, “Not suitable for funding,” if we threw working with applicants at all our calls, including these difficult ones, I think you would have me in front of you saying that was not a good use of resources. We target it. We have a whole package. We have research inclusion as a condition of funding. Despite all the wraparound we have, it did not work in this instance, which is why I am back here. But as I say, if we then offered it to the other 99%, that would take funding away from other areas that need it.
Q73 Chair: I understand we have a hard stop at 5 pm. It is two minutes past 5. Unfortunately, the votes pushed back the start time. We have a whole load of other questions. Are you happy to receive them in written form?
Baroness Merron: Yes, and we will of course be very pleased to be as helpful as we can.
Chair: Thank you. I am going to give the last question to Kevin. I am sorry to other Committee members that we did not get to their questions.
Q74 Kevin McKenna: If I am honest, from everything we have heard so far, it seems to me that there is no way we can generate the level of evidence to the threshold that you are looking for—that is what it feels like right now; that is what I think it feels like to a lot of service users—and that even if we do, it will not produce an answer that will allow the Government and the NHS to make a decision. What do you say to that?
Professor Chappell: I confidently expect that we will generate the level of evidence that would allow NHS England—and that is why we are working really closely with NHS England on that. A trial is very much more likely to lead to services being commissioned than case series with single people in them; that is not going to tell you whether or not you should be commissioning services across the country. Interestingly, we were ready to go faster on stage 2. It was the applicants and the lived experience groups who said, “We hear what you’re saying about driving high-quality research.” That might be frustrating but those are the groups we are working with. You are absolutely right: if we are going to change NHS England services it should be research that matters.
Q75 Chair: Professor Chappell, my frustration is that it is never your organisation and processes that are at fault; it is always those of the applicants. That is the case with this set of research bids as well as with other ones outside the FGM space. I think what Kevin is saying is: are you asking for a threshold that is far too high on something as specific as FGM and as specific as needing hugely traumatised volunteers to come forward from groups that will not be forthcoming in coming to work with organisations such as yours?
Professor Chappell: They were; they came forward and produced applications. Do you know what? It would be so much easier if we just said, “Yes, go ahead,” but if I was back here with a piece of research that did not change practice—that is what you are trying to do. You are asking how we will lead NHS England to commission services, and the answer is through this route. Of course you are hearing about this tiny percentage where it does not work, but we should recognise that we have funded thousands and thousands of studies because everyone got it right it right and everything came together.
Q76 Chair: But they are in areas that are already very well researched where we have seen huge amounts of progress. That is great; it is fantastic that we have seen survival rates for breast cancer and other cancers increase, but the areas where we have not seen increases in survival rates or improvements in treatment are those like FGM and brain tumours where you have failed to get the money out of the door because research bids do not meet your standards. What we are trying to say is: are those standards that you have set achievable in this circumstance?
Professor Chappell: If I could always predict the ones that would fall short then I would be running a different service, but we cannot because we fund hundreds and thousands of research studies in difficult areas every year. I could name areas from neonatal care to end-of-life care to disease areas that are seen as too difficult where we are funding every week. I am very happy to describe those to you further, which is how that approach works. That is done because we have had patient and public involvement and we are driving up the quality of the applications. As I say, if we do not get it right in one in 100 applications we can put in more support for the other 99 but I do not think that is an effective way. I take on your feedback and if I could always predict that this team were not going to come up with a good enough application—but we have named two areas. We have named brain tumours and FGM, but there are many other topics where we can say that we have taken really difficult areas and we have funded studies at the first go.
Q77 Chair: So you are comfortable with those two areas not being funded at the moment.
Professor Chappell: We are on the path to funding FGM. We have funded the brain tumour consortium. It is up and running and it is flying. It took a huge amount of work to get there and we recognise that support.
Q78 Chair: And a huge amount of pressure, in a similar way to what we have had to do today. I feel regretful because there is a huge amount of cross-party consensus, there is a huge amount of support from the public on this issue and there is a huge need—a need that is probably still under-calculated because we know so many women do not come forward until it is far too late for many of them.
Professor Chappell: That is why placing it in the wider services is absolutely critical.
Chair: Thank you. We have so many more questions and we will continue the conversation because we need to get to the bottom of this. We all clearly want the same thing; let us help each other get to that point. That brings this session to a close.