University of Surrey – Written evidence (LSI0077)

1. How can investors be encouraged to invest in turning basic life science research into new innovations in treatment? Why has investment been lacking in this sector? Does the research base have the necessary infrastructure to be world-leading?

1.1 Focussing on the last sub-question first, it is clear that the UK is world-leading in life sciences. Taking evidence from the Scimago journal and country rankings, the UK sits second after the USA in the impact of the scientific publications (measured as h index by SciImagao JR 2017, over 2006-2016) in; agriculture and biological science; veterinary science; psychology; pharmacology, toxicology and pharmaceutics; health professions; immunology & microbiology; biochemistry, genetics and molecular biology; neuroscience and nursing.

1.2 In the last decade, China has increased outputs and its total publications are now cited more as a nation each year than the UK in; Agriculture and Biological sciences; Biochemistry, Genetics and Molecular Biology; Pharmacology, Toxicology and Pharmaceutics. These are key areas for delivering innovation and have potential for economic returns. The UK remains second in impact but there must be continued investment in infrastructure to future-proof our position, so we are stronger and continue to deliver more impact in life sciences against increasing competition.

1.3 One approach to future proof basic science is to incentivise national research centres where capabilities can be linked or shared. Such centres should not serve to concentrate expertise but to enable collaboration through leading research hubs e.g. https://www.methodologyhubs.mrc.ac.uk/about/hubs/ , regionally and internationally, through working at a distance but sharing methods and linking capabilities.

1.4 The UK government should ensure that policies or assessment exercises do not inadvertently disincentivise interdisciplinary science. Much of the excellence that could be translated into innovation requires cross-disciplinary teams. For example in digital health and in diagnostic devices, two areas of potential for public health, contribution to the economy through direct revenue and through fitness to work, there is a need for biomedical scientists to work with data scientists and technologists to realise the opportunity. There is a funding and skills gap risk that must be met in future strategies to enable rapid forward movement.

1.5 Encouraging investors and industry to invest may require a different and more dynamic mind-set from investors, providing an entrepreneurial culture that protects patients while accelerating innovations to bring benefits for patients’ health and investors. This culture is better developed in silicon valley than in the UK.

1.6 Early investors who are active in the start-up biotech industry consider that the current capital gains tax system is a major disincentive. Instead, the financial incentive for investors is to make a quick and highly tax efficient exit, early on. This is at the time when the inventors are in need of further cash injections which may come from overseas corporate investment and buy-out. The inventor and the UK would lose from later investment from overseas if the control of the business and the ownership of technology defaults to an international partner. On the other hand, tax efficient dividends could encourage UK Biotech investors to be incentivised to stay beyond the early stage investment, this retaining UK ownerships and control.

3. What can be done to ensure the UK has the necessary skills and manpower to build a world class life sciences sector, both within the research base and the NHS?

3.1 This is a critical question. Ensuring the means for people flow, between sectors and countries, is an important facet for skills and workforce development.

3.2 At the undergraduate level, the Universities that excel in offering placements tend to report higher levels of graduate employability (HESA statistics). The likely reason underpinning this observation is that working in the real world during undergraduate training enhances the work-readiness of graduates. There is an excellent opportunity for delivering the manpower and skills for world-class life sciences into the NHS with the UK strategy to increase the number of medical school places and new Medical Schools. Within this framework, new curricula could be adopted to ensure that newly graduating doctors are equipped with the skills to be innovators, who are accomplished in the application of technology for healthcare and who can capitalise on the wealth of digital information e.g. https://www.surrey.ac.uk/faculty-health-medical-sciences/news/new-school-medicine-planning-stages-surrey Management, business development and leadership skills should be delivered alongside clinical education so that new graduates are empowered to effect innovation and change.

3.3 The UK has an important opportunity to capitalise on growing recognition of the One Health agenda – that the health of individuals in intimately intertwined with the environment and animal health. Our agricultural strengths and food production expertise, environmental awareness and surveillance and management of disease in animals has enormous potential to expand scientific knowledge and innovation in human health care.

3.4 An important focus for new medical school development lies in widening participation and apprenticeship routes. There are already examples of apprenticeship training within the NHS. The framework standards are already under development for Nursing and will enable experiential learning in paid employment for people who may not otherwise choose to access a higher education path.

3.5 Postgraduate research training that includes industrial partnership e.g. through CASE awards within the UK or EU RISE partnerships provides developing researchers with opportunities to better understand the impact of their research and how to realise the impact. Research Council funded students have been offered the chance to observe and get a better understanding of policy setting at RCUK. The opportunities for inter-sectoral training during researcher development already exist but could be profiled more and the advantages of such experiences be made clear to developing researchers.

3.6 Professional doctorates e.g. in allied health professions offer an opportunity for enhancing the quality and quantity of research skills, and is aimed at graduates who are already in practice e.g. https://www.surrey.ac.uk/postgraduate/health-sciences-integrated-phd and the Clinical Psychology doctorate, provide exemplary training e,g, for evaluating innovation in clinical practice. By increasing confidence and skills in the workforce, as well as inter-sectoral relationships, the opportunity for capitalising on life sciences sector development will be enhanced. Professional doctorate “trainees” represent a body of joint “appointees” between academia and the NHS. Simplifying the route to joint appointments e.g. contractually and pension arrangements etc, could increase mutual awareness and capacity for innovation.

3.7 People flow is key to bringing in the best manpower to build a world class life sciences sector, particularly at the post-doctoral level. There are some excellent examples of mobility funding provided through the Horizon 2020 programme. The UK should emphasise its commitment to people flow and highlighting career opportunities for highly qualified researchers, post-Brexit.

4. How does the UK compare to other countries in this sector, for example Germany and the United States?

4.1 For the research base / academic sector, we have benchmarked against the USA in our response to Q1. The UK is ahead of Germany in impact from research in the life sciences (measured as h index by Scimagao JR 2017).

5. What can be learnt from the impact of the 2011 UK Life Sciences Strategy? What evidence is there that a strategy will work for the life sciences sector? How can its success be measured against its stated objectives?

5.1 The 2011 strategy envisioned that the UK would be a global leader in life sciences, providing the best academic research, treatments and technologies through increased commercialisation. The strategy aimed to bring closer working and support for the UK private sector, researchers in academia and clinicians in the NHS. It listed a series of actions with a range of potential measureable outcomes. This latter point highlights one of the biggest challenges to impact – the need to effectively mobilise and coordinate different sectors that may be differentially engaged because of priority pressures. E.g. the stretch on NHS resources and time pressures that impact on prioritisation and capacity for local innovation evaluation.

5.2 Nevertheless, this has been aided by the Kent, Surrey, Sussex ASHN which has effectively promoted collaboration between the University of Surrey and the Surrey and Borders Mental Health Trust through the time for dementia project. This innovative two year project will use technology to enable People with dementia in Surrey and North East Hampshire to live in their own homes for longer. “Individuals and their carers will be provided with sensors, wearables, monitors and other devices, which will combine into an ‘Internet of Things’ to monitor their health at home. The information from these devices will help people take more control over their own health and wellbeing, with the insights and /alerts enabling health and social care staff to deliver more responsive and effective services.

5.3 The ‘Test Bed’ project aims to prevent or delay the need for costly long term care in nursing homes. It also aims to reduce the need for unplanned hospital admissions or GP visits, thereby taking the pressure off other NHS services. In the long term it is hoped that this approach will improve the care and quality of life for vulnerable patients while helping to save the NHS money.” The AHSN, developed under the Life Sciences Strategy has been a pivotal partner.

5.4 Another positive example of the strategy has been on the emphasis on access to the rich datasets that are available within the NHS for improved monitoring and risk identification. The Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) is one of the longest established primary care sentinel networks. In 2015 and it established a new data and analysis hub at the University of Surrey. It provides important weekly reports on disease prevalence, has promoted partnership in an extensive range of research with Public Health England and has facilitated real world studies of the interaction between factors such as physical and mental health, acute infection and chronic disease.

5.5 The emergence of the 2011 strategy was a huge boost to the sector, providing an important directional steer for researchers and increased speed for exploitation of research for patient benefit. Establishment of the Office for Life Sciences, appointment of champions and appointment of a Minister for Life Sciences has provided an important sentinel for research organisations in developing their strategies. It sends an important signal about the Government’s strategy for growth and inward investment.

5.6 The life sciences research pipeline towards drug discovery is long and leaky, hence some measures success will not be achievable in anything under 10 years. Nevertheless, some progress has been made through targeted investments in the Biomedical Catalyst funding. The focus on moving more rapidly into clinical trials has not materialised as we might have hoped, but the University of Surrey is preparing for future growth through its Medicines and Healthcare products Regulatory Agency (MHRA) approved clinical research facility and a newly approved Clinical Trials Unit (CTU).

6. Does the strategy contain the right recommendations? What is missing? How will the life sciences strategy interact with the wider industrial strategy, including regional and devolved administration strategies? How will the strategies be coordinated so that they don’t operate in ‘silos’?

6.1 The new strategy provides an excellent framework for developing the Life Sciences sector with clear recommendations for discovery and translational science, financial incentives to promote innovation through co-location and virtual working, an emphasis on digital opportunities and skills. Interdisciplinary is well-covered from the medicine to computer science to engineering to business perspectives. One area that has not been covered is the interface with veterinary medicine; it can provide both a platform for evaluation of interventions in “real disease” conditions and is an important sector e.g. in strategies for infectious disease monitoring and management. Emerging zoonotic threats are relevant to the UK for human health and food supply chain.

6.2 A key to success will be strong engagement between sectors at the local level and the roles of the AHSNs and LEPs will be key. Integration within sectors at the national level would be expected to bring added value rather than wasteful competition.

6.3 To minimise silo working, by locality and sector, the overarching Office for Life Sciences would be expected to play an important oversight and facilitator role. A related example of inter-locality participation was the DCMS-led 5G strategic venture that results in experts from King’s College London and the Universities of Surrey and Bristol, being awarded £16m to develop the cutting-edge 5G test network bringing together academic expertise and commercial leadership to trial the technology for rapid innovation.

8. Where should the funding come from to support the implementation of the strategy?

8.1 It is critical to raise the overall level of Government funding to meet the 3% of GDP target for research support. This is especially so given the counter pressures of Brexit, and keeping access to EU funding is essential.

8.2 A combination of industry and government funding has led to successful sector growth for the UK e.g. in space. Industrial challenge funding has been an effective way to leverage industrial funding and has worked well within biomedical catalysts. There is a need to increase the number of players who can access such innovation funds.

8.3 With the unique contributions of the charitable sector to Life Sciences R& D and innovation, an opportunity for charity challenge funding could support the bridge across the valley of death to innovation.

Importantly, basic science research will underpin successful innovation and the UK lags behind the leaders in life science research. To be successful in the industry strategy, an increase in underpinning science funding is urged so we keep ahead of the competition.

NHS procurement and collaboration

11. How can the recommendations of the Accelerated Access Review be taken forward alongside the strategy? Will the recent changes to the NHS England approval process for drugs have a positive or negative effect on the availability of new and innovative treatments in the NHS? How can quick access to new treatments and the need to provide value for money be reconciled?

11.1 A major impediment to the faster uptake of new medicines with demonstrated efficacy and value is around affordability. The Pharmaceutical Price Rebate system that was established between government and pharma to ensure that the cost of branded medicines stays within affordable limits will be of benefit if the cash accrued centrally is used to reimburse the local clinical commissioning group drugs budgets for the additional costs of expensive, good value, new drugs. Having effective financial incentives which recognise value for money improvements would help with accelerating uptake.

12. How can collaboration between researchers and the NHS be improved, particularly in light of increased fiscal pressures in the NHS? Will the NHS England research plan help in this regard? How can the ability of the NHS to contribute to the development of and adopting new technology be improved?

12.1 Collaborations between researchers and the NHS will be facilitated by visionary investment, sustained programme funding and affordable costs for treatments. The support for excess treatment costs that has been detailed within the NHS England Research plan offers a cost effective solution to increasing numbers of patients recruited to trials. Similarly, the visionary investment into 100,000 genomes project will offer an economy of scale for analysis and provide important datasets putting the UK at the forefront of personalised approaches to medicine.

12.2 Incentives for clinicians to make a greater contribution to research should be promoted e.g. through the NIHR talent programmes will place them in the driving seat for innovation, and as owners of new technology developments, they are more likely to act as leaders and proponents for new technology adoption. The Allied Health Professional workforce, including pharmacists, nutritionists and health psychologists have an important role to play in developing and adopting new technologies. NIHR programmes targeting clinical academic development within these communities could be enhanced.

Responsibility and accountability?

13. Who should take responsibility for the implementation of the Life Sciences Industrial Strategy and to whom should they be accountable? What should the UK Government’s role be? What should the role of the academic, charitable and business sectors be?

13.1 The Office for Life Sciences already exists and would be an obvious home for monitoring the implementation of the strategy – linking within existing frameworks offers the most logical approach. A government office implementer would offer the best opportunity to support a policy environment that underpins sector growth. It is important to stress the need for clarity of the respective roles of UKRI and BEIS here.

13.2 An important role for government through its industrial strategy has been in providing overarching challenges – this has effectively focused the minds of the community to work towards specific goals. Being a stimulus i.e. funder and a catalyst, through supportive frameworks rather than an instructor will be most likely to stimulate innovation. One of the perceived areas of slow growth within life sciences has been in innovation. Policies that support increased connections across the innovation chain e.g. industry, charities and research councils working closely together should enhance opportunities for innovation. The Charitable sector is an important funder in the sector but does not provide full economic costs for research. Increased support from government in recognition of this gap would be expected to stimulate further high quality engagement and participation between the sectors.

14. What is the role of companies within the sector, particularly the large pharmaceutical companies, in the implementation of the strategy? How are they accountable for its success?

14.1 A good example of how a successful pharmaceutical sector is complementary to excellence in life sciences is evidenced in Switzerland – considering impact of pharmaceutics research publications (Scimago), the number of publications per population is the highest in Switzerland which is home to Novartis and Roche (ranked 4 and 6 of the top 10 pharma, Igeahub 2017). Companies play an important role in funding, skills development and exploitation. Medtech and digital innovation industries will play an important role in delivering the strategy alongside pharma; the access to big data and the greater speed with which medical technology innovation have be delivered will support these sectors as early adopters. Both of these sectors will bring forward the potential to develop a personalised medicine approach – the latter is dependent on a successful pharmaceutical environment. For example, the (VAPER) trial is a safety study that is taking place at the National Institute for Health Research (NIHR) Guy’s and St Thomas' Clinical Research Facility and the NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London (BRC). Other centres at the Surrey Cancer Research Institute (SCRI) at the University of Surrey and the Royal Surrey County Hospital are hoping to commence patient recruitment to evaluate safety of an immunotherapy approach that is designed to activate an individual’s own immune response to enhance recognition and removal of those cancer cells.

14.2 New drug development and re-purposing of existing drugs that are targeting individual patient needs are open opportunities; the pharma sector is partnering actively with research council such as MRC Technology to increase screening possibilities with libraries of pre-existing compounds. Opening access to pharma library resources and initiatives such as this offer enormous potential to find new treatments.

14.3 Pharma investment in clinical trials for drug evaluation is a critical path to success.

15. Does the Government have the right structures in place to support the life science sector? Is the Office of Life Sciences effective? Should the Government appoint a dedicated Life Sciences Minister? If so, should that Minister have UK-wide or England-only responsibilities?

15.1 The Office of Life Sciences framework has created an important focus and a voice that represents the interests of the Department of Health and BEIS. Progression against the strategic objectives will require even better cross sector collaboration within the UK and will be delivered through local NHS and LEP implementers – the local implementers are therefore represented within the current structures and should continue to be so.

15.2 A dedicated life sciences minister offers a joined up approach to increased international presence. This focus may further increase inward investment. It is important to stress the need for clarity of the respective roles of UKRI and BEIS here.

15.3 A larger geographical portfolio of oversight, would better promote excellent work that is specifically based in Scotland e.g. in Dundee, and the power of data that is offered UK-wide is an important opportunity. The corollary of having an overarching UK lead is that local delivery partners could also be better linked for rolling out new innovations nationally. There would also be expected to be better flow across sectors e.g. from the creative economy into the healthcare sector around digital innovation.

Brexit

16. What impact will Brexit have on the Life Sciences sector? Will the strategy help the sector to mitigate the risks and take advantage of the opportunities of Brexit?

16.1 Like all sectors, Brexit is causing uncertainty among EU nationals who are living within the UK. Following Brexit, EU researchers may preferentially choose to move to other leading European countries in the life sciences sector.

16.2 Anecdotally Brexit is impacting on new recruitment into the UK from across the world because access to the UK has historically increased access to Europe.

16.3 Many EU researchers who are seeking international experience are intending to return home but some are seeking a long-term career opportunity. Equally, many UK researchers gain experience overseas that they bring back to the UK.

16.4 Given that one of the key strategies for successful growth and maintaining our leading position in the Life Sciences is around people and internationally collaborative networks, the need to access funding as well as people (staff and student) mobility will be a key driver.

16.5 Post-Brexit, it is important that the UK mitigates against any perceived lack of access and encourages talent flow in both the short and long term. The strategy should address career point risks for talent loss.

One important opportunity lies in creating funding streams and increasing the talent flow between the UK and the rest of the world, e.g. the USA where some of the world’s best life science is being undertaken, or China, which is growing its Life Sciences capability rapidly. Access to Chinese talent and researcher flow is in part supported through the global challenges research fund, but there are a limited number of mechanisms to support USA collaborations.

18. To what extent should the UK remain involved with and contribute to agencies such as the EMA post Brexit?

18.1 The EMA plays an important role in supporting medicines developers through guidance. It is also a key point for access to EU markets. In making recommendations to the European Commission about EU-wide marketing its committees are important market gatekeepers. The UK should continue to remain involved and contribute to the EMA but also work out how this can dovetail effectively with UK regulatory agencies to minimise load.

18.2 Non-EU countries e.g. Switzerland have had a successful history of participating in major scale projects and funding such as CERN that are not achievable on a country-by-country basis and I see the EMA as something similar for importance.

15 September 2017