Brexit pitfalls for medical science – and patients - are real, but can be avoided

Medical research in the UK could be hamstrung by Brexit – causing patients to suffer.

Failure to attract the best researchers from overseas, a reduction in funding and associated uncertainty about planning, and a divergence in regulations harming collaboration with other nations could all damage our top-class facilities.

Without the right measures from government, patients could be left without access to cutting-edge clinical trials and waiting longer for new treatments that are freely available in the rest of Europe.

This is the view of the British Heart Foundation (BHF), a cornerstone of the UK’s research into cardiovascular problems since it was founded in 1961.

The organisation has built an incredible legacy, and is one of the principle funders for the UK’s world-class research into heart and circulatory disease.

Some of its key breakthroughs include the discovery of the link between blood clots and heart attacks; mapping the anatomy of baby heart defects, and helping to develop techniques which have reduced the number of children dying from congenital heart disease by more than 80% over the last three decades; and the discovery of faulty genes that lead to hypertrophic cardiomyopathy, which can go unnoticed in families until it causes the sudden death of an otherwise health person.

Its links with Northern Ireland go back to its inception: it provided a grant to Professor Frank Pantridge, a Hillsborough man and Queen’s University academic, who in 1965 invented the portable defibrillator which has since saved millions of lives around the world.

Currently in NI, BHF funds research projects within Health and Social Care as well as our universities, including £2.5m for QUB; is enabling 65% of all secondary schools to provide CPR training; supports 150 BHF Alliance nurses in hospital and healthcare settings; and funds the Miles Frost nurs based in the City Hospital but covering all of NI, supporting the existing Inherited Cardiac Conditions service and ensuring that more people receive the screening and treatment they need to prevent sudden death.

Scope spoke with BHF CEO Simon Gillespie yesterday, and he outlined his concerns about Brexit, and what needs to happen to ensure UK cardiovascular research does not suffer.

People and talent

Mr Gillespie said there needs to be flexibility about the movement of people working in health research and that, while free movement is still currently in effect, concerns about potential complications in the coming years are already impacting on the sector.

“About 20% of the workforce in health sciences in the UK are non-UK EU nationals, i.e. people who are likely to be affected, and to an extent we are already feeling the impact of uncertainty about the future.

“In the NHS, about 20% of the clinical staff are non-UK EU nationals. In social care that proportion is higher, between 30% and 40%. Unless you deal with these issues properly then you run the risk of uncertainty, in the short term and arguably in the medium and long term, doing a lot of damage because there just won’t be the people to deliver health and social care and potentially there won’t be the people to do research.”

He said professors and other senior figures who run the projects they fund are not getting the same high-quality applicants from the EU seeking to work on their projects.

“The government is making all the right noises but the question is whether they made them early enough, or whether anyone actually believes them. People are not feeling as secure as the government would want them to feel.

“If it becomes more difficult for any UK-based researcher to work in the EU that would be harmful for their own development. International collaboration is a key feature of the research environment. It involves people moving around, developing skills and learning new approaches, which they can bring back to the UK.

“Bear in mind – and I speak with authority about the heart and circulatory sector, but I think it’s replicated in other areas, e.g. cancer – that if you carry out an assessment of the impact of UK research, compared with investment across the world, you will see that, while we obviously do not have as much money as somewhere like the USA, our impact is greater. We get really good value for money because we have built a great environment here that is really conducive for high quality research.

“We try to bring in the best talent from around the world, by providing opportunities to work with great people and in great facilities and a funding environment which is stable and brave, fostering innovation, new ideas and new ways of thinking. It has taken years to build that up.

“When the British Heart Foundation was founded, research into heart and circulatory health was very primitive. The British Heart Foundation has been instrumental in building a world-class research base into cardiovascular disease. If we have to rebuild that, it could take decades.

“The decisions people make in research consider the following 15 or 20 years. They want to have some certainty about that period when they are making these choices.

“Investors in a business venture or a research venture tend not to like uncertainty, because then you don’t know if you will get the best return on your investment. This is true whether it’s a commercial investment or, like in our case, a charity looking to invest in research.”

Funding

Mr Gillespie also said EU funding was, as things stand, a crucial part of an overall funding picture – and that reductions in overall funding can have knock-on effects.

“The British Heart Foundation does not get EU funding but the institutions that we invest in often do. Our funding, together with EU funding, and from the Medical Research Council, alongside other potential streams, creates a funding pool of a particular size. This allows the sector to build up capacity – such as with high-class imaging, and the sharing of equipment over different settings.

“If you take away an element of that funding then you run the risk of other parts of that structure becoming unviable – for example, high-tech imaging equipment not being fully utilised, so introducing inefficiencies.

“Any reduction in funding going into universities – whether directly from Europe or subsequent replacement funding from the UK government – will have a detrimental impact on our funding, because universities might ask us for more money just to maintain current programmes.”

The UK government has given some indications that it is willing to match the funding provided by the EU with similar programmes from the domestic pot.

Then, of course, there was the Leave campaign’s figure of £350m per week, which Boris Johnson claimed was the UK’s net contribution to the EU, and which he furthermore said should be spent on health.

“I don’t know if the figure on the bus is right, but the UK has been a significant net beneficiary of research funding. This reflects well on the strong research base in the UK, and the quality of people, institutions and structures that we have.

“We receive €500m and €600m a year, on average, and if we lose that then it needs to be made up from somewhere. Whether government itself will do that is a different matter.”

He said that, when our existing collaborations and partnerships with institutions across Europe at very stages over the next few years, there is a worry about a “cliff edge” whereby we are not able to set up similar arrangements into the future.

“We are already picking up some indications that European collaborators that would otherwise have approached institutions in the UK to look at partnerships are not doing so because European institutions are worried about the uncertainty around the UK.

“In medical research, we need to keep as close as we possibly can to the arrangements we have had as a European member.”

Regulation

The BHF CEO also said that the UK regulatory system needs to mirror that in the EU to ensure the continuing competitiveness of our research sector – meaning it cannot just stay as it is, but will have to track changes in Europe in the future.

“There are two strands to this. The first is to do with the research around clinical studies. Increasingly now we have to look not just at multisite but at multinational patient populations in order to undertake these types of studies. This is vital when you are dealing with relatively rare conditions, but also important for more common conditions as well.

“Unless you have got common procedures then we run the risk of being excluded from those trials – because the data sets ultimately have to be comparable - so therefore patients in the UK might not get the opportunity to benefit from those trials.

“The second area is medicinal regulations. If we have a different regulatory regime here compared with the one for the rest of Europe then the European market, with a single regulatory structure and its bigger market overall, is more likely to be attractive to pharmaceutical companies, medical biotech, and so on.

“That’s because a huge amount of money needs to be invested to work through the early stages of the regulatory process and those firms want a return on their investment – so getting access to a bigger market is likely to be more appealing. Patients in the UK might get delayed access to new developments that counterparts across Europe will have earlier access to.

“The smallest bit of different in regulations between us and Europe could cause these issues. Our concern is that firms will then invest in Europe first and go through processes here later on, maybe even years later.”

Ultimately Brexit does not have to cause massive problems for the UK’s research base – but in order to avoid any crises there is a series of specific measures that needs to be followed by government.