Fools' gold

Published: 01/04/2004, Volume II4, No. 5899 Page 32 33

The balance in medical research and development funding unfairly favours the golden triangle of London, Oxford and Cambridge, leaving poorer regions with poorer health outcomes. John Hacking asks what can be done to change this historic bias

The geographical distribution of publicly and charitably financed medical research and development in England is grossly inequitable.

Over two-thirds of total funding goes to just three cities: London, Oxford and Cambridge, the so-called 'golden triangle'.

The distribution of research and development funds is an area within the government's sphere of influence that is ripe for reform.Approximately£1.5bn is spent annually on not-for-profit medical R&D in England.

The Medical Research Council and research funding charity the Wellcome Trust each give around£300m, and about£450m comes from NHS R&D funding.

As table 1 shows, London and Oxbridge account for about 65 per cent of MRC grant funding for England in 2002-03. In addition, of the 34 MRC institutes and other centres supported by the MRC in England, 23 are in the golden triangle.And for charity Cancer Research UK, projects and awards to institutes in England, as at April 2003, showed 72 per cent went to the golden triangle.

However, NHS R&D funding shows probably the worst inequity: in 2003-04, of the£437m badged against R&D, 68 per cent went to trusts in London.

Table 2 shows the figures for the allocations to trusts over£7m. This is one source of funding where Oxbridge is not exceptionally funded compared with the London trusts, although it is still far better funded than most other provincial trusts despite having many fewer patients to access for research purposes.

The funding disparity came about by historical accident - research funds largely followed teaching funds. Before the expansion of universities and the development of health services in industrial cities that meant mainly London and Oxbridge.

Ideally, the geographical distribution of funds should include the following factors:

Value for money

For example, staff costs, infrastructure and capital costs, and the related factor of ease of recruitment.

Value for money is a problem in the golden triangle:

London is poor for recruitment, and Oxford and Cambridge will also have problems in that area because of high housing costs.

Equity of health service

The fact that R&D is known to improve health outcomes is a reason to focus resources in poor health regions. The golden triangle does not have the highest health needs; these are in the northern England.

Burden of disease

Preference for areas with the largest patient bases is particularly relevant to the government's current priority for translational and experimental research in clinical trials.None of these areas, especially not Oxford and Cambridge, have the highest rates and varieties of the major medical problems.

Government economic policy

London, Oxford and Cambridge are located in the three richest and fastest-growing regions. The Office of the Deputy Prime Minister, the Treasury and the Department of Trade and Industry are setting a national public service agreement target to reduce regional disparities in prosperity.And the ODPM select committee last year published a report on the topic of reducing regional disparities in prosperity - publicly funded research is a catalyst of economic activity. The report highlighted the important role of the location of publicly funded R&D in stimulating regional economies.

In addition, the core cities group, comprising eight main cities outside London, is working with government departments and the regional development agencies to develop strategies to improve their economies and global status.

London has accepted that there is a problem.A memo from the London Development Agency said: 'The RDAs met the research councils to discuss research funding across the UK.

There is a particular issue relating to health research concentrated in London, Oxford and Cambridge. It would be useful to undertake a joint piece of work to look at how some of the southern teaching hospitals could be twined with facilities from elsewhere to share excellence and potentially establish centres of excellence elsewhere in the country.'

Common defences against geographical redistribution include the cost and disruption of change.However, this cost can be minimised by using gradual equalisation over a period of, say, 10 years.

This is particularly appropriate for the NHS research budget and could be achieved by a positive approach towards relocation of staff.All potential candidates for regional centres of excellence are substantial cities with large universities and teaching hospitals that are capable of building a critical mass of expertise. The best people will usually follow the funds.

Another defence is the need to support current quality, and of course this is unarguable.

In a bidding system such as that used for half of MRC funds, the status quo is likely to remain since the golden triangle receives two-thirds of all funding. The problem is made worse by a lack of funds, although last month's Budget announcement of increased funding to the MRC could help stimulate more successful bids from outside the triangle.

If such local initiatives then attract significant further funds from the main funding bodies, this will help in the move to greater geographical equity.

In general, if critical mass builds up in centres outside the triangle by movement in NHS R&D funding and MRC funding, this should start to draw in more funds from HEFCE, where funds follow a research assessment, and from charity funds attracted by new institutes and more high-quality bids.

The best outcome would be a fairer distribution of funding so that the golden triangle converts into a larger golden polygon, where each region in England has a centre of medical research excellence of similar stature to those in London, Oxford or Cambridge.

Key points

London, Oxford and Cambridge receive an unequal share of research and development funds.

Eight other cities are working with the government to raise their own status generally.

New regional centres of excellence would reduce the disparities.