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New arrangements for funding academic medical research in England have left some disciplines, particularly in the field of psychiatry, out in the cold, depriving them of research funds and limiting career prospects for people wanting to work in these areas, researchers have warned.
The new system, announced last year, merged the budgets from the two existing streams for the public funding of medical research, those of the Medical Research Council and NHS Research (BMJ 2006;332:994, doi: 10.1136/bmj.332.7548.994).
There is now a single fund for academic medical research, administered by the National Institute for Health Research, which was set up to deliver the government's research strategy. Researchers in many disciplines who previously received funding directly from their NHS trusts have had to apply to the institute, and some have now been told that their research money will cease next year.
Peter Tyrer, professor of community psychiatry at Imperial College London, and a member of the panel that reviewed applications for funding in mental health, considers that research applications in forensic psychiatry, child psychiatry, and intellectual difficulties have fared particularly badly. None of the bids in these fields were funded, even though many of the researchers making them have international reputations and have previously been successful in gaining funding from a wide range of research bodies.
Of the 132 applications in mental health, only 15 were funded, Professor Tyrer noted. “However, four were funded for research in early interventions in psychosis, which is already vastly overfunded. Fashion is dictating to some extent what gets funded, but the real problem is that there is too little money available and everyone is scrambling for any share, however tiny.” he said.
“In areas such as dementia research (which comes from a different funding stream), there are more resources and a much greater chance of success.”
“There is a serious risk that some of the smaller specialties in psychiatry will now cease to exist,” he warned. “One of the great strengths of psychiatry in the UK has been the diversification into specialist interests. It will be a great loss if they are lost from academic research.” He considered that the loss of research could also directly affect patients' care by failing to provide an evidence base for clinical decision making.
Sheilagh Hodgins, professor and head of forensic mental health science at the Institute of Psychiatry, London, was one of the researchers whose application for funding for forensic psychiatry was turned down. She said, “In our trust, the forensic psychiatry budget takes up 31% of the general adult psychiatry budget—and most of the patients we see come from general psychiatry.”
Her bid included three studies of interventions in general psychiatry aiming to reduce the need for transfer to forensic services. “Failing to develop this area will mean that the number of patients requiring care by forensic psychiatry will continue to be high, using up a major proportion of the psychiatry budget.”
She is concerned that bids for funding in psychiatry may have failed because research methods differ from those used in physical medicine.
Failure to get funding from the National Institute for Health Research may also lead to redundancies. Professor Hodgins said that her department has lost three academic posts. “There is already a shortage of forensic academics in the UK. Losing three more adds to this shortage.”
Jeremy Coid, professor of forensic psychiatry at Barts and the London, Queen Mary's School of Medicine and Dentistry—another of the researchers failing to get funding from the institute—considered that the loss of staff had not been thought through. His salary, together with the salaries of a research secretary, a statistician, a lecturer, and a data manager, were previously paid from the research budget provided by the NHS trust. “This will all be gone from 1 April 2008, so all of the staff will be made redundant, apart from those providing medical services to the NHS.”
He suspects that very large research “super-centres” have gained research funding that has been lost from some of the smaller centres and less favoured research fields. “My trust—East London and the City Mental Health NHS Trust—spent £1m (€1.5; $2m) a year on research,” he said. This supported three small research units working on forensic psychiatry, community and social psychiatry, and nursing research. Despite being judged, on the basis of assessment of research and publications, a “strong” research unit, the entire programme will now close.
Lack of funding will also affect teaching. “We will have fewer academic staff, and we won't have research programmes in which to involve masters and PhD students,” warned Professor Hodgins. “Students will have to conduct small research projects that have no impact on services, rather than being able to participate in large multidisciplinary teams undertaking studies that have the potential to make substantial contributions to improving patient care.”
Other concerns are about how the bids to the institute were shortlisted. “We gathered that a civil servant from the Department of Health shortlisted bids, not on the science but on whether they ticked boxes,” said Tom MacDonald, dean for research at Barts and the London, Queen Mary's School of Medicine and Dentistry.
None of the bids submitted from his institution was shortlisted, even those from researchers with international reputations. A spokesperson for the health department confirmed that original applications “were sifted by programme management people to ensure they fulfilled all the selection criteria.”
The 132 bids in mental health were pared down to 60 before the panel on which Professor Tyrer sat even saw them. There were then too many for the panel to deal with in the two days the panel was allocated. “So they were further chopped down to 33—I don't know how—before we reviewed them. This means that half of the shortlisted bids were dumped before discussion,” he said. He is concerned that the process was not sufficiently transparent.
Professor Coid is concerned that no one has been told the criteria on which decisions were based. Despite being told they would receive individual feedback, applicants have so far received only generic letters containing general information.
He is concerned that the changes will deter doctors from pursuing careers in research, because of the lack of clarity about how research funding will be determined, and will also reduce the ability of smaller centres to do research. “If you are a small centre, your research is going to be shut down. Smaller medical research centres—even those with high research ratings—have been left out in the cold.”
Professor Coid added: “There is something sinister behind this—nothing to do with excellence, more about imposing a certain viewpoint. It's about centring research, with no concern for the collateral damage.”
Professor MacDonald concluded, “The new scheme has been rushed in too quickly without thinking through the consequences for the future of research or for people's careers.”