Chapter 3 - Targeted Deployment of Resources
CSO invests a total of £67m per annum in Scottish research, representing a significant investment from the taxpayer and the Health Directorates. It is therefore important that all CSO investments are reviewed regularly against competing demands for funding and are not considered ring-fenced for any particular discipline or geographical area.
The need for regular review has been heightened by the need to invest in new or emerging technologies to allow Scotland to remain at the forefront of health research. In recent years the importance of Precision Medicine as a means of transforming the way the NHS diagnoses disease and provides care has been recognised as an important area in which research is essential, while the capacity of informatics is only now beginning to be realised. For this reason CSO needs to ensure that it has an acceptable balance of longer-term commitments and flexible funds to deploy as new priorities and initiatives emerge. At present there is an imbalance towards the former.
18. CSO will aim to free up a minimum of 1% of its budget in 2016-17, rising to 5% by 2019-20, to be deployed in support of new initiatives.
Such a change will allow CSO to invest strategically in the future, but will require compensating savings to be made elsewhere. To ensure existing investments remain a priority and have a suitable focus, a number of reviews of long standing areas of investment commenced in 2014-15 and will continue over the next three years. CSO's intentions for those investments are set out in the remainder of this chapter.
Response Mode Grants
CSO currently funds research projects through its two response mode funding committees:
- The Experimental and Translational Medicine Research Committee ( ETM)
- The Health Services and Population Health Research Committee ( HSP)
At any one time around 100 CSO funded studies are active with a value of around £15m. Early findings from the ResearchFish evaluation database suggest that CSO grants generate a considerable volume of additional activity, and in the most recent university Research Excellence Framework exercise 21% of the case studies submitted cited CSO support. CSO grants are highly valued by the research community and demand remains high at over 150 applications per year. However only 20% of applications are funded.
CSO also operates within the wider landscape of UK health research funding and contributes to a National Institute for Health Research ( NIHR) funding pool in excess of £100m annually, allowing Scottish-based researchers to apply for the majority of the research programmes administered by the NIHR Evaluation, Trials and Studies Coordinating Centre ( NETSCC). Notwithstanding the scale of funding available through these programmes, applications to NETSCC are just a third of those made to the CSO response mode schemes and also proportionately lower compared with the total number of applications made to NETSCC programmes from across the UK. There is therefore a need to address this imbalance.
CSO has re-examined the remits of its response mode committees and was unable to identify any major thematic gaps in the NETSCC programmes that were being filled by the CSO funding stream.
"The CSO response mode grant schemes are an invaluable resource for the Scottish clinical research community. They furnish studies that have, over the years, delivered high-quality data, increased understanding of disease processes and in turn have thereby led to meaningful change in clinical practice. CSO grants offer an admirable degree of flexibility that allows for example leverage of additional funding to mutual benefit with partner agencies. Moreover they have not infrequently provided Scottish-based researchers with the critical early data to facilitate further large scale funding opportunities from UK and international organisations."
Professor Iain McInnes - Institute of Infection and Immunity and Inflammation, University of Glasgow
We therefore believe that CSO response mode schemes need to have a clearer definition of how they play into this wider funding environment. Going forward:
19. CSO will create a budget to support pilot work designed to provide underpinning evidence for applications to larger funding schemes. At up to £35k, such awards will be determined within CSO in response to applications.
20. The CSO ETM and HSP Committees will be replaced with researcher initiated grant schemes with a closer focus on proposals of direct patient, or health services or public health, benefit. This emphasis will mean that early stage studies are unlikely to progress for consideration. The upper threshold of this scheme will increase to £300k.
21. To increase the policy relevance of the research funded, CSO will create a new scheme for research proposals that address specific Scottish Government policy priorities.
22. A greater emphasis will be placed on the analysis of project outcomes and impact on health and public health systems nationally and/or internationally. To that end CSO will introduce end of project interviews with the project principal investigator.
These changes should be sufficient to refocus applications to the appropriate funding source and ensure the relevance to the Scottish Government Health Directorates of the research it funds. CSO will review these new arrangements in 2018-19 to ensure they are delivering as expected.
" CSO support for developmental research studies to underpin much larger applications to other funders is really valuable. Following on from our CSO grant for an exploratory study of a specialist mental health service for maltreated children, we were awarded £3.4m by NIHR for a definitive trial. The knowledge we gained from our CSO funded study was crucial, allowing us to establish the acceptability, feasibility and size of a definitive trial and support our application to NIHR."
Professor Helen Minnis - Institute of Health & Wellbeing, University of Glasgow
CSO Core Funded Research Units
Each CSO unit is funded as a centre of excellence to help inform the development of effective health service or public health practices and policies. They provide different functions such as undertaking research in areas of strategic need, providing policy advice and capacity building, and working in even closer collaboration with CSO and Scottish Government colleagues. In addition to CSO core-funding, units attract significant funding from other sources.
Total investment in units represents £3.9m which is just under 6% of CSO's annual expenditure. Each unit enjoys an effective working partnership between the CSO and the unit's host institution.
23. CSO will conduct a strategic review of unit purpose and funding in the course of 2015-16.
As a priority CSO will:
- review the scope for closer relationships between CSO units and Scottish Government policy interests; and
- consider the funding consequences of posts funded by CSO yet attracting significant grant funding from external funders.
" CSO funding has provided us with the stability necessary to construct a solid foundation not only to deliver high-quality research that makes a difference to the health of the people of Scotland, but also to generate enhanced research opportunities for the NMAHP community. This stable support, coupled with detailed oversight and monitoring, has enabled us to maintain a focus on important long term outcomes, and the freedom to work strategically with other HEIs, policy makers and Health Boards to achieve those outcomes on a non-partisan basis."
Professor Brian Williams - Director, The Nursing, Midwifery and Allied Health Professions Research Unit
NRS Strategic Investments
Since April 2008 CSO has been investing an additional £10m per annum in NRS Infrastructure. This budget was allocated to the Health Boards in Grampian, Greater Glasgow and Clyde, Lothian and Tayside to ensure that new staff were in place both to support current NHS research needs and deliver our requirements for the future. Critically, CSO allowed the Health Boards to determine the specific areas in which to deploy the new staff to best meet CSO's strategic aims. Now that these investments have been in place for some time, it is appropriate to review their effectiveness and the extent to which they are contributing to our national ambition.
With clinicians indicating that there are still unmet needs to support ongoing studies there may also be a need to assess the prioritisation of the resources to meet key NHS needs.
24. The paramount priority for deployment of CSO resources is meeting the NHS service support costs for eligibly funded studies. CSO will ensure this principle is clearly applied across all of our investments, with funding being redeployed where necessary.
The aforementioned £10m infrastructure allocation was delivered as a redeployment of resources already with the Health Boards; as a consequence the level of funding had little relationship to the scale of the wider research activity. This is rightly seen as inequitable by those Health Boards who were relatively underfunded.
Managing the infrastructure as a single investment has also been challenging, both from a local and national perspective. Additionally the various streams of investment require different methods of assessment to determine their success.
Some investments have been made to pump-prime posts that would otherwise be funded through research grants on a study by study basis. CSO fully funds such posts and has not assumed a level of cost recovery of these services through grants. While CSO is advised that these investments are being fully utilised, that has not been evidenced to date from the costs declared as recovered from grants.
25. From 2016-17 CSO will revise the allocation of NRS infrastructure funds to ensure a more equitable deployment of resource based on activity.
26. From April 2016, NRS Biorepository and NRS Safe Haven funding will be separately contracted. Where costs for these and other activities should be included in research grant applications, this will be reflected in the NRS funding offered for subsequent years. This will allow Health Boards and universities to consider whether they wish to continue to have all such posts funded.
More generally, CSO is keen to ensure that a greater emphasis is placed on the creation of a biorepository network for the supply of tissue for eligibly funded non-commercial and industry research, with the biorepository resources working to the NRS principle of common costs and processes. It is recognised that there is greater co-ordination of activity than was previously the case but, eight years on, a fully co-ordinated and efficient national service is still not fully in place.
With Precision Medicine assuming greater prominence we anticipate an upturn in demand, but whether that will focus on the provision of fresh tissue or utilise the investment in stored tissue, and on what scale, is yet to be determined. It is important that this demand is properly assessed and matched with investment.
Likewise, the rapid development of health and bio-informatics research infrastructure in Scotland, following the launch of the Farr Institute, requires us to ensure that the NRS safe havens investment is suitably targeted towards supporting a national network and adding value. We anticipate that a fully functioning network of NRS safe havens will be a valuable resource, both in its own right as a vehicle through which research quality data can be accessed and as a resource that will support Farr research activity.
27. A review of NRS biorepository activity and funding that will be completed during 2015-16 to inform future investment in the network. A review of the NRS Safe Haven opportunities and investments will be conducted in the course of 2016-17.
The remainder of the functions funded under the NRS Infrastructure budget will be reviewed during the life of this Strategy. Some of those posts are clearly linked to the level and type of studies undertaken e.g. pharmacists to clinical trials and can therefore be linked to activity.
It is a long-standing matter of concern of some Health Boards that while the four most active Health Boards have been the main recipients of the additional investment in infrastructure, the remaining Health Boards have not had the opportunity to have similar support. CSO believes that there are good reasons why strategic investments should be restricted to those Health Boards that lead on the majority of externally funded studies with their university partners. However the same case cannot be made for service support costs, which apply equally to all participating Health Boards. With the recent introduction of a single service support cost across Scotland, there is no reason why the opportunity to have such posts funded through NRS Infrastructure funding should not be extended to all Health Boards.
28. CSO will extend to all Health Boards the opportunity to have service support posts funded as NRS infrastructure.
" CSO support for the network of NRS safe havens facilitates safe and secure access to routinely collected health data for research. Through the NRS Safe Havens, we used data from a number of Health Boards to develop a risk calculator identifying diabetes among people admitted to hospital in Scotland to help early diagnosis."
Dr David McAllister - University of Edinburgh