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Priorities in Medical Research: elite dynamics in a pivotal episode for British health research

Published online by Cambridge University Press:  23 March 2021

Stephen M. Davies
Stephen M. Davies*
Affiliation:
The Centre for History in Public Health, London School of Hygiene and Tropical Medicine
*
*Corresponding author: Stephen M. Davies, Email: [email protected], [email protected]
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Abstract

Priorities in Medical Research (PMR) was published in 1988 by a select committee of the House of Lords. The report ushered in an era of NHS research and development (R & D) that lasted from 2001 to 2006. The inquiry's origins lay in concerns about academic medicine in the United Kingdom, yet PMR gave relatively little attention to this subject. Instead the report focused critically on the disconnect between the Department of Health and the NHS in R & D. This, the committee argued, had led to the neglect of research into health services and public health. To sidestep the report's unwelcome proposal for a National Health Research Agency, the department eventually grafted R & D management onto structures created as part of wider NHS reforms. The Medical Research Council successfully pursued a strategy of keeping the committee's attention away from sensitive aspects of its own programme. The final focus of PMR was shaped by an alignment between committee members with an industrial view of research and champions of health services research. The actions of the various actors involved are interpreted using elite models of the state, and the applicability of these models is critically examined.

Type
Research Article
Information
The British Journal for the History of Science , Volume 54 , Issue 2 , June 2021 , pp. 195 - 211
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of British Society for the History of Science

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References

1 In April 1988, the government department concerned was the Department of Health and Social Security (DHSS). In July 1988, responsibility for health and social security was divided between two ministries, and the Department of Health (DH) was created. ‘The Department of Health’, or just ‘the department’, is used for either incarnation, except where quoting from a source.

2 House of Lords, Priorities in Medical Research: 3rd Report of the House of Lords Select Committee on Science and Technology 1987–88 Session, London: HMSO, 1988.

3 Scotland followed a separate path in health research policy.

4 Department of Health, Research for Health: A Research and Development Strategy for the NHS, London: HMSO, 1991.

5 Mark Baker and Simon Kirk (eds.), Research and Development for the NHS, Abingdon: Radcliffe Medical, 1998.

6 Stevens, Andrew and Milne, Ruairidh, ‘Health technology assessment in England and Wales’, International Journal of Technology Assessment in Health Care (2004) 1, pp. 11–24CrossRefGoogle Scholar; Allen, Pauline, Peckham, Stephen, Anderson, Stuart and Goodwin, Nick, ‘Commissioning research that is used: the experience of the NHS Service Delivery and Organisation Research and Development Programme’, Evidence and Policy (2007) 3(1), pp. 119–34Google Scholar.

7 Smith, Richard, ‘Filling the lacuna between research and practice: an interview with Michael Peckham’, British Medical Journal (27 November 1993) 307, pp. 1403–7Google Scholar.

8 Daly, Jeanne, Evidence-Based Medicine and the Search for a Science of Clinical Care, Berkeley: University of California Press and Millbank Memorial Fund, 2005Google Scholar.

9 Ince, Martin, The Politics of British Science, Brighton: Wheatsheaf Press, 1986, p. 186Google Scholar.

10 Williams, Roger, ‘UK science and technology: policy, controversy and advice’, Political Quarterly (1988) 59(2), pp. 132–44CrossRefGoogle Scholar; Christie, Ian, ‘Research and development policy: the great debate’, Policy Studies (1988) 8(4), pp. 11–22CrossRefGoogle Scholar.

11 Austoker, Joan and Bryder, Linda, Historical Perspectives on the Role of the MRC, Oxford: Oxford University Press, 1989Google Scholar.

12 Sheard, Sally, ‘Quacks and clerks: historical and contemporary perspectives on the structure and function of the British medical civil service’, Social Policy and Administration (2010) 44(2), pp. 193–207CrossRefGoogle Scholar.

13 Stephen M. Davies, ‘Organisation and policy for research and development: the Health Department for England and Wales 1961 to 1986’, PhD thesis, University of London, 2017, at https://researchonline.lshtm.ac.uk/id/eprint/4646130/.

14 Davies, Stephen M., ‘Rothschild reversed: explaining the exceptionalism of biomedical research’, BJHS (2019) 52(1), pp. 143–63CrossRefGoogle ScholarPubMed.

15 Mark Evans, ‘Elitism’, in Colin Hay, Michael Lister and David Marsh (eds.), The State: Theories and Issues, Basingstoke: Macmillan International, 2006, pp. 39–58.

16 Patrick Dunleavy and Brendan O'Leary, Theories of the State, Basingstoke: Palgrave Macmillan, 1987, pp. 184–97.

17 Nick Black, ‘A national strategy for research and development: lessons from England’, Annual Review of Public Health (1997) 18, pp. 485–505.

18 Michael Peckham, A Model for Health, London: The Nuffield Trust, 2000, p. 6. ‘Academic medicine’ is a term used to describe the advancement of research and education in clinical settings.

19 House of Lords Debates (subsequently HL Deb.) vol. 482 (26 November 1986), cols. 591–621.

20 Walter H. Holland, Improving Health Services, Cheltenham: Edward Elgar, 2013, pp. 186–7.

21 Christie, op. cit. (10)

22 Tom Wilkie, British Science and Politics since 1945, Oxford: Basil Blackwell, 1991, pp. 96–122; Jon Agar, Science Policy under Thatcher, London: UCL Press, 2019.

23 House of Lords, Civil Research and Development: 1st Report of the House of Lords Select Committee on Science and Technology 1986–87 Session, London: HMSO, 1987.

24 Williams, op. cit. (10).

25 Roger Makins, 1st Baron Sherfield, 1904–96.

26 National Archives (subsequently NA), FD 7/2686, correspondence and file notes August to November 1986.

27 Henry George Nelson, 2nd Baron Nelson of Stafford, 1917–95.

28 House of Lords Archives (subsequently HLA) HL/CP/1481.

29 HLA HL/CP/1482, 1483, 1485, 1486.

30 HLA/HL/CP/1506 ST/87/M1 Appendix 1.

31 HLA/HP/CP/1491.

32 House of Lords, op. cit. (2), paras. 1.7–1.8.

33 House of Lords, op. cit. (2), Chapter 3

34 House of Lords, op. cit. (2), para. 3.24.

35 The submissions of South East Thames and Trent Regional Health Authorities make cogent arguments for an increase in locally initiated research, especially health services research. HLA/HL/CP/1506 ST/87/M24, M57.

36 House of Lords, op. cit. (2), Chapter 4.

37 House of Lords, op. cit. (2), paras. 4.26–4.32.

38 HL Deb. vol. 498, cols. 273–345.

39 HL Deb. vol. 498, cols. 279–80

40 NA JA 367/190/2, Skelmersdale to Minister of Health, June 1988.

41 NA JA 367/190/1, Notes of a Meeting on 25 April 1988.

42 NA JA 367/191/3, Metters to Slater, 8 September 1988.

43 Brian Edwards and Margaret Fall, The Executive Years of the NHS: The England Account 1985–2003, Oxford: Radcliffe Publishing for the Nuffield Trust, 2005, pp. 64–71; Rudolph Klein, The New Politics of the NHS, Oxford: Radcliffe Publishing, 2006, pp. 140–52.

44 HLA HL/CP/2720, written question and response, 1 November 1988.

45 Department of Health, Working for Patients: The Health Service Caring for the 1990s, London: HMSO, 1989.

46 HLA HL/CP/2720, Nelson to Clarke, 2 February 1989.

47 Roy Griffiths, NHS Management Inquiry: Report to the Secretary of State for Social Services, DHSS: London, 1983.

48 Klein, op. cit. (43), pp. 117–23.

49 HLA HL/CP/2720, Clarke to Nelson, 6 June 1989.

50 HLA HL/CP/2720, Nelson to Clarke, 16 June 1989.

51 HLA HL/CP/2720, Jellicoe to Clarke, 8 March 1989, reply 19 April.

52 Cm. 902, para. 2.10.

53 Alan Maynard, ‘Peanuts and a job for God’, Health Service Journal, 25 February 1990, p. 443; Douglas Black, ‘Rothschild revived?’, Times Higher Education Supplement, January 1990, p. 4.

54 NA FD9/2687, MRC comments, 26 February 1990.

55 HLA HL/CP/2720, press release, Department of Health, 16 May 1990.

56 Department of Health, op. cit. (4); NHS Management Executive, Research and Development Strategy: Guidance for Regions, September 1991.

57 Paul Atkinson, Sally Sheard and Tom Walley, ‘All the stars were aligned? The origins of England's National Institute for Health Research’, Health Research Policy and Systems (2019) 17, article no. 95.

58 T.StJ. Bates, ‘Select committees in the House of Lords’, in Gavin Drewry (ed.), The New Select Committees, Oxford: Clarendon Press, 1985, pp. 37–53.

59 Interview with Walter Holland, London School of Economics, March 2013.

60 Mahler, Robert, ‘William John Hughes Butterfield, Baron Butterfield of Stechford in the county of West Midland’, Monk's Roll (2000) 11, p. 83Google Scholar.

61 McLachlan, Gordon (ed.), Portfolio for Health: The Role and Programme of the NHS in Health Services Research, London: Oxford University Press for the Nuffield Provincial Hospitals Trust, 1971Google Scholar; Cook, Christopher, ‘Oral history: Walter Holland’, Journal of Public Health (2004) 26(2), pp. 121–9CrossRefGoogle ScholarPubMed.

62 Davies, op. cit. (13), pp. 244–66.

63 NA BN 82/227, role of the chief scientist, 30 September 1986.

64 NA JA 367/190/1, briefing report, 6 April 1988. Appendix B.

65 NA JA 367/191/1, notes of a meeting, 9 June 1988.

66 NA JA 367/191/2, Merrifield to Woolley, 2 August 1988.

67 NA JA 367/191/2, Rayner to Woolley, 28 July 1988.

68 Maurice Kogan and Mary Henkel, Government and Research: The Rothschild Experiment in a Government Department, London: Heinmann Educational, 1983.

69 NA JA 367/191/2, Metters to Slater, 12 August 1988.

70 NA JA 367/191/3 HPSS (88)30, August 1988, extract from minutes of meeting, 8 September 1988.

71 Davies, op. cit. (14), p. 147.

72 NA FD 7/2684, Subcommittee 1 call for evidence.

73 NA FD 7/2684, briefing note Harrison to Gowans, 19 March 1986. Research Council Overlap, 19 May 1986.

74 NA FD7/2684, written evidence from Gowans, 2 May 1986.

75 House of Lords, op. cit. (23), paras. 46, 48.

76 NA FD 7/2686, file notes and correspondence, August 1986–January 1987.

77 Davies, op. cit. (13), pp. 255–60.

78 House of Lords, op. cit. (2), 3.17.

79 NA FD 7/2687, file note by Dodd, 1 August 1988.

80 Schmitter, P., ‘Still the century of corporatism?’, Review of Politics (1974) 36, pp. 85–131CrossRefGoogle Scholar.

81 Thomson, Arthur Landsburgh, Half a Century of Medical Research, vol. 1, Origins and Policy of the Medical Research Council, London: HMSO, 1973Google Scholar.

82 Rose, Hilary and Rose, Steven, Science and Society, Harmondsworth: Pelican, 1970, pp. 111–14Google Scholar.

83 NA JA 367/191/1.

84 Interview with former civil servant, Kent, October 2019.

85 NA FD 7/2687, file note, 1 August 1988.

86 Ince, op. cit. (9), p. 204; Williams, op. cit. (10).

87 Black, op. cit. (17), p. 488.

88 Joseph Schumpeter, Capitalism, Socialism and Democracy, New York: Harper and Row, 1942; Carl J. Friedrich, Man and His Government: An Empirical Theory of Politics, Oxford: Oxford University Press, 1963; Heinrich Best and John Higley, ‘Introduction: democratic elitism reappraised’, in Best and Higley (eds.), Democratic Elitism: New Theoretical and Comparative Perspectives, Leiden: Brill, 2010, pp. 1–22.

89 Bates, op. cit. (58).

90 Giddings, Philip, ‘Select committees and parliamentary scrutiny: plus ça change’, Parliamentary Affairs (1994) 47(4), pp. 669–86Google Scholar.

91 Bevir, Mark and Rhodes, R.A.W., The State as Cultural Practice, Oxford: Oxford University Press, 2010CrossRefGoogle Scholar.