This is a guest post from Ellen Buckley, Billy Bryan and Duncan Gillespie, members of the Medicine, Dentistry and Health’s Research in Policy Group
At the recent Medical School Research Meeting, Dr Duncan Gillespie (MDH RSA, Research and Policy group) sat down with Rt Hon Sir Kevin Barron (Labour MP for Rother Valley) to talk about the importance of research on changing legislation. His diverse parliamentary experience includes chairing the Health Select Committee that brought through the 2005/6 ban of smoking in public places and held evidentiary hearings for minimum unit pricing of alcohol in 2010. More recently, Sir Kevin has been Chair of the All-Party Group on Pharmacy, protecting the availability of community pharmacies and protesting against pharmacy cuts by presenting a petition to Number 10, Downing Street, which had 2.2 million signatures.
Now more than ever, it is vital that health researchers attempt to bridge the gap between their research and the politicians who need it to inform policy decisions. Sir Kevin’s visit was the perfect opportunity to discuss the research-policy interface from a politician’s perspective.
DG: Could you start by giving us an example from your experience of how research has made an impact on a policy decision?
KB: The biggest one for me was when in 2005 when the issue of smoking in public places came to light, it was quite clear by then there was enough science around to say that secondary smoking was damaging to health. If you go back 10 years that wouldn’t have been the case and that was very difficult for legislators to get their head round on the basis that it’s just an assumption until that evidence stacked up.
DG: Thinking about your role in the all-party parliamentary groups and select committees, how do you think that evidence made its way into the policy discourse?
KB: It certainly did through the Health Select Committee while I was chairman. We did two things in that 5 year period.
One was the ban on smoking in public places in which we led, effectively. It was massively useful for that. The other was the unit price of alcohol and alcohol consumption debate. We looked at that, just before the 2010 General Election, and unfortunately it didn’t go any further. But good research had been done in here at the University of Sheffield, about consumption in pubs and how price related to consumption and we were able to use that research in that particular Health Select Committee report. Sadly, parliament ran out and people ducked the implications of it so we haven’t got there with it yet.
DG: It sounds like the select committee’s role is to make the case for that evidence, potentially going against the party manifesto.
KB: In part yes. The 2005 Labour party manifesto on being able to smoke and drink in pubs or private members clubs but not in public houses that served food, as a public health policy was incoherent. I had a very strong view about this; the evidence was there by 2005 that secondary smoke was damaging to health. So [the health select committee] had to then set about how to [make the case for a comprehensive ban]. When we set off with our very short enquiry shortly after the 2005 general election the majority of people on the committee were not in favour of a comprehensive ban on smoking in public places. When we’d finished the enquiry, the vast majority were in favour. Indeed we ended up changing the law.
DG: When you think about how you became aware of the evidence around smoking, what was the route? Did you have direct contact with researchers or was it through intermediaries like the House of Commons library?
KB: House of Commons library in part, but there was written evidence put into the committee at the time. And there was some contradictory evidence. It’s a matter for the research community to sort that out. For the community of legislators, it’s having that good research there that’s vitally important to make the arguments.
DG: How would you advise researchers, who are submitting evidence to enquiries and to consultations for the first time, to put together their evidence or to communicate it well?
KB: Look at who you’re communicating to. Look at the many constraints that they have. I remember quite well in 2005 this awful word – the “nanny state” – you’re telling people what to do. At that time this was the worst possible thing you could do to infringe the rights of individuals. So look at who you’re communicating to, and what you’re communicating, and the circumstance that they’re receiving it in of course.
DG: It also sounds like you’re taking on some new challenges in your current roles and we picked up on your work with pharmacies. Is that the same sort of story as tobacco with the use of evidence or something different?
KB: It is [the same], because the work I do around pharmacies is not so much about the products that they dispense etc but as using them as a wider tool out there in the community for healthier lifestyles. This country is going to go into a permanent problem with very predictable, major long-term conditions, because of lifestyles. The National Health Service will always be in a crisis situation unless we take that on. I think pharmacies (even more so than general practice) have a role to play in that but it is very difficult to do this. We have got healthy living pharmacies here in Sheffield and different parts of the UK, and they are there to guide people on to better ways to improve their lifestyle.
DG: Do you think that in your team you would benefit from having qualified researchers – people with a health science background?
KB: I think the answer to that is yes. The health select committee, has a team in there, and then depending on what you’re looking at – like we did in relation to smoking in public places – you would bring people in to work alongside you and advise you at that time. Now these individuals need to have flexible employment, but they could get involved for one or two days a week for a very short period of time.
DG: Are these people who are active researchers, maybe just done a PhD, looking for a bit of experience?
KB: No, some of them can be [from the] establishment, but someone involved in public health from a university (who you wouldn’t call an establishment figure), will ask the questions that sometimes the establishment wouldn’t ask. Legislators should be the ones asking the questions, because if we don’t, the only food chain that ministers get is through the civil servants. I’m not saying that that’s wrong but having a bit more progressive thinking about how things could be different challenges what’s there.
DG: We’re aware that there are fellowship opportunities through POST (Parliamentary Office for Science and Technology) that help researchers get involved [with government]. Do you think that that system is really functioning as well as it could be, or maybe there are other things that could be done to help?
KB: POST is a good organisation. The greater problem you’ll find with all of this in the end, is that even when you’ve done that, most select committee work that gets done is ignored. In the unit price of alcohol debate, we published just before the 2010 general election and I don’t think it’s resurfaced since. It’s a great shame, because these are the societal issues that we have to take on.
DG: It does sound bleak, is there still hope of bringing evidence together to make the case?
KB: There is hope. We got that piece of [smoking] legislation through by running a campaign with national charities and with the leisure industry, sending constituents to MPs surgeries saying “will you be voting for a comprehensive ban when it comes up in parliament”, although it wasn’t publicly known at the time. The leisure industry were initially against it, when they saw the implications of what the government were proposing, they came on board with us. So there are ways of doing that.
DG: In your role, how have you found the balance of communicating science about prevention vs. the treatment and the new technologies?
KB: I think the communication’s quite good. I think one of the problems that you have in politics, is that when you get innovation through pharmacy, like a drug that’s going to be sold multi-millions of times, it’s not a problem. But how do you encourage them to look after dose-value relationship.
In this country we’ve had a pharmaceutical price regulation scheme for many decades. The government because they’re a big buyer, because we have the NHS, can say to companies “we’ll pay a bit more for that product on the basis that you’re doing R&D or manufacturing in this country”. Pharmaceutical exports provides a massive income (£8-9 billion a year) to the economy. The rest of manufacturing exports have been going out of fashion for decades, so you can recognise what that scheme does. I think that it’s very important that we recognise their worth to the economy, and what they do in drug development, to improve quality of life.
DG: So researchers who are working on that more discovery or technical side – they can communicate to the policy side of things but they also can focus on getting that translated into commercial product and business?
KB: That’s how the world works. Sometimes drugs come on the market that are very expensive and people might argue that they have very high clinical value. I’m not in a position to say that that’s true or not, but by and large, if you look round at the advancement of medical research and science in my lifetime – it’s absolutely phenomenal. It puts pressure on the NHS and everything else, but it is phenomenal in having the ability to improve people’s quality of life.
DG: Last question: thinking about the future of health and healthcare – what do you think the challenge is going to be and how are researchers and the next generation going to meet that?
KB: I think it’s going to be lifestyles. I’m not saying medical science is not going to carry on – put a lot of people out of work, and the NHS may find it challenging. We have to accept that medical innovation does that, but what I’ve been involved in for many years now is the issue of lifestyles and how we can improve population health. That’s the real key to this, and it goes from the environment you live in, to what we do or don’t do as individuals. These are going to be the determinants of the future. Medical science is going to carry on and help us, but it can also find out why we need to be changing lifestyles. We need that evidence so legislators can put that into the public domain.
Our conversation with Sir Kevin has shown us yet again how important our research can be in turning the tide of national policy, but it also shows the work yet to be done. Now is the time to get involved in policy, Sir Kevin certainly gave us some great suggestions for how to do so and we encourage all our colleagues in MDH to explore these avenues.
For more information related to anything discussed here, please contact the MDH RSA Research and Policy group at email@example.com and visit our website for future events here.
Photo Credit: http://www.acumenimages.com Uploaded to Flickr by The Health Hotel; Ellen Buckley