Professor Stephen Leeder writes:
If you missed the release of the McKeon review on Friday you’re not alone. The Commonwealth government released theStrategic Review of Health and Medical Research just before the weekend – a time usually reserved for reports the government would rather bury – and it barely got a mention in the mainstream media.
The government commissioned the review panel, headed by Simon McKeon, in 2011 to investigate the state of health and medical research in Australia. The panel released a consultation paper October and delivered the final report to government in March.
The review sets out a ten-year strategy to better integrate health and medical research into the public health system. To improve the health system and contain its rising cost, the report states that “research must be routinely performed as a part of health-care delivery and there must be greater linkage between health-care providers and research organisations.”
This is an energising vision. The current reality could hardly be more different. Apart for pockets of clinical research, such as drug trials and evaluation research by specialist clinical groups to assess the effectiveness and worth of medical interventions in real-life scenarios, research is not a strong player in the health system.
As a result, the connection of health services to research is informal and erratic, with estimates that 43% of Australians not receiving appropriate, evidence-based care. The CareTrack Australia study found that nearly 90% of patients with sinusitis were prescribed antibiotics, where this was known to be ineffective. And just 18% of asthmatics had a documented action plan for when they had an attack.
The McKeon Review explores how this might be remedied.
First, money. The report calls for the investment of 3-4% of government health expenditure in health and medical research, up from around 2%, or A$1-1.5 billion.
The rub will be in the extent to which this increased investment will be shared among state and territory health ministries and the Commonwealth.
But motivation to invest may be stimulated by the formation of integrated health research centres (IHRCs) which combine “hospital and community-care networks, universities, and research organisations such as medical research institutes”. These institutions would give state and federal governments a stake in the research conducted within them, with an open corridor to apply the research in the associated health-care facilities.
Strategic research, which encompasses research with a specific, practical focuses such as vaccine development and the evaluation of different forms of care for the frail aged, would be elevated from single figures to consume 10-15% of the National Health and Medical Research Centre (NHMRC) budget.
This would be politically feasible only if the NHMRC budget was simultaneously increased: push-back from the laboratory scientists would otherwise prove intractable.
Second, dedicated funding will be needed to grow capacity within the research empire to contribute to the quality and efficiency of health services through research. At present, health services research sits low on the status totem of research, and funding for the development of a research workforce in this field is low, although it is growing.
Third, Australia should maintain its current excellence in research. This would enable Australian research to hold its head high in international research forums, rapidly access research findings for application in Australia, and grow the intellectual base of research so it can support applied and health service research efforts.
When grand plans such as these emerge, we need to ask who’s buying and who’s selling. We need to see what the buyer (the various arms of the health service) will get for the money it is expected to contribute. The seller (the research community) will need to come up with far more impressive evidence that it can indeed help cut health care costs, improve quality and increase efficiency.
If the federal government considers the proposals to be good, it will need to reach deep into its pockets to convince the buyers that this is the product they have been waiting for. Federal health minister Tanya Plibersek has said she will take the report to the standing council on health for discussion with the states and territories. Her reception will be much warmer if she comes carrying gold.
Whatever is decided, any implementation implies change. I can’t imagine that the change required by this report will happen without elaborate, deliberate and adequately-funded management.
For the McKeon report to succeed, we will need to invest more resources into bridging the cultural and intellectual gap between health services and research, which is currently very wide. Those who manage the system and focus on health-care delivery do not necessarily share the enthusiasm or expectations of career scientists.
Indeed, translational research (a very popular term without clear meaning) will need to go far beyond introducing a laboratory insight at the bedside. Clinicians will need to feel that the questions they are asking are being taken seriously by the research community. This is an exciting challenge, although a large one.
Overall, the McKeon review provides an energising view of what could be done to bring health care and research together in productive partnerships. Every innovative industry needs high quality research and development – and health is no exception.
** Stephen Leeder is a professor of public health and community medicine at the University of Sydney and chairs the board of the Western Sydney Local Health District.