Clinical research has been at the heart of the National Health Service since its inception. Patients and their families expect doctors to be able to recommend treatment on the basis of firm knowledge of what is best for them. The chance of surviving cancers of the breast and bowel, as well as leukaemia and other malignancies, has hugely improved in large part because of clinical trials involving drug treatment, surgery, radiotherapy and screening. But by the end of the 20th century, conducting clinical research in the NHS was getting harder because of increasing bureaucracy and a focus on meeting targets.
In 2001, there was a step change in the manner in which the NHS supported research, starting with the creation of the National Cancer Research Network, followed by networks for other diseases and mental health, and the creation of the (English) National Institute for Health Research. Major reforms of the research governance processes curbed excess bureaucracy, and cancer research funders co-operated through the National Cancer Research Institute and supported more clinical trials.
By 2010, there had been a fourfold increase in the number of cancer patients enrolling into national portfolio studies. Research, now in the NHS operating framework, is rightly back on the agenda of many trust boards. Clinicians "embed" the option of research into routine care: for many randomised cancer trials, patients can be offered the chance to take part at whichever UK hospital treats their cancer.
We need the next government to keep clinical research at the centre of the NHS to improve the care of this and future generations; all politicians must resist the temptation to cut the R&D budget that makes research happen, as it may take a generation to reverse the damage. Clinical research improves the health of patients and probably the wealth of the nation. It is too important not to be at the heart of NHS care.
Director of the National Cancer Research Network