Go8 response to the Discussion Paper: Improving alignment and coordination between the Medical Research Future Fund and NHMRC’s Medical Research Endowment Account

July 14, 2023

Introduction

The Group of Eight (Go8), which represents Australia’s leading research-intensive universities, is pleased to provide feedback on the Government’s Improving alignment and coordination between the Medical Research Future Fund and NHMRC’s Medical Research Endowment Account discussion paper.

Please note that this submission represents the views of the Go8 network and member universities may wish to make their own individual submissions. The Go8 also consents for this submission to be published in full.

The Go8 is highly supportive of the Australian Government’s ongoing funding for Health and Medical Research (HMR) – through both the Medical Research Future Fund (MRFF) and the Medical Research Endowment Account (MREA) administered by the National Health and Medical Research Council (NHMRC) – and the benefits this brings to the health of the Australian population. This consultation provides an opportunity to cement and build on this support, improve health service delivery and achieve better health outcomes for Australians for generations to come.

Collectively, the Go8 is the heavy lifter in HMR in Australia. In 2022 the Go8 received 73 per cent of all competitive funding announced by the NHMRC and has received 57 per cent of funding disbursed by the MRFF since its inception in 2015. This is part of a total annual investment by the Go8 of over $3.44 billion in health, biomedical and clinical sciences – representing more than a third of the total national investment in these areas across business, government, independent medical research institutes and the university sector.

The Go8 is also at the heart of Australia’s international collaboration in HMR as seen during the COVID-19 pandemic and more broadly as evidenced by USD 142 million (approximately $210 million) in research funding received from the US National Institutes for Health (NIH) in the period 2018-2022. [1]

Recommendations

The Go8 makes the following recommendations in response to the Improving alignment and coordination between the Medical Research Future Fund and NHMRC’s Medical Research Endowment Account Discussion Paper.

Discussion

In the big picture, the critical endpoint for the reform of Australia’s Health and Medical Research (HMR) sector is that it operates under a coordinated and comprehensive national strategy that delivers the health outcomes that the Australian community demands.

This includes a recognition that a whole of government approach is required to managing HMR across portfolios. There needs to be a coordinated approach that brings together not only HMR in a cohesive way – across the spectrum of activity from basic research, applied research, translational research, implementation science and the non-linear pathways between them – but also research in fields such as the sciences, technology and the humanities, arts and social sciences (HASS). This is essential to ensure our world leading HMR can continue to deliver positive health outcomes for the Australian community.

This coordination between government portfolios will also require consideration of detailed funding arrangements that sees Research Block Grant funding from the education portfolio being used as a major source of funding for the indirect costs of NHMRC and MRFF projects not supported by these HMR funders.

The Go8 submission to the Universities Accord consultation goes into significant detail on these issues.[2]

Given that the current consultation places the consideration of the governance arrangements for the MREA and NHMRC ahead of the development of an HMR strategy, it is important that these governance arrangements are flexible enough to support the development and execution of an ambitious HMR strategy. If governance arrangements constrain or even pre-determine elements of a national strategy, then they will have failed.

In particular, the new governance arrangements must

• Support and protect the full range of research including basic research, applied research, translational research, and the implementation of research findings into health care, and
• Provide flexibility within a strategy that enables Australia’s world leading HMR community to pursue research questions to create new knowledge, utilising multi-disciplinary approaches, that will address key health priorities under a national HMR strategy.

In order to better inform both a national HMR strategy and the governance arrangements for the MRFF and MREA it is critical to have a detailed understanding of the characteristics of funding recipients including by rural/regional/metropolitan location, State/Territory jurisdiction, and health professional group. The Go8 proposes that a detailed analysis of this type is undertaken and published as part of the current process.

Recommendation 1: The governance arrangements for the MREA and MRFF support the development and execution of a National Health and Medical Strategy that fits into a coordinated whole of government approach to research.

With the aforementioned caveats in mind, of the three options presented in the discussion paper, the Go8 supports a staged implementation of Model 2 that sees the management of both the MREA and MRFF under one agency (the NHMRC). This model provides coordinated oversight of Commonwealth Government HMR funding, while structurally protecting the spectrum of research including basic research and translational research in separate funds while maintaining the flexibility to support a national HMR strategy.

A staged implementation of Model 2 would allow for modifications to be made to the governance arrangements as the HMR strategy is developed and prevent the governance arrangements from inhibiting innovation and radical rethinking of health service delivery in Australia.

The timing and detail of the staged implementation would require further and ongoing consultation, including in the context of the development of a national strategy.

In pursuing Model 2 it is important that overall funding to HMR is not cut and that the support for basic research through the MREA be indexed to reflect the rapidly increasing costs of conducting basic research in health and medical fields.

The Go8 also has reservations concerning the other two models proposed in the Discussion Paper:

• Model 1: The MRFF and MREA continue to be separately managed (by the Department of Health and Aged Care and by the NHMRC respectively), with a new coordination mechanism established to embed and facilitate collaboration and alignment of investment and policy between the two funds.

Given the MRFF was established in 2015 and the lack of alignment with the NHMRC has been pointed out repeatedly by stakeholders – including the Go8, these largely operational matters should already have been remedied and do not constitute the substantive and strategic reform that is needed.

• Model 3: The two funds are merged and disbursed as a single grant program (managed by NHMRC) to maximise flexibility and facilitate complementarity. This approach would require the careful design of new governance arrangements to preserve the unique value of the MRFF and MREA investment streams.

This centralises control without sufficient structure to the funding to ensure that the core elements of basic, applied, and translational research, and their implementation, are appropriately supported in a sustainable and consistent way.

Recommendation 2: That Government adopts a staged implementation of Model 2 from the discussion paper – that is, the management of the MRFF is transitioned to NHMRC, which maintains the two separate funding streams with distinct funding responsibilities under unified governance and administrative arrangements.

There has also been discussion of a fourth model based on the U.K. model of a Medical Research Council – to support basic research – and a translational fund – the National Institute for Health Care and Research – aligned with health service delivery through the National Health Service. The Go8 does not support this model. Health service delivery in Australia is the responsibility of the six States and two Territories, therefore this model would be ineffective. In addition, a recent review of UK Health Research by the U.K. Academy of Medical Sciences published in 2023[3] has highlighted many of the same issues facing Australia around career structures for researchers, cross-subsidisation of research, and the lack of embedding of research in health service delivery, supporting the premise that the adoption of the UK model alone is not a “silver bullet” for Australia.

It is also important to note that one of the key drivers for the UK model was to apportion funding activity to overcome the problem that the HMR budget was split significantly across five different government departments. As noted above, the issue in Australia is not the separation of HMR funding – which would remain consolidated in two funds in the health portfolio under Model 2 – but coordination with an overall whole of government approach to all of research.[4]

Recommendation 3: That the Government does not adopt governance arrangements for Health and Medical Research based on a U.K. model of a research funding council (the U.K. Medical Research Council) and a translational research funder (the U.K. National Institute for Health Care and Research) managed through a national healthcare system (the U.K. National Health Service).

[1] https://www.usaspending.gov

[2] 15 ideas to deliver a seamless tertiary education system Go8 submission to the Universities Accord consultation https://go8.edu.au/submission-australian-universities-accord-panel-discussion-paper-consultation-15-ideas-to-deliver-a-seamless-tertiary-education-system

[3] Future Proofing UK Health Research: https://acmedsci.ac.uk/policy/policy-projects/future-proofing-uk-health-research

[4] Setting aside the issue already noted of Research Block Grant support for the indirect costs of HMR through the NHMRC and MRFF.