Prescription for a healthy economy

The health research sector is critical to Scotland’s economy, generating thousands of highquality jobs, but without more government support it will be in serious trouble, says BHF Scotland

M MEDICAL RESEARCH FUNDED BY CHARITIES is a pillar of Scotland’s global prestige.

Recent successes include a breakthrough in diagnosing heart attacks in women by BHF clinical research fellow Prof Nick Mills of Edinburgh University, which has changed the way diagnostic information is assessed all over the world.

The work of Prof James Leiper, of the BHF Centre for Excellence in Glasgow, is focused on developing a new drug to tackle dangerously low blood pressure. If successful, it could keep alive patients with septicaemia long enough for antibiotics to tackle their infection. Such a drug would have the potential to save huge numbers of lives.

But work such as this doesn’t only improve health. It has another benefit too: it’s vital to the Scottish economy.

Just how vital is starkly laid out in exclusive, soon-to-be published research by the Fraser of Allander Institute (FAI) at Strathclyde University. The report shows that in 2019, charity-funded medical research created 7,475 jobs in Scotland, 5,125 of them directly in professional roles and the remainder from the spill-over effect of the workers spending their money.

It also generated £470m in output and £370m in gross value added, including the impact of research on universities and on supply chains and wages.

Medical research funding by charities such as BHF Scotland, the Wellcome Trust, Cancer Research UK and Versus Arthritis is estimated to be 46 per cent of all third sector and public funding of medical research in Scotland.

Without that cash, the Scottish Government would have to increase funding of medical research and development by 73 per cent to make up the shortfall.

As a generator of highly skilled employment, this sector has a crucial part to play in Scotland’s economic future, but it has taken a major hit during the pandemic.

An estimated 575 jobs have been lost in just one year.

This reflects a drastic drop in charity donations. In 2019, £226m was ploughed into the medical research sector by charities but in 2020 that had dropped to £208m.

The Association of Medical Research Charities (AMRC), a grouping of the UK’S leading third sector medical and health research

organisations, reports that a pandemic-related drop in funding has forced three-fifths of charities to cut back on support for early career researchers. Eighty two per cent of those researchers feel less secure as a result and 40 per cent have thought of leaving medical research altogether.

BHF Scotland and other charities are deeply concerned that without support, the current pipeline of researchers in Scotland – the next generation who will maintain Scotland’s status as a world class research centre – could be lost to other countries and critical life-saving research will be delayed or simply not happen.

Prof Leiper is the British Heart Foundation’s Associate Medical Director for research and moved to Scotland five years ago from Imperial College London. He has an acute awareness of both the benefits of charity-funded medical research and the difficulties facing medical researchers in Scotland.

He says Scotland has a lot going for it as a research destination.

“The big draw for me coming to Scotland was that there was a BHF Centre of Excellence in Glasgow and the second thing that there was great access to patients in Scotland.

“In Scotland, there was electronic medical records for all patients. If you want to improve outcomes for people with cardiovascular disease, you need excellent research and you need it to be close to patients.”

He also believes that the shorter chain of communication between universities or researchfunders and the Scottish Government may make it easier than in England for scientists to get their voices heard.

But the catch is that while young scientists can find opportunities in Scotland, it is hard to retain them later as there is no clear pathway for them into a secure scientific career. That can lead to them leaving Scotland and sometimes science too as a result.

The biotech company Prof Leiper set up to develop his low blood pressure drug initially employed 12 early career researchers and then 25 more staff, including more such scientists. It is typical of many. But when research funding is cut, retaining those staff becomes very difficult.

“This is not a uniquely Scottish problem but the Scottish Government does not fund [science] to the same extent that England and Wales does,” notes Prof Leiper. “Funding per capita is very significantly less than south of the border.”

In 2018/19, Scotland’s Chief Scientist Office (CSO) provided £65.6m of funding across its portfolio. The equivalent figure for England, administered through the National Institute for Health Research (NIHR), was £1.06bn. That means that per capita, the CSO’S funding is just 63.9 per cent of NIHR’S.

What’s more, the budget held by the CSO has been stagnant for a number of years. Between 2011/12 and 2018/19, spending by the CSO fell from £66.3m to £65.6m, which when inflation is taken into account means a decrease of more than £13m.

Funding fellowships is one way to support early career researchers who hope to go on to secure independent academic positions. They help sustain and retain talented staff. In 2018/19, the CSO spent £1.8m on fellowships compared to over £100m invested by NIHR in 2019/20.

Prof Leiper says: “You have brilliant scientists in Scotland, you have brilliant opportunities to link science to patients, but all that potential is realised if there’s funding to reassure scientists that there is a career here for them. Not everyone will reach the top, that’s unrealistic, but there needs to be an identifiable pipeline for people to go down. And if we are not careful, we will lose a generation of researchers. People will think it’s too difficult, it’s too risky. They’ll move because they are talented people and they can move.”

Charities like BHF Scotland see complacency about Scotland’s research sector as a threat to its future. Scotland is an international player in medical research now, but without investment, given the competitive global environment, it could lose that status.

The story is the same for heart and cardiovascular diseases, cancer and neuroscience: the research environment is attractive now but if it starts to degrade, researchers will leave.

Prof Leiper believes attracting more biotech and pharmaceutical companies to Scotland would also benefit the sector. He explains: “The proximity of research to commercialisation is important. It’s not the case that if you have a brilliant idea in Scotland then you can raise money in Singapore and do your trial wherever. The proximity is important.

“We know west-of-scotland-man is a cardiovascular phenotype, it’s very well defined, there’s very good medical records, so the potential to do good clinical trials is huge.

“The missing piece in that jigsaw is having the small biotech and pharmaceutical companies close at hand so the dialogue between the basic scientists, the clinicians and the biotech and pharmaceutical industry can lead to the development of new therapeutics and diagnostics.

“I think Scotland does pretty well but there is a role for government in this and lots of my colleagues in Glasgow constantly remind me if we were in England, the NIHR would fund this or that, but we don’t have that in Scotland and we miss out.

“So let’s level the playing field. Let’s get the same investment in biomedical research in Scotland that’s enjoyed in England, and then I think that will really fuel the potential that we have.”

Right now, his biggest concern is the blow Scotland’s medical research has taken as a result of the pandemic.

He says: “The implications are pretty bleak to be honest. Last year there was a 50 per cent cut in BHF research funding.

“If you’ve got 50 per cent less money realistically that’s halving the number of grants you can give going forward, so we’re going to lose people from the research community.”

The AMRC proposed a life sciences charity partnership to the UK government in 2020, to help the sector recover from the pandemic. The idea was for government to match charity funding in medical research pound for pound until funding recovered to pre-pandemic levels.

“Unfortunately and rather disappointingly, the government didn’t want to join us in that and a very small amount of money was allocated to medical research charities. So the consequence of that is that we’ll lose people because our bright young scientists will say, you’ve got less money to spend. It’s too hard to make progress in this environment, I should go off and do merchant banking or whatever.

“I think there’s a real opportunity here for governments to say, we value medical research, we understand the difficulties that the medical research charities are having, how can we work with these charities to preserve the work that they are doing and make sure that the research ecosystem survives? What can we do?

“A lot of it will come down to money, but some of it will come down to partnerships, thinking creatively about fellowships that we might offer to retain the best talent.”

BHF Scotland wants to see the CSO increase the amount of money it spends on medical research, bringing it up to the same level per capita as the NIHR in England.

They are calling for £30m, which would be an investment not just in new treatments and diagnostic techniques, but a shot in the arm for the economy.

The FAI report leaves no room for doubt about how important this sector is to jobs and prosperity in Scotland.

Prof Leiper concludes with a warning and an appeal for support for these vital high-skilled jobs: “Our funding is recovering which is great, but it will take several years for us to get back to our pre-pandemic level, several years in which we will lose people, the pace of research will be slow and discoveries will be delayed.

“It would be fantastic if government could join us and say how can we fill the gap.” •

“If we are not careful, we will lose a generation of researchers”

“From the very beginning of the pandemic, we were pressing the UK Government for temporary fiscal flexibilities to allow us to make decisions quickly,” Forbes says. “What I was avoiding was health decisions being held up because we didn’t have the financial support in place. We procured ventilators, we procured PPE, we went full steam ahead because lives depended on it even though there were lots of financial issues to resolve…”

Forbes says Covid and the associated costs have strengthened the argument for a “robust review” of the fiscal framework.

“Within a £40bn-plus budget, I manage risk usually in the millions. We don’t have capacity to manage risk in the billions and the cost of Covid was of that level. We asked for temporary fiscal flexibilities. Unfortunately, and I still don’t know why, those temporary fiscal flexibilities were denied.”

In the run-up to Christmas, Forbes inadvertently managed to throw her own party leader a curve ball when she questioned whether an independent Scotland would need the ability to carry out quantitative easing (QE). Used in response to the 2008 financial crash and the pandemic, QE allows central banks to inject money into faltering economies by buying government bonds. Continuing to use the pound following independence would prevent Scotland from carrying out QE in a time of crisis.

At an event hosted by the Royal Society of Edinburgh, Forbes asked economist Professor Sir John Kay whether the inability to carry out QE following independence would be “such a great loss”. When the Labour MSP Michael Marra put the same question to the First Minister at FMQS, Sturgeon appeared wrong footed. “Nobody should think these are good things because the situations which make them necessary are not good things,” came the First Minister’s stuttering response. A video of the exchange tweeted

“If you think that being part of a country with some of the biggest economic inequalities in terms of regional inequalities is as good as it gets, then I probably can’t persuade you otherwise.”

by Holyrood has been watched more than 125,000 times.

“The notion that there is only one way to do something is blind to what other countries around the world do,” Forbes says.

“Quantitative easing is not the only way in which countries around the world have managed both the 2008 crash and the current challenges. Anyone who suggests it is the only macro, fiscal or monetary lever that we have is not conscious of what’s going on elsewhere.

“In the event of independence, Scotland would go through a transition period and during that period we would set up our own (financial) infrastructure and there would be decisions to be made for independent Scottish ministers and there would be really important decisions to be made for independent leaders within independent institutions.”

In 2020 it was reported the Scottish Government had dropped plans to publish an annual “economic case for independence” due to the pressures of responding to the pandemic.

I ask Forbes if the economic case for separation is harder to make than the political one: “No, but post-pandemic we have a new starting position. Every country around the world is grappling with this and many of them are looking at what their own economic prospectus is for the next ten years.

“I don’t think the underlying strengths of the Scottish economy have changed but every country has gone through two years of immense challenge. Incidentally, many have emerged stronger than the UK.

“It sounds crazy to talk about 2014 as a different era but think about how many seismic shifts have taken place since then, whether it’s Brexit, the global pandemic or other significant global trends in terms of demographics and technological change.”

Forbes cites the example of Denmark as a small independent country which Scotland could follow. But why be Denmark when you could be the UK, the world’s sixth largest economy?

“Ultimately that comes down to whether you think the status quo is as good as it gets. If you think the status quo is as good as it gets, then I’m

“To preach tolerance means you must be willing to speak to and be open to the views you do not share.”

not sure I can persuade you otherwise. If you think that being part of a country with some of the biggest economic inequalities in terms of regional inequalities is as good as it gets, then I probably can’t persuade you otherwise.

“If you think Scotland has internationally recognisable competitive advantages whilst also seeing children in poverty is a problem, then it’s not the status quo you should be defending. I think we’re at a really interesting crossroads right now where there’s no longer an option for no change. The question is what kind of change do you want to see.”

Delivering her Budget statement in early December, Forbes said she was offering a “bold and ambitious” package which would prioritise spending on public services and help meet Scotland’s climate change targets. Scotland’s local authorities saw things differently, however, complaining of a £371m real-term cut to their funding and accusing the finance secretary of putting them in an “armlock” ahead of this year’s council elections after giving councillors control over council tax for the first time since the SNP came to power in 2007.

According to the Institute for Government, difficult decisions over public services are something Scots will have to get used to in the event of independence. Publishing its report How Would An Independent Scotland Borrow last year, the think tank said separation would require “difficult tax and spending decisions in the medium term”.

“We would have to make intelligent decisions because economic prosperity is not an inevitability,” Forbes says. “I don’t accept that we would be looking at a prolonged period of austerity; we’re starting from a very strong economic base.”

Forbes admits to being “weary” of renewed discussion of so-called Devo Max, a possible third option on the independence ballot which would likely give Scotland full fiscal autonomy while remaining inside the UK.

“Additional powers still don’t resolve the fundamental question at the heart of the independence argument which is one about a democratic deficit,” she says. “I can’t see a Devo Max which actually fixes that without there being prolonged debate and challenges about where powers should sit. We’d still be going round in circles.

“Independence is going to happen; 2014 normalised the notion. If you look at most polling, particularly under the age of 55, there is a pretty consistent and settled picture of support for independence. Devo Max had its debate day a few years ago and it’s probably flown the nest in people’s consciousness. It’s a fairly binary option right now between independence and remaining with the Union.” •