Nick Fahy, Senior Researcher, Nuffield Department of Primary Care Health Sciences, University of Oxford, is a researcher and consultant in health policy and systems, looking at how health systems work; what we can learn by comparing health systems across countries; and how to bring about constructive change in health systems.
At the EHFG 2019, Nick moderated the Lunch Workshop Horizon Europe: Strategic priorities in European health research, organised by the European Commission. After the session we discussed his views on the future of health research under Horizon Europe and the key take-home messages from the debate.
Michele Calabro’ and Verena Struckmann (MC & VS): You opened the debate with a very powerful statement: “This is the best time to shape the next years of healthcare research policy at European level”. Building on this, could you share with us your views and some key take-home messages from the session on what direction health research should take under Horizon Europe?
Nick Fahy (NF): Indeed, this is a huge opportunity for health policy research, and I believe the direction in which Horizon Europe is moving will have positive impact – it is focused on trying to make a real difference in our world. Of course, research itself has a value, but Horizon Europe will attempt to ensure that European Union (EU) funded research will have a real and tangible impact on the life of European citizens.
On this, I would like to bring up the point raised by Fiona Godfrey (former Secretary General of the European Public Health Alliance) during the session – we are living in a time of populism, where the very existence of the EU is being contested. However, if you can give people concrete examples, such as the European Reference Networks, it enables them to see tangible outcomes and subsequently the real value of being a member of the EU. Missions such as the Mission on Cancer or the partnerships for interdisciplinary research draw together projects and research around an overall societal goal we are trying to achieve – this is clearly an important and positive direction.
MC & VS: What is the role for health systems in European health research?
NF: In the past there has been a tendency by the EU to consider health systems to be the sole responsibility of individual Member States, that even EU funded research should not engage in national health systems at all. However, when you are looking at health and looking at Europe, the thing that makes a real difference is our commitment to universal access to high quality healthcare, funded on the basis of solidarity and provided on the basis of equity. That is unique, no other region in the world offers this.
So, if you are carrying out European health research, for me, health systems must play a role in this. I therefore welcome the fact that health systems are now part of the six key goals for Horizon Europe and the idea that translational work – building on basic scientific research to create new therapies, medical procedures, or diagnostics – is included as part of that.
MC & VS: Do you think that public engagement in research is a necessary focus for Horizon Europe?
NF: Another final point to highlight is indeed around the degree of public engagement in research itself, both in priority setting and in the process of carrying out research. We have spoken about engaging the public but, in practice, we almost never do. Often researchers find it difficult and are uncomfortable – on this point, quoting Rachel Melsom (Director of Tobacco Free Portfolios): “If you find yourself in a situation where you are a little uncomfortable and feeling challenged, and you think it is a good idea in principle but you are really not enjoying the experience, then that is probably where you should be”. That is a real disruptive situation and exactly where most researchers are in terms of public engagement and where research in general should be. Public engagement in research is of great importance, not just for the legitimacy argument: it clearly helps research to better respond to people’s needs whilst improving its overall quality.
In my work at Oxford we still encounter discomfort from most researchers when trying to improve public engagement. It is not how we are trained as researchers, but when we do co-create and design research with the public, what we find out is that the research is much better as a result. Researchers themselves therefore become very persuaded in the value of engaging patients and the public.
One of the things I really hope Horizon Europe achieves is to advance the processes of public engagement, influencing the entire life-cycle of research projects, from the very start of the funding process to delivery. If we want to be serious about public engagement, Horizon Europe should invest in facilitating real engagement processes to enable and ease collaboration with public and patients’ groups. So, when we come to the calls, we have public involvement in place, co-designed priorities and therefore a solid basis to start from. If we do not do this, public engagement will never really work.
MC & VS: One of the innovative aspects of Horizon Europe is surely linked to the so called ‘Missions’, including the Mission on Cancer. From what we could gather during the session, there is still time to shape what these should look like, as well as their objectives and goals. Could you share with us your views on this?
NF: We are trying to do something similar to American research, setting an overall goal to achieve an objective. However, I think we should organise only part of the research this way, although in general I support the idea of focusing and funding some key areas and projects which are oriented towards achieving an actual goal and outcome.
To demonstrate the challenge for the Commission, I used the metaphor of Lego bricks and each of these research projects is a Lego brick. Finding the Lego bricks is not the challenge, but the difficulty lies in how all these Lego bricks fit together. Only the compilation of highly specialised research does not necessarily lead to more understanding. Thus, the missions are more about the question of how we create the design and the processes, how do we assemble the people, and how do we really get the different experts in the field working jointly together?
Besides the missions’ necessity and their potential to be brilliant, they will also create expectations within the society. You invest millions of euros into these missions, so in five years you will have cured cancer, correct? And this will of course not be the case. It is not an easy task to realistically take researchers out of their comfort zones, out of their own speciality, and try to help them understand how the different Lego bricks fit together. Potentially, this is exactly how we really generate innovation and creative research. It is important that this does not end up being just another bandaging exercise because we really need to change the way of thinking regarding how we organise research on a European level.
We must begin the process of taking the various ideas into an overall understanding of the challenge, which is bigger than original sectoral domains. In the end, researchers themselves need to be willing to put the investment and the energy into how we can assemble the Lego bricks together and how we can get everybody out of his or her comfort zone.
This interview was conducted during the EHFG 2019 by Young Gasteiners Michele Calabro’ – Policy and Communications Manager, European Health Management Association, Belgium (at the time of the interview, currently Policy Advisor at European Patients’ Forum) and Verena Struckmann – Postdoc researcher at the Department of Health Care Management at the Technische Universität Berlin, Germany.