“How are you going to get the government to implement this, particularly since we are liable to have a change in government in September and it could be back to the beginning, Groundhog Day.” Norman Swan, interviewing members of the McKeon Review Panel in 2013.
The final report of the McKeon Review, the Strategic Review of Health and Medical Research, was released four years ago. At over 300 pages in length, the report articulated a 10-year vision for ‘Better Health Through Research’ in the form of 21 recommendations. Such a major investigation of the health and medical research (HMR) sector had not been undertaken since the Wills Review in 1998. The McKeon Review’s vision for Australian HMR covered areas including leadership, workforce, governance, funding, quality, evaluation, translation, and commercialisation. The McKeon Review, like the Wills Review before it, called for an intentional investment and engagement with HMR as an important part of Australia’s future social and economic wellbeing. The McKeon Review is still a frequent reference point in dialogues about Australian HMR and yet, no formal, comprehensive response to the Review was ever received from government. This post will provide a background for the Review, explore its impact and contextualise it in the current conversation.
In April 2011, rumours of $400 million in funding cuts to the NHMRC’s budget sparked major backlash from the HMR community. By September, the Gillard government had commissioned a ‘Strategic Review of Health and Medical Research in Australia’ to be led by former Australian of the Year, Simon McKeon. After extensive public consultation and feedback on a draft, the panel gave the final report to government in February 2013. This was released by Health Minister Tanya Plibersek in April that year. The low-key nature of the release left some questioning if the report was being buried. Plibersek cited the need for consultation with the states and territories before making specific commitments in response to the recommendations. In June of the same year the ALP’s internal leadership spill saw Kevin Rudd return to the position of Prime Minister. Throughout this period opposition ministers continued to criticise the government for delays in responding to the review. In August, almost six months after receiving the report, Rudd and Plibersek released an ‘initial response’ to the McKeon Review on the re-election campaign trail. At this time, the opposition also released HMR policy and funding agenda which featured findings from the McKeon Review. Health and medical research policy and funding arrangements had become a major election issue. Tony Abbott’s Coalition went on to win the election and form government in September 2013. The Liberal Party had their own leadership spill two years later with Malcolm Turnbull becoming Prime Minister in 2015.
Throughout its commission, conduct, and release, the McKeon Review’s vision for Australian HMR has been overshadowed and forestalled by tumultuous circumstances. In the corresponding period to now, the HMR sector has seen two political parties in government, led by four different prime ministers and five health ministers. Despite a positive response to substantive content of the Review across the sector and the aisle, no sustained, coordinated and comprehensive response to the Review was ever provided.
This is not to discount the major impact of the McKeon Review on the Australian HMR sector.
Impact & Current Context
Several elements of the McKeon Review’s 10-year strategy for Australian HMR have been implemented in the last four years. A key development since the McKeon Review is the $20 billion Medical Research Future Fund (MRFF) which will make its first disbursements this year. The MRFF is an endowment fund supported by legislative instruments to ensure ‘a predictable and secure ongoing flow of funding for health and medical research and innovation’. The MRFF Strategy and Priorities echo many of the opportunities, challenges, and urgent needs of the HMR sector outlined in the McKeon Review.
But in this four-year period the conversation has also changed. Where the McKeon Review provided a HMR-specific strategic vision, the current National Innovation and Science Agenda (NISA) brings HMR under a bigger tent. In the context of the NISA, HMR strategy is now aligned with the broader ‘Innovation, Science and Research System’ under the purview of ‘Innovation and Science Australia’ which is chaired by member of the McKeon Review panel, Bill Ferris. The ISA conducted a ‘Performance Review of the Australian Innovation, Science and Research (ISR) System 2016’ and are also tasked with producing a ‘Strategic Plan to 2030’ for the whole system. Although the work of ISA and through the NISA covers many other sectors as well, it is still highly relevant to the HMR sector.
Many recommendations of the McKeon Review are reflected in developments over the last four years. Some of these include the MRFF, the ‘Watt Review of Higher Education Policy and Funding Arrangements’, the Biomedical Translation Fund, the ‘Review to Strengthen Independent Medical Research Institutes’, the recently completed ‘Structural Review of NHMRC’s Grant Programs’ and the ‘Performance Review of the ISR System’. Yet, other recommendations of the Review still go unaddressed. Some of these include rationalising the indirect costs of research, empowering and resourcing a leadership body with comprehensive sector oversight, and developing a consistent framework for monitoring the inputs and outputs of the HMR sector.
The MRFF Strategy echoes many of these recommendations. Whilst the MRFF is an important part of the HMR sector’s future, it cannot, and is not attempting to, provide all the solutions.
The final recommendation of the McKeon Review was ‘Action Report Recommendations: Set out a robust implementation plan and process to deliver the recommendations’. Throughout over 300 pages the Review described many of the HMR sector’s challenges and opportunities. The Review panel recognised that ultimately, success would depend on the robustness of the processes and plans for implementation. Since the Review, much has been achieved and there is still much to be done. However, without a coordinated and comprehensive response to the McKeon Review and an accompanying robust implementation plan we are not as far along as we might be. It is certainly more difficult to confidently benchmark what has been achieved because of the piecemeal and fragmented nature of the approach. The reality is that four years after the Review’s release, it is not ‘Groundhog Day’ but we are also not four years into a 10-year strategy with a robust implementation plan. The work of the HMR sector is as important as ever; there is an ongoing need for sustained, intentional, and coordinated engagement with and investment in it. Otherwise, there is a danger of the kind of amnesia Mr Swan alluded to; a by-product of fickle politics, elections, budget cycles, and ministerial staff turnover.