Consultation: Improving alignment and coordination between the MRFF and the MREA webinar 2 – 3 July 2023

BLAIR EXELL:

OK, good afternoon everybody. I think this is actually our third go, trying to come through, apologies for what I think was technology errors. We did do a test before the run, and then something went wrong, just as we went live. So, hopefully, I can see the screen ticking over, I think you can all hear me now. I'll quickly introduce myself. My name is Blair Exell, I'm Deputy Secretary here in the Department of Health and Aged Care and Sport here in Canberra. I have with me my colleagues, Masha Somi here, the Head of the MRFF and Anne Kelso, Head of NHMRC, and Phillip Gould, the Division Head for Health Economics Research here in the department. Thank you very much for your time. Can I just quickly and importantly acknowledge the Traditional Owners and Custodians of the Lands that we are on, across Australia, pay our respects to Elders past, present and future, and importantly also acknowledging our Aboriginal and Torres Strait Islander colleagues that are on the call here with us today.

We've got a two-part session that we're looking to run. So, Masha and Anne will kick off the initial presentations with really a summary of the discussion paper and issues. Slightly differently, this is the sixth I think... consultation that we've had, looking at these issues around improving alignment and coordination between the MRFF, and the Medical Research Endowment Account in the NHMRC. So today, rather than spend too much time on the background, we will kind of run through it at a high level. We're going to focus a bit more on some of the existing or the messages that we've heard already through those existing forum. So that's what we're aiming to cover in our first two or our first part of program and then we'll move into a question-and-answer session. To do that, I'm sure many of you are familiar with Slido. That's what we'll be using as the mechanism to take questions. So, either use the QR code that I can see on the screen, or if you can't use that, then I can provide the code.

If you join as a participant using the code 3927435. I'll just repeat that, 3927435. If you can, if you see another question there that you like, or that was a question that you were going to answer, no need to repeat, you can thumbs up on that question. I'll be using that to guide us in terms of which of the issues that have the highest commonality or the highest interest from yourself. So we'll be prioritising that. Just also a reminder, the first webinar, I referred to previous mechanisms was held on the sixth of June. This is up on the website on the Department of Health website, you'll see if you look for MRFF consultation. You'll see they actually recorded in transcripts from those previous forums. So if you want to kind of dive in a bit deeper and hear some of stuff, you can find that there. With that background, I'll pass over to Anne to lead through our first presentation, thanks.

ANNE KELSO:

Thanks very much Blair and hi everyone. It's great that so many people can join us today and have a chance to hear where we're up to in this very important consultation. We've heard a lot from people around the country already, and Masha is going to talk about that in a bit more detail later. But I think this is a great opportunity to engage with a wider group today. I know there are some people online who have attended previous sessions, so I'm sorry that some of what I'm going to say will be very familiar to you already. But for those who haven't joined us before, I hope that background will be useful. So first of all, we're talking about two large funds which collectively provide more than $1.5 billion for health and medical research around the country already. And it's really important, given how great the needs are for this research funding that we use those dollars as effectively as we can. So that we undertake the research that Australia needs today, but also in the future for the improvement of the community's health and wellbeing.

And from our point of view, this encompasses a very broad range of types of fields of research. It goes everywhere from discovery research through to research to improve clinical care and the delivery of health services, and also to inform public policy to improve population health. It includes support for translational research, whether that's directly into policy and practice or via a commercialisation pathway. It also includes research that addresses the specific needs of a diverse range of people and communities around the country, whether it's to address today's challenges or to have the capability and flexibility to respond to whatever the future is gonna bring. So as you know, I think the purpose of this consultation is to discuss models for the governance of the MRFF and the Medical Research Endowment Account, NHMRC account, that will allow us to make the best strategic use of these funds and really to take their administration to the next level. We think we need an open discussion with input from many different perspectives, perhaps beyond the ones we normally speak with.

Researchers have been talking to us about these issues for quite some time. And so it's really important and we've been really delighted to hear many other points of view through the consultation so far, and I expect we will today as well. And again, as you probably know, the consultation is being undertaken in the context of a pending review of the MRFF Act, which will be slightly delayed to enable this consultation to happen. And then as we'll discuss a little bit later, the future development of the National Strategy for Health and Medical Research, which is not what we're up to now. So, the next slide outlines what the MREA is, and what the MRFF is, and this will be very familiar to many people. But for those who don't apply to these funds, it's probably useful to point out what they really for. So the Medical Research Endowment Account is the fund from which NHMRC grants are delivered. It receives funding every year through the federal budget, and that's currently approaching $900 million per annum.

And that's specifically to support grants for medical research and public health research. So NHMRC has been around for a long time. It has an established place in the delivery of competitive research grants to the sector, in universities, medical research institutes and hospitals, and that's its remit. NHMRC reports directly to the Minister for Health and Aged Care. And importantly for this discussion, its strategy, priorities, and policies are developed with the advice of its council, NHMRC Council and a range of committees and are then approved by the Minister and articulated through our annual corporate plan. So, a really key point of difference from the MRFF is that most NHMRC grants are investigator initiated and that means that the applicants decide what they want to work on, and then they can compete for funding openly to support the projects, the researchers, the teams, and the collaborative networks that are needed to undertake the work. The grants can be in any field provided their ultimate purpose is the improvement of human health.

So, in practice they range across the full spectrum, from basic to clinical to public health to health services research, discovery research, translational research, clinical trials, cohort studies, early-stage commercial research and partnerships with health providers and policy makers. So that system has contributed to, I think, Australia's very well recognised strength in health and medical research. And our situation overall is as one of the healthiest countries in the world. Was recognised quite some time ago that this model of research funding, while it's effective for what it needs to do, it's underdone when it comes to priority driven research that's directed at the specific needs of the community and the government. And an ideal funding system would have a balance between investigator initiated or bottom-up research and priority driven or top-down research. And many will remember that that's exactly what the McKeon Review called for some years ago. So, in 2015, the Australian government established the MRFF, an innovative approach to redress this imbalance and establish a perpetual source of funding for medical research and innovation.

So, the $20 billion MRFF was established and that's now fully capitalised from which the earnings are drawn down each year to provide grants. And that's currently 650 million a year, on top of the 900 million that was delivered by NHMRC. So, in a way, as I've already pointed out, the critical difference from the MREA is that these grants are awarded in priority areas that have been determined by government, on the advice of the Australian Medical Research Advisory Board, or MRFF, which follows a national public consultation that's held every two years. The funds are then delivered through a range of missions, targeted research schemes and some innovative approaches to funding, such as the Frontiers program. And like NHMRC, but with a different focus, they also support a very wide range of types of research and research topics with a focus that's more on translational research and innovation. So unlike the MREA, delivery of the MRFF is overseen by the Health and Medical Research Office in the Department of Health and Aged Care, and that's headed by Dr Masha Somi, using grant services that are provided either by NHMRC or the Business Grants Hub.

So, the next slide summarises what the problem is to be addressed here. And you could ask really what is the problem? Because we've got more money now for research coming from the Commonwealth Government than has ever been before. And we have now a mix of bottom up and top-down research supported by these two funds. But it's a good time to ask the question after more than seven years of operation of the MRFF. A lot of progress has been made in those seven plus years as the MRFF is evolved, and as the two agencies have increasingly worked together. So many of the early issues that were brought up by the sector in the MRFF was first rolled out and have now been satisfactorily addressed. But there are issues that remain that stakeholders raised with us and with others and the major ones are summarised here and they're also elaborated in more detail in the discussion paper. Now some of these issues just flow directly from the fact that the two funds have managed separately through different government bodies, and NHMRC and the Health and Medical Research Office.

And their strategies are developed separately through different consultative processes and there's no formal coordination between them, although there is some informal coordination. So that strictly speaking, these strategies are neither coordinated nor integrated. There are a lot of overlaps in the types of research that the two funds support, and that in itself isn't necessarily a problem. But there is a lack of clarity in many people's minds about the different purposes of the funds. And users are calling for greater coordination of grant topics and funding cycles (COUGHS) excuse me, and also of application requirements and funding policies so that the workload for researchers and for peer reviewers can be as streamlined as possible. Then across the board, there's a need for greater consumer and community involvement in setting priorities and in the design and conduct of research. And there's a need for greater embedding and integrating of research into clinical environments and public policy development, as well as commercial R&D.

So the last of these issues, the last two really more ones are strategy, but the first three are very clearly in this group of issues that are governance and administrative issues that we want to talk about today. So the next slide just summarises what we want, how as a result of this reform and how these problems could be addressed. Really, the overarching issue is how do we make the best use of the MREA and the MRFF together for the improvement of health and prosperity of the country? And this slide lists some of the things that we would like that to be. We want research that's informed by and involving community. We want it to be efficient and effective for all users across the research, government and industry spectrum. We want to balance the benefits of investigator-initiated research, which is often working at the frontiers of knowledge, and priority driven research that's flexible and responsive to government and community needs. So the ultimate goal of the consultation is an integrated approach to funding that will deliver the research we need as a country.

We've already heard from people during the consultation how much they valued the different approaches of NHMRC and the MRFF. And Masha will talk about this and more. But we want to be clear that the possible changes don't mean that the special features and benefits of each fund will be lost. They continue to be different schemes for different purposes with different review processes and reviewers as required. It's also clear that whatever outcome there is, there'll be changes for the roles of the Health and Medical Research Office and for NHMRC. And it will be critical that whatever changes are made, that there are the appropriate advisory structures and capability to deliver a much broader grant program than today. So there are two stages to this consultation. The first stage is the one we're here to talk about today. That's how to improve the alignment and coordination of the MRFF and the MREA to address the various issues that were outlined before. So that's the governance arrangements for overseeing the two funds, including their advisory structures and accountability, and the administrative arrangements to deliver the actual grants from the two funds.

There will be a second stage, and that is the development of an overarching national strategy for health and medical research in Australia that would take into account the states and territories, philanthropy, industry and all interested parties. So many people I know want to talk about the strategy now, and it is important that we start those conversations because they're critical for the future. But today we are really concerned with the first stage of consultation, and that is governance and administration. So what we want is the outcome of this is that we're able to present advice to government on a viable model for the integrated governance and administration of the MRFF and the MREA, so that we'll be capable of delivering grant programs that are consistent with the future national strategy. So the next slide just lists the three potential models which are talked about in much more detail in the discussion paper that I'm going to go through now. But they really represent small, medium and large scale going from one to three reform of our current arrangements.

And these are models. They're not options to choose between, they are models that are really designed to stimulate thinking rather than options that we're asking government to choose between. Now the first model retains the current structures for NHMRC and the Health and Medical Research Office, but it introduces a formal mechanism for coordination between them. Model two has NHMRC leading and managing both funds, which then continue as separate funding streams, the MREA and the MRFF with their distinct roles. But obviously in this case we'd need new advisory structures to support NHMRC to meet the needs of both funds. And then model three, which is the most ambitious and would need the most work to implement, has the two funds merged and distributed as a single grant program managed by NHMRC and this also would need more new governance arrangements, and would deliver a single cohesive investment strategy. So that really summarises most of the content of the discussion paper. And I'm now going to turn over to Masha to summarise the feedback we've received as we've gone around the country over these last few years.

Thanks Masha.

MASHA SOMI:

Thank you Anne. And so I'll quickly talk through what we've heard. This isn't to tell you what to tell us, but to be respectful and to show that we're listening and hearing the different views and perspectives that we're hearing. So you won't necessarily agree with everything that we've summarised here. And I think that's the value of the additional consultation today, and also the opportunity to provide written submissions as well. So what we know and many of you already know, is that research and the research sector are absolutely passionate and diverse. And what we're hearing is that there are a lot of strong views coming through the variety of interested stakeholders, all the way from researchers to health service providers. Industry has got a lot of views, our consumers and particularly our priority populations, have really played a valuable role in the last few weeks, giving us views and perspectives. And that's been through the formal mechanisms, but also in formal mechanisms because we're hearing a lot through our normal engagement and consultation processes.

As Anne said, what we're hearing really strongly and it's sort of embedded in the discussion paper, but coming through all of the conversations that we're hearing is that the research sector values having both an investigator and a priority driven approach. These are well recognised and accepted views. And another key theme of what we're hearing from our conversations and the discussions is that the reform process should promote and build on what works. It's not an opportunity to start necessarily from scratch, but to take the best of both funds and make something even better. So on the next slide, I've just started each of these with a little bit of a quote. And the first quote is, seamless that not homogeneous. And the main message that we've taken away from this is that there's great things in both funds and that we can work better together. We can bring the funds closer together to offer improved administration and more seamless processes. However, people don't want them to be the same.

So not homogenous, not to make them too similar in their operations because they do different things within the health and medical research sector. We've also been asked to think about what we can start early, so some of the proposed reforms are quite significant and will take time, potentially legislative change. And there's a call from the sector to think about what early steps that we could take that don't require some of those bigger changes. And on to the next slide. Again, a quote, there was a perception that models two and three is a takeover, not our words. It came from one of the discussions that we had. And people are really asking us to work together towards a merger, taking the best of both funds and making it even better, leveraging the strengths that each of the funds brings and the benefits that they brought into the sector, and that there's an opportunity to gain more value through a merger and working together. On the next slide. Some stakeholders have asked us to think about staging, particularly noting that some of the changes are quite significant.

Again, asking us to look at what we can fix as quickly as possible, especially the administrative issues, and allow for more time for careful planning, for consideration of legislative changes that might be required, and also to really factor in change management processes that we processes that would be required to deliver an effective outcome. A key message is, don't disrupt what's working well. And we've also been asked through the conversations to look at other models. So for example, in the United Kingdom, where they have two separate funds, their way that they've delineated those is to have the funds operate and focus on different parts of the research pipeline. Another kind of key message is we're hearing that people see a place for themselves in each of the funds. They see different things of value in the two funds and they value them quite differently. So the message is that the two funds play quite different roles in the system, and we need to think carefully about how to preserve what's value in each of the funds moving forward.

And that value comes from different value is seen by different parts of the research sector. As Anne flagged, there's a real discussion around strategy versus governance. And everyone's really keen to talk about the strategy and what the future could look like from a broader investment from the Australian Government. And a particular call that, yes, we're looking at governance and administration first and strategy second. However, you need to account for a future strategy when you're thinking about your governance arrangements. Those two things aren't completely divorced. And just to let people know that we have heard all of the comments around the strategy conversations, particularly concerns around workforce and early to mid career researchers. And we've taken all of those notes and we'll keep them available for when we do start the discussion around the strategy. (INAUDIBLE)

BLAIR EXELL:

Thank you. Thanks Anne. Thanks Masha, for that summary of the discussion paper. And then Masha, for the kind of feedback on the consultations that we've had today. Thank you for those are starting to put some questions in. We're getting a mix of questions at some are about sort of factual understandings of MRFF and some more about issues going forward. To be consistent with my comment about going to those at the thumbs up, I will try and do that as much as possible. So first of all, I've got a question which goes to, I guess, the future of the NHMRC. The question is asking around that change period with both new leadership and then referring to new governance. So there is concern that the NHMRC is at a crossroads with both new leadership and new governance within the month. Will the incoming CEO make any public comment? And Anne, will you respond to that one? (INAUDIBLE)

ANNE KELSO:

OK, thanks Blair, and thanks for the question because it's a good one. I finish late in July and Steve Wessling will commence as the new CEO of NHMRC late in August. I think that the it'll be less of a crossroads from the point of view of leadership transition than the possible outcomes of this consultation. The outcomes of this consultation could as we can see, have a very big effect on the future activities of NHMRC. I think the transition of the CEO position will be helped by the fact that Steve has been a member of our Council of NHMRC for the last triennium and a half, so five years roughly, and he's also Chair of Research Committee over that time. So he's already knows NHMRC very well, but more importantly has been involved in the background discussions for this consultation. Steve was also present at the Ministerial Roundtable in Adelaide early in the consultation period. So he's already very well integrated into the process. I'll leave it to him to say whether he wants to make a public comment at some stage, but I'm sure once he starts will want to be talking broadly with the sector and it'll be up to him how he does that.

BLAIR EXELL:

Thanks Anne, I might just then turn to another question, which was later in the sequence of questions, they're asking, when are we expected to start implementation once the consultation closes? Really it's too early to make a comment around that. Obviously, as you would guess, it depends very much on terms of the options. We do appreciate the feedback, we appreciate the advice that's coming through. That's once we also look at formal written submissions as well, then there'll be some advice the government will look at that and obviously it depends on the options as to when the implementation will start. So I'll just cover off that one at the same time. Again, a number of people interested in a technical question. Masha might come to you if that's right. The maximum annual distribution for FY 23-24 for the MRFF is 870 million, yet there appears to be a cap of 650 for grant rounds, which not a cap that's been existing level of investment for a number of years. What happened to an extra 220 million?

MASHA SOMI:

Thank you Blair. So the maximum annual distribution is just that, it's the maximum. It's not a recommended amount or a required amount. The government has forecasts for a number of budgets now that there would be $650 million dispersed through the Medical Research Future Fund, and that's the level that's being committed to in 23, 24 and also in future financial years. So those funds are not lost. They will remain in the Medical Research Future Fund and can help continue to grow the base and future investment and also then disbursements.

BLAIR EXELL:

Thanks. Next we've got, I guess, a question about the consultation process. Maybe, actually Masha or Anne, maybe Masha you first and then you Anne can add. The question is are State Health departments being formally consulted, it might be useful also just to quickly run through the consultation mechanisms we've had so far, just so you get a sense of who.

MASHA SOMI:

Sure. Do you want to - yeah? So we have, so many of you know, we kicked off our consultation at the beginning of June. We had a webinar that was quite well attended. Thanks for all those who are able to participate. We've had five roundtables to date. Two were led by ministers. So Minister Butler led a council roundtable in early June, and Assistant Minister Kearney also had a roundtable, hers was in late June. As well as that, we've had Commonwealth roundtables. So these are ones that had been led by the department and also NHMRC. They were held in Sydney and in Perth and in Brisbane. And they were opportunities to bring together a diverse range of voices to those structured processes. This is our final webinar that's broadly open. We are doing some additional work with the Consumers Health Forum to do a targeted conversation with consumers, and that's all culminating in the written submission process. And all those are due on the 14th of July. So that's the external conversations that we've been having.

We also need to have conversations across government because investments in research impact not only us here in health but also across a range of departments and also states and territories. So we have a conversation with states next week and that's with senior responsible officers with an interest in research. And we'll be having a discussion next week. And we're also having a senior conversation with relevant departments and agencies across the Commonwealth. So that's a number of departments, including industry and education, but also bringing together groups who have an interest in research, including the Australian Research Council and the Chief Scientist office as well, and...

BLAIR EXELL:

I think it's great, thank you, might move the next question. Could model three be modified to ensure they're always both top down and bottom up grant programs with entirely separate review processes in the reviewers? Anne.

ANNE KELSO:

Yeah, from my point of view, absolutely model three is completely open at the moment as it's described in the discussion paper. There's not much detail at all because we're interested to hear from people what they think about how that should look if it were to be a preferred model. So I think it's a matter of how that model is designed. But I think given everything we've talked about already, the idea of having both investigator initiated and priority driven research covered, and that you would continue to have a diversity of grant schemes for different purposes that I think will be highly desirable to retain. But those are exactly the sorts of things that would be worked out in designing that model and then developing the legislation for it.

BLAIR EXELL:

Thank you for the comments. I'm going to read a question that relates a bit later down, in model three, will splitting funds remain the same or will funds not used in MRFF be redirected to MREA or vice versa on a needs basis?

ANNE KELSO:

Yeah, and I would say again, that's completely open for future discussion, if the government would prefer something like model three. And clearly a model like that has flexibility, you could either establish in advance what you want the ratio to be for the longer term, or you can have the flexibility to shift it according to me. So those are the sorts of things that would, I think, be discussed in a great deal of detail if the government were to go down that path.

BLAIR EXELL:

Thank you. Next question. What are the plans for the different review pathways in MRFF e.g Sapphire versus (UNKNOWN) submitted schemes?

MASHA SOMI:

Yeah, thank you. So I might just do a bit of an explainer before I launch into the (LAUGHS) answer because I feel like knowing the system so well means I understand the question potentially more. So we do have two ground hubs that administer the Medical Research Future Fund, NHMRC and Business Grants Hub. And the processes and the systems are a little bit different. So the proposal in the discussion paper is for a single hub to manage all MRFF grant opportunities, and that's to achieve efficiencies and a commonality so people have the same experience whenever they're applying for the Medical Research Future Fund. There are some differences, though, that our Business Grants hub has been able to achieve because they are much more focused on the industry commercial side of the system. And so. I guess the key thing is those are things that need to be resolved. We don't have an answer straight away. The discussion paper puts it out as a proposal, and we're looking for feedback, particularly if there's unintended consequences.

We know the world from where we sit, but if there's something from your part of the system that is very important and very clear, please put that in as part of the submission process so that we can account for it as part of planning our way forward.

ANNE KELSO:

Perhaps I could add to that, if I may. Sapphire has been designed as a very flexible system. And so I think if it were Sapphire that was managing all grant applications that are now covered by business grants, then they'd need to be a discovery process, as Masha says, to understand exactly what it is that's beneficial for industry and other applicants through business Grants Hub so that the value of that can be retained in any transition to Sapphire. Sapphire is a series of components that are highly modular and flexible. So it would be possible to design what's needed on that platform.

MASHA SOMI:

And I guess it's the separation of the 'what' from the 'how' and working through implementation arrangements. So any feedback and advice would be really well appreciated.

BLAIR EXELL:

Thank you. I think next highest on the thumbs up, this is other Commonwealth Funding Consultations, like the current Cancer Australia Consultation being considered as part of stage one, or stage two of these consultations. Thank you for that question. I think we are working on this across the department to make sure we check out some of the views and feedback. So, yes...

MASHA SOMI:

(INAUDIBLE) ..has been involved in conversations, attended a roundtable with us, as well as us working in officer level.

BLAIR EXELL:

But if there's particular issues or aspects that you think it's important we pick up through this, then then yes, keen to hear that as well. But I can answer that they are involved. I will answer a practical one. Will the slides be available afterwards? I think yes, we can share those. So they will be provided. There' s a couple of, I guess, follow up on our timeline, understand why you can't detail the timeline for changes, can you comment if we're going to pause on funding calls that changes not made while schemes are open? I think we can take that as advice too for us to certainly consider the issue around existing funding calls? I'm not sure if Anne or Masha want to comment.

MASHA SOMI:

I mean, I think we're both totally committed to making sure that our funds are spent in any implementation needs to account for any transition needs to occur, and absolutely minimising disruption. So we're not impacting our regular BAU as we move forward. So it's a really, it's feedback. We've heard that there's concern about disruption, but it is, I guess, important for us to reiterate that, we will factor that in. All that will be factored in as part of moving forward.

ANNE KELSO:

Yeah, I absolutely agree with that. I mean, we know how many people are reliant on the cycle of NHMRC grants schemes, like investigator and ideas grant, so we wouldn't want to disrupt that. So it'll just simply be part of managing any kind of implementation alongside. And also giving plenty of notice to the research sector about any changes in systems once we know how we're proceeding.

BLAIR EXELL:

Thank you, and I think, again, a similar sort of related question. Is there any indication of implementation timelines for all three strategies and a plan for implementation? Again, just really too early to be able to answer that with any detail. Obviously, the more radical or the larger change and the more time we needed indeed, that goes for some of these when you're talking legislation or acts indeed, then I think that does change the time. What I probably would say is our administrator is very committed. The government is very committed to looking at this and is actually quite keen to keep smoothing but it does depend on the model in terms of how quickly we can move. And indeed, the answer to the previous question that goes to the tight timelines as well. I think this is next, is there going to be a better funded Secretariat to help implement these changes, pre-award to improve grants, post-award to improve monitoring of outcomes? Again, we can take that into like as a suggestion or a feedback.

MASHA SOMI:

I mean, I think I can comment... (INAUDIBLE) We're certainly making efforts in those areas and always grateful to receive feedback. It doesn't need to be through this format, but certainly are taking a lot of effort in the post-award space, so happy to engage with people through usual mechanisms on those issues.

BLAIR EXELL:

Again, a more technical grant-based question. NTP-connected ministered MRFF schemes aren't addressed in the consultation paper. Would these also be merged as part of the consultation or remain separate?

MASHA SOMI:

So, the way that the grants through our medical research commercialisation initiative there, that's the funding that MTPConnect and Brandon Capital (UNKNOWN) support organisations using MRFF funding. That's the initiative that's used for that funding. So, that is captured within the overall program. So, there isn't a separate stream for MTPConnect, that's part of the broader MRFF and it is subject to, what's proposed in the discussion guide.

BLAIR EXELL:

Thank you, what's the right balance between pure research and research-translation/commercialisation? How do we ensure that commercialisation continues to be a priority? The question and that's also come up in previous consultations.

ANNE KELSO:

And also an impossible question to answer because what's the magic number? But I think also we're recognising that it's a kind of a continuum from fundamental research through to various sorts of translational research. That's certainly what we see in NHMRC applications quite hard to classify them in many ways. But what is critical is that whatever the outcome of the type of model that's developed is that we continue to support that full spectrum in the most appropriate way for that type of research. So the answer is clearly different for discovery research compared with pre-commercial and commercialisation research. So I think we want to be really clear of our intention. I think in the Department and in NHMRC that there continues to be support across that full spectrum and that the support is whatever is needed.

MASHA SOMI:

Agreed and just to add that the discussion around the strategy. So this is where we're kind of in stage one consultation versus stage two, the discussion about the strategy really will be able to delve into those issues in more detail. And also just to add, you know, whilst we're talking about the MRFF and the MREA, there's lots outside in terms of Australian government funding and other interested parties across the Commonwealth that we need to bring to the table. So we have the Biomedical Translation Fund that we talk about. There's the National Reconstruction Fund that's ramping up and so they're part of a second stage discussion around what's the role of these two funds playing into that system. That's a pipeline across the Commonwealth and with other funders as well.

BLAIR EXELL:

Thank you, and I think in a similar vein to balancing trade-offs, next question goes to investigator versus priority are reviewed differently. Health economics risk (INAUDIBLE) Etc. will this be retained?

ANNE KELSO:

Well, of course, it depends whose decision that ultimately is. But I imagine that if it's NHMRC responsible for delivering the MRFF they will want to understand what is the best set of criteria and therefore also the best groups of reviewers for the different schemes that MRFF currently runs in, which might continue or might continue in modified form, I really don't know. But I think the whole point is to keep that diversity regardless of the model but to be able to have a coordination of delivery and strategy. So this is not about getting rid of something, it's absolutely not that. It's about streamlining and coordinating.

BLAIR EXELL:

Thank you, given that both the NHMRC and MRFF advocate for greater consumer-driven research and consumer involvement, how are consumers being elevated into governance?

MASHA SOMI:

Do you want me to say about the MRFF? So last year we had a consumer reference panel appointed. That was with agreement of government. And so I work with them. We had a meeting last Friday actually, and they contribute to quite a few considerations about how the MRFF operates. They helped us redesign our assessment criteria last year. That's just a really practical example of the way that they support us to do our work. In all of our advisory groups, we have consumer representatives. So many of you will have seen that we've got four expert advisory panels operating at the moment. Giving us advice on things as diverse as childhood mental health and post-acute sequelae following COVID. On all those groups, we have consumer reps, so we're embedding consumers in our advisory structures In advice direct to me as the Chief Executive Officer overseeing the Medical Research Future Fund. And many of you will know we already have consumers on all of our grant assessment committees, so they're involved in supporting decision-making around what's funded once grant opportunities are announced.

ANNE KELSO:

There are similarities and differences at NHMRC, we've had a consumer and community advisory group for quite a long time now and we seek their advice on all major funding policies and many other issues as well. And we have consumer representatives on council and on our various principal committees who provide advice to council and the CEO. So in that way, it's quite similar to the Health and Medical Research Office in the MRFF. Now we're not at this point involving consumer representatives in peer review of all of our schemes, but we are in our targeted calls for research and this is a relatively new initiative. But we've had consumers advising on peer review in targeted calls for some time and we now have them formally also scoring specifically for the outcomes of the grant applications. So that's a really useful step for us to learn how to engage and involve consumers more directly in peer review. It's a somewhat different circumstance because most of our schemes are investigator-initiated, incredibly diverse, and it's a challenge to know how to involve consumers in peer review across those thousands of applications.

But for the targeted calls, it's working really well.

PHILLIP GOULD:

If I might just add very briefly to that, I think, while I'm not talking here about peer review processes or those specifics throughout this consultation and going ahead, we're really alert to the fact that we're dealing with a broad group of stakeholders with different interests. So the research community are obviously a critical stakeholder for health and medical research, but consumers have been raised through this question. Also incredibly important as businesses we may at one point, commercialise the research and translate that into commercial activity as well as service providers and clinicians. So we're very keen as we go through this process to hear those views and really encouraging people with those perspectives to put in submissions through our consultation process.

BLAIR EXELL:

Thanks everyone for the questions that continue to come in. Really appreciate those that are going to questions which are in part suggestions or feedback to the process. So it's useful because I think it is helping. I can see the questions are coming through building on those. So thanks for those that are using them that way. I think, again, building on some of the answers, there's a current gap for researchers who fall between ARC Medical Research Policy and MRFF, NHMRC funding, such as medical engineering. Is there any scope to address this?

ANNE KELSO:

Well, I'd say that's been a longstanding issue brought up by people who do work at that intersection, and from NHMRC's point of view, there's no barrier at all from our perspective to people who are working in, let's say, bioengineering, applying to NHMRC for funding. There's probably more of a barrier on the ARC side because of the rule against medical research funding that they provide. I think the challenge is really then whether peer review is able to manage truly interdisciplinary research. We know we fund a lot of biomedical engineering at various times, you know, tissue engineering, all sorts of device work. So it kind of depends on what you're talking about, we know a lot of it is funded. If there are areas that are falling between the cracks and it's always useful for us to know about that and to know whether it's an issue to do with finding appropriate peer reviewers.

MASHA SOMI:

And I think we're looking at this as an opportunity rather than sort of a missed opportunity 'cause there's lots of amazing skills that we need to draw into the health and medical research sector, so mathematicians, statisticians, economists and other groups who really could add value to the research that we're doing through targeted health and medical research. So we do see it as an opportunity and we'll continue to look at ways to increase it and improve that connection.

BLAIR EXELL:

Thank you, a question that has rocketed to the top of the numbers. Have you done any modelling on whether there'll be cost savings associated with the three models? If so, which is the most cost-effective and efficient?

ANNE KELSO:

Well, I suspect cost-effective and efficient might measure slightly different things and it might depend on your perspective, but no modelling has been done at this stage because we don't know what the model is. So I think it's quite difficult to do, they're rather high-level models that are described in the discussion paper. If I just talk off the top of my head without official authority, it seems to me that in the period of implementation of any major change, there have to be additional costs with that because you have to manage business as usual as we've already discussed. But you also have to do a whole lot of work to make sure that whatever the new governance and administrative structures are, that they can really support what's needed. So I don't see this at all as a cost-saving exercise. However, you think to the longer term, then you can imagine we have a more efficient system. Now what the costs of that will look like if we look five or ten years down the track, I can't possibly speculate, but it seems to me that we will have a more efficient system.

Whether it's a cheaper system is much harder to say.

PHILLIP GOULD:

One thing to add to that. So, I think I mean, realistically, the scope of what scale of expenditure within government on this is tiny compared to the expenditure on medical research across the two funds. But that being said, we are acutely aware of the cost to the sector of going through processes where there might be low success rates and the value of that more efficient system to people participating in it. So in our mind, we would be very much separating out those two types of costs and efficiencies.

BLAIR EXELL:

And just to note that through the government processes of that consideration, there is a requirement for a cost analysis. It's very hard to given what we're hearing is different versions of model three or different versions of model two that you can do. But, there is a fundamental requirement for whatever we go forward to government to have that costing done. So yes, they will come into it and they will be part of it. But it won't drive the process in and of itself. But thank you for that question. I'm just trying to check. Are there any plans to actually support smaller research organisations? This all sounds very big fish projects.

ANNE KELSO:

Well, we currently support a very wide range of sizes of institutions. NHMRC has close to 100 administering institutions. There's a larger number that are eligible organisations for MRFF grants and so naturally they range from the very largest universities, for example, done from our point of view at NHMRC to some quite small medical research institutes and other research groups that are independent administering institutions. So there's already intent to cover that full scale and not to, you know, through policies, deliberately favour a certain scale of institution. Some schemes are more suited for larger groups, but often they can be achieved through collaboration between multiple small institutions. They don't necessarily require a large institution. We just require that the institution has the capability to meet the financial and other requirements to deliver Commonwealth funds.

BLAIR EXELL:

Thank you, was there a reason to consult on governance and admin before strategy and direction? Governance and admin should be set once the strategy is operationalised.

PHILLIP GOULD:

That has been something which has come up quite frequently in discussions whether form should follow. Basically, you could do it the other way. We acknowledge that. And we actually had, as we say, I think I said before, a kind of passionate but respectful debate internally about the pros and cons of the two models. I think ultimately this is a really large, complex space and actually trying to come up with a strategy without understanding who would be accountable and responsible for delivering it, poses some significant challenges. So that was one of the key reasons why we felt it was better to take the approach that we have taken here. That said, we do realise this is something that's open for debate but think throughout the process, as you would have seen with the slides that we put up we've actually received a lot of really valuable feedback. So it has been a useful process for us doing it in the way we have.

BLAIR EXELL:

Thank you. Now I think there is a comment here, which is the next highest, a strong benefit to management by one agency is consistency in terms of guidelines (UNKNOWN) outcomes and priority. It's a comment here, highly beneficial for applicants.

MASHA SOMI:

I might comment on that in that it might depend on where you sit in the system as to whether consistency is a great thing. And you may have seen in some of the slides that I presented earlier, it's actually some of the difference in how that assessment occurs that's been considered valuable by some parts of the sector. So I think that there is a value and consistency that I think what we're also hearing has to be nuanced through the funding criteria and methods and mechanisms being fit for purpose for that outcome that you're trying to achieve.

ANNE KELSO:

I think one of the sorts of consistencies that's good regardless of the purposes of different schemes is that if you only need to put your information into a grant management system once and then it can be drawn on for different types of applications, different purposes, that in itself is an efficiency and there may be overarching policies that can be consistent across all of the schemes, regardless of whether they're MREA or MRFF or a joined-up fund. So, consistency doesn't mean the same, but I think wherever possible to have similar policies so that the applicants and industry and others are not trying to work out what's this fund and therefore, what are the rules. I think that that would be very helpful.

BLAIR EXELL:

Thank you. Just going through a couple of questions that are coming through. What would formal ongoing stakeholder engagement look like under models two and three?

MASHA SOMI:

I think from my perspective, I think just reflecting back to Anne's earlier comments that they're kind of very flat models that are meant to elicit feedback and comments. I don't imagine that we're gonna propose to implement any one of them in their existing format. And what we're looking for through this feedback process. And we have been hearing it so far and really keen to hear more through the written submission processes, you know, what we could look like, what are the sorts of engagement processes that people would be keen to see. One of the things we've heard in the context of the NHMRC is there's really strong support and value for the advisory mechanisms and structures because they provide a really strong framework for the operation of the MREA And on the other hand, we're hearing for the Medical Research Future Fund that having these sort of flexible adaptive processes where we bring together experts to set research for investment strategy, for example, through the missions, that works well when you've got this really sort of targeted, priority-driven approaches.

So we're really keen to hear, you know, what we've got and we're really keen to hear from you, what you think works well and what new things we could adopt.

BLAIR EXELL:

Thank you, blanket adoption of NHMRC guidelines, especially PSP levels and budgets, might have unintended consequences for growth. Medical research is already under costed, comments.

ANNE KELSO:

Well, I think that's not the sort of thing that we could really address at the moment. It's an issue for NHMRC at the moment, what those PSP levels are. So let's hope that can be addressed before too much longer. But I think it's too soon to really address that kind of issue. We're aware of the differences, so that's really important.

BLAIR EXELL:

Thank you. Another question. Have there been any targeted consultation with Indigenous researchers on how changes could best support Indigenous researchers health issues?

MASHA SOMI:

Yeah, so, I mean, just, we've had Aboriginal and Torres Strait Islander researchers and also health service providers at all of our conversations. And so we've made a really concerted effort to include Aboriginal and Torres Strait Islander voices through all of these processes. That being said, if there's something that we've missed, please contact us because we see that as a really important part of what we do in the MRFF and also the NHMRC. And if we've missed something, we'd really like a chance to address that.

ANNE KELSO:

And we've also discussed the consultation with our principal committee, Indigenous Caucus, which is a fabulous group of Aboriginal and Torres Strait Islander researchers, and encouraging them to talk to their colleagues and for everybody to submit written submissions, because that will be another really useful way for us to hear from voices that might not have been able to attend the webinars or any of the roundtables.

BLAIR EXELL:

Just checking, we had actually already adapted and changed the consultation process. So we do value that feedback and take that on board. There's a couple of comments that I'll just try and work together. If the MRFF and or NHMRC acts need to be amended, how long is that likely to take? And then there was a question that was related. Regardless of the model that is implemented, will these changes be protected from a change of government? I think the answer is subject or apart from a constitutional amendment, the answer is no. Obviously, there's different dimensions there in terms of the size of change. That introduces cost elements that makes it more difficult for a government to undo things. But essentially, no, a government could reconsider any change that is proposed according to its mandate. My experience of how long it can take is a bit mixed. It depends on the prioritisation and importantly, depends also on the consultation process. Things can be sped through. As many people know how things work through Parliament, but generally it's a minimum three months in my experience and can often be nine months to 12 months.

And that's based on a combination of, because, it's still a consultation process that happens when you actually propose 'lege' and it goes through its formal hearings in Parliament. And, indeed, then you've got the legislative agenda for the government anyway that at different points and cycles can get very crowded and can get very hard to get on. We have a sort of a six-month planning cycle across government about what is going forward, literally timetables, so...

PHILLIP GOULD:

Just one little adenda to that. As Masha said, during the consultation process, thus far, we've had a lot of people advocating for a staged approach, and that really allows us to think about what we can actually implement more quickly that might address some of the pain points that we've talked about. So while legislative change might be part of the end game, we're certainly looking at ways that we can make effective changes in a timely manner.

BLAIR EXELL:

I'm just going to pick up a comment. I think someone said, did they hear correctly that there is no timeline? Does this mean three years plus? Again, the answer wasn't, there isn't a timeline. It's just it's very hard to advise you of a timeline because it depends on what's proposed. It's probably fair to say (INAUDIBLE). A three-year timeframe is not what we're expecting. However, I do think it's at least a year. I think in reality, and that's not kind of taking consideration of some of the feedback that we received in terms of stage process (INAUDIBLE). So again, it's just hard to give sort of specifics in there. But I'm trying to give you a sense of our expectations.

MASHA SOMI:

So just to add on to that, a few people have said to me, what, like is there a decision that's already been taken? And we're just going through a consultation process. And I think just to reiterate, there is no final endgame in mind. This is a truly open consultation. And so that means that we don't know what the future will look like. And so we're not able to give the specifics of a timeline or a model or how particular things will look because we are genuinely listening to the consultations, we'll be reviewing in detail the written submissions so that we can build and create the future steps based on what we're hearing.

BLAIR EXELL:

Thank you. Researcher burnout was flagged as a concern in the slides. How would this be mitigated model to other than application platform similarity? I guess indeed that's a question across whatever model really.

ANNE KELSO:

I think we're thinking about how you would coordinate support for researchers and perhaps particularly for early and career researchers, where the burnout pressures are probably the greatest at the moment. And so a coordinated approach across the MREA the MRFF to workforce support, I hope, would make life a bit simpler for researchers applying for, particularly for their own salaries. But I think this is all it's all a critical element of the design workforce support, making sure that there's real clarity about what's the appropriate scheme to apply for depending on the type of research you do and what your goals are. Greater coordination and alignment should simplify that.

MASHA SOMI:

I think so, and again, research workforce. So workforce planning and workforce support is something that's really clearly come out as a conversation for the strategy and thinking about how to support workforce but across the pipeline. So thinking beyond the academic workforce as well. So a conversation that needs to be had in partnership. It's not just the funders that need to be involved in that conversation. We need the academic institutions at the universities and MRIs to also be involved in that conversation. And another reminder that we're not the whole system. There's lots of discussions happening, for example, through the universities accord conversation around issues like research, workforce support, indirect costs and other things that affect the broader system of which health and medical research is just one component.

BLAIR EXELL:

I'm going to pick up the next highest comment, which I think was a subsequent comment, which was, Sapphire doesn't accommodate consumers with lived experience. Will this be included in review and more importantly, incorporated into future plans? So happy to take that as a comment or feedback. Unless...

ANNE KELSO:

Presumably means consumers as chief investigators or associate investigators on grants. So that's a very specific issue that could certainly be picked up, doesn't need a new model of funding to achieve. Thanks for the comment.

BLAIR EXELL:

The system is frozen, there we go. I think, again, a comment is the next highest on the list is a single research strategy for Australia is critical. Training taxpayer dollars must fund the best research (INAUDIBLE) So again, I think we would agree with that. With model three, is there a risk the government of the day could cut the overall investment in HMI, health medical research. (CROSSTALK) I think it would be very difficult for government, in this process to do that. But that's an interesting risk. Ultimately, those funding levels are a decision of government.

ANNE KELSO:

And that's true today.

BLAIR EXELL:

OK, I think we're working towards getting lots of comments here that are more specific bits of feedback rather than sort of broad questions to go to review. Again, I think that one's picking up. Is there any scope for investigator-driven research in NHMRC, with increasing emphasis on consumer engagement? We've covered that already through a number of questions. But just checking in on anything on that one. State governments and local hospitals invest in infrastructure and in clinician researchers how their priority is being accommodated through this process. (INAUDIBLE)

MASHA SOMI:

So, a single line question, but highly complicated in terms of how to address and do so effectively. And we know this is a really, a live issue and has come through a number of consultation reports and documents that we've seen through the sector. So we'll be having the discussion with states around this particular reform next week and starting that discussion. The question of co-investment and how we work together is something we really need to turn our minds to as part of the strategy, because I think that's where we'll be able to really have those deeper conversations around how we manage co-investment and support for states and for research in particular.

BLAIR EXELL:

Thank you, in due course, could there be co-ord with ARC on a shared policy and operational issues, e.g., approach to common interest and foreign interference?

ANNE KELSO:

Yeah, it's an interesting thing because obviously the NHMRC and ARC or these two health funds and the ARC are operated out of separate departments and can go in separate directions. There's a lot of discussion regularly between the ARC and NHMRC staff about these policies and we harmonise wherever we think it's appropriate. But I think that work will need to continue. We have taken a slightly different approach on relative to opportunity, conflicts of interests, I'm not aware of what the differences are, but I'm also aware we've taken a different approach on foreign interference. So sometimes those are for very well considered reasons and we have extensive discussion with the other agencies, so we understand each other's position. So, we can't always join everything up, but we do the best we can.

BLAIR EXELL:

Thank you, I actually love this question. MRFF is excellent at marketing where the NHMRC is very conservative in that space, but it's more (INAUDIBLE) consolidate your strengths. (INAUDIBLE)

ANNE KELSO:

Yeah, let's consolidate our strengths.

BLAIR EXELL:

Good to think how we could bring these two things. I think there's more strengths on both sides actually. But that is the intent through this process is to look at how we can bring together those aspects that work very well across both and consistent with the feedback that we've been getting, that there are key aspects of both funds that people value and would like to see move forward. And that's very much about trying to find the best mix there. (CROSSTALK)

PHILLIP GOULD:

(INAUDIBLE) (CROSSTALK)

ANNE KELSO:

Yeah, that's so conservative.

MASHA SOMI

And I'll pass on the confidence to our comms team.

ANNE KELSO:

I think we've got something to learn on radical communication. We'd love to learn it.

BLAIR EXELL:

If Model three were to be adopted, would it be realistic to expect any short-term improvements or interim improvements to the operational issues noted? Again, I would say that goes to some of the stage models, things we've had. I think the answer is yes. We actually I know there's an ongoing process from both entities to think about how they can improve, but we're certainly getting more detailed feedback through this process. So short answer would be yes, but how in what areas and how quickly would it have been agreed upon the model? I think we might start turning to what are the next steps. Actually, there's one question, can you share the link to submit the written submissions again so we can try and do that online while we're talking. Thank you. That's the contact, actually the link. So...

MASHA SOMI:

So, just need to, if you just put into your browser, I won't say which one you might prefer. Just, Department of Health Consultation hub and there'll be a list of consultations that are open and they're listed in order of closing date. And if you just find the 14th of July, that's your way directly into the site and that'll give you the discussion paper and also the questions and the way to make your submission as well.

BLAIR EXELL:

So what are the next steps once this stage of consultation is completed?

PHILLIP GOULD:

So, as I think we've discussed, we're looking for reading submissions on the 14th tomorrow at 11:59, from memory, we were very specific.

11:59PM and we'll go through a process. We don't actually know how many we will receive. We will put in our best estimates, but the time that it takes to process those will obviously impact how long it takes for us to actually put up a written response or a report. So that's expected to be within weeks or sort of a months of two and a half, after that, depending on the number of submissions that we have that will detail in itself next steps. I think that we're keen to use the momentum that we've gathered in this process to drive change. But as we said, we can't give any sort of specific feedback on any time, timeframe.

ANNE KELSO:

I guess, the critical first step after we finished our work is a decision from government. So that then fires the staff and a lot of work will begin very quickly that. Not expect to work and have to deliver whatever the government decides.

BLAIR EXELL:

Yeah, and then there may, there's also been process once there is a model that is revised there or in that process, there may be another stage of consultation or indeed at least testing. I have seen that. But that again, ultimately, the decision of governments by how they want to see that next step. So that is something we're looking to get that advice certainly this year of it. Took about a month to finalise a written submission then there's a period to review those to consolidate or that feedback and think about the implications for those models. And then there's a consideration by government, and that involves price and discussions themselves across different parts and then potentially all the way through the cabinet, depending on the size of the issue as well. So imagine that taking a number of months to. Work our way through that. Process, if that helps give you a bit of a guide in that vein, which minister would a single unified model report to ultimately currently all report through the Minister, the Senior Cabinet Minister, Minister for Health, Mark Butler.

So, I wouldn't imagine that changing. We have, assistant ministers, have corresponding areas of interest, but they ultimately report through to the cabinet minister, which is Mark Butler. So that's that reporting line. When will the strategy consultation start? I think we have a timeframe?

MASHA SOMI:

We haven't set a time frame, yet because we've been just working through this process. But we'll certainly make sure that we give lots and early advice about what that consultation will look like and give people plenty of opportunities to make a contribution. We think it'll be quite a bit bigger than the one we've had just because of the level of interest, but also having to work with states, having to work with philanthropy and businesses as well. I think it's something that we really need to work to scope and then share information once it's available.

BLAIR EXELL:

So I think we've, I think, in terms of questions we've got now lots of single or two thumbs up responses, which are generally bits of feedback which is advice rather than questions that are going to the broader process. So I'm just going to give another chance if you've any other burning issues or questions that people want to put forward or I'm looking for a thumbs up on any particular issues that people feel haven't been covered. As Philip was saying, the written submissions is next - key date on the 14th of July. That is a really important part of this process and we will give a summary of the outcomes of those written submissions as well. So with that, and I think no, there are no rocketing up the polls, thumbs up. Can I say thank you. It's a little early, but I think that's not a bad thing. Can I say thank you very much to colleagues and everyone who joined online, Really appreciate the time. It's a very important process that we're considering that deals with a significant amount of funding.

So we're investing heavily and really appreciate the way that you've invested in this time with us as well. I thank my colleagues for joining and the team that you all can't see that are just sitting behind the camera here that are supporting us today online. Thanks very much, everyone.