Introduction
Transforming Evidence has been commissioned by CRUK to examine the major challenges and opportunities for high quality clinical research in the UK. Our aim is to identify approaches which could be adopted to support improved clinical research practice, delivery and governance.
The UK has a long history of excellent clinical research, which is essential to provide the evidence base underpinning effective action by the National Health Service and other health and social care providers. Participation in research enables doctors and patients to access cutting-edge treatments, technologies and drugs, and research-active health organizations tend to have better staff retention and improved patient outcomes. Investment in science is important for the UK domestically as well as internationally.
From the outset we were aware of a proliferation of frameworks and reports intended to address perceived problems in UK clinical research. However, recommendations have often not been accompanied by feasible, budgeted action plans, and there has been a gap between policymakers and the clinicians and researchers who are best positioned to make a difference.
Our Approach
This Transforming Evidence work draws on interviews, as well as grey and academic literature. To do this, we combine insights from:
- Data on clinical research systems, using research funding and output databases to identify major funders of health and cancer research, and to characterise research activity
- Published research and grey literature to identify and explore different perspectives, and empirical data about challenges and enablers of effective clinical research; and
- Interviews conducted by Transforming Evidence between June-Sep 2024 with eighteen clinical leaders, funders, practitioners, and those involved in the organisation and delivery of care in countries of interest. Interviewees included:
- commissioners and service providers from both health and social care
- academics studying research policy, clinical trials and public administration
- clinical academics working on cancer
- those responsible for regulation and policy-making for clinical research.
Recognising the value of learning from how other countries have handled political, economic, and competitive pressures to maintain and grow a successful clinical research environment, our approach includes interviews with clinical research leaders in Australia, France, Germany, Spain and the USA.
This is what we’ve learned so far
In general, we found challenges to be well-described in the literature and familiar to everyone we spoke with. Our assessment of progress to date in the UK showed:
- A research-ready NHS: The UK’s mechanisms to support excellent clinical research do not work together optimally. Metrics do not incentivise research activity, and capacity is limited for non-commercial trials. Access to drugs and funding is a growing problem. Current networks struggle to coordinate research portfolios across the country.
- Incentivising and enabling a research-active workforce: The UK has useful mechanisms to support research time and careers. Improvements could include broadening existing opportunities for portfolio careers beyond the medical profession, better university-practice exchange programmes, and frameworks for career pathways in research.
- Creating the right data infrastructure: Globally, the potential value of existing data assets and infrastructure is growing, with pragmatic / digital trials, secondary data use, and the genomic data all seen as potentially transformative elements. However, the UK lacks the data infrastructure for a coordinated integration of genomics, pharmaceutical and trial activity.
- Improving how clinical trials are set-up and run: The UK has taken useful steps to reduce the regulatory burden, although progress would be faster with better trial and patient data. It is difficult to gain oversight of research portfolios, so prioritising new research is challenging.
- Making the most of commercial investment: Commercial research is highly valued for providing innovative drug treatments and therapeutic access. Additional contributions to digital services, innovation in care pathways, and assistive and rehabilitative technologies, would be valued.
- Funding the right research: Commercial, academic, clinical, management and patient research agendas are in competition for limited funding and resources.
International comparisons
Our international interviewees shared stories of their successes, but also highlighted their many challenges, pointed out facets of the UK system that they wished could be adopted in their own challenges, and shared that often important policy wins were the result of unique circumstances which were perhaps not easily replicable.
Particular UK strengths identified included dedicated research funding for applied health research, innovative funding to address regional disparities in health research activity, workforce management tools such as fellowships and hybrid roles to enable clinical staff to participate in research, and a publicly-funded health system which is – at least nominally – a single provider. We also heard that the UK’s research environment and data assets are internationally renowned. Overall, the feeling was that the UK had many useful levers, but not all were being optimised to improve clinical research for the UK.
Outputs and findings
Our full report, Optimising the value of clinical research for the UK, published October 2025
CRUK Summary report, Global insights for UK clinical research, published October 2025