Podcast – A Brain Health & Dementia Research Strategy for Scotland

Voice Over:

Welcome to the NIHR Dementia Researcher podcast, brought to you by dementiaresearcher.nihr.ac.uk, in association with Alzheimer’s Research UK and Alzheimer’s Society, supporting early career dementia researchers across the world.

Adam Smith:

Hello, and thank you for tuning in to the Dementia Researcher podcast, where we discuss career, science and research. I’m Adam Smith, and it’s my pleasure to be hosting this week’s show, where we’ll be discussing the Scottish National Brain Health and Dementia Research Strategy.

Adam Smith:

I’m joined by two fantastic guests, who are the people behind the first of its kind policy. We have Professor Craig Ritchie, director of Brain Health Scotland and chair of the Scottish Dementia Research Consortium, from the University of Edinburgh; and Jim Pearson, from Alzheimer Scotland’s director of policy and research. Hello, both of you, and thanks for finding time to join us today.

Professor Craig Ritchie:

Hi, Adam.

Adam Smith:

Should we start by introductions? Jim, maybe you could go first.

Jim Pearson:

Yeah, so I’m Jim Pearson. I’m actually the director of policy and practice at Alzheimer Scotland, but that’s a very recent change. But that doesn’t necessarily change some of my areas of responsibility around research, and I’m delighted to be here this afternoon. Thank you.

Adam Smith:

What about you, Craig?

Professor Craig Ritchie:

Yeah. So thanks, Adam, for inviting us on today. I’m Craig Ritchie, and you mentioned a few main roles I have at the University of Edinburgh, professor of the psychiatry of aging as well as director of Brain Health Scotland, and chair of the Scottish Dementia Research Consortium. I’ve been working in clinical practice and research in Alzheimer’s disease for going on, gosh, almost 30 years now, so yeah. It’s a real pleasure to join you today.

Adam Smith:

Thank you. So I have to admit, when I was writing the briefing, and we spoke yesterday, Craig, I hadn’t quite appreciated that the policy we’re going to talk about today isn’t necessarily a singular policy that’s standalone. It’s part of Scotland’s wider work to look at brain health and dementia research.

Adam Smith:

So before we move on to talk about this policy and what it means, I know this is jumping ahead to something you’re working on at the moment, but brain health and cognitive reserve and things are topics that we’re hearing a lot about, and they’re attracting more research funding. Can you maybe give us an overview as to what’s meant by these terms?

Professor Craig Ritchie:

Yeah. I think it’s a really great place to start is, what is brain health? Because we do often get asked that question. Where does brain health start and mental health finish? How does brain health relate to other conditions? Maybe not necessarily neurodegenerative diseases, but things like stroke and multiple sclerosis.

Professor Craig Ritchie:

I think one of the things to realize about what we’re doing in Brain Health Scotland is, our main audience is actually the public. And interestingly, when we’ve spoken to the public about the term “brain health,” they seem to understand it at a very clear level, where I think academics and clinicians and researchers can get a little bit more bogged down in the philosophy and the definitions and sub-definitions, et cetera.

Professor Craig Ritchie:

So brain health, to me, is having a healthy brain. We often talk about the fact that, although it’s a very complex organ, at the end of the day, if you have good nutrition, good blood supply and that blood supply is full of oxygen, and dare I say, you sleep well at night and you clear all the toxins that accumulate during the day, you’ll have a healthy brain. And that’s quite accessible to the public.

Professor Craig Ritchie:

And I think one of the things you also mentioned about cognitive reserve is the sense that, if you do develop, through lifestyle and education in early life, resilience and cognitive reserve, the ability to do well if you like, in cognitive testing through your life, you’re more likely be able to tolerate, dare I say, higher levels of brain disease, without necessarily expressing symptoms.

Professor Craig Ritchie:

Of course, as you know, the bad news is that when people do have a sort of symptomatic breakthrough, if they’ve had high levels of education, you often find their deterioration is more rapid than it would be in others. So brain health is almost a definition that doesn’t need defining, I would say, because the public get it already. And I think sometimes, clinicians and academics can be a little bit too particular. We should just work with the public with something they understand anyway.

Adam Smith:

I understand that, and I think actually, I think it helps, doesn’t it? Because when people think of this distinction between “mental health” and “brain health,” I think brain health, I think people can get that this is about the physical, not necessarily the psychological, whereas “mental health” gives that impression of the psychological. Although, is brain health both?

Professor Craig Ritchie:

I tend to think of the brain, dare I say, as an organ like any other in the body, and we’re trying to communicate, talk to the public about that. This isn’t being medical at all. This is being anatomical. You have an organ in your head, which you need to look after.

Professor Craig Ritchie:

Now, that organ does a lot of really cool things. It acts. It reacts. It’s how we think, how we feel, how we exist in this universe. Part of that, of course, is mental health, is our psychological wellbeing, but the brain does so much more than that. So yeah, I think there is a need to maybe distinguish psychological illness from the illnesses specifically related to brain disease like, of course, Alzheimer’s.

Adam Smith:

So then, it makes complete sense that you’d have brain health policies, just like we do in other areas, like trying to promote good heart health or healthy living and things like that.

Professor Craig Ritchie:

Exactly.

Adam Smith:

Brilliant. So does that mean, then, I guess a policy like this is to encourage … Well, obviously, we’re going to talk about the research policy today, but brain health policies as a whole are to encourage the public to care and raise awareness about it?

Professor Craig Ritchie:

Yeah. Yeah, definitely. And I think one of the things that we’ve learnt a lot in a research setting, certainly, particularly from epidemiological research over the years, is that there are influences on brain health, both positive and negative.

Professor Craig Ritchie:

I think they’re best summarized by the Lancet Commission Report, and I think what we sought to do, one thing we sought to do within Brain Health Scotland, in a sense, was operationalize and translate the Lancet Commission Report into practice.

Professor Craig Ritchie:

So that, as you know, has many risk factors, 12 risk factors operate across the life course. So you’re not just talking about older people and trying to modify risk in an older population. A lot of the risk factors that seem to be potent and prevalent for brain health issues are in midlife, so that’s why brain health policy is targeting younger people than necessarily would have been the case when we just thought about dementia a few years back.

Adam Smith:

We had Martin Rossor and Martin Knapp on the show last … Oh, actually, it might not have been last year now. I think it’s probably … Oh, yeah. Last year. 2019. The last summer. For anybody who’s listening, you can go back and listen to that one, talking about the cognitive footprint work that they’d published in the … I think that might have been in the Lancet as well, actually, in this similar vein.

Adam Smith:

And some of the feedback that we got, particularly from the public that listened to us, was this surprise that things like education levels that you might have in very early age can have such an impact throughout your life. And trying to explain this to people was quite challenging, so you can understand how a policy’s got to be able to try and do quite a lot.

Professor Craig Ritchie:

Yeah. Yeah, no. I think that’s right. I think we’ve got into conversations with the public over recent years, and probably over recent decades, where I think we’ve conceptualized brain health or dementia or Alzheimer’s disease as a disease of older people.

Professor Craig Ritchie:

And therefore, it’s quite hard, but something we will achieve, to shift the conversation to younger individuals, to recognize that there are things that are actionable, and dare I say it, probably will have an effect on brain health, and therefore, risk of dementia, that take place from birth onwards in many ways.

Professor Craig Ritchie:

So that’s a very important challenge, is to say … Dare I say, that’s why we deliberately to call Brain Health Scotland, “Brain Health Scotland,” and not “Dementia Prevention Scotland.” Because I think if we’d gone down the “Dementia Prevention Scotland” route, we’d have had those real challenges in having conversations with young people and people in early midlife, because to them, dementia’s not, dare I say, it is not on their radar, whereas brain health is for everybody.

Adam Smith:

Yeah. Not just clever marketing, but you can see how that makes absolute sense when you explain it like that. Jim, now that we have an understanding of the importance of brain health, can you give us an overview of this new research strategy and how it came about?

Jim Pearson:

So I think the most simplest way of describing this is, the strategy is essentially, about creating an environment, and enabling a sustainable infrastructure for good, high quality research to happen within Scotland. And the strategy, as I will say it, so some actions that need to happen to support that.

Jim Pearson:

But it is about recognizing, I think, where we are in Scotland. Scotland is small enough to be able to get things done quite easily. We have quite an accessible Parliament. It’s a small country. It’s easier, in some ways, to bring people together.

Jim Pearson:

And of course, as Craig has already described earlier, this starts within the context of over a decade now of national work being done around tackling dementia as a priority, so as of today, we have the National Dementia Strategy since 2010, and that strategy that was a particular focus in supporting research.

Jim Pearson:

We would have had, and we would have been in the process last year, of having a series of national dialogue events, of a fourth National Dementia Strategy, but of course, for the COVID-19 pandemic. But what’s happened in place of that was to develop a COVID-19 and dementia national action plan, which runs for … I think the Scottish government anticipates it to run somewhere between 18 months to 24 months. And then we would go back and revisit developing that fourth National Dementia Strategy.

Jim Pearson:

One of the key commitments in the action plan was establishment of Brain Health Scotland, as Craig has already mentioned, and of course, Craig directs. And of course, Brain Health Scotland has been sponsored by, funded by the Scottish government, and is hosted with Alzheimer’s Scotland.

Jim Pearson:

Brain Health Scotland will be developing a National Brain Health Strategy for Scotland. And of course we, some years ago now, supported the development of the Scottish Dementia Research Consortium, which Craig actually also chairs.

Jim Pearson:

And then, we’ve been supporting the Scottish Dementia Research Consortium now … I think it was about, since about 2007, Craig? Can’t quite remember the date that that started. But the Scottish Dementia Research Consortium was brought together to bring researchers from all disciplines across Scotland to work together and collaborate, and almost have Scotland as, for want of a better phrase, a kind of virtual dementia research center, bringing together all those skills and different levels of experience and knowledge, to collaborate in a way to promote better research on dementia within Scotland.

Jim Pearson:

And to attract, of course, investment in research, and also to involve more people within research. So the strategy that we’ve just developed, the Brain Health and Dementia Research Strategy is really about building on that infrastructure, and creating the conditions that enable us to continue going forward. I don’t know if you would add anything to that, Craig.

Professor Craig Ritchie:

Well, no. No, I think there’s a … Yeah. I mean, I think the one thing that I would maybe highlight, and if you like, it’s the headline of the strategy itself, is that we are all researchers. I think the explanation for that is that we’ve recognized, certainly from a clinical research perspective, that the observations and the ideas and the challenges and the, “Why is this happening? Why is not happening?” Actually come from people, patients, not from researchers.

Professor Craig Ritchie:

I think we have a role to translate their observations and their concerns and their worries into research projects, and then deliver those. But at the end of the day, the research journey starts with the person, either at risk or with dementia. And our role in this as academics is to do the science that they’re asking us to do. That’s why we’ve said, “We are all researchers.”

Adam Smith:

And it has to be said. Scotland, considering the size of Scotland and the population, I mean, it’s massive for research compared to the size of its population and output, I feel sure. Is that just my impression?

Professor Craig Ritchie:

I’m going to just jump in. And I always have to preface these things, and as many of you listeners know, I actually still live between London and Edinburgh, and I’ve probably spent more time in London than I’ve ever spent in Scotland, so none of what I say is hopefully going to be sounding parochial.

Professor Craig Ritchie:

But Scotland does have the highest per capita higher education institution system in the world. There’s more universities per capita and more university places per capita in Scotland than there is anywhere else in the world.

Professor Craig Ritchie:

So, I think we’re very fortunate to have an incredible backbone and infrastructure for academic activity and output. I often reflect that sometimes, people say Scotland punches its weight, but I don’t like the term. I don’t think we’re punching people. I think we influence people above our weight, and I think that’s part of this research strategy may be able to do, not just for Scotland, but dare I say, for the rest of the UK and beyond.

Adam Smith:

Although, given … If I remember rightly, doesn’t Scotland have the lowest life expectancy of any country in western Europe as well? So you can see why having policies like this are actually really important to add to the greater good. Either that, or you come to Scotland, get your education, then leave. Is that a good, clever thing to do?

Professor Craig Ritchie:

And then go back again, in my case.

Adam Smith:

Yeah.

Professor Craig Ritchie:

Right, but no, I think that’s a really, really important observation, because I think that’s the shame of the first statement is the observation you made in the second statement, that although you have this incredible health survey and incredible powerhouse of academic activity, how come … and I don’t think it’s the whole population. I think it’s just pockets of deprivation of Scotland are, dare I say, obscene, relative to the country.

Professor Craig Ritchie:

I mean, it’s part of … but also, if we’re going to throw figures to each other, the highest GDP per capita of any city in the UK is not London. It’s Edinburgh. But you go 30 minutes down the road, the along the M8, and you have the highest levels of social deprivation in Europe.

Professor Craig Ritchie:

Now, that’s not going to be fixed by a brain health strategy or research strategy. But what it needs to do is, all of these strategies have to accommodate those particular issues. We know, for instance, that the risk factors for dementia, the Lancet Commission Report 12 risk factors, if you like, almost every single one of them accumulates in people from more deprived socioeconomic backgrounds.

Professor Craig Ritchie:

So we’re to develop a brain health strategy or a dementia strategy or a research strategy, it has to, first and foremost, be able to address the needs of people from those communities.

Adam Smith:

And a good, well-delivered brain health strategy is also going to benefit in so many others as well, isn’t it? Because so many of the things that are in that Lancet Commission that will help with brain health and prevention of dementia are also the same things that you would use to have good cardiac health and …

Professor Craig Ritchie:

Exactly.

Adam Smith:

Yeah.

Professor Craig Ritchie:

What’s good for your brain is good for your heart.

Adam Smith:

Yeah. Well done. Somebody had to say it. Jim, just coming back to you. So I mean, with … I guess, for this particular strategy, for a research strategy, actually developing a baseline and working out whether you’ve actually delivered on this is a little bit easier than it will be when you move onto your brain health strategy later in the year.

Adam Smith:

Can you just tell me, what are the main takeaways from the strategy? Because I remember that I’ve read it, but let’s hear you say, what are the main … I think there are four main aims from this? Am I testing your memory now?

Jim Pearson:

I don’t know [inaudible 00:18:12] my memory, but I’m sure Craig will jump in if I need to. But I think … I mean, Craig has already highlighted here, I think, the importance of everyone having a stake in research, so we are all researchers.

Jim Pearson:

And that ability, I think also, to take good research and rapidly translate that into practice, so those specific actions. And I think this may be worth remembering. This is not a government strategy, so it’s not the Scottish government’s strategy.

Jim Pearson:

And we already know, as an organization, the challenges of taking the commitments of even a National Dementia Strategy and having them truly implemented locally, even when it is a government strategy. So this strategy was developed by the Scottish Dementia Research Consortium, but also in consultation with a wide range of stakeholders.

Jim Pearson:

So I think that one of the things we are asking to happen is that, within every NHS board, we have a brain health and dementia research board established, and that the representation from each of those boards to form part of a national forum, a national board, to develop that leadership at a local and national level around aspirations of the strategy and how it aligns with things like the brain health strategy.

Jim Pearson:

So it’s about creating, as I said earlier, that infrastructure. Those are key parts of that. Some of the challenges, of course, around that will be that it’s not prescriptive. It’s not the Scottish government. We’re going to have to do this by consensus and having people onboard, but I think the process so far, in terms of both in engagement around us, and the endorsement that we’ve had for our successes and good standing, I think, for having those conversations going forward, and getting by that local level to establish each of those boards within a local level.

Jim Pearson:

So I think that really, what we are doing over the next period is creating an environment … and I’ll always remember that … You probably don’t remember this, Craig. A few years ago, a good colleague of both of ours, John Starr, who led the Alzheimer Scotland research center at the Edinburgh University, always used to talk about what he did.

Jim Pearson:

And his role was almost like creating the scaffolding. So Alzheimer Scotland had a key part around this, that we host the Scottish Dementia Research Consortium and Brain Health Scotland. But we don’t necessarily fund. We don’t fund research.

Jim Pearson:

Our goal within that, I suppose, is to support and create the research community, and support that infrastructure, support involvement of people with dementia in research. And I think the strategy takes that on up a huge step further, actually, and if we can deliver on these, and we can get the buy-in that we’ve already started to get, then we will achieve that ambition of having that leadership within every NHS board through the brain health and dementia research boards, and that national oversight board or forum.

Adam Smith:

So, I’m going to read from your policy now, on the … I think it’s NHS Scotland’s website, I think it is, that said … So you’re going to establish brain health and dementia research boards within each NHS board, to pursue local research agenda in relation to dementia and brain health, and ask them to all come together in a national forum. So this is specifically with a view to growing the research in that area, to make sure it’s driven by local population, that it’s what they want.

Professor Craig Ritchie:

It’s growing, but it’s also … What’s the word I’m looking for? I think there’s sometimes a risk with researchers that you do a lot of research, which dare I say, may be to support your PhD or maybe to … You’ve got a pilot project idea, or you … It’s an overused term sometimes, is like a “me too” project.

Professor Craig Ritchie:

And I think what often happens is, there’s a disconnect between amount of research activity and the amount of impact that activity has on [inaudible 00:22:53] or clinical care. And I think what we’re trying to do here is … I mean, Jim mentioned earlier, we’re a relatively small country.

Professor Craig Ritchie:

We can hopefully wrap our arms around the portfolio of research that is taking place within Scotland, and dare I say it, almost … “rationalize” isn’t the right word, but it’s making it work effectively as a whole, rather than necessarily things maybe organically making it to the public arena, or into having impact.

Professor Craig Ritchie:

So that’s where the local research boards, where the research takes place would be expected to understand their portfolio of activities. We’ll share those on the SDRC website, allow people to have an idea. There’ll be some way of saying, “Oh my goodness. They’re doing this [inaudible 00:23:38] already. Maybe I should collaborate.”

Professor Craig Ritchie:

And when these things are produced, they’re discussed in this national forum. And in doing so, dare I say, from an SDRC perspective, from a research community perspective, we should, kind of at any moment in time, know what’s going on from a research perspective.

Professor Craig Ritchie:

And that might allow us, in conjunction with the dementia strategy and the Brian health strategy, to be able to see what’s coming through, to be able to prepare, if you like, the market for implementation. So there’s no CLAHRC, Collaborative Learning and Allied Health Research system, as there is in the NIHR in England, in Scotland. So there isn’t that body that has been established to get research into practice, so we had to embed elements of CLAHRC within this brain health strategy.

Adam Smith:

Perfect. I mean, That’s really clever, because I think that addresses … I mean, researchers, for quite some time, have been making this kind of complaint, if you like, particularly early career researchers, that they deliver their outputs, they publish their journal articles, and then that’s it. It’s done.

Adam Smith:

And there is an increasing frustration that you can discover something really works, but taking that from discovery to implementation, or to getting it actually used, there’s a gap there at the [inaudible 00:25:10]. I think it came out in Alzheimer Society’s care review, back at the end of 2019.

Adam Smith:

It’s here again, and I think if … and also as well, I’ve done this myself because I’ve done these reviews, where you look at what research is going on in our area. But I think even in England, whilst there is the NIHR infrastructure there, still, nobody has this real overview of everything that’s going on in a given area.

Adam Smith:

There are still pockets and silos. And all the time, we’re … I went to do some work in Northern Ireland a while ago, and every time we met somebody new or spoke to somebody different, we kept discovering there was more and more research going on, that just nobody had a … There was no handle on exactly what was going on everywhere.

Adam Smith:

And I guess through boards like this, and also as well, we haven’t talked about this yet, but another part of your policy, this rapid review service element to it, has a real opportunity to bring that together. And I can’t imagine this is something that’s unique to Scotland, or England either, I would imagine. If you’re listening to the States, it’s exactly the same problem, or if you’re in Australia or wherever in the world you are.

Professor Craig Ritchie:

And I think it’s … I mean, I’m sure Jim has a view on this as well, but I mean, we even say these things like “connection” and “interoperability” and “networking” and all these sorts of things. But I think what we’re probably capable of doing here is actually putting some meat on the bones of those statements and saying, “So let’s, for argument’s sake, a local board … ”

Professor Craig Ritchie:

If I found out that a local board … It’s not about pleasing me, but if I found out a local board had seven professors and one PhD student, and no nurses or doctors, I’d go, “That’s a failed board.” Because to me, that’s an academic board. That’s looking at a portfolio of papers ready for the Lancet.

Professor Craig Ritchie:

You need to have the allied health professional leads, and the nursing leads, and the clinical leads, the finance people, all in the room at the same time, saying, “We see this project coming through. It’s going to be a year or two until it delivers.”

Professor Craig Ritchie:

But in a sense, what these boards should also do is, dare I say, create the post-translational environment that these ideas and these things can be adopted into. One thing I’d also like to add to this is that … This is a slightly sort of philosophical point, but as a small community, 5.2 million people, whatever we are, with a single NHS and the ability to interconnect our academic community under a particular theme, with actually also great electronic medical records and data systems, we often boast about being dynamic and agile, and about how things can … and as Jim said earlier, we can get things done more quickly here.

Professor Craig Ritchie:

Well, that’s true. But we also have to be willing to take risks. If you’re going to innovate, part of innovation is risk-taking. Now, as long as the risks you’re taking don’t cause harm, then I think that’s where Scotland needs to position itself in terms of its USP.

Professor Craig Ritchie:

So we need to have the willingness to say, “Well, we can’t do this in practice because the evidence base isn’t strong enough. Well, let’s just lower the bar for the evidence base to get something into practice.” And then, of course, what you do is, when it’s in practice, you evaluate it real-time through quality improvement or whatever it is, one it’s in practice.

Professor Craig Ritchie:

Because if we wanted to prove that Brain Health Scotland works, or prove the risk factor modification works, “Come back to me in 20 years’ time, when we haven’t done the RCT that costs two billion pounds.” Sometimes, you just have to take the risk and say … I was about to swear there, so I apologize.

Adam Smith:

No, no, no. I’m sold. I mean, I’m old-

Professor Craig Ritchie:

Just do it. Just do it.

Adam Smith:

I’m old school NHS. I mean, I was back working for the … back in the national program for IT and back in my time working at the Department of Health. I’ve been around a long time, and so I’m … Yeah, old school NHS service improvement.

Adam Smith:

I do feel that, once the Innovation Agency and things like that went away when we had a change of priorities and how services were commissioned instead of being delivered by part and parcel of the same system … I mean, I’m out of it a long time. There are probably people in the NHS now that would argue that this is still there, but I feel like we lost a little bit of that at that point.

Adam Smith:

There was this sense of being able to rapidly test and make changes, and then if it didn’t work, you moved on. So actually, that leads us really nicely into talking about this rapid review service. So, exactly what does that do? This is taking research outputs, looking at them … I guess it’s not trying to replace NICE or trying to …

Professor Craig Ritchie:

No, no. Definitely not. No, it would be, dare I say, a low bar to entry, as we’ve talked about, in terms of getting things out there. I think we’ve also lived through what a colleague of mine once described as “pilot purgatory,” where you do pilot studies forever and you never actually get to the point of doing the big study in the real world.

Professor Craig Ritchie:

So I think what this rapid review service would do, would be to look at outputs from local boards, or two or three boards who are working collaboratively on a project, and to make a recommendation, which will be, obviously, sitting with the national board, to the people who have got the competencies and capacities to do delivery, chief execs, medical directors, integrate a joint board, leads, et cetera and say, “We recommend that you should actually put this into practice for a period of two or three years. It’s called a mega pilot, and then we’ll regroup.”

Professor Craig Ritchie:

So it’s creating some degree of oversight of a project or an idea, that can get from the pilot stage into the practice stage, and then into the quality improvement stage.

Adam Smith:

And would this be something … Will this review process go and seek out things to consider?

Professor Craig Ritchie:

Yeah.

Adam Smith:

Right, okay. So that’s quite interesting, because we’ve certainly talked about this in blogs. I’m not sure, for anybody listening, you can look up … We have numerous bloggers on our website. Go and have a read of some of their work. But I don’t know if it’s come up in podcast before, about researchers can do to help themselves. As a commissioner of health services, it’s quite hard. I mean, you’re busy. You’ve got lots of things to consider.

Adam Smith:

You can’t possibly have your finger on the pulse of everything that’s going on, that could possibly deliver change, and researchers could certainly do a lot more to help themselves by making something implementable, by costing it, by giving instructions, by providing a ready-made package that makes it easier for commissioners to look at and go, “Oh, yeah. The evidence is there. It’s nice and clear. This is what I’d have to do to make that happen.”

Adam Smith:

And I think Anna Volkmer wrote a blog for us on this, about her speech and language therapy services for people with PCA recently. She’s had that experience of working with commissioners. So go on, have a read of that. So this sounds brilliant. So what are the challenges to implementing … This is a question for both of you, I guess.

Adam Smith:

Lots of countries have dementia strategies. Maybe not all research strategies. In fact, I chair the ISTAART PIA for elevating early career researchers, and one of the things we’re looking at right now, we’re about to launch a survey on the 1st of September on this, so go look at it if you’re just listening now.

Adam Smith:

One of the things we’re doing is to review national dementia strategies, to see what support for early career researchers is amongst those, so we can see how different countries vary in their support for ECRs. So, what’s in here for ECRs and what are the challenges to delivery of this strategy? Craig, you go first.

Professor Craig Ritchie:

I can’t see without my glasses. Page 16 of the strategy, so item 2.3, “Promoting and resourcing researchers’ career development.” So this is, I think, many … You’ve done an amazing job with the NIHR and the ARUK and DRI, Dementia Research Institute.

Professor Craig Ritchie:

We’ve all got a very, very keen interest to develop the workforce of the future, and research in our domain requires an incredibly talented, motivated, and dare I say, large workforce. And we need to make sure that the environment for early career researchers, in terms of entering the field, and dare I say, staying in the field, and dare I say, staying in the UK and Scotland as long as possible, is on us to create those environments.

Professor Craig Ritchie:

Now, I really believe sometimes that we do some incredible things, webinars and support tools, and we did something up here where we gave some quick, rapid response funding during COVID. But then I think there are some infrastructure problems. There’s some systemic problems with the way we encourage and retain early career researchers in clinical medicine and clinical academics.

Professor Craig Ritchie:

And that’s why, rather than putting into the strategy a whole sea of solutions, we’re going to throw a lot of energy and effort over the next two years to really understanding what the issues are, and making a sea of recommendations to unblock them.

Professor Craig Ritchie:

So we will produce quite a substantial analysis of early career research pathways in dementia and brain health in Scotland, to put together a report for 2023. And I think, personal view, bottom line is this. We need substantial funding, and we also need to make sure that those pinch points between PhD and post-doc, and post-doc and PI, we need to be more confident in our researchers and not leave them to 100 of them to chase one research fellowship. I think if a PhD student is good, it’s on us to support them to become a PI.

Adam Smith:

Yup. No arguments from us here. It’s exactly the same we picked up in our ISTAART work, and through Dementia Researcher as well, that those bottlenecks that exist, they’re very real. They’re the points that we do seem to lose people.

Adam Smith:

Although, I would argue as well, that you can go one step earlier than that as well. We’ve recently been following a couple of master’s students from UCL and other places, and actually, the gap, when you drop out of your master’s, there are a number of people that seem to emerge from a master’s in neuroscience or in dementia, and then want a break before they do their PhD or to find a PhD, and there are a number of research assistant posts and things like that as well.

Adam Smith:

There are very few opportunities to get hands-on experience before you go on to creating something in that space as well. And promoting the MSE program, so we had a careers festival week back in March, and we focused on undergraduates, actually, to encourage them to consider master’s programs as that stepping stone, because whilst there were slightly fewer PhD opportunities last year because of the pandemic and the charities weren’t funding in the same way, but we reached out to every one of the 50-some master’s programs that you could enter across the UK.

Adam Smith:

We reached out to all of them, and not one single … none of them were full. They all had space. They all had capacity to take more people into them, and so we were trying to encourage undergraduates to consider that as well, just to … and that could be in anything from computer sciences to allied health professionals and other specialists that work in that dementia space.

Adam Smith:

So looking at that from undergraduate right through to the end, I think is important too. And what about you, Jim? What are going to be the difficult bits of this? I mean, Alzheimer Scotland is a charity. What role does Alzheimer Scotland have to play in this? Is this lobbying governments? Is it funding yourself? What are the barriers to making this happen? I guess that’s where you’re going to help.

Jim Pearson:

Yeah, I suppose I touched on some of that earlier. And this isn’t a government strategy. It’s been developed by Scottish Dementia Research Consortium, but also, of course, in partnership and with endorsement of many other stakeholders, including the Scottish government, NHS boards, and others. And that’s a good start.

Jim Pearson:

It is always difficult. We see that even, as I said earlier, with commitments that I made nationally, through National Dementia Strategies, to get them truly implemented locally. So that is a particular challenge. However, I do think it’s one that can be overcome.

Jim Pearson:

And I think, with the willingness and the consent of partners, we will build that relationship. And I think, for Alzheimer Scotland and for organizations like us, we are not … Alzheimer Scotland is a national organization, but we’re not rolling in cash, and we don’t have the types of funding that would enable us to make a significant dent in funding research itself.

Jim Pearson:

So we’ve always focused on the infrastructure, and supporting that research community, and the subject there around early career researchers that’s critically important to us in the future, are those future researchers, those people who will be creating new innovations and better understanding of the disease processes that cause dementia, and other risk factors.

Jim Pearson:

It will be those early career researchers, and we want that talent to remain here, to create the conditions for them to have positive opportunities within developing their careers, and to remain as researchers, contributing to the knowledge base within Scotland, is really important to us.

Jim Pearson:

So for us, then, it is about infrastructure. It’s about supporting the research community. I’m no researcher. Of the three of us here, I’m the layperson talking about research. What I do know is that what we do, in terms of our campaign work, will all be with the Scottish government who we work with and try and influence positive change.

Jim Pearson:

And in the international arena, we have the World Health Organization Global Action Plan, which is requiring every country to have its own national dementia plan or national dementia strategy. They’re also now calling for every country to have its own prevention strategy.

Jim Pearson:

I think we’ve managed to get off the mark quite quickly with that, in terms of developing Brain Health Scotland. We’ve got the Scottish government committed to that. They’ve funded the establishment of Brain Health Scotland, a commitment to develop a brain health strategy.

Jim Pearson:

And there is a new national dementia strategy that will be having dialogue in the coming months, I have no doubt, as we move out of the pandemic, or hopefully we move out of the pandemic. And I think there’s a real opportunity in there to build on the existing commitments in Scotland’s National Dementia Strategy around that research, investment, and creating that infrastructure and support for research.

Jim Pearson:

There’s more, I think, to come, and stronger commitments perhaps, within the National Dementia Strategy. So an opportunity I think we’re going to be looking at for strategy, to really try and influence that. And the work of Brain Health Scotland will be critical, I think, in making sure that that’s really embedded in Scotland’s national commitments around dementia going forward.

Jim Pearson:

In fact, I said “dementia” there. I should have said “dementia and brain health.” Maybe our future national dementia strategies will actually be brain health and dementia strategies.

Adam Smith:

Leading the way, I think so many countries do … I mean, because Scotland has always been one of the first countries to put these policies and these strategies out there. I think it’s great that then, when the rest of the countries in the GA or in the US and the UK, which of course in England, of course, I think they’re going through a period now of looking at their next dementia strategy because the old one came to an end at the end of 2020.

Adam Smith:

Everybody’ll be looking to see what’s going on in Scotland, I feel sure. And great that this is covering basic science and academic and clinical, because I think in some of the feedback we’ve had recently, it was one of the things that everybody said they liked about Dementia Researcher and our podcast and things, is that we weren’t just for clinical researchers or basic scientists, that we do try to span all areas of discovery. Well, thanks.

Jim Pearson:

I think that’s actually a [inaudible 00:42:40] of ours too, and we have … and for our main work, because a lot of our work, of course, and our priorities are set by people with the experience. So our campaign priorities, our work was informed by people who have the experience.

Jim Pearson:

And absolutely, that balanced portfolio of research, which in terms of prevention, potential treatments and cures, but also, how do we support and care for those people who are living with dementia today? And I think we’ve got that balance right.

Jim Pearson:

Well, certainly, maybe not in terms of investment, but certainly in terms of the focus of the work and the strategy, and within the Scottish Dementia Research Consortium, all of those key themes are there. And I want to go, I think, in terms of having a more equitable spread of investment in certain areas of research, particularly, because I think, around practice research. But I think this approach can help with that.

Adam Smith:

And I mean, in my day job, I work with Alzheimer Scotland quite a bit on a few different things, joint dementia research being one of them that I’ve been able to work with Henry Simmons, your chief exec, on that. And there’s always been that real passion there for public engagement.

Adam Smith:

If ever you’re at a meeting and you want somebody to remind you about what’s really important about whatever it is you’re doing, Henry and yourself, Jim, have always been great at bringing it back to that direct line of sight between the research and the people that are going to benefit, the public, the carers, the people living with the disease.

Adam Smith:

And great work you do in encouraging the public to sign up to join dementia research, which we’ve done a podcast on before as well. For anybody listening who is not in the UK, this is our national service that supports anybody over the age of 18 to volunteer to participate in research studies, and then gives all ethically approved dementia research access to match up and find people they’re looking for, for their studies.

Jim Pearson:

Good. Maybe just say something now that you mention that.

Adam Smith:

No, no, no.

Jim Pearson:

That’s absolutely right. So, one of our key priorities, and one of our own key strategic aims is, as an organization, to create a culture where all of our staff, whether you’re a volunteer, a dementia advisor, a post-diagnosis supporting worker, for those people who are working with people day in and day out, are confident in talking about research and opportunities for research.

Jim Pearson:

And actually, to allow people to make those informed choices about participation and research, and a really clear message about signing up for and participating in dementia research, to join dementia research. So that is an ongoing piece of work, but it is our ambition that a key element of our work will be to support recruitment into research, and to support people to be empowered to make their own choices about that, and of course, to join dementia research does provide people with a platform that enables to decide how and when and what type of research they become involved in.

Adam Smith:

And it will get better. I’ve currently got the job of writing the spec for purchasing, procuring the item system for the next version of that. In fact, that’ll be what I spend all my day doing tomorrow, in fact. Yeah.

Professor Craig Ritchie:

Sounds like more than a whole day’s work there, Adam. I think that’s a couple days’ work, at least.

Adam Smith:

It is. It is, slightly. Although it’s fun, because I think this is an opportunity. We’ve learned so much from our work on registers and being in this space in the last few years, that I think we now have a vision for what a really good public engagement tool, and of course, the important bit is, we’ve got to … I don’t want to talk about it too much.

Adam Smith:

We’ve got a publication coming out soon, so look at Alzheimer’s and Dementia shortly and you’ll get, hopefully, a good story about how beneficial that’s been, and Alzheimer Scotland’s been fantastic in their support for that work. Thank you, Jim.

Adam Smith:

So it’s probably time we were wrapping up. The time always gets away from me. I’m notorious for being terrible at ever hosting short podcasts. But before we wrap up, Craig, what advice would you give to anybody out there who’s listening, who’s interested? What’s the hot topics for brain health? What can they do?

Professor Craig Ritchie:

Oh.

Adam Smith:

What would you recommend they do if they want to be big in this space? How are they going to find a niche in brain health?

Professor Craig Ritchie:

I think if you want to be big in this space, I think you have to take what … If you’re talking about early career researchers, you have to take what motivated you to be interested in the science, in the clinical science, and don’t lose sight of that, because I think most people go into science and go into research, dare I say, to make the world a better place.

Professor Craig Ritchie:

They don’t do it to build their CV. They don’t do it to get a promotion. They do it because they want to make a difference to the world, and that’s where I think initiatives here in Scotland will help facilitate good researchers to have high impact.

Adam Smith:

Fantastic. And is there any way for anybody to get … If anybody’s listening, and they’re in Scotland, is there any way for … What message would you give to them? Is there a way for them to get involved, or something you want to point them to?

Jim Pearson:

Yeah, definitely. Yeah, so sorry. To cut across there, Adam, we have a growing membership of the Scottish Dementia Research Consortium. We’re up to 800 members. Over the last few years, we’ve gone from about 200 to 800.

Jim Pearson:

A very large proportion of those people are early career researchers, so if you go to the website, www.sdrc.scot, then you’ll see how to sign up to become a member of SDRC. And hopefully in doing so, you’ll become part of one of these NHS boards and have your voice heard.

Adam Smith:

And you’ve been running some great webinars as well, which I’ve been catching up on YouTube afterwards. So I think there’ll be links to those webinars, both on the ones you’ve done before, and new ones coming up as well on there.

Adam Smith:

Thank you very much. Well, I think that probably really is all we’ve got time for today, so to recap, for anybody who’s looking, go and find the Scottish Brain Health and Dementia Research Strategy. It’s well worth a read if you’re looking for some inspiration for your own strategies.

Adam Smith:

There it is. Jim’s holding up a copy for those … Obviously, nobody can see that. Thanks, Jim. But I’ve got the webpage open, he reminded me.

Jim Pearson:

Perfect radio. Perfect radio.

Adam Smith:

The main takeaway is, we’re going to have these health boards. There’s going to be the rapid review service, this big piece of work to review ECR career pathways as well, and the national oversight board as well, and then that sits in this landscape of the brain health strategy and the dementia strategy, which are also coming very soon, which is fantastic.

Adam Smith:

Thank you very much to our guests, Professor Craig Ritchie and Jim Pearson. We have profiles on all of today’s panelists on our website, including details of their Twitter accounts, so please do go and take a look. And we’ll also put a link to the strategy in there as well, that you can go find out about, and a link to the SDRC that Craig mentioned.

Adam Smith:

Finally, please remember to like, subscribe in whichever app you’re listening to, and remember to subscribe to receive our weekly bulletin. And if you’d like to join us to discuss your own research on the show, please drop us a line. And you’ll find details on how to do that in the text below the podcast. Thank you very much, Craig. Thanks, Jim.

Jim Pearson:

Thank you.

Professor Craig Ritchie:

Thank you.

Adam Smith:

And we’ll be back again in two weeks’ time.

Voice Over:

Brought to you by dementiaresearcher.nihr.ac.uk, in association with Alzheimer’s Research UK and Alzheimer’s Society, supporting early career dementia researchers across the world.

END