Autumn Budget 2026

The UK's research ecosystem, including through organisations such as UK Research and Innovation (UKRI) and the National Institute for Health and Care Research (NIHR), plays a vital role in turning scientific advances into healthier lives, productive communities and economic growth. We were therefore pleased to see recognition of this through UKRI’s planned investment in the life sciences, as part of Spending Review 2025 decisions.⁵ Life sciences spend is ranked third in UKRI’s priority ‘buckets’, with a targeted investment of £1.5 billion over the Spending Review period.⁶ We welcomed recent open engagement from the Medical Research Council (MRC), in partnership with the Academy, on new funding processes and ambitions in this space.⁷

But we should not take the UK’s health research activities for granted. Unless the UK maintains its R&D spend in line with other leading nations, and shows its continued commitment to international collaboration, it risks losing its position as a key research partner and attraction for investment and talent. The previously announced 10-year R&D funding cycles are one example of where longer-term certainty can be provided for researchers and industry,⁸ alongside continued engagement on Framework Programme 10 and UKRI’s priority ‘buckets'. 

Data from the Office for Students (OfS) shows that the gap between research costs and cost recovery is widening in academic institutions. In 2024‒25, the full economic cost recovery (fEC) for research was 67.0%, and within this, fEC from UK charities was 55.7% (a deficit of £6.3 billion).⁹ The lack of cost recovery for research is making health (and other) research increasingly reliant on cross-subsidisation, including income from international students’ tuition fees (which is also at risk). This is at a time when the sector has broader financial challenges and is considering how it can specialise and collaborate.  

The OfS has noted that universities are finding it more difficult to fund research activities, and that this could make it challenging to attract the necessary talent.¹⁰ They also noted that most institutions are reassessing the financial viability of research activities. The impact of these decisions could include changes such as:

• courses and skills provision, with knock-on effects to the UK’s talent pipeline
• refocusing biomedical and health research activities, which could impact the development of new discoveries and solutions, and opportunities for patient involvement in academic research
• reducing clusters of research activity and collaborations between universities, the NHS and industry, which could impact local economies or create cold spots at a time when local leaders are expected to be granted more powers to enable innovation scale up.

Without careful consideration of the impact of these decisions, we could jeopardise the UK’s ability to operate as a research partner of choice. 

Previous research has shown that:

• Clinical research drives innovation to make the NHS more sustainable and deliver better patient outcomes. Clinically trained research staff play a central role in innovations that improve treatments, interventions, diagnosis and prevention strategies. Research-active hospitals consistently show lower mortality rates.¹⁶
• Clinical research attracts major inward investment from global industries who choose to base their biomedical research bases in the UK.
• Non-commercial clinical research funded by charities and public bodies, supporting over 8,000 FTE jobs per year within the NHS including clinical academics, contributed £72.7 billion of Gross Value Added to the UK economy between 2014 and 2024.¹⁷

There are also benefits for clinical staff who want to engage in research, including a more varied and flexible career path, opportunities for collaboration and personal development, working at the cutting edge of new developments, and reduced burnout.¹⁸

Further, clinical academics provide research-led teaching, which helps to train the medical sciences workforce. 

There are distinct funding challenges for clinical academics, who are funded from a range of sources, including universities, the NHS, industry, government and charities. These sources include research grants, fellowships and lectureships across the career pathway; co-funding from universities and the NHS to support joint posts; funding to support government policy ambitions; and wider career development funding to support progression between career stages.

This funding is needed to support salaries, pensions, research activities and infrastructure. The balance of this funding may also depend on the proportion of the role that is spent on clinical, teaching and research activities (including research time that is protected).¹⁹ This co-dependency of funding provides opportunities for collaboration across the medical sciences.  

However, it also means that funding is complex and subject to a range of partnership structures and policy considerations, including:

• Government policy direction and related funding. This includes funding for clinical activities, teaching and research. This funding is cross-departmental, including from the DHSC, DfE and BSIT. 
• Organisational strategies and research interests. This includes organisational workforce planning in the context of clinical, research and teaching activities. This may determine the nature of partnerships and workforce contracts.
• The local / regional context. This includes the ecosystem, infrastructure, opportunities and appetite to form research partnerships across academia, industry and the NHS.

The fragmentation of the clinical academic landscape is also well known. A key recommendation from the OSCHR-commissioned report was to create a more coherent national clinical academic career pathway. Research funders have endeavoured to map their respective funding opportunities for clinical academics, but this only represents one part of a complex landscape, and we need to see wider coordinated action.²⁰

A key challenge in the system is that, while many university positions are permanently funded, some of the funding streams for clinical academics are time limited. This causes challenges in the creation of permanent posts. Further, some funding streams do not explicitly state that funding is provided for the duration of a post, which gives the funder the option of stopping at any time. 

There are also challenges with protected time to conduct research, disincentivising the workforce from pursuing research careers and constraining the future talent supply. Recently published modelling demonstrated that resident doctors already lose approximately £72,000 – £81,000 in lifetime earnings during clinical academic training, disincentivising the clinical academic career pathway.²¹ A combination of job insecurity, short-term contracts, and financial disincentives (compared to consultant or industry roles), lead to post-PhD attrition.²²  

Inputs to the Academy’s UK Medical Science Careers Taskforce consultation suggest that the lack of a transparent or structured pathway, coupled with limited startup and seed funding, creates an increasing dependency on research support from the local environment.²³ Yet there is limited recognition of research time within assessments of clinical competency and progression to consultant status, and limited recognition of research time in consultant pay scales. Pay disparities between NHS and university contracts act as a barrier to academic careers, particularly with unequal access to protected time and funded development.²⁴  

Perceived career insecurity and limited progression opportunities create barriers to portability between sectors. Where capacity constraints slow study set‑up or limit research activity in frontline settings, opportunities for industry collaboration and commercial research are reduced, with consequences across the discovery‑to‑adoption pipeline.²⁵  

We need to align sector workforce plans and embed research in key performance indicators and funding frameworks, which means ensuring there is dedicated funding for permanent posts, and bridging support at key transition points (especially post-PhD and post-Certificate of Completion of Training). 

There have also been developments to government funding. On 6 July 2026, the OfS was directed by DfE to ‘no longer allocate funding for clinical consultants’ pay; the senior academic general practitioners’ pay and the NHS pension scheme compensation’.²⁶ Some institutions will be able to absorb these costs, but others will find it more challenging.  

This is just one example of the funding developments that have occurred in recent years, which collectively could: reduce the availability of funding for clinical academics; result in organisations making difficult decisions about whether to invest in this workforce; and put the future of the clinical academic pipeline at risk. 

To address this challenge, we need to reframe clinical academic training as an investment in essential national infrastructure, jointly owned and funded across health, economic, education and science budgets, rather than having a workforce that relies primarily on health budgets. In doing so, we can reduce the fragility of the funding environment and ensure we have a workforce fit for the future. 

As collated in the Academy’s report on ‘Shifting left to prevention: innovation for greater health’, research shows the economic benefits of investing in prevention initiatives:³¹

• Modelling by Schindler and Scott in 2025 has shown that a 20% reduction at all ages in the incidence of cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, musculoskeletal conditions and mental health conditions leads to increases in life expectancy, healthy life expectancy and length of expected working life, and in turn increases in labour supply and gross domestic product.³²
• Analysis by Deloitte found that, for every £1 spent on prevention, the UK stands to gain £8 in socioeconomic returns on investment. Increasing the percentage of UK health expenditure on prevention from 6% to 10% could return £42 billion within 10 years.³³
• Analysis from the Institute for Public Policy Research found that, should the Government deliver on its prevention and productivity ambitions, annual spending would be maintained at 8.1% of GDP, saving £21 billion per year on health by the end of this parliament, and £53 billion per year by 2034–2035.³⁴ 

However, Academy-commissioned research, conducted by Brown University, has identified that ‘the UK ranks among the worst of high-income nations for preventable, treatable and avoidable mortality, with the top two leading causes of avoidable mortality being cancer and cardiovascular disease’.³⁵ Further research has shown that:

• Despite key government strategies signalling that prevention and early detection are a priority, spending continues to focus on treatment of disease. According to ONS data, spending on prevention has remained relatively static over the past decade, consistently accounting for around 5%–6% of total healthcare expenditure.³⁶  
• Despite a higher proportional spending of the total health budget on prevention than the OECD average, spending remains lower than in many high-income countries, and the UK continues to experience higher rates of preventable mortality than many of its peers. This highlights the need for sustained long-term investment in prevention rather than short-term acute responses.³⁷

Feedback from stakeholders has suggested that prevention initiatives are often seen to be economically undervalued, in part due to the long-term nature of their benefits, which are often not captured in the time frame over which they are evaluated, and the application of the discount rate. The Government, therefore, needs to incentivise and sustain public and private investment in prevention and early detection, which includes incentivising cross-sector collaboration to deliver impact at scale.³⁸ 

Investment decisions include finding ways to: maximise population health, improve access to new medicines, support research and innovation activities, and attract life sciences investment. While these objectives can overlap, how they are prioritised plays a significant role in shaping resource allocation and the trade-offs involved. Feedback from research commissioned by the Academy has suggested that these trade-offs are not always made explicit in decision-making, and there is limited visibility over how competing objectives are balanced in practice.  

Without strengthening our decision-making framework, the UK will be met with two key financial risks: firstly, we do not get value for money (VfM) from the health system; secondly, investment decisions will limit the health and growth potential of the life sciences. 

All countries are grappling with how to pivot health systems towards prevention, taking varied approaches and achieving different results. The Academy is currently examining comparative patterns in prevention spending to understand how countries are responding to this shared challenge, and what the UK can learn from comparative experience.³⁹ 

Key to this, as noted in the Brown University research, is ‘rooting policy and financing decisions in empirical evidence from population health outcomes and health system performance’, to ensure that funds for health are allocated to ‘equitably address disparities in health burden’. We look forward to sharing these learnings with HM Treasury to identify where further spending can be targeted to address these disparities.

We are working with the Government and wider medical science community to go further, to ensure that policy decisions are consistent, evidence based and commensurate with the high value and potential of medical science. As part of this, our activities have suggested there is scope to: 

• design budgeting and accountability structures to better capture benefits that accrue over long-term horizons, across sectors, or through preventing future health issues. This would cover domains such as population health, protection from catastrophic events and costs, social welfare, and economic value.
• bridge cost-effectiveness analysis with evidence on R&I incentives and broader life sciences investment.  
• increase transparency of trade-offs – including resource displacement - when new spending decisions are made.

An improved framework would support UK policy makers to use budgets to support patients, incentivise innovation and improve population health. We welcome HM Treasury’s commitment to work with the Academy on this. 

This requires a national strategy, which targets investment in ways that will help the UK to:

• Create NHS efficiencies by linking diverse, high-quality datasets through methods that reduce complexity
• Evaluate the effectiveness and safety of predictive AI
• Enhance digital systems (including IT and AI infrastructure) in ways that better facilitate interoperability of, and access to, data by the health workforce
• Improve AI literacy and trust among healthcare professionals and the public
• Provide capacity to research and innovate, which will help to increase understanding and uptake of emerging technologies.

The increasing role of emerging technologies also provides new routes into medical science for people from a range of disciplines, including mathematics, computer science, engineering, physics, statistics, design, ethics, social science, software, data governance and technical backgrounds. It is important that we create and fund career pathways with opportunities to build and incorporate these skills in the life sciences. This includes investment in the wider NHS/research workforce and the specialist skills needed to develop, evaluate and adopt AI, namely: investing in AI literacy and training for healthcare professionals; and strengthening multidisciplinary training programmes, bringing together researchers, developers and clinicians.

We have heard from our Fellows that to inform national spending decisions on digital capability, the UK requires a more standardised and transparent process to calculate real-world benefit, in terms of health economics and outcomes. In cost calculations, this means recognising the holistic value that AI and data can bring to the healthcare system, whether in monetary form, in equity or royalty streams, or in technology adoption. As previously outlined, the UK’s VfM framework used to evaluate the utility of treatments is important for capturing the full value of these technologies. 

We are pleased to see this potential recognised in the Government’s policy ambitions, with a target to halve the gap in healthy life expectancy between the richest and poorest regions. The UK’s Industrial Strategy,⁴⁹ Life Sciences Sector Plan⁵⁰ and NHS 10-Year Plan for England⁵¹ also include ambitions to:

• Strengthen connections, strategic dialogue and local business environments between and within city regions and clusters​. This includes a goal to establish Regional Health Innovation ‘Zones’ for large scale development​.
• Incentivise and strengthen collaboration between industry, academia institutions and funding bodies​. A recent example of this includes efforts to provide regional consortia with funding to identify and address gaps in support for clinical researchers.⁵² 

Examples of regional strengths identified in the Life Sciences Sector Plan

• Scotland has the presence of a ‘Triple Helix model’ with industry, academia and the NHS
• Northern Ireland is home to research-intensive universities
• Wales is an export-driven, investable location with targeted skills investment
• The North-East has access to scientific talent, with high Life Sciences student density
• The North-West is a leading hub for collaborative development and commercialisation
• The East Midlands’ strategic location strengthens manufacturing and health-tech development. 

Yet despite these research strengths and policy ambitions, regional inequalities remain, many of which are outlined in the Academy’s Measuring What Matters report.⁵³ 

• Healthy life expectancy is decreasing. Data from the Office for National Statistics (ONS) shows that, in 2022 to 2024, compared with 2019 to 2021, healthy life expectancy has ‘decreased in a majority of areas within every constituent country and every region of England’. The North-East has had ‘the lowest healthy life expectancy at birth in England in every period since their time series began, and In Wales, for both males and females, healthy life expectancy at birth is lower in the most deprived areas.⁵⁴
• There are regional health inequalities. ONS has found that in 2024, in England, the highest rates of avoidable mortality were in the North-East and North-West (although the two regions saw the highest relative falls in those rates).⁵⁵ Data from the Scottish Health Equity Research Unit shows that while Scotland has begun to stabilise some indicators of living standards, ‘progress is not evenly distributed’.⁵⁶ And data from the UK Health Security Agency shows that regional inequalities in vaccination uptake persist, with coverage rates in London consistently lower than in other parts of England.⁵⁷ 
• There are links between areas of deprivation and preventable ill health. Data collated by DHSC shows that those living in the most deprived areas have shorter lives and longer periods of preventable ill health. It finds that multimorbidity, mortality rates for most cancers, maternal mortality rates and children living with obesity are more prevalent in more deprived areas. Meanwhile, density of fast-food outlets, alcohol consumption and smoking are also highest in more deprived areas, with the proportion of physically active adults lower in those areas.⁵⁸
• Regional research strengths are not equating to uniform innovation outcomes. Despite the wide-ranging locations of health research strengths and potential, OLS estimated that, in 2023/2024, the South-East accounted for 24% of employment and 27% of turnover.⁵⁹  

We need to support local connectivity by identifying priority health missions and organising training, infrastructure and careers around those missions within clusters. Health innovation should embed cross sector collaboration by design, spanning universities, NHS organisations, industry and government.

The Government’s recent announcement on the ‘Rewiring the state’ signals an opportunity to better integrate and coordinate policy and delivery at a local level. This includes plans to strengthen local accountability mechanisms to reflect greater funding freedoms and bring together education, and employment, health and local support.⁶⁰ It is worth exploring whether these mechanisms can be used to bridge local health, innovation and education policy, to maximise regional strengths and tackle health inequalities.⁶¹ As noted earlier, some of this financial planning can be supported by an improved decision-making framework on the value of health interventions.