| Description | Prof MANDY RYAN interview at the Health Economics Research Unit, Polwarth Building, Foresterhill, University of Aberdeen on Tuesday July 11th, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) MANDY ELAINE RYAN, born 19th July 1965 in Coventry. Currently Professor of Health Economics, and Director of the Health Economics Research Unit. Comes from traditional working class background, mum and dad both worked in a factory, no medics in her family. Went to Foleshill Church of England Primary School, then to Foxford Comprehensive School, both in Coventry. Foxford was a school where pupils did not typically go to university; has fond memories of teacher Mrs Fellows who contacted her parents to suggest Mandy went to university. Mandy went off to study Economics, explains; speaks about her interests at school; sport and studying. Chose to study Economics because she thought it could get her a job; explains how she chose which university to go to; chose Leicester, close to home, which was good because her mother got ill and subsequently died. (0:05:12) Further explains choice of Leicester University; difficulties of someone from her background going to university in 1983, explains. Did not live normal student life, because was going home at weekends to see her mother. Can remember exactly the point she became interested in Health Economics; a lecturer mentioned that there was a Masters degree in Health Economics at the University of York, sounded attractive to her as did not want to work in business or banking. Lecturer knew Prof Alan Maynard, big figure in health economics at the time. Mandy applied to do the Masters at York, got scholarship from Dept of Health. Her mum died while she was at York; has fond as well as difficult memories of York, explains, but enjoyed the course. (0:09:50) Explains what she did after graduating in 1987 with her MSc in Health Economics. She wanted to get away, job came up in Aberdeen, travelled up and she got the job with HERU (Health Economics Research Unit), explains. Talks about the staffing and reputation of HERU when she joined it in 1987; unit then ten years old, good reputation, much smaller than now. Director of unit was Anne Ludbrook, interviewed and employed Mandy, Anne now an Emeritus Professor at the unit; a colleague who still works for the unit, Chris Spoor, was here; Ken Buckingham, now retired; William Moffat, left to go into teaching. (0:13:54) Explains what HERU does, health economics is the study of how to spend the healthcare budget (at this point in the interview we paused to allow a helicopter to pass overhead!). Talks about her responsibilities and challenges on becoming a Research Fellow at the Unit in 1990. Explains that in first three years at the unit, was not sure that academia was for her; Anne Ludbrook had stood down and unit was directorless. Then came Prof Gavin Mooney, who had been at the unit in the early days. Explains about origins of unit, with the late Prof Roy Weir and Prof Elizabeth Russell having this idea to bring Economics and Medicine together, back in 1974; Gavin Mooney involved, became first Director of the unit in 1977, left in the early 1980s. Gavin came back after Anne Ludbrook stood down, he was a character, very influential in Mandy’s career, explains; crucially suggested that she do a PhD, explains in detail. Did PhD between 1990 and 1995, basically introducing a new method to Health Economics, called Discrete Choice Experiment; Mandy discovered she loved academia. (0:19:53) Explains how she came to work in Australia for a few months starting in October 1993. Gavin Mooney was supervising her PhD, he was by then working at the Centre for Health Economics (Centre for Health Economics, Research and Evaluation (CHERE)) in Sydney, suggested she go out there, explains she did an economic evaluation of In Vitro Fertilisation (IVF) as part of her PhD. Talks about how in October 1997, back at HERU, she became a MRC (Medical Research Council) Senior [Non-Clinical] Fellow and Reader in Health Economics. Explains the method she had worked on for her PhD from 1990-95 was then known as Conjoint Analysis, but is now known as Discrete Choice Experiment. Decides she wants her own research money so she can have her own research programme, so applied for an MRC non-clinical senior research fellowship, explains; she was the first applied health scientist to get an MRC [non-clinical] senior fellowship. Real springboard for her career, spending five years looking at the development and application of Discrete Choice Experiments in Health Economics. (0:23:56) Explains in detail about Discrete Choice Experiment; explains Quality-adjusted Life Year (QALY); asked to do evaluation of IVF, explains in context of her PhD; can get a measure of value that takes account of everything, idea in her PhD that just grew arms and legs, explains now commonly used across Health Economics. (0:29:31) Addresses question of how much DCE has helped change the usefulness of methods of finding out what people really want from their healthcare. The great thing about the Discrete Choice Experiment is it puts people into the real life situation of making choices, explains in detail; we (in HERU) changed the face of benefit of valuation in Health Economics. Centres internationally now that look at Discrete Choice Experiments. We’re always pushing the method forward, testing it, investigating it. Impact at a Policy level, explains in detail. By early 2000 organisations like NICE (National Institute for Health and Care Excellence) coming about, economics they are using to inform their decisions is the QALY; explains impact of her work on this. (0:34:09) Clarifies whether she can be regarded as the inventor of DCE; took an existing method used in Transport Economics, and looked at its application in Health; has been referred to as "The grandmother of DCE". In 2002 Mandy becomes Professor of Health Economics, still working within HERU; gives her thoughts on becoming a professor, and explains in detail how this came about; the Health Foundation put out a funding call to fund a fifteen-year Professorship post in Health Economics at a university, explains what happened, her involvement, and realising her colleagues thought she could be a professor. She was 36 at the time, reflects on this. Explains about going to the University of Calgary in 2004, to do a year’s sabbatical; influenced by a colleague who worked at the unit and had gone to Canada, and came back to Newcastle, Prof Cam Donaldson, explains. (0:39:20) Explains what she did while in Canada. Then recalls what HERU was like in the early 2000s. John Cairns took over the directorship, but then moved to London, unit left directorless; Prof Alan Maynard helping run the unit till they found a director. Mandy suggested Prof Bob Elliot from the Economics Dept in Aberdeen, whom she had worked with. He became Director of HERU in 2002. Mandy talks about how she became the Interim Director of HERU in Oct 2012, and Director in April 2013. Explains why she did not want to take over the Director’s role, loved her research; but then saw who was applying, medics rather than economists; so she applied and was appointed to the post. Faced challenge of having been part of a unit, and then finding herself running it, explains in detail; Bob Elliot has remained a mentor for her. Explains how she was helped to prepare for the role by a woman (name not given) who then worked for the university around Coaching. Other key challenge was she did not have all her time for research any more, explains; absolutely loved being director. (0:46:31) Explains that a health economics unit cannot be run by a clinician; attitude of medics and the NHS towards health economics. Recalls teaching a course on health economics in the late 1980s for health professionals, people would not accept concept of Opportunity Cost in health, explains in detail; can see things have changed over time, don’t have same debates. Explains economic method of Willingness to Pay, and Value. In 1960s Health Economics started, using Cost Benefit Analysis, medics did not accept this, thought it unethical to value life in monetary terms. In 1970s moved to Cost Effectiveness Analysis, explains. Then in the 1980s the Quality Adjusted Life Year. Thinks medics now accept that they can’t do everything. (0:51:15) Comments on application of health economics in North-east Scotland. Really interesting time for HERU; funding from CSO (Chief Scientist’s Office of the Scottish government). In 1977, following application by Roy Weir, Elizabeth Russell, and Gavin (Mooney) got this core funded Scottish government unit, explains why this was important. When Mandy came to the unit in 1987, most of the unit’s funding came from CSO; now have university funding and external grants, so CSO is now providing about a third of their funding. But in 2014, then Chief Scientist Andrew Morris decided there would be a review of CSO core funded units; outcome announced just before lockdown, in February 2020, withdrawing their core funding from units in Aberdeen - HERU, and the Health Services Research Unit - and units elsewhere; introducing competitive grants instead. Announced a tapering, HERU in fourth year of tapering, where from March [end of March] 2024 have no more CSO core funding. HERU has around 35 staff. Still have a good investment from the university, but will have to diversify. (0:57:54) Explains their contracts are with the university. Explains about terms used by politicians about the NHS like "Value for Money" and "Cost Effectiveness". Future for health economics is pretty good she thinks, explains in context of current mess that the NHS is in. Addresses question of people having to change their expectations of the NHS, how it is funded in future, maybe an NHS-based tax. Economics can inform the discussions around how to fund healthcare. One of the big projects HERU is working on, funded by the Health Foundation and in collaboration with University of York, is looking at the supply of the workforce; crucial, explains. (1:02:48) Reflects on her achievements; and future of the NHS. (ENDS 1:04:20)
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