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BY 1995, the 400 or so researchers and staff who now work at the Clinical
Research Centre in Harrow, Middlesex, will be gone. The laboratories they
now occupy will be empty, the equipment dispersed. Sir Christopher Booth,
the last director of the centre, leaves no one in any doubt about his view
on the closure. Speaking at the Royal College of Physicians in London last
October, he said: ‘The finest research facilities in the country are to
be heedlessly thrown, like an old and broken pipette, onto the scrapheap
of science.’

The announcement in October that the Clinical Research Centre (CRC)
is to close, probably by the end of 1994, came as a shock to some of those
who work there. Perhaps it should not have done. Geoffrey Asherson, head
of the division of immunological medicine at the CRC, pointed out that the
closure has not hit the centre ‘like someone slipping on a banana skin’.
‘It is more as though,’ he said, ‘if you walk through a minefield, you must
expect to be blown up.’

The path through the minefield, leading to the eventual closure of the
CRC, originated many years ago. Some would argue that the centre was doomed
from the start because of the way in which it was set up. This is not to
say that it was a failure. As Asherson put it: ‘The major loss is that you
had an institute that was doing well, but could do better, and you destroyed
¾±³Ù.’

The idea for a clinical research centre came from Sir Thomas Lewis,
who ran a department of clinical research at University College Hospital
in London. In 1929, he suggested to the Medical Research Council (MRC) that
it should set up an institute ‘within which the workers may be free from
the distractions presented by the petty and mainly diagnostic problems of
diverse and obscure cases, and in which they can settle down to a more profound
and uninterrupted study of the natural history of selected diseases’.

It was not until the 1960s that the MRC began to translate Lewis’s suggestion
into reality. The council wanted a centre that would initiate and carry
out top-class clinical research, as well as encouraging clinical research
throughout the country.

The boundary between medical research and clinical research is not clear
cut. Medical research in general has a wider brief: it can encompass the
intricacies of chromosomal abnormalities, the development of new imaging
techniques for diagnosis, the study of statistical methods for evaluating
data from clinical trials. Clinical research is always, in some way, directly
connected to patients. At one end of the spectrum is the collection of information
about patients who have various diseases. This includes epidemiology, the
branch of medicine that established, for example, that people who smoke
are more likely to get lung cancer, or that people’s diets can influence
their risk of developing heart disease.

Further along the spectrum towards basic research is work that involves
studying pieces of tissue or specimens from patients. For example, researchers
trying to identify the causes of certain types of diarrhoea will study samples
of faeces to see if they can identify the bacterium or virus that is to
blame. Another example is the study of how the lining of the stomach regenerates
itself after an ulcer has formed, and what influences the speed of healing.

Clinical research naturally merges into the clinical end of basic medical
research: in the example of the study of causes of diarrhoea given above,
this work could move on to the basic research work of analysing DNA from
the bacteria that cause the diarrhoea and, armed with this in formation,
trying to develop a vaccine. The research would become ‘clinical’ again
when scientists were ready to evaluate the vaccine’s effectiveness in patients.

The MRC decided to put its new centre next to the new district general
hospital being built at Northwick Park, near Harrow. The idea was that researchers
would there be able to study common diseases which would, by definition,
be important ones. These diseases would include, for example, heart disease,
high blood pressure, stroke, dementia and psychiatric disorders.

The teaching hospitals in London, unlike general hospitals, tended to
study patients who had been referred from all over the country because their
cases were unusual. (Booth quotes AP Herbert to illustrate this point: ‘I
love the doctors, they are dears/But must they spend such years and years/Investigating
such a lot/Of illnesses that no one’s got?’) The new CRC also had to be
sited at a district general hospital in order to avoid its researchers having
to compete with academic staff for beds for their patients, as they would
in a teaching hospital. In addition, if there were two sets of researchers,
their research policies might have clashed.

The Queen opened the centre and the adjoining hospital in 1970. The
ceremony was attended by, among others, Margaret Thatcher, who was then
Secretary of State for Education and Science. Booth, who had previously
been professor of medicine at the Royal Postgraduate Medical School at the
Hammersmith Hospital in west London, became the centre’s director in 1978.
He said in his recent address to the Royal College of Physicians that, when
he arrived at the CRC, he found it had decided advantages, with ‘magnificent’
research facilities.

Booth added: ‘The laboratories were excellent, equipment lavish and
the centralisation of services such as electron microscopy, histology, media
preparation, glassware and washing up, animal-house facilities and computing
were quite remarkable.’ The MRC supplied a smooth administration, and 160
of the beds in Northwick Park Hospital were available for research purposes.
Plus, the site at Northwick Park encompassed 45 acres, against just 12 overcrowded
acres at Hammersmith.

Just 10 years after the centre had opened, rumblings of dissatisfaction
with its approach were apparent. An editorial in The Lancet, for example,
spelt out the challenges that had faced the ‘pioneers of Watford Road’ a
decade earlier (vol ii for 1980, 25 October, p 899). These were ‘to establish
a top-rate district general hospital; to establish research programmes that
would be important both at home and internationally; and to integrate the
work of research centre and hospital, forging a creative unity’.

The first of these challenges, The Lancet said, had been met, for the
hospital had a good reputation locally. The journal also approved of the
research programmes: ‘There is much to be proud of,’ it said. But it added
that the work differed little from that of any good medical institution.
The leader writer wanted to see more emphasis on basic techniques such as
protein chemistry, molecular biology, genetic engineering and work with
monoclonal antibodies. ‘We do need more basic, clinically relevant medical
research, and the CRC is surely the place where it should be done,’ the
editorial concluded.

Many researchers who have worked at the CRC over the past decade agree
readily that the centre had its faults. The concept of the CRC was developed
before many of the big developments in molecular biology, molecular genetics
and cell biology. Applying the latest technology in these fields to many
problems in clinical research would have been rewarding, but researchers
say the CRC was slow to adapt.

Another problem was the relationship between the staff of the CRC and
the consultants at Northwick Park Hospital. Many people perceived this as
poor, although others have argued that it was no worse than the conflict
between the academic staff and the NHS doctors in many teaching hospitals.

As the years went by, the interests of many of the NHS consultants at
Northwick Park seemed to diverge more and more from those of the researchers
at the CRC. Many of the consultants appointed at the hospital were not full-time
NHS employees: they spent part of each week on private practice. With the
opening of the Clementine Churchill Hospital in 1980, the trend towards
private practice and away from research accelerated. According to one ex-employee
of the CRC, ‘The NHS people were supposed to provide the CRC people with
common clinical problems, but they didn’t. The two sides didn’t speak the
same language. Many NHS consultants regarded the research staff as lofty,
while the researchers often looked down on the financial greed of those
doctors who did a lot of private practice. These doctors had no interests
in cooperating with research, yet they had made their reputations by virtue
of Northwick Park being connected to the CRC.’

Another problem perceived by some researchers was a sense of complacency.
One researcher who used to work at the centre said: ‘In some departments,
when the head of department barked, people would jump, and a lot of good
work would result. These departments had good reputations and they fed on
it. But a research institution of that size will not stay alive because
of a few strong divisions. No one was doing that kind of ‘barking’ for the
whole place, whether on the research or the NHS side.’ He believed that
the director, Booth, was too weak: he was ‘not ruthless enough’, he said.

As time went by, the MRC became increasingly concerned that the CRC
was failing to meet its objectives, especially at a time when research funds
were increasingly hard to come by. The MRC closed down several of the units
that it supported directly, not because they were doing a bad job, but because
the council believed it could obtain better value for money by redeploying
the funds.

It was not entirely clear, however, what these objectives were: the
centre had no formal remit. So the council set up a committee in March 1984,
chaired by Sir Michael Stoker, ‘to examine the remit of the CRC’. The report
of this committee recommended carrying out a detailed and wide-ranging review
of the centre. In response, the MRC set up a second committee, in January
1985, also chaired by Stoker, ‘to consider the original concepts and objectives
of the CRC’ and to propose new objectives and any changes that might be
needed to achieve these goals.

The conclusions of the Stoker report backed up many of the criticisms
mentioned above. Just 16 years after its inception, the CRC was told that
it was not doing the job that it should have been, and that part of the
problem was that it had been set up in the wrong way. On 30 January 1986,
the MRC accepted the report’s recommendations. The council said that it
warmly welcomed the proposal for a single centre for postgraduate medical
education and research, which would be formed by merging the CRC and the
Royal Postgraduate Medical School, at Hammersmith, on a single site. Major
basic medical science was to be an integral feature of the new institution.
In line with the committee’s recommendations, the council agreed that if
it was not able to establish the new centre, the CRC should not be maintained
as such on the Northwick Park site.

A series of committees began to evaluate potential sites for the new
centre. A costly independent appraisal of the potential sites was carried
out and, by the time the council’s annual report for 1987/88 was published,
it seemed that the MRC had made up its mind which of the two sites to go
for. The report said there were ‘important factors’ in favour of the Hammersmith
site and that the MRC looked forward to establishing the new centre at Hammersmith.

What would be the cost of this move? In 1988, the MRC said that it would
need almost Pounds sterling 100 million for the merger. The Advisory Board
for the Research Councils, the body that advises the government on the allocation
of funds for scientific research, said that it supported this scale of operation
in principle, but asked the council to propose a scaled-down initial phase
for the project. Last December, Dai Rees, the secretary of the MRC, said
that the council had revised its original proposals and would instead proceed
in stages. The first stage would need about Pounds sterling 50 million over
five or six years, which would mainly be spent on capital costs.

In March 1989, the MRC announced definitively that it proposed to create
the new centre at Hammersmith. The council saw the new institution as the
‘spearhead of its initiative to expand clinical research in the United Kingdom’.

Six months later, the council had to revise its plans yet again. Since
the announcement in March, a group of advisors, its members drawn from several
government departments, had asked the council to ‘test’ the Hammersmith
option ‘against other possible ways of investing resources in clinical research’.
David Evered, second secretary at the MRC, told ¿ìè¶ÌÊÓƵ at the time
that some of the options involved a new national centre and some did not
(This Week, 16 September 1989). By the following month, the fate of the
CRC had become clear. It would close. Some, but not all, of its research
groups would move to Hammersmith; others would be dispersed around the country,
and not necessarily to the ‘golden triangle’ of Oxford, Cambridge and London
(This Week, 21 October). Evered told ¿ìè¶ÌÊÓƵ that the amount available
for the expansion of facilities in west London would be ‘significantly less’
than Pounds sterling 50 million.

By all accounts, the decision not to build a big new centre for clinical
research at Hammersmith is directly attributable to Margaret Thatcher, the
Prime Minister. Her ‘wielding of the handbag’ is perhaps understandable:
she was present at the opening of the CRC and must have wondered why, if
the CRC did not work, the problem would be solved by building another centre.
She is also known to be against big institutions and, according to one source,
she questioned the wisdom of building the centre in the crowded southeast
of England, and in an inner city at that.

Had it been possible to achieve the dream envisaged by the Stoker committee,
and subsequently by the MRC, little of the current acrimony over the Stoker
report would have surfaced. If a complete merger had gone ahead, as Stoker
and his colleagues had planned, even those who suffered the inconvenience
of moving would have had the consolation that it was all in the name of
benefiting research. As it is, there is considerable anger in some quarters
at both the remit of the Stoker committee, and what it concluded.

One of the main bones of contention is related to the sentence in the
introduction of the report which said: ‘Specifically, we were not charged
with any detailed assessment of the quality of the scientific work of the
CRC . . nor with examining in detail the feasibility of implementing any
recommendations we might make’. Booth told ¿ìè¶ÌÊÓƵ: ‘I think it’s
ludicrous to pass any judgment on a scientific institution without looking
at its scientific work.

He pointed out that the CRC has produced 25 professors over the years,
five of them NHS consultants who went on to get chairs.

Booth did not mince his words at his recent address to the Royal College
of Physicians. He said he viewed with profound concern the reliance of the
Stoker committee on the words of one witness who told them that the study
of common diseases did not accord with the direction that clinical research
was now taking. This was, he said, ‘a crude and rather obvious attempt to
attack one of the major raisons d’etre of the CRC’. In contrast, Booth said,
modern clinical research is rightly involved in the study of many common
diseases such as high blood pressure, coronary heart disease, cancer of
the breast and bowel, schizophrenia, and disorders such as alcohol abuse
and obesity.

Booth is already on record as saying that he thinks the Stoker report
was naive and superficial (British Medical Journal, vol 296, p 1382). To
those gathered to hear his lecture, he added: ‘As the vultures gather, any
historian will see that what happened is this: the clinical academic community,
all, like Brutus, honourable men, lobbied the MRC for years to obtain better
facilities for clinical research. The MRC responded by setting up an institute.
The honourable men grumbled – after all, they had really wanted the money
for their own institutions. And then, just as the institute was beginning
to achieve real success, with a string of peer reviews from the council’s
visiting committees that ranged from good to excellent and outstanding,
the clinical academics who advise the council, all, like Brutus, honourable
men, destroyed ¾±³Ù.’

Gerald de Lacey, consultant radiologist at Northwick Park Hospital (an
employee of the NHS, not the CRC), agrees with Booth that, if the MRC had
wanted to assess the CRC, its scientific work should have come under scrutiny.

‘For all I know, it might be a good idea to close the CRC at Northwick
Park. But I want to see the evidence,’ he said. ‘I’d like to be shown that
it doesn’t work. I don’t want to hear from those people who have a vested
interest in it not working that it doesn’t work.’

De Lacey said that he came to Northwick Park ‘partly because I thought
it was very refreshing, there were no nineteenth-century traditions here’.
He says he did not give up a position as a consultant at a London teaching
hospital to come to a common or garden district general hospital. The atmosphere
at Northwick Park compared favourably with that in any teaching hospital.
‘It’s been a marvellous ambience for many of us,’ he said; all his links
with the CRC had been ‘absolutely fantastic’.

Others hold contrasting views. Elizabeth Simpson, head of the transplantation
biology section at the CRC, said that the meshing between the CRC and Northwick
Park Hospital was never as good as had been hoped. There was ‘no shadow
of a doubt’ that there was need for a change, she said. Others believed
that it was not possible to glue academic work onto a general hospital where
there were no students.

While the workings of the CRC have come under the microscope, some scientists
complain that no one has examined the lumps and bumps of Hammersmith’s physiognomy.
They have mused about what the outcome would have been for Hammersmith if
it, too, had been given the Stoker treatment. How well deserved, they have
asked, is its reputation of scientific excellence? The answer, according
to David Keer, dean of the Royal Postgraduate Medical School, is that Hammersmith’s
reputation is very well deserved indeed. He points out that it has twice
in the past five years shared top ratings in the field of clinical medicine
(once with the University of Oxford, then with both Oxford and Cambridge),
in the league tables produced by the UGC and UFC.

There does seem to be a consensus that the unique integration of clinical
services and academic work at Hammersmith has great advantages. The conflict
between academic and medical staff does not exist there: the academic staff
are also the NHS chiefs of service. Nevertheless, some researchers believe
that the traditional departmental divisions at Hammersmith, which are arranged
according to the systems of the body, will have drawbacks for those involved
in modern clinical research. Someone who is investigating immunological
mechanisms, for example, may need to study skin, gut and lung at the same
time.

Whatever the advantages of the Hammersmith, there were sound arguments
against siting the new centre there, as in the original plan. A group of
researchers at the CRC outlined these objections in a letter to the British
Medical Journal in 1987 (vol 295, p 1211). They pointed out that Northwick
Park Hospital serves an area with a population of about 200 000, against
the local population of less than 90 000 in the region of the Hammersmith,
whose catchment area is bordered on all sides by other large hospitals,
including teaching hospitals. The spacious site at the CRC would be far
preferable to the cramped one at the Hammersmith, they said, where any expansion
would involve buying up a playing field from the local education authority.

Unexplored alternatives?

The letter concluded that as the ‘acknowledged weak link’ at the CRC
was lack of academic responsibility for hospital beds, then the obvious
solution would be to move the academic departments from Hammersmith to Northwick
Park.

‘Local Hammersmith patients could be absorbed by neighbouring hospitals,
and sales from the valuable real estate (Hammersmith) used to help fund
the new national centre,’ the group added.

One researcher who has worked at both Hammersmith and the CRC listed
the faults of the Hammersmith: difficult to get to, isolated, no facilities
nearby such as shops or restaurants, run-down building, poky laboratories,
cramped conditions. ‘But,’ he said, ‘the place is buzzing. It’s full of
good people, so you put up with all of that.’

If it had been possible to move the Hammersmith, together with its special
ambience, to the CRC’s site, all the problems of lack of space and poor
accommodation would have been solved. But the strength of the Hammersmith
lobby, by all accounts, ensured that the Royal Postgraduate Medical School
stayed put. Not only that, with the proposed new unit, even at a greatly
reduced size, Hammersmith would have what it previously lacked – basic science,
including molecular biology, on the same site.

Some researchers have argued that the original plan to site a Pounds
sterling 100-million centre at Hammersmith was so ambitious as to be unattainable.
Booth, for example, believed that it was bound to be turned down. One would
have assumed, he said, that the MRC ‘would have made some soundings to determine
whether it was all pie in the sky’, although he now believes that this is
a generous view. Booth said that if the council did not believe it would
get the money, then it comes out of the affair looking conspiratorial; if
it believed it would get the money, then it looks very naive. He agreed
that, if the MRC suspected that the money would never materialise, then
there has been a huge waste of time and money in evaluating and planning
for a centre that would never exist.

In defence, David Evered, second secretary of the MRC, refutes the view
that Pounds sterling 100 million was an excessive amount to ask for. ‘Pounds
sterling 100 million is considerably less than the cost of a destroyer,’
he said. ‘In terms of the science budget overall (Pounds sterling 825 million
in 1989/90), it looks like a considerable sum. But in terms of the NHS overall,
it’s not an inconceivable sum. The MRC is the R&D agency for the NHS,
so Pounds sterling 100 million is not that extraordinarily expensive.’

The rumoured capital cost of the projected new centre at the Hammersmith
has now shrivelled to somewhere in the region of Pounds sterling 10 million
to Pounds sterling 15 million, a figure that, according to the MRC, has
no substance in fact. How will clinical research in Britain fare when the
CRC closes and its component parts are parcelled out to the regions, with
a sizeable slice at Hammersmith?

According to Evered, one of the aims of the new combined centre, as
it was originally planned, was to strengthen clinical research in Britain.
‘I’m not saying that there’s nothing going on, but, on a broad base, there
is no substantial core of basic scientists and clinicians working together,’
Evered said. ‘There is therefore limited opportunity for making biologists
aware of what the clinical problems are.’ For the same reason, it is difficult
for people who want to pursue a career in clinical research to do so: there
is a conflict between the need to develop specialist medical skills, and
the requirements for training in research, which take people away from the
bedside. The demands of patients are always more immediate than the demands
of research.

A large centre for clinical research would have helped to solve some
of these problems, as well as attracting the brightest young researchers
into the subject. David Kerr, dean of the Royal Postgraduate Medical School,
said: ‘The merger would have put on the same site a much larger tranche
of basic scientists . . it would have created a ‘critical mass’ that is
essential if you want to appeal to bright young people who will be attracted
by famous names who will give them good references and so on.’ Although
the smaller scheme would not do everything that the larger project would
have set out to do, the advantage is that it will be achieved earlier, Kerr
added.

Evered says: ‘We won’t be able to get the broad, multi-disciplinary
approach that we wanted.’ Simpson, from the CRC, agrees: ‘We won’t be able
to cover so many areas, there’s no doubt that it won’t be comprehensive.’
She thinks it is a disaster that the idea of a big centre in London has
been ditched, particularly because London is such a good place for exchange
of scientific information because so many people pass through it. But Evered
describes it as ‘a disappointment, not a disaster’. James Scott, head of
the division of molecular medicine at the CRC, says: ‘If you’ve aimed high
and fallen short, you could still get something very good. We could have
got things right here, without having to destroy it. But if the research
is good, the future is fine – somewhere.’

* * *

THE REPORT THAT DOOMED THE CLINICAL RESEARCH CENTRE

THE Stoker report first scrutinised the CRC’s success as a national
centre – one where the research was, or should have been, mainly concerned
with ‘common diseases’. The committee said it had been impressed by one
witness who had questioned the merit of categorising research according
to the frequency of disease.

This witness suggested that ‘the creation of an institute for research
on common diseases did not accord with the way scientific knowledge had
developed over the last 15 years’. Stoker and his colleagues said they kept
this observation in mind while considering the interaction between the centre
and the hospital. This relationship was a less than optimal one, they found.
The specific problems were as follows: The absence of specialist units,
such as those for kidney transplants, heart surgery, plastic surgery and
the treatment of burns, together with the lack of firm plans to develop
such units in the future, had restricted the development of scientific work
at the centre.

The links between the senior staff of the centre and those on the NHS
side were ‘not as strong and influential’ as those between the academic
staff of a medical school and its associated hospital. For example, the
committee was concerned that the director of the centre did not have more
say on the appointment of senior hospital staff.

There was a lack of cohesion between the centre and the hospital. The
regional health authority told the committee that those in the NHS community,
while encouraged to undertake research, may be ‘submerged by their service
workload (that is, patient care), may not have the necessary research flair
or may develop interests outside the hospital, including private practice’.
The committee concluded that there was a growing divergence of the two populations
of staff. ‘The symbiotic relationship of MRC and NHS staff which we understand
to have been a real feature of the early days seems largely to have disappeared,
although there are of course outstanding exceptions.’

Despite the efforts of the director to introduce and apply new biological
techniques to research, the committee believed that more was required, to
create a ‘solid body of freestanding basic science’.

Having taken evidence on these and related topics, the committee members
asked themselves whether the contributions of the research groups at the
CRC amounted, in aggregate, to a distinctive excellence. ‘Has the CRC developed
as a national centre? Given that 15 years is a short time in the life of
any institution . . . has the CRC the potential to become a truly national
centre?’ The answer was telling: ‘It is perhaps answer enough that we have
to ask these questions’. The centre had failed to establish itself as a
‘major force’ in clinical research in Britain, the committee concluded.

One possible solution to the problem, the Stoker committee pointed out,
was to move the National Institute for Medical Research (NIMR) from its
site at Mill Hill to join the CRC at Northwick Park. The MRC had originally
intended to ensure that there was strong basic research on the CRC site
by making such a move. The council accepted, after a report in the early
1980s, that this option would be far too expensive. The Stoker committee
examined it anyway, because the prospect of having clinical and basic research
scientists from the CRC and the NIMR working side by side was ‘extremely
²¹³Ù³Ù°ù²¹³¦³Ù¾±±¹±ð’.

The director of the NIMR told Stoker and his colleagues that there would
be ‘undoubted benefits’ in merging the NIMR with the CRC. But the committee
agreed with the director that transferring the institute to the CRC site
could take 10 or more years to complete: ‘With the twin perils of blight
and flight, it could be that by the end of this period there would be little
of substance left to transfer.’

Instead, the committee fixed on another option, that of merging the
CRC with the Royal Postgraduate Medical School (RPMS) at Hammersmith in
west London. The committee identified the RPMS as being the institution
that most closely paralleled the CRC, in that it carried out clinical research
on a large scale.

The set-up of the RPMS at Hammersmith had important differences from
that at Northwick Park, however. Most consultants at Hammersmith Hospital
are employed by the school and the heads of the academic departments are
in many cases also responsible for NHS services in their specialties. ‘Academic
and clinical work is thus fully integrated’, Stoker and his colleagues observed.

Overall, the Stoker report said, there was no single major focus for
clinical research in Britain. ‘While the present director of the CRC has
gone a long way towards meeting the challenges of present day clinical research,
he has done so within a framework which we consider has hampered him and
which will continue to prevent the realisation of the full scientific potential
of the CRC.’

The report concluded: ‘We are firmly of the view that there should be
for the future, one major centre, staffed, equipped, structured and governed
in such a way as to allow the challenges of clinical science to be met to
the full.’ Such a centre would have to incorporate a first-class hospital
with appropriate NHS support, with major basic medical science on the same
site, connected to a university and providing postgraduate tuition. The
staff would be free to raise funds from a wide variety of sources, and there
would be adequate space on which to build, where necessary. Most importantly,
it would have appropriate methods of controlling its research, academic
and clinical components.

The report added that several of the factors that the committee identified
as ‘restricting the development of the CRC as a national enterprise’ sprang
from the initial failure to achieve a special form of governance that would
have ensured that the hospital and the centre worked together with a common
aim. This failure was a result of compromise, the report said, adding that
it would be just such a compromise to accept the ‘obvious fall-back position’
whereby the two institutions would establish more formal links while staying
on in their respective sites.

The best way of forming the new centre, the report said, would be to
merge the CRC, the RPMS and the NIMR on one site. In the short term, the
first step should be the merger of the CRC and the RPMS, either at Northwick
Park or at Hammersmith, although ‘we are quite clear that (such) a merger
. . . is not in itself sufficient to create the new centre’. Stoker and
his colleagues urged the MRC and all others concerned to endorse their proposal
and bring the new centre about as quickly as possible. Then, sounding the
death knell for the CRC, they added, ‘If this cannot be achieved, we would
be bound to recommend to the council . . . that it should not maintain the
CRC as such on the Northwick Park site.’