Dr Manish Saxena is a cardiovascular physician and hypertension specialist at St Barts Health NHS Trust and Queen Mary University London. He is Deputy Director for Research at Barts Health NHS Trust and Queen Mary University of London and cardiovascular speciality research co-lead for North London with the National Institute for Health Research.
He has worked with the Health Research Authority (HRA) for over 14 years as an expert member and has chaired multiple national research ethics committees (RECs) for over 12 years. Here, he shares his experience.
Why did you get involved?
As my involvement in research increased in my clinical role, I wanted a clearer, first-hand understanding of the ethical and regulatory frameworks behind it. It was important to me to be confident that my own research was truly in the best interests of patients. At the same time, I wanted to use my time in a way that felt purposeful and impactful - something I could take real pride in. Encouraged by a colleague, I initially joined as a REC expert member, and it quickly broadened my perspective on how I could contribute beyond my day-to-day role.
What do you enjoy most about being a REC Chair?
I value engaging with the wide range of perspectives and experience within the committee, which has reinforced for me the importance of inclusivity - ensuring every voice is heard and contributes to the discussion. Reviewing applications individually is an essential part of the process and bringing those perspectives together helps shape more balanced, well-informed decisions. It’s particularly rewarding to see how committee feedback - such as recommending simpler study procedures, fewer clinic visits, or clearer patient information - can make research more accessible and easier for people to take part in.
What have you learned?
I’ve learned the value of truly collaborative decision-making. No single person on the committee has the full picture; we rely on the combination of expertise around the table. For me, that collaboration is grounded in professionalism and respect - both within the committee and towards researchers and sponsors.
Having been on both sides of the process, I understand how important that balance is. It underpins the HRA’s focus on trust and transparency, which are not just procedural principles but are essential to how decisions are made and to maintaining public confidence in research.
How do RECs ensure research is patient-centred?
A key part of the REC’s role is ensuring research remains genuinely patient-centred. When reviewing applications, we focus on the patient journey-how easy it is to take part and whether the demands placed on participants are justified. As a REC, we may question additional procedures in clinical trial applications, such as extra tests or imaging, particularly where there is no direct benefit, encouraging greater flexibility or making them optional.
Practical details also matter. Factors like fasting, travel, or frequent visits can significantly affect someone’s experience. By highlighting these, we can encourage simple changes - such as providing travel support, refreshments, or offering remote and home-based options - which make participation much more manageable.
One important aspect of the review process is checking patient and public involvement in any proposed study. This includes their input into key aspects such as study design, the patient journey, and patient-facing materials, helping to ensure the research is patient-centred from the outset.
What’s the biggest challenge in your role?
The biggest challenge is balancing the time commitment alongside a busy clinical role. Preparing for meetings and reviewing applications does take time and careful thought, as you always want to give each study the attention it deserves. That said, the flexibility of the role makes a real difference. Being able to take part in evening meetings or share responsibilities within the committee helps make it manageable. Over time, you also become more familiar with the process, which makes it easier to fit into your routine.
What would you say to others who would like to get involved as a REC member?
If you’re interested, I would really encourage you to come along and observe a REC meeting. It’s the best way to see how it works in practice and get a sense of what the role involves, including how decisions are made and how different perspectives come together.
I would strongly encourage anyone with an interest in science, healthcare or research - particularly medical, science and social care students - to consider applying to be a REC member. It’s a great opportunity to see how research translates into patient care.