Funding research in the NHS

This paper is the text of the 1994 Francis Fraser Lecture given at the Royal College of Physicians on 2 June 1994. It presents the outcome of the consultation exercise conducted by the taskforce on R&D in the NHS chaired by Professor Culyer and identifies the principle problems currently confronting the conduct of R&D in the NHS, including both R&D supported by other sponsors that is dependent on NHS resources and a flow of suitable patients. The main points addressed include: • The fact that some arrangements for the funding of research (e.g. non-SIFTR, and R&D support for London Postgraduate hospitals) are temporary; • That SIFTR is a general hospital subsidy, more related to undergraduate numbers than R&D activity, which is not quality assessed and which appears to be poorly targeted on R&D activity within teaching hospitals, and which is not available to support non-teaching institutions or community-based care; • The pressures of the internal market for patient services which threatens the funding of research currently met through prices; • That there is evidence of non-cooperation in R&D projects from some fundholding GPs; • That referrals are increasingly local and increasingly difficult to obtain for major research centres; • That service support for non-MRC research is not always available; • That there is inadequate coordination at the top level between different funders of R&D and an inadequate mechanism for identifying and prioritising the service needs of R&D; • That much R&D in trusts is not evaluated or supported by explicit mechanisms; • And that the reform of the NHSE is seen as a threat to the valuable work of Regional Directors of R&D.