Culyer reforms will create new opportunities for research

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1168 (Published 11 April 1998) Cite this as: BMJ 1998;316:1168
  1. Clark Lewis, Director of research and development
  1. King's College Hospital, London SE5 9RS

    EDITOR—The role of director of research and development in a teaching hospital is a challenging one, particularly during the introduction of the Culyer reforms. It does not include discouraging clinical staff who are industrious in their service work, enjoy teaching, and are active in research from continuing to develop evidence that can lead to improved clinical practice.1 Trusts that wanted to obtain money from the levy fund that was established to support research and development had to satisfy the NHS Executive that they would, firstly, implement a corporate research strategy; secondly, prospectively review the quality of proposed studies; thirdly, rigorously manage support costs for research; and, fourthly, encourage but not subsidise commercial research. These obligations are the result of a major evidence based reform of NHS finance and translate directly into the messages from the author's anonymous director of research and development that were quoted in the article.

    Under the new support arrangements for research, clinicians are subject to a higher level of research management, and their projects, properly peer reviewed and costed, must be placed in a coherent strategic framework. These changes are deemed to be inimical to clinical research, but is this true? By rising to this challenge we were able to put forward a competitive bid for levy funds. Its success will allow us to strengthen the research support that is available to our clinical researchers, thereby enhancing their ability to compete for grant funding and further improving the high quality of their research output.

    Although consultants in this trust think that applying for grants is futile and believe that funding bodies favour basic science, the evidence contradicts this. Many sponsors fund research into health services and assessment of health technology across the range of clinical specialties. Successful applicants show that authoritative proposals can be put forward in any area of health care. Satisfactory scientific peer review should be a precondition for ethical approval.

    The Culyer reforms will clarify how NHS resources support research and development, improve value for money, and widen participation in clinical research. Some clinicians, whose pilot studies are never followed up and whose substantive studies are too small to inform clinical practice or unnecessarily duplicate earlier work, will feel discouraged by the new environment in clinical research. They will probably be unwilling to change their established pattern of research and will therefore not come within the new support framework. I believe, however, that most will welcome the opportunities created by a system that forces researchers to articulate their research plans explicitly, encourages multicentred and multidisciplinary studies, and demands that fellow professionals respond to rigorous evidence.


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