FINANCE DoH proposals could lead to 'collapse' of teaching hospitals

Published: 01/09/2005, Volume II5, No. 5971 Page 7

Radical proposals by the Department of Health to overhaul health research could threaten services and lead to the 'collapse' of major teaching trusts, experts have warned.

They voiced concern as the NHS Confederation published a guide to the new National Health Research Strategy, currently out to consultation.

The strategy was designed to streamline research and development. It proposes centralising management in a new National Institute for Health Research, with funding that ensures 'transparency' between the annual£650m research funds and trusts' own research activities.

Funding of£100m will be allocated to a 'premier league' of 10 research hospitals, known as academic medical centres. The money will be in addition to existing research and development funds.

New funding streams, open to all NHS trusts, will prioritise applied research and frontline services.

Instead of the current system whereby DoH funds are largely allocated on a historical basis, money will reflect the level of patient involvement in studies.

Sheffield Teaching Hospitals foundation trust senior research manager Brenda Zinober welcomed the move and said targeting funds made 'good sense.' But she warned that in many trusts research funding was 'deeply embedded' in services: '[The changes] seem poorly thought out.

This is not just about research - it has implications for services.' Bonnie Sibbald, professor of health sciences research and chair of Manchester University's Institute of Health Sciences, said extracting funding could be disastrous.

'Research costs are embedded in trusts. Saying 'research money is here - now let's take it away' is near impossible. It would precipitate the collapse of many big teaching hospitals.' The strategy, which the DoH intends to implement from April 2006, allows a two-year 'beddingin' period. A DoH spokesperson said: 'We do not want to destabilise trusts. We want to reflect how much research is done. It is much fairer.' The proposal to select the academic medical centres only from top research hospitals has also drawn criticism. Professor Sibbald said: 'My own group [the Greater Manchester research and development alliance] is DoH-funded, but it couldn't be in the elite as it is not a hospital. It is very disappointing.' The absence of primary care from the strategy 'sticks out like a sore thumb', she added.

NHS Confederation policy manager Jane Austin wrote a guide to the strategy, published on the confederation's website last week. She told HSJ: 'Our primary care members are concerned because they feel, once again, that they have been left out. I do not think that is the DoH's intention. There is a lot packed in to quite a small document.' Consultation closes on 21 October.

The key proposals

National Institute for Health Research - a virtual institute, coordinating Department of Health units - which will manage the NHS research infrastructure.

Centrally funded faculty of researchers.

Transparent funding streams, replacing 'historical' allocations.

Set of technology platforms to support clinical research.

Premier league of 10 'world-class' academic medical centres.

Expansion of national research and development programmes.

www. dh. gov. uk/consultations

www. nhsconfed. org. uk