Little has been done to redress the imbalance in research funding which favours large teaching hospitals at the expense of smaller units, say Anne Lacey and Margaret Fall

The NHS research and development strategy is under review - again.The funding system is to undergo a radical overhaul in the next few years in order to bring it further into line with government priorities.

The present system, which has been in operation since 1997, was instituted following the Culyer report and various white papers outlining R&D strategy since 1991.

Since 1997, R&D levy funding, or 'Culyer money'as it became known, has been used to build up research support infrastructure in trusts that are doing research.

Although opening up the funding system to all healthcare providers, the process has used a competitive bidding system, and the lion's share has continued to go to the traditional centres of research, with little being won by non-teaching hospitals, community providers and primary care. The whole of Trent region, for example, received less in 1999-2000 than a single large teaching trust in London in the same year.

The Trent Institute for Health Services Research was established in 1994 by Trent region R&D group to promote and support research activity in the region. The institute is based in three universities at Sheffield, Nottingham and Leicester, and funds health services researchers both to carry out research and support NHS staff in their own work. The institute encourages collaboration across Trent region and between university and NHS researchers.

A small survey was carried out by the institute's Sheffield unit in mid-1999 using a grant from its training development budget. The Sheffield unit serves the north of the region which comprised, at the time,17 trusts and one special health authority spread over a wide geographical area, with very diverse R&D agendas and training needs.

In order to assess training needs for 2000-01, an interview survey was conducted with R&D managers in every trust. This fulfilled a dual purpose of gathering information and views, and of establishing better links with trusts throughout the area. The institute's database of key personnel in each trust dealing with R&D was checked and updated as necessary. A letter was then sent out to the key personnel explaining the purpose of the survey and requesting an interview.Appointments were subsequently made by telephone, and the interviews carried out by one of two researchers.

Twenty interviews took place during May and June 1999.

An additional interview was held with the North Trent coordinator of Trent Focus - the sister organisation to the institute - which supports R&D within primary care.

Interviews were mostly held on trust premises. Responses from R&D managers to the survey were very positive.

This small survey revealed the diverse state of development of NHS R&D in trusts in part of one region.

While trusts which have been successful in attracting substantial R&D funding are developing sophisticated support systems for research activity, and are able to access appropriate help from university staff, there is a lack of confidence as well as resources among non-funded trusts.

The new proposals for research funding include encouragement of collaborations and networks across health communities, and in time this may be a fruitful way forward for those with less research experience.

If healthcare is to become more evidence-based and innovations such as the national service frameworks and the National Institute for Clinical Excellence are to be exploited to the full, 'users' of research as well as 'doers' need to be resourced adequately to participate in the R&D agenda.

Winners and losers Trusts varied widely in their resources, expertise and experience. The largest trusts based in acute teaching hospitals had a permanently staffed research office, good infrastructure to exploit research opportunities, and were able to provide some research training and support in-house. Others, including most district general hospitals outside Sheffield, smaller community trusts and primary care organisations, had only recently begun developing the R&D agenda, and consequently had few staff with expertise in the area, and very scarce resources available for the task.

R&D levy infrastructure funding was very unevenly distributed across the area. All the trusts in Sheffield received some funding, but only one DGH and one community trust outside Sheffield had been successful in the bidding process. Smaller trusts felt they were in a 'catch 22' situation, whereby their inability to attract levy funding resulted in few resources being available to develop potential for funding in the future.

The university was seen by some trusts outside Sheffield as an 'ivory tower' that staff did not always feel confident to access. Personal contacts with academic staff were seen as the key to getting help.

REFERENCES

1 Research and Development for a First-Class Service.DoH, 2000.

2 Culyer A. Supporting Research and Development in the NHS: a report to the minister of health.HMSO, 1994.

3 Research for Health: a research and development strategy for the NHS. DoH R&D division, 1991.