'Failing the acid test' judges the NHS R&D programme too harshly.

The programme has shifted the focus of NHS research from a predominantly reactive bio-medically oriented programme to a commissioned programme driven by NHS and patient care priorities. For the first time, the significant sums spent by NHS providers on research infrastructure and 'own account' work has been properly identified, and exposed to an accountability process.

Through the Culyer process, money has been shifted and the objective of bringing new entrants in has been achieved. The significant investment in the programme has played a major part in the creation of an evidence-based culture in the NHS.

Of course there is more to be done.

Timescales between inception and publication are too long. Communication and dissemination need to be improved.

The Culyer process needs to produce further change. The strong baseline of studies already within the programme on preventive and health/social interface themes needs to be expanded to reflect the NHS's changing expectations.

It is hard to have sympathy for researchers who complain they are forced to be reactive. This is the NHS R&D programme, and it is appropriate that researchers should respond to priorities. As for the complaints about bureaucracy: yes, having to be fully accountable for the spending of significant sums of public money can seem inconvenient at times. However, if all researchers met the standards of the best by expressing their ideas and proposals concisely and clearly in the first place, at least some of the time spent clarifying over-complex and obscure proposals could be reduced.

Problems disseminating and incorporating results into practice are as much the responsibility of the NHS as of the R&D programme. Locally, regionally and nationally the NHS needs to develop processes for applying the results of research to clinical practice and planning in a systematic, open and accountable way.

Publications from the NHS R&D programme are at last beginning to flow into the system. Let us not damn it just as it begins to offer the prospect of a real contribution to decision-making.

Julie Woodin, Chief executive, Nottingham health authority.