I scarcely recognise the NHS R&D programme from Barbara Millar's carping account ('Failing the acid test', pages 24-27, 26 March). Nor do I read of the myriad ways in which the programme constantly tries itself against tough tests of prospective usefulness.

How could anyone imagine that its acid test is 'to ensure better patient care'? That's for managers and clinicians. The programme has lots of acid tests, whose application is certainly its job, though readers did not get them from the article.

The programme has two strands:

£350m for portfolio and task-linked support for trusts and consortia, and£75m for central and regional support for projects, research capacity building and dissemination (mainly the Cochrane Centre and the NHS Centre for Reviews and Dissemination).

The£350m now goes to where it best bears fruit for the NHS without destabilising institutions. Five years ago we didn't even know what the sum was. In last December's announcement, nearly 60 trusts no longer received support and slightly fewer received funding that hadn't had any.

This is because they failed or passed the programme's acid tests; 47 major trusts received less than before. Some will receive less still over the coming years when institutions' ability to respond to the tests will be assessed and success rewarded.

This is hardly 'absolutely no change' even on a snapshot view. Hospitals are more R&D aware and much better at managing their own R&D.

There has actually been a cultural revolution. This may not pay dividends now in terms of outcomes for patients, and revolution may not be universal, but it is underway.

High-quality trials take years. Estimates of future payback from research is difficult (you wouldn't think from the article that the NHS R&D programme had pioneered ways of estimating this payback). Institutional change takes time too - unless one pays the huge redundancy costs, which would do nothing for research output in the short term, and might seriously damage the Medical Research Council's research - work which this funding is there to support.

Uptake is indeed crucial. The programme disseminates effectively and is set to enhance this activity (these plans are not mentioned).

But disregarded disseminated results are not its failure. The New NHS white paper contains some useful mechanisms which directly address the matter. They would be hamstrung without the R&D programme. Conversely, fruits of R&D lie unharvested if disseminated knowledge is ignored.

Professor Tony Culyer, York University.