Letters

'Failing the acid test' presented a partial view of the NHS R&D strategy. It appears to start from the premise that the key criterion for the strategy's success is the rapid movement of R&D support funding between NHS institutions: from established to new providers, from London to elsewhere, from the acute to the community and primary sectors. While investment decisions are easily tracked and inevitably have a high profile, they are only part of the strategy, and are more means than ends in themselves.

The essential elements of the strategy are quality and applicability. These require that clinical research questions are directed to issues which matter to the NHS and are addressed with appropriate rigour, and that findings are disseminated and applied. As the article indicates, it is the last requirement which is the most challenging. Investment decisions need to be made explicitly to support these goals and there can be little benefit in redirecting investments in ways which cut across them simply on the contention that the current distribution is unfair.

One of the strengths of the strategy is that it impels all institutions active in clinical R&D to manage their programmes in ways which are more focused on the NHS's needs. There is, therefore, great scope for achieving the core benefits of the strategy without redirecting large sums of money.

The concentration of clinical R&D support in London must appear unbalanced on geographical grounds, but is understandable and defensible on grounds of quality and strategic management. In fact, in the first 'Culyer' allocations significant sums of money were redirected. All London acute providers saw their levels of support decline, and we are currently addressing the challenges that this poses. It certainly does not feel as though we were winners from the process.

Robert Creighton, Chief executive, Great Ormond Street Hospital, London WC1.

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