The first edition of this useful book, which appeared in early 1996, was full of optimism about the potential of the NHS research and development strategy introduced in 1991. It was, however, as the editors themselves admit, rather naive about the politics of health service research and the obstacles encountered in getting research into development and into practice.
With evidence-based medicine and clinical governance now in high fashion and seen by many politicians and health service researchers as panaceas for sorting out ineffective clinical practices, this book offers a timely and sober analysis of the state of the R&D strategy.
Some of the optimism in the first edition remains, notably in Anthony Culyer's contributions, but for the most part it is tempered by a welcome maturity and honesty about the deep-seated obstacles that exist. If not addressed these will threaten the relevance and sustainability of the R&D strategy.
Mark Baker's thoughtful contributions, in particular, repay careful study. His account of the history of the R&D strategy, and its relationship to NHS changes in the mid-1990s, is honest and contains important insights. As befits a former insider, no punches are pulled. The nub of the problem is what Baker terms 'the interaction between management research and politics/government policy'.
He is not hopeful of finding a solution to the dilemma posed by 'the proximity of political control of NHS policy and management' which makes policy makers nervous about evaluating the consequences of their policies. Evidence-based policy may be much talked about but the actions of ministers belie their rhetoric. How otherwise can one explain the drive to cut waiting lists? And would we be witnessing a rash of mergers had the evidence been heeded?
Baker also targets the academic research community for sharp and well- deserved criticism and for failing to maximise the opportunities opened up by the strategy. In particular, the obsession with the research assessment exercise runs counter to the need for collaborative working across disciplines and institutions, and especially to the needs of NHS managers and practitioners who are seeking applied research solutions for their problems.
Other key problems with the R&D strategy include the absence of management ownership of it, the lack of a career structure for health service researchers - which could seriously weaken the capacity of the research community to meet the NHS's research needs - and the failure to give sufficient attention to dissemination and implementation.
After seven years or so, the R&D strategy is, in Baker's words, 'tolerated by clinicians but is owned only by researchers', with the NHS - 'supposedly the customer' - having only 'observer status'. The problem is compounded by the narrow ownership of the strategy among researchers and its excessive biomedical focus.
As Culyer observes, the 'disdainful attitudes' still found within and between branches of the clinical and social sciences are destructive of co-operative endeavour. And, as Andrew Long notes, the hierarchy of evidence gives short shrift to qualitative methods, believing the only acceptable ones to be quantitative.
A key problem with the R&D strategy is that its virtual capture by a narrow group of academic researchers has resulted in a focus on research at the expense of development.
The book is a rich source of useful material on R&D, combining practical chapters on using research with strategic overviews of the key policy concerns. There are helpful chapters on the morality and ethics of clinical and health services research, and on R&D in nursing and in primary care. Stephen Harrison usefully reviews models of implementation in order to shed light on the 'implementation gap' and how it might be closed.
Whether the NHS R&D strategy has a future depends on resolving the dilemmas which the book explores in detail. The editors refuse to indulge in false optimism and leave the reader with a cool, sober assessment of the likely future of the strategy.
This is entirely appropriate in the light of what Baker acknowledges to be a 'rather downbeat review' of the subject. But the refreshing realism of the book is its strength. It should be required reading for all those concerned about the R&D strategy and who want it to succeed.
Professor of health policy and management at the Nuffield Institute for Health, Leeds University.