The Culyer reforms' impact on patient care may still be uncertain, but they have raised the profile of research which benefits health providers, writes Barbara Millar

Five years after a taskforce headed by Professor Tony Culyer called for an overhaul of NHS research and development, an independent evaluation has concluded that it is still too early to assess any impact on patient care.

The review praises the reforms' 'positive effect' on the quality of research and the transparency of the process, which has made R&D 'a more visible part of healthcare providers' businesses'.

But it adds that it is still too early to say whether, in practice, the reforms will lead to research which is more relevant to patient care, and concludes that the lack of an up-to-date R&D strategy for the NHS as a whole is causing problems.

Technopolis, a specialist R&D evaluation and management consultancy, together with the science policy research unit at Sussex University, carried out the review.

It focused only on how the reforms are working in the old North Thames region. But, as Technopolis consultant Ben Thuriaux points out, the region accounts for 56 per cent of NHS R&D spending - just under£200m a year.

'So the lessons learned from this review are potentially relevant to all those involved in R&D management.'

On the positive side, the review says the overall profile of NHS R&D has been increased by the attention given to the Culyer reforms. New management tools and capabilities have been created which have had 'a strong, positive impact on providers' ability to manage R&D and to define and implement an R&D strategy, and on the quality of decisions taken on R&D priorities'.

The reforms have also increased accountability and allowed a broader range of people and organisations, particularly in primary care, to get involved in R&D.

But the way R&D resource allocation has been managed - in line with the Culyer recommendation to limit turbulence and to constrain cuts in the support budget for large providers - means that providers do not have equal access to resources.

Mr Thuriaux says it would be 'foolish' to expect new entrants to R&D to be able to start research at a large scale.

He believes the gradualism of the approach to redistributing the money is justified.

And, while access to resources is not yet equal, the reforms have improved it so that many previously unsupported providers now see R&D as a legitimate activity for their organisation, he adds.

The review says trusts were 'cautiously optimistic' about the value of the reforms (see figure 1). 'They are taking research seriously and taking control of what they do.'

Most also felt that the reforms had improved the quality of research by forcing proposals to undergo more intensive administrative procedures and checks before being submitted.

But there are still 'obstacles', the review adds. For larger providers - teaching hospitals and larger tertiary centres - the recurring administrative costs created by the reforms (around 1.5 per cent or less of their R&D support funds) are small.

But for smaller providers - mainly district general hospitals - the costs of the financial and management systems needed to apply for and manage Culyer funding are 'perhaps excessive'.

These organisations have mostly not received increases in R&D support funding, and the costs of the new systems are high in proportion to R&D funds received, says the review.

Perhaps surprisingly, bigger researchers are less happy with the implementation process (see figure 2).

The review says providers' cost management and measurement tools do not give information about R&D support costs at a managerially-useful level of detail.

'We were also surprised costing systems seemed to be so different across the region, ' says Mr Thuriaux. 'If providers are costing in such different ways it is very difficult for the region to know what is really going on.'

The review recommends standard costing and accounting systems. To help smaller R&D performers, it says the region should consider providing centralised R&D management support or sharing part-time R&D managers.

It also wants to see the NHS Executive update its national R&D strategy and to develop a regional strategy 'which addresses both regional needs and helps implement national strategy'.

Catherine Johns, assistant director of R&D for London region, says the new bidding system for support funding has been hard work, but has led to greater awareness and understanding.

'There are early signs that research quality is being raised, which is good, ' she says, 'and this will undoubtedly lead to improved evidence-based care as people become more aware. We will learn from the lessons highlighted in this report.'

Implementing the Culyer reforms in North Thames - final report . From NHS London region, 0171-725 5461; or Technopolis, 01273204320.