The benefits of the NHS research and development strategy could be lost if its findings are not used in genuinely research-based practice, argues Roger Paxton
The aim of the NHS research and development strategy introduced in 1991 was to create a health service in which clinical, managerial and policy decisions would be based on research findings and scientific developments.
The Culyer working party identified R&D funding from the NHS budget and, for the past two years, has been directing it to support local research and to fund commissioned research on identified priorities.1 Other Department of Health R&D funding supports the policy research programme and research on priorities. The resources involved are substantial, amounting to£350m nationally on the Culyer programme alone.
But how much has the R&D strategy achieved? It has been successful in establishing R&D priorities, redirecting some research activity and funding, enhancing the prominence and quality of NHS R&D, strengthening NHS and academic partnerships, and adding to the body of research knowledge. But if success refers to the more fundamental aim of improving health, or even the intermediate aim of improving the quality of healthcare through knowledge-based decision making, the answer is less clear.
This has led to research on the implementation of research - what methods can be shown to promote the successful adoption of research-based practice? This was identified as an NHS R&D priority and also led to work commissioned through the King's Fund promoting action on clinical effectiveness programme, established in 1995. But there is already a substantial body of knowledge on methods that influence professional practice, conveniently summarised and evaluated recently.2
This shows, first, that successful change should begin with assessment of the obstacles and incentives to professional behaviour change. Simply disseminating educational materials using various media has not been effective, and mixed results have been obtained for audit and feedback. So it is not just that much research remains unused; even research about methods that could lead to research use seems neglected. Meanwhile, research continues to be commissioned.3
The National Institute for Clinical Excellence wants systematic dissemination of the R&D programme's findings, which will either add to, or reduce, the information overload problem, depending on your point of view.
In primary care teams and trusts, the R&D initiative will have succeeded not when every GP and nurse is doing research but when they are all using the results of research. Their practice will then be evidence-based and therefore improved in both effectiveness and efficiency. Attention is being directed at this through the clinical effectiveness drive and, most recently, through clinical governance, with chief executives now personally obliged to ensure that we all provide better care by using evidence-based methods, quality initiatives and continuing professional development.
Perhaps clinical governance will promote further cultural change so that all of these worthy activities will be properly valued and taken up. But how likely is this? Why wasn't research activity reoriented in the same ways - through information dissemination, clearer lines of responsibility and exhortation?
Research implementation (and not research on research implementation) needs to be funded - a point noted in the recent Effective Health Care bulletin on this subject.2
If GPs, nurses and all the rest of us are to practise genuinely evidence- based healthcare we need funding for the time and resources required for us to read journals, search databases and attend professional development events.
A few of us produce research, but all of us need to use its results, and that requires a change that is bigger and potentially much more beneficial than the likely gains of the present R&D strategy, with its emphasis on the production rather than consumption of research.
Dr Roger Paxton is head of psychological therapies and research, Northumberland Mental Health trust.
1 Supporting R&D in the NHS (Culyer report). HMSO, 1995.
2 Getting Evidence into Practice. Effective Health Care 1999; 5 (1).
3 Kirk S. Developing, Disseminating and Using Research Information. Research and Development for the NHS: evidence, evaluation and effectiveness. Baker M, Kirk S (eds). Radcliffe Medical Press, 1996.