- Email: [email protected]
The future of health research in the UK
Correspondence
The future of health research in the UK Richard Horton (July 8, p 93)1 asks whether the UK National Health Service (NHS) Research and Development (R&D) programme provides evidence for decision-making by policymakers and others. For technologies (ie, anything that the health service or its staff might do or use in the care of patients), the answer is an emphatic yes. For instance, the Health Technology Assessment (HTA) programme, part of NHS R&D, has delivered more than 100 projects for the National Institute for Health and Clinical Excellence, and the National Screening Committee identifies 33 HTA studies, from the past 4 years alone, of direct relevance in setting policy. The HTA programme is appropriately “NHS needs-led”: it asks the NHS to identify problem technologies, and then commissions research into the most important to the NHS. The research commissioned includes clinical trials (Horton cites three recently published in The Lancet) as well as evidence synthesis, to consider effectiveness, cost-effectiveness, and likely NHS impact. Many trials fill important gaps identified through our previous evidence synthesis, a link which other funders lack. Horton chooses to ignore “future promises” for NHS R&D but these are already bearing fruit—for instance, the HTA programme launched a reactive funding stream for clinical trials earlier this year, which attracted 255 applications. Since 1993, the HTA programme has funded 127 clinical trials. The portfolio differs from that of the UK Medical Research Council (MRC) by disease (41% of MRC trials in cancer compared with 10% HTA), by type of health technology (54% MRC trials were of pharmaceuticals compared with 22% of HTA’s), and by outcomes considered (13% of MRC trials included economics compared with 77% of HTA’s). These differences largely reflect the different focus of the MRC and NHS www.thelancet.com Vol 368 August 26, 2006
R&D. David Cooksey, in his study of the best arrangements for a single fund for medical research, will appreciate the need to preserve the important contribution made by both. TW is Director of the NHS HTA programme and a member of the MRC Health Services and Public Health Research Board. JR is Director of the National Coordinating Centre for Health Technology Assessment, which is funded by the Department of Health.
*T Walley, J Raftery [email protected] Department of Pharmacology and Therapeutics, University of Liverpool, The Infirmary, 70 Pembroke Place, Liverpool L69 3GF, UK (TW); and National Coordinating Centre for Health Technologies Assessment, University of Southampton, Southampton, UK (JR) 1
Horton R. Health research in the UK: the price of success. Lancet 2006; 368: 93–97.
Richard Horton’s Comment1 on the relative achievements of the MRC and NHS R&D provides an informative and interesting scene-setter for the Cooksey review. How the conclusions drawn follow from the information presented is not entirely obvious, but the analysis does seem to use a limited set of measures in assessing how the two programmes might fare when judged by “Cooksey criteria”. So, for example, it seems that the judgment about economic effects has been made solely on the basis of income from intellectual property rights. A report from the UK Evaluation Forum sets out a range of approaches for assessing medical research.2 One of the report’s conclusions is that different methods of assessment will be appropriate for different organisations at different times. The NHS Service Delivery and Organisation R&D Programme (SDO) has been assessing its effect using a mix of the methods proposed in the Evaluation Forum report. Our conclusions, which will be submitted to the Cooksey review as supporting evidence, set out a range of effects on policy and practice as well as the more conventional academic currency of publications, citations, and training awards. This type of effect seems entirely appropriate for
a research programme funded by the NHS, yet it is not much discussed in Horton’s Comment. When it comes to economic effects, income from intellectual property rights is a poor measure of overall social and economic benefit.3 This is particularly true for an applied health services research programme like SDO which is active in a field that is unlikely to yield much in the way of rights that can be protected, for reasons both of law and of public policy. Yet this type of research is still of economic importance because it addresses issues of costeffectiveness in health-care delivery and of the usefulness and quality of health services. I hope that the Comment serves to start a more sophisticated analysis in which the emphasis is on achieving a range of research effects to meet different needs, rather than on setting one institution against another. I declare that I have no conflict of interest.
Stephen Davies [email protected] Director, NHS Service Delivery and Organisation Research and Development Programme, London School of Hygiene and Tropical Medicine, London WC1E 6AA, UK 1 2
3
Horton R. Health research in the UK: the price of success. Lancet 2006; 368: 93–97. UK Evaluation Forum. Medical research: assessing the benefits to society. London: UK Evaluation Forum, 2006. http://www. acmedsci.ac.uk/p47prid1.html (accessed Aug 7, 2006). Lambert R. Lambert review of business– university collaboration. London: HMSO, 2003. http://www.lambertreview.org.uk (accessed Aug 7, 2006).
Richard Horton’s Comment on funding health research in the UK greatly underestimates the breadth and achievements of NHS R&D’s applied research for improving patients’ care.1 It is important to know whether treatments are safe and effective, of course, but we also need to know whether they are cost effective, about how to organise services to best deliver effective care, about workforce and training for staff for those services, about the effect of policies
e-mail submissions to [email protected]
727
The future of health research in the UK Richard Horton (July 8, p 93)1 asks whether the UK National Health Service (NHS) Research and Development (R&D) programme provides evidence for decision-making by policymakers and others. For technologies (ie, anything that the health service or its staff might do or use in the care of patients), the answer is an emphatic yes. For instance, the Health Technology Assessment (HTA) programme, part of NHS R&D, has delivered more than 100 projects for the National Institute for Health and Clinical Excellence, and the National Screening Committee identifies 33 HTA studies, from the past 4 years alone, of direct relevance in setting policy. The HTA programme is appropriately “NHS needs-led”: it asks the NHS to identify problem technologies, and then commissions research into the most important to the NHS. The research commissioned includes clinical trials (Horton cites three recently published in The Lancet) as well as evidence synthesis, to consider effectiveness, cost-effectiveness, and likely NHS impact. Many trials fill important gaps identified through our previous evidence synthesis, a link which other funders lack. Horton chooses to ignore “future promises” for NHS R&D but these are already bearing fruit—for instance, the HTA programme launched a reactive funding stream for clinical trials earlier this year, which attracted 255 applications. Since 1993, the HTA programme has funded 127 clinical trials. The portfolio differs from that of the UK Medical Research Council (MRC) by disease (41% of MRC trials in cancer compared with 10% HTA), by type of health technology (54% MRC trials were of pharmaceuticals compared with 22% of HTA’s), and by outcomes considered (13% of MRC trials included economics compared with 77% of HTA’s). These differences largely reflect the different focus of the MRC and NHS www.thelancet.com Vol 368 August 26, 2006
R&D. David Cooksey, in his study of the best arrangements for a single fund for medical research, will appreciate the need to preserve the important contribution made by both. TW is Director of the NHS HTA programme and a member of the MRC Health Services and Public Health Research Board. JR is Director of the National Coordinating Centre for Health Technology Assessment, which is funded by the Department of Health.
*T Walley, J Raftery [email protected] Department of Pharmacology and Therapeutics, University of Liverpool, The Infirmary, 70 Pembroke Place, Liverpool L69 3GF, UK (TW); and National Coordinating Centre for Health Technologies Assessment, University of Southampton, Southampton, UK (JR) 1
Horton R. Health research in the UK: the price of success. Lancet 2006; 368: 93–97.
Richard Horton’s Comment1 on the relative achievements of the MRC and NHS R&D provides an informative and interesting scene-setter for the Cooksey review. How the conclusions drawn follow from the information presented is not entirely obvious, but the analysis does seem to use a limited set of measures in assessing how the two programmes might fare when judged by “Cooksey criteria”. So, for example, it seems that the judgment about economic effects has been made solely on the basis of income from intellectual property rights. A report from the UK Evaluation Forum sets out a range of approaches for assessing medical research.2 One of the report’s conclusions is that different methods of assessment will be appropriate for different organisations at different times. The NHS Service Delivery and Organisation R&D Programme (SDO) has been assessing its effect using a mix of the methods proposed in the Evaluation Forum report. Our conclusions, which will be submitted to the Cooksey review as supporting evidence, set out a range of effects on policy and practice as well as the more conventional academic currency of publications, citations, and training awards. This type of effect seems entirely appropriate for
a research programme funded by the NHS, yet it is not much discussed in Horton’s Comment. When it comes to economic effects, income from intellectual property rights is a poor measure of overall social and economic benefit.3 This is particularly true for an applied health services research programme like SDO which is active in a field that is unlikely to yield much in the way of rights that can be protected, for reasons both of law and of public policy. Yet this type of research is still of economic importance because it addresses issues of costeffectiveness in health-care delivery and of the usefulness and quality of health services. I hope that the Comment serves to start a more sophisticated analysis in which the emphasis is on achieving a range of research effects to meet different needs, rather than on setting one institution against another. I declare that I have no conflict of interest.
Stephen Davies [email protected] Director, NHS Service Delivery and Organisation Research and Development Programme, London School of Hygiene and Tropical Medicine, London WC1E 6AA, UK 1 2
3
Horton R. Health research in the UK: the price of success. Lancet 2006; 368: 93–97. UK Evaluation Forum. Medical research: assessing the benefits to society. London: UK Evaluation Forum, 2006. http://www. acmedsci.ac.uk/p47prid1.html (accessed Aug 7, 2006). Lambert R. Lambert review of business– university collaboration. London: HMSO, 2003. http://www.lambertreview.org.uk (accessed Aug 7, 2006).
Richard Horton’s Comment on funding health research in the UK greatly underestimates the breadth and achievements of NHS R&D’s applied research for improving patients’ care.1 It is important to know whether treatments are safe and effective, of course, but we also need to know whether they are cost effective, about how to organise services to best deliver effective care, about workforce and training for staff for those services, about the effect of policies
e-mail submissions to [email protected]
727