UK National Health Service R&D funding—a bureaucratic nightmare

Abstract

When the UK National Health Service (NHS) research and development (R&D) levy was first proposed by the Culyer Task Force in 1994, it was welcomed by clinical academics who naively anticipated that funding patient-oriented research, focusing on improved diagnosis, investigation, and treatment, would be high on the NHS R&D agenda. The reality has been, at best, a disappointment and, at worst, a time-wasting bureaucracy that flagrantly consumes public funds with little tangible benefit. There have been repeated attempts over 8 years to identify research expenditure within NHS trust budgets. The reality is that most of these funds—supposedly designated for research support costs—are an illusion and that the money reputedly spent on research in teaching hospitals is embedded in essential expenditure. Any attempt to redirect resources into research has proved almost impossible, since the budget is insufficient to meet the many clinical demands. When it comes to the choice between research and patients' care, NHS managers obviously opt for the latter. Despite the lack of a real research budget within the NHS, trusts are expected to report their research expenditure annually. These annual reports have become a farcical exercise, since funds used to deliver care are redesignated to R&D. The preparation of these reports requires new departments with full-time R&D staff, which divert many hours of clinical and research time that could be better deployed. Overall, the NHS must now employ thousands in its new R&D industry. For academics, the information is required in a different format from that already requested in the university research assessment exercise, thereby wasting everybody's time. Although research ideas need to be investigated quickly before they become outdated, the process for identification of priorities for NHS R&D funding takes 2 years. If the research was worth doing, it would have been done by then. NHS R&D has become a sizeable and ill-informed bureaucracy, which consumes more resource than it delivers in directly funded research. It is difficult to identify how much, if any, money actually flows into research projects. Perhaps the audit commission should investigate this situation, since real funding for clinical research is desperately needed. This letter has been signed by 32 senior academics working in NHS teaching hospitals.