In the early 1990s, an expert group chaired by Professor Anthony Culyer, was commissioned by the government to report on the state of research and development (R&D) within the National Health Service (NHS) in the UK, and to make recommendations which would secure and strengthen its future. His report, published in 1994, drew important conclusions which have had a far reaching effect on R&D within the NHS. The financial resources associated with R&D entered the NHS vernacular with his name attached, so called "Culyer money", and the consequence of his recommendations has been the construction of an entirely new NHS organisational element both centrally in the Department of Health and in NHS trusts and other local NHS organisations. R&D directors and managers are now a necessary part of the life of every NHS trust, large and small, and a new brigade of civil servants in the Department of Health have preoccupied themselves with the appropriate use of NHS resources for R&D.
I have been an R&D director in two different NHS organisations for five of the seven years since the Culyer report began to be implemented. Having recently passed on the role, my aim in this paper is to recount the positive force for good which these developments have offered, as well as noting (usually with the wisdom of hindsight) how more realistic thinking among policymakers, and wiser approaches to local implementation, might have allowed us to achieve even more.
The Culyer report made two crucial observations, Firstly, an unequivocal statement that R&D must be regarded as a core activity of the NHS, and must therefore always have some funding priority. A truism for many of us perhaps, but clearly a principle susceptible to pressure in a cash restricted NHS increasingly preoccupied, in the mid-1990s and ever since, with its failure to deliver the health expectations of the nation. Secondly, he confirmed that the NHS was already spending substantially on R&D yet had little real idea of the extent of that spend, nor had any reliable mechanisms to identify it. He drew the inevitable conclusion that, unless these deficiencies were corrected, a relentless restriction on R&D spending was inevitable as other health care priorities were driven into an NHS budget which in the mid-1990s was not growing in real terms.
The Culyer report was accepted virtually in its entirety, and NHS trusts were soon being required to divert managerial resources to support R&D. Trusts such as my own, a provincial teaching hospital of moderate size, appointed R&D directors, typically consultants with a personal research track, along with an R&D manager and other appropriate administrative support. The two immediate goals were the development of an R&D strategy for the trust and the accurate identification of the money presently being spent on R&D, "Culyer money". Enthusiasts grasped with relief the first substantial evidence that the NHS was truly committed to R&D, the sceptics immediately feared that accurate identification of our "Culyer money" would inevitably mean that we could lose as well as...