Volume 1
Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology.
- Great Britain. Parliament. House of Lords. Science and Technology Committee.
- Date:
- 1995
Licence: Open Government Licence
Credit: Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology. Source: Wellcome Collection.
86/132 page 84
![APPENDIX 7 The Culyer report: Opinions of witnesses The single funding stream 1. Professor Culyer and Mr John James explained to us why the Task Force recommended drawing NHS R&D expenditure together into a single, explicit funding stream. First, the existing situation involved numerous research funding streams being used in diverse ways with no consistent quality control or objectives, and limited “ownership or understanding” on the part of purchasers or providers (Q512). Secondly, the existing situation was in fact failing to support research (Q536). Creating the single stream is intended as an enabling mechanism, to “provide language in which...people can explain what it is they are aspiring to and appropriate decisions can then be made”’. 2. Dr Malcolm Green, a member of the Task Force, likewise believes (p210) that the single stream will allow “clear identification of funds to support the service costs of research, which were in danger of being driven out by the service market...Within provider units, it will be possible to identify money which flows down to support research and its service costs. This will powerfully focus the minds of managers, health professionals and scientists on the need for priority to be given to this activity and of its value to the organisation. This is an important shift already evidenced within the ex-SHAs. It should give more power to clinical researchers within the service framework”. However he points to two potential dangers. First, although the present Secretary of State has added money to the funding stream, others may see it as a target for raids. Secondly, the flow of the stream may be “unduly influenced by the perspectives (or even prejudices) of a very small number of people”, namely the DRD and the RDRDs. In the view of the ABPI, however, creating a single explicit stream of R&D funding is “good business sense” (p246); Dr Doyle (Q824) welcomes an end to the present situation, in which “there was great opportunity for frittering money away”. 3. Our witnesses are by and large content with the proposed construction of the single funding stream. The SHERT (p286) raise the question whether local and national endowment funds will be subsumed within the stream; the Department of Health assures us (p385) that they will not. 4. The Culyer report implementation plan announces that guidance on provider declarations will be issued in August 1995; a pilot exercise will take place, “to ensure that what is proposed is realistic and cost-effective and can be applied on a consistent basis”; revised guidance will be issued early in 1996, and in May of that year the process will be completed. The CSTI has doubts about inviting Trusts to “declare” R&D expenditure for inclusion in the single stream: “providers may be tempted to over-declare R&D in order to remove costs from services”; and they may subsequently decline to support pre-protocol research, on the ground that “all R&D has been declared”. The latter fear appears to be confirmed by evidence from NAHAT: see below. The AUDGP similarly considers total transparency a risky strategy (p428): “There may...be dangers in opening up the true cost of research to purchasers”. Professor Robert Boyd, a member of the Task Force, agrees (p181). 5. The ABHI warn (p415), “If all research is specifically funded, there could be an increasing divide between those doing research and routine clinical practitioners. This could have a tendency to reduce the assessment of newly available data rather than increase it, and could also reduce commitment at an operational level to an information-based service”. R&D levy 6. Mr John James, a member of the Culyer Task Force, explained to us why they recommended a levy for R&D: “The first idea was simply saying [to purchasers], it is actually money that is taken out of the money for services, and you should be involved in and understand the decision point which is reached. It was an extremely important point of principle” (Q512). 7. The NHS Director of Finance explained to us the Department of Health’s thinking on the levy in some detail (QQ564-5). In the first year, 1996-97, the levy will be “supply-driven”, consisting merely of the sum of identified NHS expenditure already committed to R&D. But from 1997-98 the levy will be “demand-led”, on the basis of the identified costs of R&D (cp Professor Culyer Q516, Professor Peckham Q1280); it will be “flexible enough to ensure that we do balance demand and supply for research” and to “prevent any cross-subsidisation with service contracts”; and it will have to “compete with other priorities and contending NHS services”. The process for settling the](https://iiif.wellcomecollection.org/image/b32219337_0001_0086.jp2/full/800%2C/0/default.jpg)
