Fund juggler upbeat after NHS pruning

Martin Ince asks John Swales, the man responsible for NHS research, how he will cope with a cut of Pounds 10 million from his budget

John Swales, director of research and development at the National Health Service, is bullish about life despite the apparent rebuff of losing Pounds 10 million of his biggest research budgets just before Christmas. The NHS is the biggest single research spender in British biomedicine, putting almost Pounds 420 million into medical research plus another Pounds 29 million into policy research.

Professor Swales says: "All this money has to be argued for, ultimately in competition with money for patient care, so we have to show that it is of value for preventing or treating illness. The money we get for research will go to patient care unless we can justify top-slicing it for research."

He adds that the Pounds 10 million cut made to the biggest part of his budget, the Pounds 340 million put into support for other funders' research, is not as bad as it looks. Although money was lost because of the need for cash to keep sick people off corridor trollies, some of the work it would have funded will be picked up in the Pounds 79 million the NHS puts into its own research. This funds major centres for work such as the study of systematic data reviews, and responds to requests from the NHS for research on areas of patient or financial priority.

He says: "Other research funders perform research that involves clinical staff as well as requiring access to patients, samples and notes. That means costs for us, especially of staff time. We fund care providers against bids they make for money to support this work, as well as for research they wish to do on a small scale themselves and for work that is at too early a stage to attract external funding."

This system means that medical charities and the MRC can take decisions that cost the NHS money. But a concordat with the MRC (of whose council Professor Swales is a member) means that it cannot overuse the relationship and gives the NHS a say in what the MRC does. With the research charities, less formal agreements have a similar effect.

The loss of Pounds 10 million from the budget is less significant for the big research players than the addition of a new category of recipients for the funds announced at the end of 1997. For the first time, primary carers have been able to bid, winning over Pounds 2 million, some of whom have previously had research funding with no NHS backup.

However, Professor Swales stresses that the bulk of the money (Pounds 297 million in the coming year) is still awarded in "portfolio" contracts, which are awarded to major research participants such as teaching hospitals. These 47 winners have substantial management control over the money allocated to them and almost all involve university departments and personnel.

He says that "we are not about giving every district general hospital a molecular biology lab", stressing that the NHS looks for "the most appropriate environment" for each project. Big teaching hospitals with strong university links will continue to dominate in research needing high-technology equipment, for example, for imaging or basic biomedicine. But the NHS has another huge asset - patients, as well as people who are not patients but are a valuable asset for surveys and trials. This means that the criteria on which the NHS allocates funds differ from those for university funding. This is exacerbated in Professor Swales's view by differences between the criteria adopted in the research assessment exercise for university excellence and those used by the NHS. He points to work at Oxford on data reviews, where a high-level review of excellent academic quality cannot be submitted for the RAE but a paper about it can: a working party involving the NHS and the Higher Education Funding Council is looking at this issue.

The loudest complaints about the lost research funds come from the biggest spender among the NHS regions, North Thames, which includes major research centres such as the Royal London Hospital, University College Hospital and Hammersmith Hospital. There research director Sally Davies controls a budget of over Pounds 200 million in 1998-99, and she stresses that there are "signs of damage to world-class institutions" in the allocations announced just before Christmas.

She says that "people who do well in the RAE tend to do well here", while others tend to submit projects with flaws such as incomplete familiarity with existing knowledge. But she is also keen on research strategies that match providers' patient care strategies, praising a bid which won over Pounds 3 million for Camden and Islington Community Health Services for work on mental health, primary care, sexual health and community health. She says: "We often see district general hospitals which want to ape teaching hospitals. But we prefer them to use their position in the community, in particular the patient base which is their real strength."