Quality control plan 'to improve all aspects of NHS': Research and development worth pounds 440m will subject the service to 'rigorous analyses'

A MULTI-MILLION pound planning programme for the NHS, designed to introduce quality control into every aspect of the service, from the most effective management techniques to the best surgical laser, is to be launched in June.

By 1997, the programme of research and development will account for 1.5 per cent of the annual NHS budget - pounds 440m a year at current prices.

Next month, the Department of Health will invite applications for a new university-based NHS research unit, which will be multi-disciplinary and have a budget of pounds 1.5m a year, as part of the broader research and development programme.

This silent NHS revolution will put in place rigorous analyses of new and existing concepts and technologies - the research and development approach that industry has taken for more than 30 years. It will shift progress within the NHS from today's science-based and usually piecemeal adoption of new methods to a planned development of the details of the service.

The guidelines to doctors and managers that will follow the R and D initiatives, will have, as key considerations, cost-effectiveness and benefits to patients. Inevitably there will be criticism of the plans on grounds that they will limit professional freedom and eventually outlaw procedures that can be offered on the NHS.

However, Professor Michael Peckham, a cancer specialist and academic who was appointed the first NHS Director of Research and Development in 1991, said that it would be hard for clinicians to resist guidelines about the best way forward, if 'we have developed appropriate research information, and explained this properly'. He went on: 'Differences in clinical practice that matter, will not be justifiable if there is valid data on the problem. I am absolutely convinced that this approach will liberate clinicians.'

Professor Peckham has spent the past two years planning the research and development programme. Much of the new programme will be to harness existing research and to commission new projects. Huge gaps in knowledge about how the system really works and even of what patients want from it, have become apparent.

'Very little research has been done on the health service. We have to create a sound knowledge base and to correct anomalies that exist,' he said.

Examples of discrepancies include unexplained differences in referral patterns by family doctors. It has been found that the further away patients live from their regional liver disease centre, specially funded to provide a region-wide service, the less likely they are to be referred.

'We just don't know why this happens,' he said.

Another example is how consultants differ in putting cataract patients on waiting lists for surgery. 'Some consultants do not put patients on the list until the cataract has advanced, others put patients on the lists sooner. You would suppose that the patients put on later would be treated with more urgency. This seems not too happen.'

Hundreds of millions of pounds are spent on research each year by drugs companies, charities and the research councils, but there is no structure for assessing the results and making the best use of them.

He has estimated that pounds 800m is spent by the pharmaceutical industry annually on research, about a quarter of this is spent in NHS hospitals and medical schools. At the same time the NHS spends about pounds 700m a year on equipment.

Professor Peckham's department will also forge links between different research agencies.

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