Letter: Start-up funding for research in the NHS

Sir: The letters from the President of the Royal Society and Dr Max Perutz to the Prime Minister reported by Nicholas Timmins (21 October) were timely. They highlighted the clash between the strategic and long-term responsibilities of medical research and the short-term, parochial market approach to provision of health care.

Take as an example the St Mary's meningitis unit featured last week on Channel 4's Cutting Edge series. Before the professor of paediatrics, who leads the unit, was appointed three years ago, I was informed that the District Health Authority could not sanction his appointment because the clinical service he would provide would cost too much. Without a clinical contract with the authority he could not care for patients and without patients he could not be a clinical professor. The university appointed him none the less because he was outstandingly the best candidate. He would inspire students for the next 25 years and we could offer him the ideal environment for his clinical research into acute infections. We also knew that there was an immediate need in London for the service he would provide.

We nearly lost him. It took nine cliff-hanging months to secure his clinical contract. The debate went to the highest levels of the Department of Health. Eventually, the North West Thames Regional Health Authority (which we are deeply concerned to hear will be abolished) stepped in to help. We now had some nurses and one intensive-care bed but a single- handed consultant service was a non-starter. The medical school had to fund a new senior lecturer to partner the professor in providing the service.

There is a desperate need for the NHS to rediscover a way of pump- priming new developments. The universities can provide expert leadership. They can also multiply by research and teaching the long-term value of a service investment, but they have no venture capital for service - that is the responsibility of the NHS. New clinical services should become self-supporting in due course through the internal market but they may incur substantial setting- up costs beyond local means. What was difficult three years ago would probably be impossible now. Without NHS investment in innovation, creative initiatives like this will die - and so, unnecessarily, will patients.

Yours faithfully,

PETER RICHARDS

Dean, St Mary's Hospital

Medical School of Imperial

College

London, W2

27 October