title: Who needs what from a national health research system: lessons from reforms to the English Department of Health's R&D system.
abstract: Health research systems consist of diverse groups who have some role in health research, but the boundaries around such a system are not clear-cut. To explore what various stakeholders need we reviewed the literature including that on the history of English health R&D reforms, and we also applied some relevant conceptual frameworks.We first describe the needs and capabilities of the main groups of stakeholders in health research systems, and explain key features of policymaking systems within which these stakeholders operate in the UK. The five groups are policymakers (and health care managers), health professionals, patients and the general public, industry, and researchers. As individuals and as organisations they have a range of needs from the health research system, but should also develop specific capabilities in order to contribute effectively to the system and benefit from it.Second, we discuss key phases of reform in the development of the English health research system over four decades - especially that of the English Department of Health's R&D system - and identify how far legitimate demands of key stakeholder interests were addressed.Third, in drawing lessons we highlight points emerging from contemporary reports, but also attempt to identify issues through application of relevant conceptual frameworks. The main lessons are: the importance of comprehensively addressing the diverse needs of various interacting institutions and stakeholders; the desirability of developing facilitating mechanisms at interfaces between the health research system and its various stakeholders; and the importance of additional money in being able to expand the scope of the health research system whilst maintaining support for basic science.We conclude that the latest health R&D strategy in England builds on recent progress and tackles acknowledged weaknesses. The strategy goes a considerable way to identifying and more effectively meeting the needs of key groups such as medical academics, patients and industry, and has been remarkably successful in increasing the funding for health research. There are still areas that might benefit from further recognition and resourcing, but the lessons identified, and progress made by the reforms are relevant for the design and coordination of national health research systems beyond England.
authors.affiliation: Health Economics Research Group (HERG), Brunel University, Uxbridge, UK. stephen.hanney@brunel.ac.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hanney
authors.forename: Shyama
authors.initials: S
authors.lastname: Kuruvilla
authors.forename: Bryony
authors.initials: B
authors.lastname: Soper
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mays
references.citation: Health Technol Assess. 2007 Dec;11(53):iii-iv, ix-xi, 1-180
references.pmid: 18031652
references.citation: Annu Rev Public Health. 1997;18:485-505
references.pmid: 9143728
references.citation: Health Res Policy Syst. 2008 Mar 09;6:3
references.pmid: 18328108
references.citation: BMJ. 2006 Dec 16;333(7581):1231-2
references.pmid: 17170394
references.citation: Lancet. 2005 Jul 2-8;366(9479):86-92
references.pmid: 15993237
references.citation: Bull World Health Organ. 2004 Oct;82(10):724-31; discussion 732
references.pmid: 15643791
references.citation: Lancet. 1991 Aug 10;338(8763):367-71
references.pmid: 1677710
references.citation: JAMA. 2002 Dec 4;288(21):2701-8
references.pmid: 12460093
references.citation: Milbank Q. 2002;80(1):125-54
references.pmid: 11933791
references.citation: Health Res Policy Syst. 2006 Oct 18;4:9
references.pmid: 17049079
references.citation: East Mediterr Health J. 2008 May-Jun;14(3):502-17
references.pmid: 18720615
references.citation: BMJ. 2008 Jan 19;336(7636):120-2
references.pmid: 18202063
references.citation: J Health Serv Res Policy. 2008 Jan;13 Suppl 1:1-7
references.pmid: 18325161
references.citation: Milbank Q. 2008 Mar;86(1):125-55
references.pmid: 18307479
references.citation: Soc Sci Med. 1999 Mar;48(5):633-46
references.pmid: 10080364
references.citation: Lancet. 1999 Oct 30;354(9189):1539-45
references.pmid: 10551515
references.citation: Health Res Policy Syst. 2008 Jan 29;6:2
references.pmid: 18230124
references.citation: Cochrane Database Syst Rev. 2002;(1):CD000389
references.pmid: 11869574
references.citation: Health Aff (Millwood). 2000 May-Jun;19(3):236-40
references.pmid: 10812803
references.citation: Health Res Policy Syst. 2003 Jan 13;1(1):2
references.pmid: 12646071
references.citation: J Health Serv Res Policy. 1996 Jan;1(1):35-43
references.pmid: 10180843
references.citation: BMJ. 1998 Jul 4;317(7150):72-5
references.pmid: 9651281
references.citation: BMJ. 2007 Jan 20;334(7585):129-32
references.pmid: 17235094
references.citation: BMC Health Serv Res. 2006 Oct 18;6:134
references.pmid: 17049092
references.citation: Int J Technol Assess Health Care. 2004 Winter;20(1):77-80
references.pmid: 15176181
references.citation: J Health Serv Res Policy. 2007 Apr;12 Suppl 1:S1-23-31
references.pmid: 17411504
references.citation: J Health Serv Res Policy. 2008 Jan;13(1):3-4
references.pmid: 18325148
references.citation: J Health Serv Res Policy. 2003 Oct;8 Suppl 2:1-6
references.pmid: 14596741
references.citation: BMJ. 2003 May 31;326(7400):1167-70
references.pmid: 12775614
references.citation: Bull World Health Organ. 2003;81(11):815-20
references.pmid: 14758408
references.citation: Health Technol Assess. 2004 Apr;8(15):1-148, III-IV
references.pmid: 15080866
references.citation: BMJ. 1995 Jul 8;311(6997):109-12
references.pmid: 7613363
references.citation: J Health Serv Res Policy. 2005 Jul;10 Suppl 1:6-20
references.pmid: 16053580
references.citation: Int J Qual Health Care. 2002 Jun;14(3):175-81
references.pmid: 12108528
references.citation: Br Med J (Clin Res Ed). 1988 Apr 16;296(6629):1109
references.pmid: 3132228
references.citation: J Health Polit Policy Law. 1990 Fall;15(3):525-42
references.pmid: 2273216
references.citation: BMJ. 2000 Apr 8;320(7240):998-1001
references.pmid: 10753159
references.citation: Implement Sci. 2007 Feb 19;2:7
references.pmid: 17309803
references.citation: Lancet. 2005 Oct 22-28;366(9495):1416-8
references.pmid: 16243076
references.citation: J R Soc Med. 1998;91 Suppl 35:2-6
references.pmid: 9797742
references.citation: J Health Serv Res Policy. 2005 Jul;10 Suppl 1:35-48
references.pmid: 16053582