Dr Paul Atkinson BA (Hons), PhD

I am the researcher on a project to describe the origins of the National Institute for Health Research and learn lessons from this history for future research policy. The link takes you to the transcript of a witness seminar I organised with key participants in events, in which they discuss what they did and why. A scholarly article reporting our findings is currently (June 2019) in peer review. Origins of the NIHR

Our team has recently secured a costed extension to Professor Sally Sheard's Wellcome Trust Investigator Award, The Governance of Health: medical, economic and managerial expertise in Britain since 1948. The extension will fund a 3-year exploration of the origins and development of NICE, which celebrates its twentieth anniversary in 2019. NICE has developed into one of the most critical health systems governance techniques within the NHS, a model which has subsequently been emulated worldwide. NICE was a political response to an increasingly challenging situation in which the government was asked to adjudicate on demands on the NHS’s limited budget, specifically for new (and expensive) drugs and technologies. The system created a ‘fourth hurdle’: treatments had to be cost effective before NICE would recommend their adoption (in addition to the existing three hurdles that pharmaceuticals had to clear to get licenced: safety, quality of manufacture and efficacy).

Our research objectives are
1. To analyse the timing and process in the formation of NICE in 1999
2. To establish a detailed history of the development of NICE
3. To identify changing public attitudes to this significant new determinant of NHS policy
4. To identify and analyse ‘tension points’ when NICE has provoked new challenges to NHS governance
5. To analyse how NICE has exploited/competed with existing health policy expertise, and
6. To establish the mechanisms through which the NICE model has been exported globally.

The project aims to produce a monograph, scholarly articles, and a contribution to a major exhibition on medicine and politics being prepared for 2021.

‘There are,’ in the words of the UK’s Five Year Antimicrobial Resistance (AMR) Strategy (2013), ‘few public health issues of greater importance than antimicrobial resistance.’ Research to inform policy in this field needs to address complex social, behavioural and biological questions. Previous work, including my own on the NIHR, shows that research and health policy work together best – that is, delivering research which is used, and policy, or advocacy, which is shaped by evidence – when actors from these very different epistemic worlds find ways to develop shared goals, rather than working to reductive (for example, ‘customer/contractor’) models. Little, however, is known about how best to organise such collaboration. The methods of contemporary history have much to offer here, and have scarcely been used in the field of AMR so far. Previous researchers have made only limited use of interviewing, and they have not focussed on the important question of managing collaboration between research, policy and advocacy. The project I am preparing will recommend more effective approaches by helping policy makers and research leaders in government, industry and food retailing to learn from recent experience.

The proposed project is an investigation of the recent history of global responses to AMR. It will contribute to the more effective use of research in policy making and advocacy, and the better commissioning of research, by establishing what the most effective ways have been to link researchers, policy makers and lobbyers since the 1990s. My recent research on the origins of the National Institute for Health Research (NIHR) has demonstrated the effectiveness, as an input to policy, of interviewing participants to examine contemporary history: this prompted the Chief Medical Officer to ask us to look at the topic of AMR. The proposed research would form part of our response to her. CMO’s personal enthusiasm for this work will give us privileged access to participants who could otherwise be reluctant to assist, as we found in the NIHR project.