BACKGROUND In 2006, the research and development (R&D) activity of England's national healthcare system, the National Health Service, was reformed. A National Institute for Health Research (NIHR) was established within the Department of Health, the first body to manage this activity as an integrated system, unlocking significant increases in government funding. This article investigates how the NIHR came to be set up, and why it took the form it did. Our goal was a better understanding of 'how we got here'. METHODS We conducted oral history interviews with 38 key witnesses, held a witness seminar, and examined published and unpublished documents. RESULTS We conclude that the most important forces shaping the origin of NIHR were the growing impact of evidence-based medicine on service policies, the growth of New Public Management ways of thinking, economic policies favouring investment in health R&D and buoyant public funding for healthcare. We note the strong two-way interaction between the health research system and the healthcare system - while beneficial for the use of research, challenges for healthcare (such as stop-go funding) could also produce challenges for health research. CONCLUSIONS Understanding how and why England came to have a centralised health service research system alongside a long-established funder of biomedical research (the Medical Research Council) helps us interpret the significance of the English health research experience for other countries and helps English policy-makers better understand their present options. Learning lessons from the features of the English health research system calls for an understanding of the processes which shaped it. Firstly, the publicly funded, nationally organised character of healthcare promoted government interest in evidence-based medicine, made research prioritisation simpler and helped promote the implementation of findings. Secondly, the essential role of leadership by a group who valued research for its health impact ensured that new management methods (such as metrics and competitive tendering) were harnessed to patient benefit, rather than as an end in themselves. A policy window of government willingness to invest in R&D for wider economic goals and buoyant funding of the health system were also effectively exploited.

中文翻译：

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“所有的星星都对齐了”？英国国家健康研究所的起源。


背景技术2006年，英国国家医疗保健系统——国民医疗服务体系的研发(R&D)活动进行了改革。卫生部内成立了国家健康研究所 (NIHR)，这是第一个将这项活动作为综合系统进行管理的机构，从而大幅增加了政府资助。本文探讨了国家卫生研究院 (NIHR) 的成立过程以及其为何采取这样的形式。我们的目标是更好地理解“我们是如何走到这一步的”。方法 我们对 38 名关键证人进行了口述历史访谈，举办了证人研讨会，并审查了已发表和未发表的文件。结果 我们得出的结论是，塑造 NIHR 起源的最重要力量是循证医学对服务政策日益增长的影响、新公共管理思维方式的发展、有利于卫生研发投资的经济政策以及活跃的医疗保健公共资金。我们注意到健康研究系统和医疗保健系统之间强大的双向互动——虽然有利于研究的使用，但医疗保健的挑战（例如走走停停的资金）也可能给健康研究带来挑战。结论 了解英格兰如何以及为何拥有一个集中的卫生服务研究系统以及一个长期存在的生物医学研究资助者（医学研究委员会），有助于我们解释英国卫生研究经验对其他国家的重要性，并帮助英国决策者更好地了解他们目前的选择。从英国健康研究体系的特征中吸取教训需要了解其形成过程。 首先，医疗保健的公共资助、全国性组织的特点促进了政府对循证医学的兴趣，使研究的优先顺序变得更简单，并有助于促进研究结果的实施。其次，重视研究对健康影响的团体的领导作用确保了新的管理方法（例如指标和竞争性招标）能够为患者谋福利，而不是仅仅作为目的。政府愿意投资研发以实现更广泛的经济目标的政策窗口以及卫生系统的充足资金也得到了有效利用。