Research is one of the four main responsibilities of hospital trusts in Norway, cf. the Act on Specialist Health Services ("Lov om spesialisthelsetjenesten",www.lovdata.no/all/hl-19990702-061.html). Research activities must therefore be included in business plans, budgets and reports on the activities of the health trusts and regional health authorities, as well as of each individual hospital.

The Ministry of Health and Care Services provides research funding for health trusts and university hospitals amounting to several hundred million kroner per annum. These funds are administered by the regional health authorities and the cooperative bodies in each region. Since 2003, the results-based segment of funding to each health region (currently 60%) has been based on the number of completed PhD theses and points merited for publications in international journals. Basic funding (currently 40%) is the same for all health regions. Further details regarding the evaluation system can be found in Chapter 8.

It is likely that the national meriting system will be coordinated with the current university evaluation system within a few years. Work is in progress at a national level to design a simple, effective system for measuring resources available for research in health trusts. The evaluation of research and reporting of results and resources used has also engendered a spirit of optimism within research environments. There are now greater opportunities for applications for research funding and many researchers are increasingly optimistic about the future of research within health trusts.

Parliamentary Bill No. 20 (2004-2005) "Vilje til forskning" sets out the major strategies for research in Norway for the next few years (www.odin.no/ufd/norsk/dok/regpub/stmeld/045001-040014/dok-bn.html). Regional and local research strategies have also been developed in collaboration with health authorities and universities. These can be found on the websites of the relevant universities and the regional health authorities. Other national research strategies affect the field of medical research.

Nationally

The health trusts in Norway must ensure management of patients, research and education (See Act on Health Trusts: odin.dep.no/hod/norsk/publ/otprp/030001-050012/index-dok000-b-n-a.html). The Ministry of Health and Care Services ("Helse- og omsorgsdepartementet") is responsible for health trusts, whereas the Ministry of Education and Research is responsible for universities. This division of responsibility for medical research had led to considerable challenges at all levels.

There are four regional health authorities (RHF, "regionale helseforetak" in Norway with overall responsibility for individual hospital trusts ("helseforetak"- HF). The Ministry of Education and Research has overall responsibility for university faculties and departments and for university colleges. The South-Eastern Regional Health Authority have recently developed their research strategy, but the overall funding for research is presently not clear (www.helsesorost.no/modules/module_123/proxy.asp?C=124&I=841&D=2&mids=) . There are established reporting procedures for the utilization of research funds allocated to the regional health authorities. The Ministry of Education and Research is responsible for funding allocations to universities and university colleges. The Norwegian Research Council is in an intermediate position, receiving funding from several ministries, as well as from other sources. NFR makes contributions to research through a various framework- and strategic programs. Funding is directed at individual researchers, research groups or universities.

Research activities in health trusts are by nature often based within research groups at university hospitals where expertise and equipment required for translational research is available. However, small hospital trusts are also required to conduct research. In addition, national or regional research functions are located at the university hospitals.

Regionally

The regional health authorities receive instructions from the Ministry of Health and Care Services (Helse- og omsorgsdepartementet), which outline the framework and principles for research activities and regulate collaboration between regional health authorities and universities in key areas. Since 2002 collaborative bodies ("Samarbeidsorganet") between the regional health authorities and the universities/university colleges have been established in each region. This is a result of the reforms in the organization of the health care system (2002).

Local suggestions and advice for UUS
All research at UUS is administered at a divisional level, including financing for which each project is allotted a unique UUS project number. Some projects are organized at institute level, for example via the Institute for Experimental Medical Research ("Institutt for eksperimentell medisinsk forskning", IEMF) or the Institute for Medical Genetics ("Institutt for medisinsk genetikk"). Some researchers are organized in research groups awarded scientific group grants by the previous authority, Helse Øst, such as "Helse Øst forskningsgrupper" and "Helse Øst fagspesifikke kjernekompetansemiljøer". The latter have an obligation to increase research collaboration and productivity within the health region in their field. In addition, the Regional Centre for Clinical Research ("Kompetansesenter for klinisk forskning") was established in 2000 as a resource base for clinical research both locally and regionally.

The Director of Research and Education at UUS (currently Andreas Moan) reports to the CEO of UUS (currently Tove Strand).

"Vitenskapsrådet Ullevål universitetssykehus", VIRUUS, the central Advisory Research Board) A strategic plan for research activities at UUS (2002-2005) was passed by the UUS board in 2002 and a new strategic plan for 2006-2009 has recently been passed (see the Intranet). An outline of the organization and a list of contacts is found on

The time allocated to research activities varies across departments and divisions. Doctors may hold positions in which a minimum of 50% of working hours are allocated to "research and professional development" ("D-stillinger", "Fordypningstillinger"), but the degree to which this time is to be used exclusively on research remains to be clarified. However, guidelines are currently being drawn up by UUS indicating that such positions should be used as research positions, in particular as a means of recruiting doctors to conduct research leading to a PhD. Nurses, physiotherapists, ergotherapists and nutrionists are also increasingly involved in research activities, including PhD thesis work. Some nursing staff and other health care workers undertake research work financed by funds for commissioned research obtained by researchers or research groups.

The Section for Research in the Nursing profession ("Seksjon for sykepleieforskning", SFS) was established in 2000. Four doctoral thesis grants are awarded on the basis of applications and peer review for a period of up to 4 years, including 25% (1 year's) clinical work. The Head of the Section for Nursing Research, which provides research supervision, as well as arranging courses and seminars, is Nursing Research Manager Nina Aarhus Smeby (nism@uus), who is also employed by the Centre for Clinical Research at UUS.

The Faculty Division at Ullevål University Hospital (University of Oslo) provides financial rewards to the research units according to the annual number of published papers. Thus, publications in international peer-reviewed journals significantly impact the allocation of resources for research at the university. Furthermore, the CEO at UUS introduced in 2002 a financial reward system for publication in high impact journals (see VIRUUS on the Vevus Intranet for further details.) The awardees are the first authors as long as they are UUS employees (see Chapter 8).

Since 2002 the head of each unit at UUS has been required to submit an annual report regarding ongoing projects and results published or PhDs completed.

Local suggestions and advice for Helse Bergen
Research activities at the trust cover the whole spectrum of basic to clinical research. There is ongoing research on all aspects of diagnosis, treatment, care, and rehabilitation, as well as education of patients and their families. This also includes research and development projects on health service quality, as well as monitoring of morbidity and mortality rates and other relevant information for the health region.

Many researchers have an academic position at the University of Bergen. Research results are reported on the university website via the relevant institute at the Faculty of Medicine at the University of Bergen

The head of each hospital unit reports to senior management about ongoing research projects and any publications or completed PhDs resulting from these. In addition, researchers receiving research funding from the Western Norway Regional Health Authority are required to submit annual reports to the Regional Cooperative Body. Submitted reports can be searched for in the regional research register (www.helse-bergen.no/forskning/samarbeidsorganet/forskningsregisteret).

PhD students and post doctoral researchers working in hospital units or university institutes are usually funded both internally and externally by health authorities, trusts, universities, the Norwegian Research Council and a variety of research funds. In general, these are physicians or researchers with a medical or scientific degree (MD, "cand. med" or MSc, "cand. scient") or similar. The number of nurses, physiotherapists etc. completing honors degrees ("hovedfag", master) is steadily increasing and this is likely to lead to an increase in the number applying to take part in doctoral programs. It is important for all professional groups to recruit high quality researchers and research groups. This provides the best foundations for work in research environments which are becoming more and more international.

The number of doctoral candidates funded by the Regional Cooperative Body has greatly increased over the last years. Most are to be found working in the clinical departments of university hospitals. This has led to increased productivity in research activities in the health trusts.

Physicians have the opportunity of applying for combined clinical and research positions in which a minimum of 50% of working hours are to be spent on research and professional development ("Fordypningsstilling"). Personnel with other types of health care qualifications also conduct research activities, although this is not usually independent research work. However, nurses and others with health care qualifications have carried out research work funded by resources obtained by researchers or research groups as a result of carrying out pharmaceutical trials for external clients.

Innovest AS
Innovest AS was set up in 1997 by Hordaland County and the University of Bergen to centralize work within commercial, commissioned research in the health sector. Helse Bergen currently owns 50% of Innovest and the remaining 50% is owned by The University Research Foundation ("Stiftelsen Universitetsforskning", UNIFOB). Innovest is an independent limited liability company established to promote research and trade development within the Western Norway health sector.

Innovest AS runs the Top Research Program at Helse Bergen whose primary aim is to stimulate research environments so that new centers of expertise may be established within the health trust. Innovest AS provides assistance on new contracts, as well as providing administrative support for following up contracts, finance and accounting. Innovest AS administers earmarked research funds in specific accounts. Contact Innovest AS to set up an account and for advice on the use of research funding. Further information regarding other services provided by Innovest is to be found on: www.helse-bergen.no/forskning/innovest