184 Alex Faulkner and McGuire 1992). A consequence of this is the formation of new strategic alliances between the various producers and consumers of research knowledge, in which research disciplines participate in the strategic action of healthcare policymaking agencies.The scope of the national health technology assessment movement brings into view many healthcare issues of interest to a sociological analysis. It raises issues to do with interests, values and inter-organisational relationships. It raises questions about the shaping of research agendas, healthcare policies, regulation of health technologies and, indeed, about the evolving patterns and methods of healthcare which we might have to call upon as health service users. It also raises issues germane to some of the prime concerns of the sociologies of medicine/healthcare and science/technology, including trust and contestability in medical authority, construction of health and healthcare risks, rhetorics of scientific projects and knowledge claims, relationships between the disciplines of medical and healthcare knowledge, and relationships between healthcare experiments, laboratories and technology tests.In this chapter I am concerned with only a limited set of the possible themes. The focus, therefore, is upon the use of rhetorical discourse in the construction and shaping of a 'need' for health technology assessment around new constellations of institutions and disciplines -'strange bedfellows' -which are negotiating agendas in healthcare knowledge. I locate this analysis by developing the notion of the NHS as a massive laboratory in and around which healthcare knowledge is produced. Implications for key themes in the sociological study of science/technology and healthhllness are discussed. I confine myself largely to considering some of the key activities and developments which are part of the formal national NHS HTA movement in the United Kingdom, with some reference to related activities in the Medical Research Council (MRC), rather than the wider range of healthcare research activity much of which might also follow a broadly health technology assessment model.Before moving on to consider the main themes of the chapter, I sketch briefly the state-co-ordinated formal structure which has been created for national HTA activity in the United Kingdom, followed by a description of the methods used in producing the analysis of HTA presented here.
Formal organisation and function of national HTAHealth technology assessment is the only one of the many research programmes, set up under the new NHS Research and Development Directorate, to receive support through the formation of a permanent standing group to oversee it, the Standing Group on Health Technology (SGHT). The SGHT identifies priorities for assessment through nation-wide 0 Blackwell Publishers LtdEditorial Board 1997Health technology assessment in the United Kingdom 185