The development of evidence-based health care has highlighted the need for a complementary process: needs-based research. The NHS in the UK has established a Research and Development strategy to help develop its knowledge base, and the Health Technology Assessment Programme is a large part of this strategy. Now in its fifth year, the HTA has its own nerve centre at the National Coordinating Centre for HTA based at Southampton. The National Coordinating Centre undertakes five stages of work every year: (i) identification of new topics (1500 in 1997} by widespread and focused consultation, (ii) prioritisation in four stages into 50 topics with a system of expert multi-disciplinary panels, (iii) commissioning systematic reviews (25) and primary research (25 mostly RCTs) via a commissioning group of HTA methodologists, (iv) monitoring and assessment of the commissioned research and (v) dissemination both routinely and actively to the Health Service. Two hundred and forty-two HTA priorities have been set, and over 100 assessments commissioned to date. The results from the first assessments are now available including reviews on prostate specific antigen, near patient testing, home parenteral nutrition, fragile X screening, wound care, outpatient services for chronic pain, and neonatal metabolic screening. The strategy for setting priorities, the spectrum of priorities and the programme's first results are reported and analysed. The analysis focuses on the proportion and potential impact of research concerning different types of intervention (drugs, diagnostic tests, etc), new versus long-standing interventions and the payback of the research.