MASC response to the Science and Technology Committee request for evidence to inform 'Cooksey Report' evidence session
9 January 2007
Letter addressed to Dr Lynn Gardner, Clerk of the Committee, Science and Technology Committee from John Maingay, Head of Hospitals Division
Science and technology select committee – Cooksey Review - British Medical Association memorandum of evidence
Please find enclosed the British Medical Association’s (BMA) written submission to the above inquiry by the Science and Technology Select Committee. If required, the BMA welcomes any opportunity to contribute further on the issues raised in the submission.
British Medical Association memorandum of evidence to the science and technology select committee – Cooksey Review
1. The British Medical Association (BMA) is a voluntary, professional association that represents doctors from all branches of medicine all over the UK. It has a total membership of over 138,000, rising steadily, including more than 2,500 members overseas and over 19,000 medical student members.
2. The BMA’s Medical Academic Staff Committee (MASC) is a UK Committee representing the interests of those employed by higher education institutions, medical schools, Research Councils and other institutions engaged in medical research. The MASC broadly supports the recommendations in the Cooksey report A Review of UK Health Research Funding.
3. We note that the synergistic interlinks between research, education and clinical practice are not covered in detail in the report. Excellent clinical practice should not be separated from clinical education and clinical research. It is essential that the links between education, research and clinical practice are maintained and that all academic posts involve training the next generation of academics as well as the delivery of excellent clinical services.
4. The MASC has been supportive of the proposals in Best Research for Best Health including the establishment of a National Institute for Health Research (NIHR). We further welcome the recommendation that the NIHR be a real agency of the Department of Health.
5. We wish to highlight our unreserved support for the recommendations around ensuring the ring fence of the R & D budget is effective and that there are appropriate incentives for the NHS to spread best practice in health research.
6. In our response to the Cooksey consultation in July 2006, the MASC expressed concern about the funding for the Walport trainees through the Multi Professional Education and Training (MPET See ‘Key to Terms’ at end of evidence for definitions ) budget. In November 2006, the MASC outlined in more detail the concern over the instability of the current funding arrangements for academic medicine in Supplementary Evidence to the Health Select Committee’s 2006 inquiry into NHS deficits.
7. Previously the MPET budget was a direct central allocation to NHS organisations but in 2006, a number of budgets were given to directly Strategic Health Authorities (SHAs) for local management (The affected budgets are: public health, medical education and non-medical clinical training (i.e. MPET), GP performance reimbursement, clinical excellence awards and walk-in centres/OOH/NHS Direct. See NHS financial performance – Quarter 1 2006-07, Department of Health.) However, first quarter performance for the NHS (Ibid) indicates that SHAs have been required to save £350m which is to be used to off-set overspending elsewhere and will be held centrally by the NHS Bank as a ‘contingency fund’. It appears that many trusts are cutting MPET budgets to meet the requirement to support the ‘contingency fund’.
8. Medical academic salaries in England and Wales are primarily funded by a combination of monies from the Higher Education Funding Council (FC), the NHS (the SIFTand MADEL elements of MPET), with a small proportion funded by the Research Councils. However, in some medical schools, and in some specialties, the proportion of NHS funding for clinical academic posts is much higher than FC funding. This includes the medical schools at Swansea, Keele, Bristol, Leicester and Warwick (Clinical Academic Staffing Levels in UK Medical and Dental Schools June 2006, A data update by the Council of Heads of Medical Schools and the Council of Heads and Deans of Dental Schools):
| Medical school | % posts paid for by NHS funding (SIFT/MADEL) |
| Swansea |
94.74% |
| Keele |
93.14% |
| Bristol |
71.07% |
| Leicester |
66.75% |
| Warwick | 58.10% |
UK Average % of posts funded by the NHS – 38%
| Speciality |
% posts paid for by NHS funding (SIFT/MADEL) |
| Radiology |
63.83% |
| Anaesthetics | 59.80% |
9. In effect, Universities have gradually reduced the numbers of clinical academics, (primarily teaching academics), by moving the funding of teaching academic salaries away from universities into the NHS funding streams, that is, SIFT and MADEL.
10. Over the past five years, the number of medical students has increased by almost 10,000 to meet the future needs of the medical workforce, and at the same time there has been a 25% reduction in academics (Ibid). and an associated shift of undergraduate education to the NHS. This shift has primarily been brought about by pressure from the Research Assessment Exercise, which moves the emphasis away from teaching and NHS research.
11. Despite the significant decline in the clinical academic workforce over the past five years, the number of vacant posts currently comprises 7% of the total number of academics. Vacancies have continued to increase over the past year are especially prominent in senior academic positions – there were 91 professorial vacancies across the UK in 2005 (Ibid).
12. In addition, over the last 10 years a significant number of medical academics have been made redundant (mainly arising from Research Assessment pressures which encourage universities to divest academics that are not likely be returned), but the latest round of MPET funding cuts may well disproportionately fall on academics.
13. For example in Leicester, the Chief Executive of University Hospitals Leicester Trust wrote to the Vice Chancellor of the University advising that funding for clinical academics would need to be reduced by 20 per cent to help the SHA make savings of £52m. The reduction in funding to NHS employed teachers has not been quantified to the BMA, but may well be significant. Making the required savings would be equivalent to a 15% reduction in Leicester’s medical academic staff or 11 or 12 posts. In addition, there are approximately four senior (senior lecturer or professorial posts) that are currently vacant and the advertisements for the vitally needed Walport Academic Clinical Fellow and Clinical Lectureship posts were threatened.
14. There are financial disadvantages of undertaking a career in academic medicine that must be addressed. Clinical training in academic medicine will take longer than standard training due to periods spent undertaking research that ultimately provides tangible economic and health benefits to the NHS. These separate periods of pecuniary disadvantage accumulate over the course of a career.
15. For example, trainees that choose to spend time teaching or undertaking research are likely to be disadvantaged in terms of pay if salary is linked to the ‘intensity’ of work, or linked to university pay scales. Attainment of academic posts equivalent to SpR level requires completion of a higher degree – at which point trainees’ salaries are based securing a grant unconnected to the NHS pay rates. In addition, the length of academic training delays appearance on the consultant pay scale, there are restrictions on private practice and crucially, comparatively worse conditions and benefits by the substantive University employer.
16. Follett principles of ‘joint working to integrate separate responsibilities’ and the synergistic nature academic work must be properly acknowledged by both employers (A Review of Appraisal, Disciplinary and Reporting Arrangements for Senior NHS and University Staff with Academic and Clinical Duties - A Report to the Department for Education and Skills by Professor Brian Follett and Michael Paulson-Ellis, DfES 2001) . Despite the recommendations of Follett, employers do not fully recognise the need for balance between the three core areas – clinical, research, and education and training. The BMA is aware of examples where Universities press individuals to reduce their NHS commitment especially if they have over five NHS programmed activities in their job plan, without considering the impact this may have on research and service delivery. University and NHS employers must acknowledge the pressures each sector faces. There is a long overdue need to remove the problem of the Research Assessment Exercise rewarding non-science laboratory based research, to the detriment of clinical research and the doctors that undertake this research.
17. We note that the report recommends that “the UKCRC should develop a model framework for partnership working to improve university-NHS collaboration” (p73). We wholeheartedly support this recommendation and the Select Committee may like to note that the BMA has been working with the University and Colleges Employers Association on agreeing a Memorandum of Understanding on joint working. The Memorandum outlines the employment and joint working arrangements that usually apply in the case of staff engaged in both teaching and/or research as well as the delivery of patient care (The document covers those staff with honorary contracts engaged in both teaching and/or research as well as the delivery of patient care.) and should be published shortly.
18. We are also pleased that the report recommends that the funds to support the leaders of health research in the UK should be moved into the new single ring fenced budget and so safeguard the workforce which delivers UK health research.
19. The MASC calls on the Select Committee to ascertain from Sir David whether the Department of Health has supported the following recommendations:
- That the salary component of the funds for the Walport Clinical Academic Fellows and the Clinical Lecturers currently funded though the Department of Health’s Multi-Professional Education and Training Levy (MPET), be moved into the single ring-fenced budget for Research and Development and used specifically for this purpose
- That the funding for the Clinical Scientist Awards for post doctoral training of Clinical Lecturers (also currently falling within in the MPET budget) be moved into the single ring fenced budged and used specifically for this purpose
- That the funding for people doing research who are employed by both the NHS and universities whose salaries are currently funded via the patient care budget, should be identified and transferred it to the ring-fenced DH Research and Development budget and used specifically for this purpose
21. Finally, we further call on the Select Committee to outline the progress made by the UKCRC in discussions with the Department of Health in using incentives such as Clinical Excellence Awards to reward successful dissemination of research findings as indicated in the report (p78, 79)
Key to Terms
MPET
MPET stands for Multi Professional Education and Training levy (MPET). It is a funding stream from the Department of Health that funds the additional costs to the NHS of supporting the practice experience of medical and dental students. The single funding stream comprises the following levies NMET (Non Medical Education and Training), MADEL (Medical and Dental Education Levy) and SIFT (Service Increment for Training).
SIFT – The Service Increment for Teaching
The Service Increment for Teaching (SIFT) component of MPET covers the costs to the NHS of supporting the teaching of medical undergraduates. It is not a payment for teaching as such. For example, consultants in an outpatient clinic or a GP in a surgery generally see fewer patients if students are present. SIFT is intended to meet this sort of excess cost, rather than pass it on to healthcare purchasers.
MPET – Medical and Dental Education Levy (MADEL)
The MADEL component of MPET was introduced in April 1996 as a means of providing support for postgraduate medical education in the NHS and to support key central initiatives in medical education. The majority of the budget funds salary and non pay costs, which are identified as the training element of medical and dental training grade posts, as set out in EL(92)63. However study leave and the infrastructure costs of providing Postgraduate Medical and Dental Education are also funded. Funding for the salary element is based on the number of training posts accredited with the appropriate educational approval. Additional posts are funded via the Workforce Numbers Advisory Board's process of projecting national consultant requirements.