Written evidence from the MASC to supplement Jonathan Fielden’s evidence to the Health Select Committee’s inquiry into NHS deficits
2nd November 2006
Background
1. Previously MPET (See key to terms at end of document for definitions) money was a direct central allocation to NHS organisations but in 2006, a number of budgets were given to directly 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, DH.) The select committee should give consideration to ring fencing the MPET budget once again.
2. 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”.
3. 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 SIFT and 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% |
4. 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 - SIFT/MADEL.
5. 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 as moves the emphasis away from teaching and increased pressure to devolve undergraduate medical education from Universities to NHS/MPET funding. Thus while universities retain administrative and curriculum control, in practice, the majority of teaching particularly in the clinical years, is carried out by personnel whose salaries are funded by SIFT/MADEL.
6. Ironically, despite the significant decline in the clinical academic workforce over the past five years, the number of vacant posts 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).
7. The continued delivery of medical education by medical academics was only just manageable by the reduction in academic numbers (standing at 85% of the workforce in 2000) and the funding shift to the NHS. However the threat to academic posts by MPET funding cuts puts 100% of teaching in the NHS at serious risk. Further pressure on funding would make the delivery of medical undergraduate education in many medical schools unsustainable. There are currently around 35,000 students in UK medical schools.
Job losses
8. The DH reports 167 clinicians have lost their jobs due to efforts to reduce NHS deficits; we are unsure of how many of these are doctors.
9. The pressure for job cuts, especially teaching posts, appears fairly high. There is a real concern that funding cuts will reinforce a continued high vacancy rate amongst medical academics, especially if money is not available to recruit to vacant positions.
10. 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.
11. For example in Leicester, the Chief Executive of University Hospitals Leicester Trust has written to the Vice Chancellor of the medical school 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 yet 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 – i.e. 11 or 12 posts. In addition, there are approximately four senior (senior lecturer or professorial posts) that are currently vacant in Leicester. It is doubtful these posts will be filled if the requisite funds have been cut.
12. If the cuts proposed in Leicester are replicated in other SHAs, undergraduate medical education will be severely disabled, with patient care also likely to suffer (as these doctors undertake clinical work and research, as well as teaching).
Particular groups of healthcare professionals affected by the deficits and cuts in education and training
13. Medical students will be directly affected by the deficits and cuts in education and training. SIFT monies go towards funding of clinical teaching salaries and infrastructure to support medical students. If the number of teaching posts in the NHS and the universities dips below a critical level, it would endanger the viability of teaching and potentially the medical school itself.
14. In Leicester, the anticipated cuts have been the subject of discussions between the Dean and medical student representatives. Concern has been that reduced resources could ultimately lead to loss of GMC accreditation of the Leicester medical course, and loss of jobs.
15. Concerns about SIFT funding have been reflected in conference motions to the association’s annual policy making meeting, in particular the potential reduction in teaching resources in medical schools and consequent impact on teaching. There is a concern that a lack of teaching staff and increases in class size will compromise standards of training for students.
16. In addition, it is anticipated that the cuts would have a detrimental effect on opportunities for medical student clinical experience, with fewer clinical placements being available.
How the deficits have affected staffing issues
17. For medical academics there is the potential for removal of clinical sessions paid to doctors to teach medical students. Further cuts are likely to enhance this climate.
18. Morale is already low amongst medical academics, whose population is already severely depleted while medical student numbers are at an all time-high.
How patient services have been affected by the deficits and changes in staffing levels
19. In Leicester, where clinical academics are reliant on MADEL and SIFT to fund their salaries, patient care would suffer as a result of deficits/changes in staffing levels because:
- 58% of Leicester academics are NHS funded
- Clinical academic staff in medicine and surgery spent at least 60 per cent of their time treating NHS patients.
21. Clinical academics undertake research which is used to improve clinical outcomes. They therefore play an important long term role the delivery of patient care, which would be undermined by funding cuts.
What impact the deficits will have on employment, training and the future recruitment of health professionals
22. Two elements - the shift in funding of medical academics toward the NHS, and the haemorrhaging of the medical academic workforce – are likely to be exacerbated by funding cuts.
23. Cuts to the funding streams that support academic salaries are likely to negatively affect the existing vacancy rate, especially at medical schools that have high NHS funding ratios.
24. Recent initiatives to increase the numbers of clinical medical academics in the UK through the introduction of the Walport trainees already appear to have suffered. In Leicester, there has been a cancellation of advertisements for Walport Academic Clinical Fellows. The introduction of clinical fellowships and clinical lectureships were announced to provide opportunities for academic careers and are designed to prop up the declining academic workforce (Introduces new academic training pathway for trainees that fits into the MMC structure and follows recommendations in the report by the Academic Subgroup of MMC 'Medically- and dentally-qualified academic staff: Recommendations for training the researchers and educators of the future')
25. The NHS is currently developing a strategy to form a National Institute for Health Research (NIHR) which will bring together funding from NHS Research and Development and the Medical Research Council to make England internationally competitive in clinical research, and help UK-based biomedical science industries. A central proposal is to establish an NIHR Faculty, and it is envisaged that appointees to the faculty will be part funded by existing training and education budgets. Cutting medical academic funding will therefore affect this initiative, and is also likely to severely damage the fledgling academic training scheme which was aimed at renewing the depleted numbers of clinical academics (the Walport Clinical Academic Fellows and Clinical Lectureships mentioned above).
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). A recent Department of Health
(DoH) consultation Funding learning and development for the healthcare workforce proposed that the MPET funding should be reorganised on an interdisciplinary basis, ending the rigid demarcations between NMET, MADEL and SIFT. This change is likely to be accompanied by a new name for MPET.
Undergraduate SIFT
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