21. Memorandum submitted by the Council
of Heads of Medical Schools and Deans of UK Faculties of Medicine
THE FUTURE
OF HIGHER
EDUCATION WHITE
PAPER: IMPLICATIONS
FOR MEDICAL
SCHOOLS
1. Academic Medicine (i.e. medical schools
and their broad education, research and service agendas), supported
by close partnership with other university disciplines, other
health professions and with NHS service, is crucial to:
— the quality of the NHS workforce
and leadership;
— the development of NHS quality and
service innovation;
— one of the most substantial areas
of the UK research base on which biotech developments are heavily
dependent;
— industry, particularly the pharmaceutical
and devices industries;
— innovation and the economy in local
regions.
2. At the core of Academic Medicine are
around 3,000 "clinical academic" consultants employed
by the universities but holding honorary NHS consultant contracts.
One third of the Medical Directors for the major Teaching hospitals,
the majority of the Royal College presidents, the majority of
the medical signatories to the NHS Plan, and about half of the
NHS "czars" are clinical academics. Following the report
by Sir Brian Follett to the Secretary of State for Education and
Skills in September 2001, on his "Review of appraisal, disciplinary
and reporting arrangements for senior National Health Service
and university staff with academic and clinical duties",
there is now effective joint management and planning between universities
and NHS Trusts. A joint appraisal scheme has been introduced and
there are joint planning bodies at local level.
3. UK academic medicine has made a huge
contribution to both UK NHS and UK Plc as well as to global health.
Medical education has been a great success story, being both flexible
(eg Tomorrow's Doctors, General Medical Council, 2002) responsive
to change, eg the new undergraduate medical curricula, and medical
research has provided the basis for healthcare innovation, better
health and greater longevity in the UK and beyond. However, there
is a risk that implementation of policy decisions following the
White Paper and other recent developments may inadvertently damage
a generally very successful but deeply complex system. [Note that
academic medicine's role in clinical leadership, innovation and
service, in undergraduate (and to a substantial extent postgraduate)
teaching, and in clinical research are strongly interdependent.
Clinical academic departments contribute centrally to all three
and the great majority of individual clinical academics do so,
though not necessarily all at the same period of their careers.
Many junior clinical academics change track to become excellent
NHS consultants. The reverse is also seen.]
4. The expectation of what medical schools
will bring, for example, to the regions with the advent of the
new medical schools, flows from these interdependent functions.
The risk to new medical schools from some elements of the Higher
Education White Paper and associated funding decisions is of great
concern, in particular with the absence of mainstream funding
for research before the next Research Assessment Exercise (or
its successor). The General Medical Council's Tomorrows' Doctors
states explicitly that every medical student should during their
undergraduate training "use research skills to develop greater
understanding and to influence their practice". This implies
that they should learn in a "research-rich" environment.
Funding decisions with respect to the new medical schools are,
therefore, at risk of compromising their ability to fulfil the
GMC's requirements. Their ability to recruit and retain high quality
staff is equally threatened by the funding decisions. These problems
also risk seriously damaging some existing Schools if current
trends in funding become intensified.
5. Currently there are several major issues,
which unless effectively resolved risk very seriously damaging
the complex synergies between the clinical and academic roles
and between medical schools, the NHS and regional economies:
— Intense pressure of short-term clinical
service-led goals and for immediate clinical delivery;
— The unresolved uncertainties on the
NHS consultant and GP contracts for clinical academics;
— Concern that there is no reference
to teaching in the GP contract;
— The reform process on Modernising
Medical Careers in the NHS and its impact on academic medicine;
— The impact of the White Paper on
the Future of Higher Education and associated funding decisions:
— Top-up fees for tuition and financial
support for medical students;
— Increased research selectivity
and concentration, resulting in overall reduction of approximately
7% in research funding for 2002-03 and major reallocations between
medical schools for 2002-03 and 2003-04;
— Cuts in research funding for
Medicine are a result of:
— 6% cut in the weighting for clinical
research for 2002-03;
— Transfer of Generic Research
funding, which was predominantly related to medical charity funded
research, to mainstream QR funds for 2002-03, and therefore spread
more widely;
— Reduction in the weighting for charity
funded research for 2003-04;
— Loss of funding for RAE 3a-rated
research and substantial reduction in funding of 4-rated research
for 2003-04 and possibility of loss of remaining funds for 4-rated
research in the future;
— Reduced teaching funds for Medicine
to allow widening participation in other disciplines (eg approximately
5% reduction in English universities' teaching grant for Medicine
for 2003-04).
However, the severity of any damage will depend
on how far the universities of which the medical schools form
a part are able to protect their medical faculties.
6. Thus, in developing policy, Ministers
and Departments need to be aware of these complex and interdependent
issues and of the risk of unexpected damage if they are not taken
into account in policy decisions and their implementation. CHMS
suggests that further consideration be given to the working of
the partnership between the Education and Health Departments,
the Office of Science and Technology, and HEFCE—including
the strategic alliance between HEFCE and the Department of Health—having
regard to the central role of academic healthcare and the increasingly
important interconnectivity within universities between the clinical
and bio-sciences, and more recently the other social and physical
sciences.
7. The range of issues arising from the
White Paper and related policy developments are complex. The implications
must be adequately investigated and modelled so that a sustainable
approach to the provision of healthcare education and service,
and the conduct of research to support healthcare innovation,
can be developed.
March 2003
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