Evidence submitted by Universities UK
(WP 65)
INTRODUCTION
1. Universities UK, the body which represents
the Vice-Chancellors and Principals of UK universities and some
higher education colleges, is pleased to submit evidence to the
Health Committee to aid its inquiry into workforce needs and planning
for the health service.
BACKGROUND
2. The partnership between universities
and the health service encompasses teaching, research and service
delivery:
— Universities provide virtually all
the pre-registration education for the nation's doctors, dentists,
nurses, midwives and allied health professionals. There were approximately
489,000 health professions and medical students studying in UK
universities in 2003-04. [143]This
represents 22% of higher education students.
— Universities also provide most of
the clinical and basic medical research on which the future of
UK healthcare depends.
— Universities' 6,000-plus clinical
academic staff make a substantial contribution to patient care,
often in positions of leadership.
3. Student numbers have expanded to meet
health service demands as set out in the NHS plan:
(a) Medical student intakes have risen by
around 50% since 1999 and four new medical schools have been established.
One hundred additional places will be available in 2006-07.
(b) In 1999-2000 there were 60,000 undergraduate
nurse students in higher education; in 2003-04 that number had
risen to 83,000.
(c) Student dentist intakes have increased
by approximately 200 students per annum in 2005-06, and a new
dental school is being established in the South West.
4. Other European health systems face similar
workforce problems to those in England[144]—in
particular, inadequate infrastructure to support workforce development
and fragmentation which leads policymakers to focus on individual
health workers or a specific aspect of the system, instead of
the wider picture. The result tends to be short term, ad hoc
interventions to redress specific shortages, rather than a
wider approach that takes account of the long lead times for professional
education, and the social and economic environments that concern
service users and health workers.
ISSUES
5. The issues of relevance to higher education,
and on which we will focus in this submission are:
(a) the increasing use of private providers
(and the impact this has on practice placements etc);
(b) increasing international competition
for staff (and the extent to which UK can move to a situation
of self-sufficiency in preparing the health care workforce);
(c) changing the roles and improving the
skills of existing staff (and how education can support this);
(d) the desirability of centralised/decentralised
planning (and how HE engages with this); and
(e) examples of good practice in all/any
of the above.
THE INCREASING
USE OF
PRIVATE PROVIDERS
OF SERVICES
6. The increasing use of private providers
in the health service may be a threat to training capacity at
pre-registration and post-registration level. With routine cases
being diverted from the NHS, clinical placements there will become
less suitable for basic level student training, where practicing
elementary skills is essential. While some universities have negotiated
private sector placements, usually free of charge, the private
sector is not obliged to provide these. Since placement shortages
are one of the main limits to education capacity, the future contribution
of the private sector and foundation trusts in health service
education and training, needs to be clarified and formalised.
At present, it is assumed that the Department of Health (DH) will
fund pre-registration education for virtually all health professionals
in England, and also support the necessary clinical practice for
qualification for professional registration.
7. There are historical differences in funding
for practice experience between health professions and medicine;
in the case of the latter, Service Increment for Teaching (SIFT)
funding is available. Greater flexibility about how that funding
is used may assist with the number and range of clinical placements
available to all professions in future.
INCREASING INTERNATIONAL
COMPETITION FOR
STAFF
8. UK reliance on overseas healthcare workers
has increased markedly over the last 10 years. In 2003, 11,000
overseas doctors registered with the GMC, and over 15,000 overseas
nurses registered with the NMC. This activity has to be set against
the backdrop of an increasingly mobile world population—in
1965, 75 million people migrated; by 2000 the figure was estimated
to have doubled to 150 million.
9. Many see the current situation, where
a considerable proportion of the healthcare workforce come from
developing countries, as unacceptable and unsustainable in the
long run. Universities UK's Health Committee is seeking to work
with relevant agencies to mitigate the adverse effects of migration
by health professionals from developing countries.
10. Meanwhile, there is increasing international
competition for staff, particularly from the US and Australia,
which could make UK's traditional reliance on overseas healthcare
staff unsustainable. The rate of applications to sit PLAB (the
initial pre-requisite for doctors wishing to come to this country
to work) has fallen dramatically in the past year. Anecdotal evidence
suggests that medical graduates are choosing alternative destinations
because of difficulties in finding employment in the UK. While
self-sufficiency in the health care workforce is desirable, it
may not be realistic—James Buchan[145]
has calculated that to end reliance on international entrants
to nursing would require a 17% increase in successful home entrants.
Currently the DH is reducing education and training commissions
for these students.
CHANGING THE
ROLES AND
IMPROVING THE
SKILLS OF
EXISTING STAFF
11. Service needs are changing in line with
public expectations, new technology, and an ageing population.
Services are shifting to the community sector and there is increasing
integration with social services. DH and DfES are currently working
together on "Options for Excellence", a review of social
work and social care. The knowledge base and skill mix health
professionals require is also changing. Professional preparation
is more than training—it is the basis for lifelong learning,
helping to ensure that practitioners remain safe and competent
throughout their careers.
12. HEIs work closely with the health service
on an ongoing basis to support changing staff roles and improve
staff skills; however, some of these developments are occurring
in an unplanned and haphazard way—a strategy that identifies
the roles and training needs of future health professionals, and
is agreed among all stakeholders (health care providers, commissioners,
the Department of Health and education providers) would provide
coherence and reduce uncoordinated duplication of effort. It would
also entail close collaboration with professional regulatory bodies
whose caution in dealing with such changes can slow down recognition
of innovative and flexible training mechanisms eg skills labs.
13. If the wider shape of the workforce
can be agreed, its educational requirements can then be determined,
and curriculum planners and NHS managers can work together to
ensure appropriate programmes are delivered and systematic evaluation
of the outcomes of the education process, particularly for some
of the emerging new practitioners, are undertaken. Educational
providers are aware of service changes, and can help employers
anticipate and train staff for the new delivery mechanisms that
are emerging; the integrated team working that will be necessary
across primary care settings; the more holistic approach to health
promotion and disease prevention; and new arrangements for social
care and mental health services.
14. Universities also need to consider their
own healthcare educator workforce. Submissions from CHMS and CDDS
detail the declining clinical academic staff population, and the
difficulties in recruitment at a time of student expansion. For
the nursing and health professions workforce, the limitations
on moving between the two sectors have been an obstacle to developing
this workforce, and attracting new cadres of younger educators
and researchers. This is a particular concern, bearing in mind
the age profile of this workforce, and the likelihood of high
numbers of retirements over the next 10 years.
THE DESIRABILITY
OF CENTRALISED/DECENTRALISED
PLANNING
15. Planning the overall structure and approach
to health care delivery has to have a national focus, which takes
account of overall population health, and includes primary care,
acute care, health protection and promotion. This also ensures
that smaller, specialist health services and their educational
preparation are not neglected. The need to take a wider cross-professions
approach was recognised in the DH workforce planning structures
introduced in 2001, but changes to those structures have not allowed
the approach to embed itself and develop the capacity to look
critically at how planning for separate professions is fully integrated.
16. The ongoing discussions between the
higher education sector and the DH about health professions education
for the coming two to three years give an indication of the difficulties.
HEIs are currently being asked to make cuts of up to 30% in their
health care student intakes for 2006-07. It appears that these
figures are based on financial projections, and not workforce
needs. It is not clear when commissioned numbers will be finalized—on
occasions, StHAs have requested changes in August, for September
intakes. In Scotland, funding for healthcare students flows via
the funding council, which works with the health department to
make announcements in December for student intakes in the following
September.
EXAMPLES OF
GOOD PRACTICE
IN ENGLAND/ELSEWHERE
17. One innovative way of approaching planning
has been suggested by a new medical schools: it is managed by
a Joint Venture Board which comprises the CEOs of the local Health
Care Organisations along with senior members of the University.
This provides a forum where the impact of changes in health care
on the educational programme can be openly debated and plans to
take these changes into account developed.
18. Some StHAs have worked with their partner
universities to develop a longer term (eg five year) perspective
on workforce needs in their region. However, this seems to be
the exception at present, but a model that may have wider application
across England, with scope to feed into a more coherent overall
plan.
19. Universities UK would welcome the opportunity
to give verbal evidence to the Health Committee if required.
Professor Janet V Finch
Chair, Universities UK Health Committee
17 March 2006
143 Higher Education Statistical Agency 2003-04. Back
144
Human Resources for Health, European Observatory on Health Systems
and Policies, 2006. Eds: Carl-Ardy Dubois, Martin McKee, Ellen
Nolte. http://www.euro.who.int/Document/E87923.pdf Back
145
Paper provided for Universities UK Health Committee, August
2005. Back
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