Select Committee on Education and Skills Written Evidence


Memorandum submitted by The British Medical Association (BMA)

  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.

  The BMA's Medical Students Committee and Medical Academic Staff Committee have considered the terms of reference for the inquiry and our comments, focussing on medical education, are set out in this paper.

ROLE OF UNIVERSITIES OVER THE NEXT 5-10 YEARS

  1.  Medical students want adequately resourced, good quality education and training that will result in a professional degree and lead them to registration with the General Medical Council.

  2.  Medical students wish to see the current broad-based educational arrangements remain in place. A good doctor is one with the creativity and initiative to recognise the issues a patient has and who takes steps to address those issues. They must also have sound clinical knowledge and skills. Currently medical schools have autonomy to deliver teaching and training in a way that ensures students are equipped to meet these requirements. This variety of approach between medical schools allows a student to choose a course type that best suits their learning style, and we believe this is key to creating an environment where the student can learn effectively. This is of benefit to the profession and patients by enabling students to fulfil their greatest potential as doctors. A variety of educational methods broadens the skill mix within the profession with the ultimate goal of constant improvement in patient care.

  3.  Medical education and training in the UK is held in high regard outside the UK. In order to ensure that it remains of a high standard, it is vital that adequate funding is available. Universities have a key role to play in recognising the value of medical teaching and in hosting an environment where medical teaching careers can thrive. The quality of medical education is under significant threat from the reduction in clinical academic staff at a time when the medical student population has increased markedly. The quality of education is further threatened by instability in funding in the NHS of medical academic staff. Many Universities have responded to changes in the curriculum by increasingly devolving the delivery of medical student education to the NHS. This is happening at a time when budget cuts in NHS funding and tightening of supporting activities in NHS contracts are affecting the delivery of undergraduate education.

  4.  Increasingly, Universities will have a role to play in contributing to the UK economy through innovation and excellence in health research.[27] This will require better coordination between Universities, the NHS, pharmaceutical companies and medical device companies and an ongoing recognition of the synergy between education, research and clinical practice in medicine.

  5.  The need for greater University collaboration is especially vital given the dual funding of academic medicine. Current NHS deficits and corresponding cuts in funding for medical education will, we believe, directly affect teaching posts and medical students, potentially in the longer term[28]. If the numbers of teaching posts are reduced the viability and quality of teaching in the NHS and medical schools, as well as schools themselves, will be endangered. This will have a consequent adverse effect on the future medical workforce and impact on patient care. This is compounded by the current problems with Modernising Medical Careers (MMC) with the fear that up to 5000 doctors currently in training could be sidelined into non-training posts.

  6.  Universities need to play a key role in ensuring that the medical profession reflects the composition of society and therefore schemes encouraging school students to apply to medicine should target students from backgrounds that are under-represented in the medical profession. We believe that measures to widen participation in medicine must be targeted specifically at medicine as well as the whole university to which the medical school belongs. We are concerned that there are currently significant barriers to entry to medical school from students from lower socioeconomic backgrounds, particularly that the costs for students are prohibitive.

  7.  Figures from UCAS[29] demonstrate that there has been no change in the socio-economic number of applications to pre-clinical medicine for 2006 with 19% from the lower groups 4 to 7 submitting applications. This is of concern both to the Department of Health and the BMA.

UNIVERSITY FUNDING

Lifting the cap on student fees

  8.  We strongly believe that the £3,000 cap on student fees should not be lifted after 2009. Student fees are already affecting applications/admissions to universities and to medical schools within universities with a 4% decline in applications to universities and an almost 3% decline[30] in applications to medical schools. This is at a time when student debt is at an all-time high. Lifting the cap would we believe aggravate this situation.

  9.  Results from the BMA's annual medical student finance survey[31] demonstrate that the average amount of debt for a medical student was £12,657 and the highest figure was £53,350. Average total debt increased markedly by year of study and ranged from £6,920 for first year students to over £22,000 for students in their sixth year. Thirteen per cent of respondents had total debt exceeding £25,000, and amongst fifth and sixth year students this proportion was considerably higher at 26% and 44% respectively. Six percent of respondents had total debt exceeding £30,000. The high debt levels are explained by the fact that medical students study for two or three years longer than those on most other courses, have fewer opportunities to work part-time, and face additional expenses for travel to hospitals, and equipment.

  10.  Lifting the cap would severely exacerbate medical student debt. We are concerned that this may deter able individuals from studying medicine particularly those from lower socio-economic backgrounds.

Medical degree funding

  11.  Funding for medical degree courses is complex and lacks transparency. There are a broad and complex range of finance streams and it is difficult to obtain information about spend on medical education and training.

  12.  Given that block grant funding for medical education comprises a significant proportion of the total central funding for higher education institutions and all medical students will pay £3,000 per year in tuition, there is a clear need to improve transparency in funding within medical schools and Universities.

Funding cuts

  13.  At some medical schools, and in some specialties, the proportion of NHS funding for clinical academic posts is much higher that Funding Council funding[32]. This year, NHS funding cuts have a detrimental effect on teaching with Universities struggling to manage their finances for medical degree courses. First quarter performance for the NHS[33] indicates that Strategic Health Authorities 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".

  14.  At the same time, 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. 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 and an associated shift of undergraduate education to the NHS. Further pressure on funding, from either funding source would make the delivery of medical undergraduate education in many medical schools unsustainable, given there are currently around 35,000 students in UK medical schools.

  15.  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. The current vacancy rate is 7% of the total number of clinical academics and vacancies are especially prominent in senior academic positions—in 2005 there were 91 professorial vacancies.[34]

Flexible central funding

  16.  The University funding structure, especially the Research Assessment Exercise (RAE), has the effect of discouraging excellence and quality in teaching, in spite of the significant and increasing amount that students are expected to personally contribute to their tuition.

  17.  Despite the substantial in increase medical students (10,000 over the past 5 years), discretionary funding through the RAE has encouraged medical schools to expend disproportionate amounts of energy on attracting money for research at the expense of teaching and there is a real risk that medical teaching and medical teachers are devalued. The result is that medical teaching and its quality control has been shifted to the NHS which is under threat from a number of quarters. For example:

    —  There is a tightening up of consultant contracts and a corresponding loss of planned time for teaching through supporting professional activities in job plans.

    —  NHS money for medical education through the Service Increment For Teaching Money (SIFT) money has been mis-spent on clinical work rather than teaching. In the current climate of NHS deficits, the concern is that any cuts from this budget line will preserve money spent on clinical work to the detriment of money for education.

  18.  The present RAE actively discourages a vigorous teaching culture in Universities, as it disengages teaching from research by assessing them in different ways. Active attempts should be made to integrate research and teaching through funding mechanisms.

  19.  The measures of RAE assessment used until now have been criticised for their narrow focus and a tendency to reward laboratory based projects instead of human studies, and hence an overall failure to adequately measure the contribution of medical academics to clinical research.

  20.  University funding should give due consideration to the differential requirements of professional groups in defining quality. For medicine, funding must acknowledge innovation in clinical research where innovation or change in practise is usually the result of several (as many as four or five) complementary studies and give appropriate credit for the contribution of each piece of research made to the advancement of clinical practice. Furthermore, research quality for medicine ought to value applied/translational research, as well as basic science, to break down the divergence of research outcomes that are expected of clinical academic staff by Universities and the NHS.

CONCLUSION

  21.  The high quality and standard of medical education and training in the UK should not be eroded by lack of funding.

  22.  Medical students should have an expectancy that the fees they pay will be hypothecated towards furthering their education. As medical students pay £3,000 per year of study and leave university with significant debts and a less stable employment market, this expectancy should be met. Universities should set up transparent funding mechanisms to ensure that students are getting value for their money.

  23.  Lifting the £3,000 cap on student fees is, we believe, unacceptable. This will adversely affect applications to medical schools and for those who study medicine would have a severe impact on student debt, particularly for those from lower socio-economic backgrounds.

  24.  In addition, there is a clear need to for medical teaching to be valued and better integrated into funding arrangements than at present. These funding arrangements need clarity and openness.

  25.  The quality of undergraduate medical education should not be compromised by the significant increase in medical students and massive decline in medical teachers. Adequate funding to support teaching in medical schools is therefore essential. There are potential tensions in the funding system which also spans health sector (the latter budgets have been raided to fund NHS deficits. Quality undergraduate medical education also relies on synergy between teaching, research and clinical environment.

THE BOLOGNA PROCESS

  The Bologna Declaration has the potential to change the face of medical education as it currently stands, and consequently the experiences of the profession and those it serves. The nature of the delivery of medical education proposes additional challenges to the implementation of the Declaration and this needs to be considered before wide reaching mechanisms are implemented throughout higher education. Whilst aspects of the Declaration have possibly detrimental affects through loss of diversity and individual country autonomy through the bachelors/masters system, increased quality assurance and collaboration throughout Europe provide a valuable opportunity to enhance European achievement. It is essential that UK stakeholders drive forward discussion regarding the implementation of the Bologna Process in order to have optimal results for the profession as a whole, in both the UK and Europe.

December 2006

http://www.bma.org.uk/ap.nsf/Content/Studentfinance0506?OpenDocument&Login



27   Drive to boost Clinical Research 14 December 2006, http://www.timesonline.co.uk/article/0,,5-2502546.html  Back

28   House of Commons Health Committee, NHS Deficits, First Report of Session 2006-07, Volume 1, 7 December 2006. Back

29   Applicants to Pre Clinical Medicine & Dentistry Received by June 2006-UCAS. Back

30   UCAS figures for 2007 entry, News Release, 31 October 2006. Back

31   BMA,-Survey of medical student finances 2005-06. Back

32   Across the UK, clinical academic salaries are 38% NHS funded, rising to 66% (Leicester), 71% (Bristol and over 90% (Swansea and Keele). Source: Clinical Academic Staffing Levels in UK Medical and Dental Schools, A data update by the Council of Heads of Medical Schools June 2006. Back

33   NHS financial performance-Quarter 1 2006-07, Department of Health. Back

34   Clinical Academic Staffing Levels in UK Medical and Dental Schools, A data update by the Council of Heads of Medical Schools June 2006. Back


 
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