Select Committee on Health Written Evidence

Memorandum by NHS Education for Scotland (MMC 62)



  1.  To provide comment on: the Tooke recommendation to establish an arm's length body to oversee medical education in England, to be known as NHS Medical Education England (NHS MEE); and in particular the role of NHS Education for Scotland (NES), its role and work to date, its relationship with other bodies responsible for medicine in Scotland, its experience of MMC and its views, if any on whether such a body would be helpful in England.


  2.  NHS Education for Scotland has developed a unique model for commissioning and delivering education and training for the health professions. While there are some similarities to the model proposed by Tooke for NHS MEE, there are significant differences. NES is an NHS Health Board with responsibilities for commissioning and delivering training and education across the NHS Scotland workforce and does so to standards set by external regulators. It does not undertake workforce planning nor determine major policy on postgraduate medical education. These latter functions fall to the Scottish Government to which NES may provide advice. A focus on its key functions and responsibilities for commissioning and providing education and training coupled with close relationships with key partners are at the heart of NES's mission.


  3.  My name is Michael Watson. I am a physician and Medical Director of NHS Education for Scotland.


  4.  Here I set out what NES is and possible similarities with and differences from what Tooke has recommended for NHS MEE.

What is NHS Education for Scotland (NES)

  5.  NES is an NHS special health board accountable to the Scottish Government. It principal aim is to help provide better patient care by designing, commissioning, quality assuring and, where appropriate, providing education, training and life long learning for the NHS Scotland workforce. Its remit covers the allied health professions, dentistry, medicine, midwifery, nursing, pharmacy, psychology, audiology, as well as healthcare scientists and chaplains. It is intended that its remit will expand to include all staff groups in NHS Scotland.

  6.  Although much of the core work focuses on supporting individual disciplines there is a growing emphasis on taking a multi-disciplinary and multi-agency approach.

  7.  NES receives most of it funding from the Scottish Government. Currently the largest part of its total expenditure of £403 million is committed to supporting the salary costs of trainee health professionals (mainly doctors) and to the payment of Medical and Dental ACT (Additional Costs for undergraduate Teaching). About 12% provides for the educational infrastructure for the trainee groups described above and to provide specific training opportunities for certain other groups.

  8.  NES works closely with regional service and workforce planning groups established by the Scottish Government, to ensure that its commissioning arrangements meet workforce requirements and are compatible with effective service delivery. There are also close working relationships with relevant medical Royal Colleges and their representatives in Scotland. It was these close relationships that together made it possible to respond rapidly and effectively last year to the fallout from the failure of MTAS.

Interpreting the Tooke recommendations to establish NHS MEE in a Scottish context

  9.  Tooke made the following recommendation(s):

    "The Panel recommends the formation of a new body, NHS Medical Education England(NHS:MEE). This body would fulfil the following functions [the relevant related recommendations are referred to in square brackets]

      i.    Hold the ring-fenced budget for medical education and training for England [recommendation 23]

        Comment NES does not hold a direct and specific ring-fenced budget for medical education for Scotland. It is a multi professional Health Board with global funding provided to enable it to discharge agreed responsibilities across all heath professions.

        —  postgraduate medical education. NES is responsible for funding the base salary of almost all trainees. (Rather less than 5% of the medical training workforce currently remains directly funded by the service and then only for a diminishing number of one year Fixed Term Training Appointments). The service through 14 employing health boards provides any "additional component" of trainees' salaries—notionally the amount paid for additional duty hours. Again this element of trainees' salaries is diminishing. The training establishment is determined by the Scottish Government on an annual basis and informed by that the Board of NES determines the proportion of its budget to meet trainees' base salaries for the forthcoming year. Infrastructure costs eg for the operation of deaneries, funding for training courses etc. need to be found from within the overall NES budget and for which there are competing pressures. NES has a specific responsibility to commission training to meet workforce needs for some 57 specialties in different locations across Scotland.

        —  Undergraduate medical education. While five universities receive direct per capita funding from the Scottish Funding Council for undergraduate medical students, NES meets and performance manages the "Additional Costs for Teaching" paid to service health boards based on undergraduate training delivered within the service.

      ii.   Define the principles underpinning PGMET [recommendations 1, 2]

        While operational policies are largely determined by NES, the principles and policies underpinning PGMET, eg those relating to MMC, are determined through Scottish Government MMC governance arrangements in which NES participates. These in turn are considered within a UK context.

      iii.  Act as the professional interface between policy development and implementation on matters relating to PGMET [recommendations 3, 18]

        NES already fulfils that role in Scotland but it does not seek to be the sole source of advice to the Scottish Government on PGMET matters.

      iv.  Develop a national perspective on training numbers for medicine working within the revised medical workforce advisory machinery [recommendations 12, 13, 17]

        National workforce planning for Scotland across all health professions is a matter for the Scottish Government and on which NES may provide advice. In respect of postgraduate medical education, NES enables recruitment to meet establishment targets for each specialty set by the Government. The Government also separately determines the numbers to enter Scottish medical schools.

      v.   Ensure that policy and professional and service perspectives are integrated in the construct of PGMET curricula and advise the Regulator on the resultant synthesis [recommendation 14]

        NES maintains close links with the regulators: The Postgraduate Medical Education and Training Board as well as the General Medical Council with which it has a Memorandum of Understanding. Matters concerning the delivery of training to meet curricular standards and possible changes in the curricula to meet service requirements are considered.

      vi.  Coordinate coherent advice to Government on matters relating to medical education [recommendation 18]

        NES is one source of such advice though by no means the only one. For example the medical Royal Colleges and their faculties, often working through The Academy of Royal Colleges and Faculties in Scotland, provide advice to both NES and the Scottish Government.

      vii.   Promote the national cohesion of Postgraduate Deanery activities [recommendations 24, 25]

        This is a key task for NES. The four Scottish deaneries are not independent and are an integral part of the NES organisation and accountable to it. The four postgraduate deans report to myself as Medical Director.

      viii.  Scrutinise SHA medical education and training commissioning functions, facilitating demand led solutions whilst ensuring maintenance of a national perspective is maintained [recommendation 22]

        There is no analogous provision in Scotland. NES directly undertakes commissioning of postgraduate medical education and training across Scotland and does so in partnership with the profession and the service.

      ix.  Commission certain subspecialty medical training [recommendation 12]

        Sub-specialty and specialty training are commissioned in agreement with national establishments set by the Scottish Government.

      x.   Act as the governance body for MMC and future changes in PGMET [recommendation 6]

        The governance arrangements for MMC in Scotland lie with the Scottish Government (see ii above).


  10.  The NES approach to supporting health professional education and development may be unique. It faces significant challenges in making a balanced use of resources and in responding to demands for new and changing service roles.

  11.  One reason that this particular formula for delivering this service may be successful is that of scale. Scotland is geographically a large and diverse territory by UK standards making particular challenges for delivering education and training. Although its population approximates to a single large English deanery its distribution is variable. Scale then supports a key factor in enabling NES to meet its objectives—close working relations with key players and partners eg: the Scottish Government; the 14 health boards responsible for service delivery; as well as, importantly, independent Scottish and UK professional and regulatory bodies.

Dr Michael L Watson MD FRCP(Ed)

NHS Education for Scotland

17 March 2008

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