Memorandum by NHS Education for Scotland
(MMC 62)
MODERNISING MEDICAL EDUCATION
PURPOSE OF
REQUEST FOR
WRITTEN EVIDENCE
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.
EXECUTIVE SUMMARY
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.
SUBMITTER
3. My name is Michael Watson. I am a physician
and Medical Director of NHS Education for Scotland.
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).
COMMENT
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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