Government reform of Higher EducationWritten evidence submitted by the British Dental Association
Executive Summary and General Points
1. The British Dental Association (BDA) is the professional association and trade union for dentists practising in the UK. Its 23,000-strong membership is engaged in all aspects of dentistry including general practice, salaried services, the armed forces, hospitals, academia and research, and includes students.
1.1 The BDA was disappointed that the Browne Review did not address clinical subjects more specifically and did not show a greater awareness of the specific issues facing students and academics on long courses.
1.2 The BDA is concerned that higher fees combined with the length of the course may prove to be a disincentive to students to choose dentistry as a career. What is needed is a full impact assessment based on robust evidence to assess the changes in admission that increasing fees for dental courses will result in and we urge the government to address this as soon as possible.
1.3 Such a disincentive may severely reduce the number of students from low income or black or minority ethnic group families who choose to pursue a career in dentistry. Such a lack of diversity in the workforce could be potentially damaging for future patient access.
1.4 Although the BDA accepts the government’s conclusions about lower monthly payments, we remain concerned about the impact of lifetime debt on young dentists’ career choices. For instance, there are strong suggestions that the NHS, academia and community dentistry will become less attractive career choices and that young dentists will not want or feel able to purchase practices when their levels of personal debt are higher.
1.5 Higher levels of debt accrued during undergraduate studies may also deter students from engaging in postgraduate training and education.
1.6 While the BDA supports the need for reform to higher education, we urge the committee to recognise that finance is not the only determinant of career choice. For instance, dentistry, like other clinical subjects, requires a solid understanding of science and it is imperative that suitable careers advice exists for students from a younger age to enable them to access certain courses and make a balanced decision for their career.
1.7 Secure funding for academic dentistry must be maintained in order to ensure that universities are in a position to match supply of teaching to demand for places.
Response
2. The British Dental Association welcomed the review of higher education funding and participated in the consultations. We were disappointed to note, however, the lack of specificity in the final report. A more detailed focus on the particular issues that face longer courses and courses with multiple funding streams would have been welcome. We hope this will be addressed in the White Paper.
3. The BDA is concerned that raising the level of fees for higher education could have a severe impact on the future of the dental profession. We urge the Department of Business, Innovation and Skills to maintain a clear line of communication with Medical Education England (and its successor bodies) to ensure that adequate workforce planning is undertaken to assess the impact of higher education reform. The NHS reforms suggest that workforce planning should be performed at a local level, based on local needs. The impact of this on university admissions for dental courses is hard to predict and we urge the relevant departments to work together to mitigate the impact of the reforms on access to dental courses.
4. The Browne Review’s recommendations reflect the challenging economic climate. We are worried, however, about the impact the proposed reforms will have on students choosing to study dentistry. We would expect a full evidence-based analysis of the impact of raising fees for clinical courses, in particular as they are vital for the future of health provision. Dentistry is a longer-than-average undergraduate course and so will result in higher-than-average levels of debt. Indeed, our preliminary projections suggest that debt could reach up to £57,600 for some dental students
5. Our most recent survey on student debt showed that dental students are currently graduating with an average £25,545 of debt, compared to the average student debt of £16,614. This represents a 128% increase from 2000. The government has acknowledged that increased costs are a strong determining factor for students considering university courses. We seek assurances that a full analysis of the impact of price sensitivity on longer, and thus more expensive courses, will be undertaken. 81% of students received additional funding support from their parents, and this is, obviously reliant on parents being able to afford to help. If parental contributions are necessary, this has the potential to severely limit the opportunities for students from lower income families. If fees increase further, many parents may find themselves unable to assist their children. We consider it counter-productive for students to have to focus on financial concerns when they should be focusing on studying. Current students find the drop in income in their fifth year disruptive to their studies without the increased fear over unsustainable levels of debt. Students on shorter or non-clinical courses also generally have more time, in the evenings, weekends or during summer holidays to work to minimise their levels of debt. This option is not tenable for dental students in the fifth year of study whose week of study is often the same as an average working week.
6. Offering bursary assistance to students from disadvantaged backgrounds may not be enough to encourage them to enrol in longer or clinical subjects. Not only is there the issue of greater debt, which may be more off-putting for those from lower income backgrounds, but there is the simple problem of admissions. Dentistry is a clinical subject and requires knowledge of basic sciences such as chemistry and biology. If there is not sufficient investment in secondary education, or adequate careers advice at an early stage, then students from lower incomes may be poorly represented in higher education for clinical subjects.
7. In March 2009, the BDA raised the issue of high levels of debt having an impact on applications from students from lower income families. Raising the tuition fee barrier may well reduce applications, even if extra funding is available, as information about funding is not always easily accessible. Like medical courses, dental courses are often under-subscribed by students from lower socio-economic groups and the rise in tuition fees may exacerbate this. Many students prefer to study closer to home, a trend we expect to increase if fees are higher. With only 12 dental schools, this tendency will have an impact on who will consider studying at a dental school as a viable option.
8. We accept the government’s argument that the weekly re-payments will be manageable and that they will have no impact on future abilities to borrow money for a mortgage, for example. Dental services in the UK are, however, reliant on private investment to practices. If debt is higher and takes longer to repay, the impact that this will have on future dentists’ decisions to buy or set up in practices must be considered. Current government subsidies for dentistry are very low compared to GP practices. Combined with rising expenses and reductions in earnings, an increased level of debt may have a significant impact on the number of students choosing dentistry as a career. We urge the Department of Business, Innovation and Skills to work with other relevant departments, the General Dental Council and Medical Education England (and its successor bodies) to limit the potentially damaging impact of these reforms on the future workforce.
9. An additional concern that applies to dental students rather than medical students is the lack of incentive to work in the NHS. Not only are there not enough salaried positions in the NHS, if debt is higher it is natural for students to seek to maximise their earning potential. With the potential decline in the number of practice owners (see comments above) the NHS may well suffer from a lack of dentists in the future. This tendency was borne out by the BDA’s 2010 student debt survey where over one third of students said that debt would influence their career path and encourage them into private, rather than NHS, practice. This could be exacerbated if dentistry is included as a subject justifying the highest tier of fee charges.
10. The need to reduce high debt as quickly as possible would, we believe, also have a deleterious effect on academic dentistry or community dentistry as both are less well remunerated and require postgraduate training and education for progression. There is already considerable evidence of recruitment difficulties in these spheres and the outcome of the changes could be disastrous for the future of the profession.
11. We seek reassurance that dentistry will continue to be recognised as a clinical subject. That this will be the case has been indicated by David Willets MP in response to a Parliamentary Question on 08 November 2010. The importance of this is that it will ensure that part of the cost of training continues to be met by government. There has, however, been no confirmation about what proportion of the costs will be met. We urge the committee to seek clear figures on this important issue.
12. The BDA has worked with other representatives of professions that have a similarly long period of study and rely on a mixture of NHS and BIS funding to simplify the bursary system. There has been no progress on this, despite agreements having been reached in early 2010. Anne Milton MP, in a letter to the BDA, British Medical Association, Unison, Royal College of Nursing, National Union of Students and Royal College of Midwives stated that a “fair and affordable financial package” should be available by March 2011. The BDA urges BIS to ensure that reform of the dual funding stream for students on clinical degrees is not further delayed.
13. We welcome the government’s commitment to reducing bureaucracy and ensuring that, as far as possible, higher education funding is directed to teaching. It is important that in this financially challenging time, cross-subsidy of other courses and of research is not allowed to reduce the resources intended for teaching. An intermediary body between individual institutions and government is necessary and the creation of a reformed HEFCE is welcomed. The future of higher education involves more than just adjusting fees. To safeguard the dental profession and to justify the application of different fees for different courses, the BDA recommends that universities publish transparent accounts of how student fees support the teaching of the course they are on. As dentistry is a long course and requires significant planning for future numbers, we recommend that the government has a clear policy for ensuring that there are adequate numbers of academics to fulfil possible future demand. Clinical academic staff must retain parity with NHS. The BDA cautions against proposals to allow the expansion of private universities opening medical schools, to which dental schools are affiliated. The private nature of these entities would have serious implications for workforce planning and potentially undermine the clinical professions.
10 March 2011
References
British Dental Association Student Debt Survey 2010 August 2010, available from http://www.bda.org/Images/student_debt_report_2010.pdf
British Dental Association evidence submitted to the Panel on Fair Access to the Professions March 2009.
Hansard Written Answers 8 Nov 2010: Column 146W, available from
Higher Education (England) Regulations 2010.
Sutton Trust, P Davis et al, Knowing where to study: fees, bursaries, and fair access, 2008.