Professor Michael Rees, co-chair of the BMA’s medical academic staff committee, addressed the Conference of Medical Academic Representatives earlier today. Here’s his full speech:
In dealing with a new government in a time of austerity we should have expected a large number of changes and new directions for medical academia. And this has certainly proved to be the case.
Our first priority over the last year has been to remind the government of the importance of medical academics in the viability of our science research and teaching base in the UK. I believe this message has been heard. What clearly has not been heard is the ability to make this funding effective in the light of changes proposed in the new Health and Social Care Bill.
Changes to the funding of our universities, modifications to the funding of clinical teaching via SIFT, and the new Health and Social Care Bill in England all threaten to destabilise further medical academia in this country and with it the valuable contribution medical academics make to UK plc via the NHS, our universities and via industry.
We need to remind government that under the last administration there was a dramatic erosion of the medical academic base in this country and that this should not be repeated. Indeed, it should be reversed.
Universities across the UK are undergoing profound change. In the future all, but especially those in England, will depend increasingly on the income from student fees. The rise in fees could make it more difficult to achieve a medical student population which better reflects society. It will also bring into sharp focus the quality of education provided by our medical schools.
If the government continues to press ahead with its plans it must, as well as addressing the issues around widening access, seek to redress the balance within universities between the value placed on research and the value placed on teaching, and consequently the value placed on those undertaking each of these tasks.
The GMC is beginning to take on board the need to ensure resources for education follow the student. In the past 15 years, the number of medical academics has halved while the number of students entering medical school each year has almost doubled. Our Medical academic base is now barely able to sustain the increased number of medical students.
The temptation in this time of financial crisis might be for universities to shed further medical academic staff. This would be a grave mistake. It would result in a worse student experience at a time of rising fees and further undermine our research base. Taking the temperature of current university intentions, however, we may find ourselves fighting possible significant redundancies over the next years. We need to ensure this is not the case. Not just for the medical academics we represent, but for the current and future generations of medical students, and the patients they will serve.
During the last 15 years, because of the reductions in the medical academic base, medical schools have looked increasingly to the NHS to provide clinical teaching. This option is now under threat in part through changes to the way such work is funded, but also through increased pressure from NHS employers on consultants supporting professional activities.
The proposed changes in the way funding for clinical teaching is allocated will add to the mix of adverse effects I have already noted. These changes will impact most significantly on the traditional urban medical schools. These are schools with the proven research track records. If money follows the student out of the institutions jobs will be lost - academic jobs that are unlikely to be replaced in hard-pressed district general hospitals.
MASC has taken a great deal of time to examine the effects on teaching and research of the Health and Social Care Bill. Along with the rest of the BMA, and indeed the whole profession, we have concerns about the make-up of commissioning bodies and their oversight and the national level regulation of many of the proposed provisions. We also have major concerns about the impact of the ‘any willing provider policy’ on the provision of research and education facilities locally.
In some ways, what was of greatest concern for MASC was that the Bill made little mention of research and no mention of medical education. It betrays a fundamental misunderstanding of how education and training, research and the provision of healthcare services are inextricably linked in the UK and how all three strands can work together co-operatively to their mutual benefit and to the benefit of patients and the public.
We, along with many others, lobbied strongly to preserve and enhance the funding for medical research. This is a message that we had believed has been listened to in England and in the devolved nations. Given the preservation of much of the funding for scientific research in the Comprehensive Spending Review and the priority given to medical research by BIS and in the Health White Paper it is surprising that there is such lack of attention in the Health and Social Care bill to ensure that research and innovation is a cornerstone of the NHS.
We believe that commissioning consortia should look to have clinical academic input when dealing with issues of quality innovation and development, where they arise.
The research and development functions of PCTs must be preserved and have a home, as must the staff that support such functions. It is therefore essential that consortia take into account the place of these functions when they are making their decisions. We do not want to see medical education reduced to issues of price and we do not want to see research falter and fail because no one on these consortia has the knowledge to deal with these issues.
The government has issued policy on training in its white paper Developing the Healthcare Workforce. Like many parts of the profession, MASC had grave concerns about the effects of the policies in this paper, and the damage that could be done to hard-won structures designed to support our trainees following the MTAS debacle. Our starting principle is that, with the current level of spending, the current system of medical education and training broadly works. This does not mean that we think it is perfect or lacking the possibility of improvement, but it delivers the education and training medical students and doctors need as well as the doctors required to support the UK’s healthcare systems. Hence, any changes proposed need to demonstrably improve on the current system.
We are therefore concerned that the provisions in this white paper will sweep away structures that work. That does not mean we are against change but as local employers unavoidably lack a broad overview of workforce requirements, we believe that the management and planning of the medical workforce can only be done at minimum at a national level.
Hence, we cannot support the implications in the education white paper that funding for workforce development and training for medicine will be devolved to local level.
We had heard, for example, that universities were to be excluded from local skills networks, this is an extremely bad idea as universities are central to the provision of innovation and educational excellence and the development of medical research, changing this is a measure which we hope is part of the pause and listening exercise.
MASC has also been very busy in negotiation and I am very pleased to announce that this year we have been able to agree new guidance on pay scales for clinical academics below the grade of consultant. This means that many doctors in training and SAS grade academics should have an improvement in their pay this year. It was vital that this happened because we have to maintain the attractiveness of clinical academic training.
