HEFCE, Department of Health

Developing a joint university/NHS planning culture

Joint Department of Health/Higher Education Funding Council for England task groups

Task Group II report

Ref 99/62

November 1999

Foreword

The successful management of undergraduate medical and dental education and research requires close collaboration between the higher education sector and the NHS at all levels. The outcome of this collaboration is a key factor in determining the quality of the nation’s health care. Given the interdependency of teaching, research and patient care, we recognise the importance of ensuring that the funding policies of each of the two sectors do not operate in isolation, but take account of the needs of the other.

In 1997, in response to concerns about the 1996 Research Assessment Exercise, we announced the establishment of two joint Department of Health/HEFCE task groups. Task Group II was set up to examine how best to take account of the interdependency of teaching, research and patient care in the funding of medical and dental schools.

This report confirms the importance of effective liaison arrangements at all levels to facilitate the exchange of information and joint management of the higher education/NHS interface. It identifies some practical steps which now need to be taken both nationally and locally to ensure that the two sectors make more informed decisions in the future.

It is important that universities and NHS stakeholders develop a joint planning culture where relevant information is shared locally to inform decision making, and where changes in funding flows are effectively managed to minimise turbulence.

We commend this report to medical and dental schools and their NHS partners.

1. Introduction

2. In 1997, in response to concerns about the outcome of the 1996 Research Assessment Exercise (RAE) in relation to clinical health services, and the inter-relationship of research, teaching and patient care, the chief executives of the NHS Executive and of Higher Education Funding Council for England (HEFCE) announced the establishment of two joint Department of Health (DH)/HEFCE task groups.
3. Task Group I, which has already reported, looked at how health-related research should be handled in the next RAE. Task Group II was set up to examine how best to take account of the interdependency of research, teaching and patient care in the funding of university medical and dental schools in England.

   Terms of reference

4. Task Group II's terms of reference were as follows:

   To consider how best to take account of the interdependency of research, teaching and patient care in the funding of university medical and dental schools in England. In particular to:

   • suggest what practical arrangements might be put in place by the HEFCE and the DH to anticipate and consider the potential impact of their funding decisions on university medical and dental schools and NHS service providers
   • consider what practical steps universities and NHS employers might agree locally in order to help reconcile the competing pressures on clinical academics in delivering research, education and patient care.
5. The task group membership is attached at Annex A. The group met three times between October 1998 and May 1999.

   Context and working methods

6. The task group’s deliberations were framed by an understanding of the unique relationship between university medical and dental schools and the NHS. The mutual interests of the higher education (HE) sector and the NHS in ensuring the maintenance of high-quality medical and dental education and research are enshrined in the Ten Key Principles (attached at Annex B), drawn up by the Steering Group on Undergraduate Medical and Dental Education and Research (SGUMDER). Universities receive grant allocations for teaching and research from the higher education funding bodies. Additionally, universities are dependent on the NHS for a range of funds, services and facilities to discharge their responsibilities in medical and dental education and research, for example, facilities to support the clinical parts of undergraduate courses. The task group noted the importance of effective liaison arrangements between the higher education and NHS sectors to ensure that the funding policies of one sector do not operate entirely in isolation from the needs of the other.
7. The task group recognised that undergraduate medical and dental education requires an active strategic partnership between the higher education sector and the NHS at all levels. Shifts in funding from either the HEFCE or the NHS have an impact across medical and dental school activity, because of the interdependency of teaching, research and patient care within medical and dental schools. Maintaining stability is very important in this environment, as rapid shifts in funding, such as those produced by the RAE, could have a huge impact on service delivery.
8. The task group first surveyed the relevant funding streams which impact on the medical and dental school/NHS interface. It also noted the existing national structures in place to ensure open communication between the stakeholders and to address issues at the interface.
9. Information on these funding streams and national structures are attached at Annex C and Annex D respectively.
10. The task group also noted that several related streams of work were already in progress to address issues at the NHS/university interface which could inform the group’s deliberations:
    • the Joint Medical Advisory Committee (JMAC) exercise to identify and disseminate good practice in NHS/university interactions (HEFCE, 1999)
    • the Nuffield Trust's work on putting SGUMDER’s Ten Key Principles into practice at the local level
    • the Dental Schools and Dental Hospitals Priorities Group.
11. Further information about these related streams of work is provided at Annex E.
12. Although the task group had an English focus, the issues it addressed are of general interest throughout the UK.

    Main conclusions

13. Based on their understanding of the funding streams, existing national structures, and information sources, the task group identified a number of issues at the NHS/university interface, some of which are now being tackled by other groups. These issues and the task group’s findings/recommendations are outlined at paragraphs 13 to 49 below. Overall, however, the task group’s main conclusions are as follows:
    • It is important to have effective liaison arrangements at all levels (national, regional and local) to facilitate the exchange of information and management of the interface.
    • There is a need to improve the quality of management information and make it more widely available at all levels to enable stakeholders to assess the issues and make informed decisions.

    Issues and recommendations

14. The task group’s first term of reference was:

    To suggest what practical arrangements might be put in place by the HEFCE and the DH to anticipate and consider the potential impact of their funding decisions on university medical and dental schools and NHS service providers.

15. In relation to this term of reference, the group identified a number of issues relating to structures and arrangements, funding and information.

    Structures and arrangements Issue 1: Lack of awareness of existing national structures at the university/NHS interface

16. The task group found that there are existing structures and arrangements operating at the national level of the university medical and dental school/NHS interface. These existing structures have an important role in taking forward various interface issues, but the task group believes that their existence and roles are not widely understood at the local level.
17. The task group recommends that the background information outlined in Annex D should be disseminated more widely.
18. The task group noted that there have already been some moves to streamline existing national structures and arrangements. For example, the Committee of Vice-Chancellors and Principals (CVCP) is reviewing its health-related committees, and JMAC has extended its terms of reference to align the committee with the wider NHS/university interface. The task group supports these moves to streamline existing national structures.
19. The task group recommends that the operation of existing bodies should be reviewed regularly.
20. The task group noted that it has already been agreed that the NHS Executive and the HEFCE will schedule regular meetings to discuss interface issues and consider whether any joint management of these issues is required. The task group agrees that there should be regular dialogue between HEFCE and DH officers to exchange information and provide forewarning on major issues. Where appropriate, such meetings could include deans of medical or dental schools, and medical or dental directors of trusts or other NHS providers. This will give early warning of changes that could impact on funding and ensure that all parties are properly consulted and informed about policy developments.

    Funding Issue 1: Managing the shifts in funding arising from the movement of the Service Increment for Teaching (SIFT) into the community

21. As a result of changes to medical school curricula, in line with the implementation of ‘Tomorrow’s Doctors’ (GMC, 1993), and the expansion in student numbers, clinical teaching is now taking place in a wide range of NHS trusts (acute and community) as well as in primary care settings. The current arrangements for SIFT (see Annex C), which were introduced from April 1996, give more flexibility in the use of SIFT to support the changes in the distribution of clinical placement activity. It is important to ensure that SIFT follows the student, enabling more teaching to be supported outside traditional teaching hospitals, but these changes need to be carefully managed to ensure that trusts are not destabilised. The current SIFT guidance (HSG(95)59, NHS Executive, 1995) stresses the importance of early consultation on clinical placement plans to ensure that all stakeholders understand the reasons for the changes, and to enable the pace of change of funding shifts to be managed. The task group recognises that advance information on the number of clinical placements may be available in an indicative form only.
22. The last few years have seen changes in the distribution of SIFT. The implementation of the Medical Workforce Standing Advisory Committee’s recommended increases in medical school intakes (MWSAC, Third Report, 1997) over the next few years will broaden the distribution of clinical placement activity and will result in changes in the levels of SIFT funding for many providers. The current policy of benchmarking SIFT income received by trusts and general practices will enable these changes to be tracked.
23. The task group recommends that universities and NHS stakeholders should have in place mechanisms for ensuring regular contact over their plans for the distribution of students, so that the reasons for changes are understood and, where appropriate, the pace of change of funding shifts can be managed. Together, NHS stakeholders (trusts, health authorities and primary care groups) and universities need to find ways to manage effectively the resulting shifts in funding.

    Funding Issue 2: The transparency of medical and dental research funding

24. Data on external funding which is driving NHS research and development (R&D) costs are difficult to record and report because the funding might go through a special trustee account or be routed through a university.
25. Sources of university research funding could, however, be clarified by the current transparency review of research funding (see Annex F), in which the HEFCE is playing a major role. The DH’s Strategic Review of the NHS R&D Levy is likely to consider further the allocation and contracting arrangements to support externally funded R&D, and R&D on trusts’ own account. Proposals are likely to be announced later in the year.

    Information Issue 1: The need for HEFCE performance indicators for medicine and dentistry

26. The HEFCE has recently made a range of performance indicators (PIs) available to higher education institutions covering access, progression, outcomes and efficiency. These indicators will help the funding bodies and higher education institutions (HEIs) form a clearer picture of an institution's provision. PIs for medicine and dentistry have yet to be developed because of the complexity of the data sources.
27. The task group recommends that the HEFCE should pursue its objective of producing full performance indicators for medicine and dentistry.

    Information Issue 2: Lack of consistency in cost-centre reporting to the Higher Education Statistics Agency (HESA)

28. The quality and comparability of the information available to the HEFCE and to institutions need to be improved. The task group identified a need for greater consistency in cost-centre reporting to HESA. The issue of inconsistency in assigning subjects to cost centres has also been raised by the Dental Schools and Dental Hospitals Priorities Group, noting different practices in assigning expenditure to the clinical dentistry cost centre. Without consistent reporting of departmental expenditure it will be impossible to compare expenditure levels accurately.
29. The task group recommends that there should be greater consistency in the data reported to HESA in relation to medicine and dentistry. The HEFCE should discuss with the other UK higher education funding councils what steps would need to be taken to ensure that there is a consistent approach.

    Information Issue 3: Lack of clarity in reporting funding sources for university-employed clinical academics

30. The availability of accurate and complete information on the sources of funding for clinical academics is important for establishing transparency of funding. Information reported in the HESA record is currently limited to staff registered with an institution and with an academic workload of 25 per cent or more. This, and other more technical issues, will be considered in the forthcoming review of HESA, and should enable a closer alignment between this record and the returns made to the Research Assessment Exercise (RAE). For reporting purposes, the RAE will require institutions to detail the source of funding (university or NHS) for university-employed clinical academics.
31. Although it is important that the source of funding for clinical academic posts is made clear, the task group recognised that any suggestion that NHS-funded clinical academic posts would no longer count for HEFCE block grant could have a serious destabilising effect on those medical schools which have very high proportions of such staff.
32. The task group recommends that the HEFCE should not alter the current practice of allowing NHS-funded clinical academic staff to count towards the volume measure in HEFCE research funding without detailed examination of the funding consequences for individual medical and dental schools.
33. The task group’s second term of reference was:

    To consider what practical steps universities and NHS employers might agree locally in order to help reconcile the competing pressures on clinical academics in delivering research, education and patient care.

34. In relation to this term of reference, the task group identified the following issues.

    Structures and arrangements Issue 2: The variation in regional structures

35. The task group noted that there is a variation between regions in the structures currently operating at this level to review and assist negotiations and joint planning between multiple university and NHS stakeholders. This finding is in line with the recommendation of the Fourth SGUMDER Report (1996), which saw the need for flexibility to enable regional offices, universities and NHS purchasers and providers to develop their own arrangements which would best meet local circumstances. The task group agrees that it would not be appropriate to be prescriptive about the form of regional and local arrangements, as these need to be determined locally, but would wish to encourage arrangements which involve all key players involved in the interface, including the new NHS regional directors of education and training and the HEFCE regional consultants.
36. The task group noted the positive example of a regional SGUMDER structure in the North West region. It considered that this was an approach other regions may wish to explore.
37. The task group recommends that regional offices, universities and local NHS stakeholders should be encouraged to review their existing structures for managing the interface and, where necessary, should strengthen these structures to allow better resolution of cross-cutting issues.

    Structures and arrangements Issue 3: The need for increased clarity in local liaison arrangements between universities and NHS partners

38. SGUMDER’s Ten Key Principles provide a framework for joint working arrangements between universities and the NHS, and help to define the shared goals of the two parties. The JMAC report ‘Good Practice in NHS/Academic Links’ (HEFCE, 1999) highlights examples showing how the Ten Key Principles are being put into practice. It is important that every university, trust and health authority involved in undergraduate medical and dental education participates in effective local arrangements which build good relationships.
39. The task group concluded that in general there is a need for increased clarity in local liaison arrangements between universities and NHS partners and better information sharing at the local level to support effective joint planning. For example, the task group believes that there is an ongoing need for NHS and university partners to demonstrate that their research strategies take account of each other’s research plans. The JMAC good practice report (HEFCE, 1999) indicates that there are some areas where local liaison arrangements are well developed and well understood by the relevant bodies.
40. The task group recommends that local and regional stocktakes should be undertaken of the issues affecting the joint management of the interface. A joint planning culture should be developed where relevant information is shared locally. NHS and university partners need to demonstrate that their research strategies take account of each other’s research plans.

    Structures and arrangements Issue 4: Specification and arrangements of job plans for clinical academics

41. Service delivery, teaching and research are mutually supportive activities. The Second SGUMDER Report (1990) suggested that ‘the flexibility essential to the management of the job plans of clinical academics who are honorary consultants in the NHS might be achieved through a tightly defined package of clinical service commitments, to be delivered by university staff under the management of heads of clinical departments in consultation with NHS managers’.
42. The Richards Report (CVCP, 1997) recommended that ‘trusts shall not attempt to direct the work of each individual member of the academic staff who has a service obligation, but shall treat academic departments as a unit for service delivery purposes following the proposals in the [Second SGUMDER] Report’.
43. The task group considered that NHS trusts should recognise the importance of maintaining flexible working arrangements for clinical academics, but noted that there is some concern that the introduction of clinical governance may make this flexibility increasingly difficult to sustain. This issue is not restricted to clinical academics alone; job plans are an issue for all staff engaged on anything other than a service basis. The task group notes the contribution made by the JMAC good practice report (HEFCE, 1999) concerning this issue.
44. The task group recommends that universities and NHS trusts agree systems which address how the total teaching, research and clinical service functions (including training obligations) are to be delivered and that individual contracts should be delivered within this framework.

    Funding Issue 3: The need for greater transparency of funding at the local level

45. The task group investigated the transparency of funding at the national level (HEFCE grant, SIFT and NHS R&D funding) and found no real problems. However, the need for greater transparency of funding at the local level is an important issue. The group recognised that, historically, the use of SIFT by trusts may not be readily discernable, but would wish to encourage more transparency over how trusts deploy SIFT increases. Universities receive their funding from the HEFCE in the form of a block grant which provides flexibility in terms of internal allocation of these funds. Difficulties can arise should a university decide to invest/disinvest in areas where NHS service commitments exist. Similarly, investment/disinvestment in NHS service functions can result in difficulties for universities in the internal allocation of HEFCE funds where there has been reduction or increase in NHS service commitment for a particular speciality.
46. Greater specification by national funding bodies about the use of block grant at the local level is not desirable since it is important for local providers (universities and NHS) to retain the flexibility to respond to management pressures. However, it is equally important for information on the funding flows to be available and understood at the local level. The fifth of SGUMDER’s Ten Key Principles states that university and NHS stakeholders should ‘share relevant information and consult one another about their plans. Once agreed, policies and plans should be disseminated locally and reviewed regularly’.
47. The report of the transparency review of research (J M Consulting Ltd, 1999) commissioned by the Joint Costing and Pricing Steering Group (Annex F) recommends that universities should investigate their medical and dental costs, and seek opportunities through local co-operative action with their NHS partners to redress any gross imbalances in costs (thus reducing any adverse impact of informal knock-for-knock cost-sharing arrangements on transparency).
48. The task group recommends that universities and trusts should encourage a more transparent approach to funding flows which impact on medical and dental schools.

    Funding Issue 4: Managing the consequences of changes in historical funding streams

49. The task group noted that many posts in medical and some dental schools are funded by the NHS. It is important that there is local understanding of these funding streams, the inter-relationship between teaching, research and patient care, and how medical and dental schools would be affected if these funds were altered or phased out when the incumbent leaves.
50. The task group recommends that universities and the NHS should be encouraged to review, on a regular basis, funding allocations which affect the interface; make explicit their purposes and use; and ensure that any changes in their distribution are managed to ensure minimal turbulence.

Summary of recommendations

1. National level

2. The background information on existing structures and arrangements operating at the national level of the university medical and dental school/NHS interface (outlined in Annex D) should be disseminated more widely.
3. The operation of existing bodies at the university/NHS interface should be reviewed regularly.
4. The HEFCE should pursue its objective of producing full performance indicators for medicine and dentistry.
5. There should be greater consistency in the data reported to HESA in relation to medicine and dentistry. The HEFCE should discuss with the other UK higher education funding councils what steps would need to be taken to ensure that there is a consistent approach.
6. The HEFCE should not alter the current practice of allowing NHS-funded clinical academic staff to count towards the volume measure in HEFCE research funding without detailed examination of the funding consequences for individual medical and dental schools.

   Regional level

7. Regional offices, universities and local NHS stakeholders should be encouraged to review their existing structures for managing the interface and, where necessary, should strengthen these structures to allow better resolution of cross-cutting issues.

   Local level

8. Universities and NHS stakeholders should have in place mechanisms for ensuring regular contact over their plans for the distribution of students, so that the reasons for changes are understood and, where appropriate, the pace of change of funding shifts can be managed. Together, NHS stakeholders (trusts, health authorities and primary care groups) and universities need to find ways to manage effectively the resulting shifts in funding.
9. Local and regional stocktakes should be undertaken of the issues affecting the joint management of the interface. A joint planning culture should be developed where relevant information is shared locally. NHS and university partners need to demonstrate that their research strategies take account of each other’s research plans.
10. Universities and NHS trusts should agree systems which address how the total teaching, research and clinical service functions (including training obligations) are to be delivered, and individual contracts should be delivered within this framework.
11. Universities and trusts should encourage a more transparent approach to funding flows which impact on medical and dental schools.
12. Universities and the NHS should be encouraged to review, on a regular basis, funding allocations which affect the interface; make explicit their purposes and use; and ensure that any changes in their distribution are managed to ensure minimal turbulence.

References

Committee of Vice-Chancellors and Principals (1997) Clinical Academic Careers (Richards Report), CVCP, London.

Department of Health (1990), Supporting research and development in the NHS (The Culyer Report), HMSO, London.

Department of Health (1997), Medical Workforce Standing Advisory Committee: Third Report, London.

General Medical Council (1993), Tomorrow's Doctors, GMC, London.

HEFCE (1999), Good Practice in NHS/Academic Links, Joint Medical Advisory Committee, HEFCE, Bristol.

J M Consulting Ltd (1999), Transparency Review of Research (Report to the Science and Engineering Base Co-ordinating Committee), J M Consulting Ltd, Bristol.

NHS Executive (1995), NHS Executive Health Service Guidelines, Service Increment for Teaching: Operational Guidance, HSG(95)59, NHS Executive, London.

NHS Executive (1995), SIFT into the Future (the Winyard Report), NHSE, Leeds.

SGUMDER (1990), Undergraduate Medical and Dental Education (Second Report of the Steering Group on Undergraduate Medical and Dental Education and Research), SGUMDER, London.

SGUMDER (1996), Undergraduate Medical and Dental Education (Fourth Report of the Steering Group on Undergraduate Medical and Dental Education and Research), SGUMDER, London.

Annex A

Membership of Task Group II

Annex B

SGUMDER'S Ten Key Principles

The following principles were developed by the Steering Group on Undergraduate Medical and Dental Education and Research and published in an updated form in its fourth report (March 1996). Both the universities and the NHS should be guided by these principles, which improve the definition of their shared goals.

Strategic principles

Operational principles

Funding principles

Annex C

The funding context in England

HEFCE funding

1. The HEFCE distributes funds to universities in the form of block grant, but does not prescribe how they should allocate these funds internally. The HEFCE encourages institutions to operate a transparent approach to internal funding allocations, but institutions do not have to report to the HEFCE on how they have allocated their funds.
2. Prior to 1998-99, the allocation of funds for teaching was based on institutions’ Average Unit of Council Funding (AUCF). For 1998-99 onwards, a new funding method for teaching was introduced, based on standard units of resource. The standard unit of resource for clinical medicine compares favourably with the AUCF under the old system, while the AUCF for pre-clinical medicine and dentistry was somewhat higher than the standard unit of resource for science subjects.
3. The research component of the HEFCE’s block grant has three purposes:
   1. It covers a majority of the costs of the basic research undertaken by universities, which forms the foundation for strategic and applied work, much of which is supported by other government funds (from research councils and departments) and by charities and industrial and commercial organisations.
   2. It contributes to the costs of permanent academic staff and premises required for research council projects and to the infrastructure costs of other collaborative research undertaken with research councils.
   3. It contributes to the substantial fixed costs of training research students, premises, equipment, libraries and other essential facilities.
4. Underpinning the allocations are principles of plurality, selectivity, balance, competition and accountability.
5. Institutional allocations for teaching are not subject to significant swings but changes in RAE ratings can lead to sizeable shifts in research funding. This occurred in 1996 in the clinical units of assessment (UoA). However, it is important to note that the HEFCE has a policy of not imposing unmanageable change on institutions from one year to the next. 'Transitional funding' is used to moderate significant changes. Moderation policy is subject to review at each annual funding round; for the 1999-2000 grant allocation, moderation ensured that no institution received a reduction in resource in excess of 2 per cent in real terms compared with 1998-99. In 1997-98, when there were large gains as well as losses following the introduction of a new funding method for research and the application of the 1996 RAE results, taxation of gains and moderation of losses occurred.
6. The HEFCE also has a restructuring fund for supporting institutional changes which benefit students and the sector as a whole, rather than just an individual institution. The use of moderation and restructuring funds after the 1996 RAE meant that no medical school lost funding in cash terms, although for some the increase was below inflation.

   NHS R&D funding

7. In line with the Culyer Report (DH, 1994), in 1996 the NHS brought together a number of diverse funding mechanisms for research into a single funding stream which is now funded by a levy on health authorities. The R&D levy is divided into two budgets: budget 1 covers NHS support for providers (about £350 million) and budget 2 covers the NHS R&D programme (about £75 million). The Central Research and Development Committee for the NHS advises the Director of R&D on the distribution of the R&D levy. The first call on funding is the service support costs of non-commercial externally funded research.
8. Following the first bidding round, allocations for mainly three-year contracts totalling around £1 billion were announced in December 1997. The DH gave guarantees that no trust should be destabilised by the R&D changes. The decisions on allocations were arranged so that no portfolio contractor received a reduction in funding of more than 6 per cent in year one. The allocations for the three-year contracts were tapered so that by year three the allocations would better reflect the assessment of bids.

   The Service Increment for Teaching

9. The DH pays SIFT to hospitals and general practices where medical and dental students receive clinical teaching, in order to reimburse the additional costs of supporting this activity. SIFT is the largest single income stream for many teaching hospitals. Since 1996-97, SIFT has been raised by a levy on all health authorities; in 1998-99, it comprised £432 million for medical students and £47 million for dental students.
10. The current arrangements for medical SIFT were introduced in 1996-97 following the 1995 report ‘SIFT into the Future’ (NHSE, 1988). They aim to:
    • give flexible NHS financial support to high-quality and innovative medical education
    • improve accountability
    • create a stable financial framework within which change can evolve.
11. Since 1996-97, medical SIFT funds have been split into separate budgets for clinical placements and for facilities to support teaching. Clinical placement budgets are linked to the number of students in years three to five of the undergraduate courses, but facilities budgets are no longer directly linked to student numbers. Medical SIFT budgets are managed by the eight regional offices (ROs), which are responsible for placing NHS contracts for SIFT and for making SIFT payments to trusts and GP practices on the basis of those contracts. The system requires universities and the NHS to work in partnership, with clear roles and responsibilities. Universities have a key role in planning clinical placements to meet the undergraduate curriculum, and advise ROs on the distribution of clinical placement budgets to trusts and GPs.
12. Given that clinical teaching takes place alongside patient care, the costs of teaching and service provision are incurred jointly and are therefore difficult to separate. Traditionally, SIFT was paid to a small number of teaching hospitals. The changes to SIFT, introduced from April 1996, gave more flexibility in the use of SIFT to support the changes in the distribution of clinical placements. For example, the creation of separate budgets for clinical placements and facilities allows clinical placement funds to ‘follow the student’. That said, since facilities funding accounts for around 80 per cent of SIFT, the distribution of SIFT by regional offices is still largely a reflection of the historic levels of support for the various trusts. In 1998-99, 175 providers received facilities funding totaling £325 million, but 13 trusts (eight of which are in London) accounted for more than 50 per cent of this total.
13. There is wide variation between medical schools both in the spread of clinical placements across provider type and in the SIFT income received by trusts and GPs per student week. Regional offices are using a benchmarking approach to monitor the effect of changes in the distribution of SIFT and of clinical placement load on the efficiency of SIFT contracting.

Annex D

Existing groups which consider NHS/university interface issues

1. UK-wide national structures

   Joint Medical Advisory Committee

2. The four UK funding bodies are advised on medical and dental education matters by their Joint Medical Advisory Committee, which is comprised of leading academics and lay members with experience of university/NHS issues. A key JMAC function is advising on the maintenance and development of appropriate clinical environments for medical and dental education. This requires close analysis of the partnership and interface between the NHS and universities.

   Medical Workforce Standing Advisory Committee

3. MWSAC was established in 1991 as an expert committee to advise on future developments in the balance of medical workforce supply and demand in the UK and to make recommendations on medical school intakes. In 1998, MWSAC’s Third Report recommended an increase of 1,000 in the annual intake of medical students to be implemented as soon as possible. An MWSAC Joint Implementation Group, co-chaired by the DH permanent secretary and the chief executive of the HEFCE, has taken forward this work in England.

   National structures in England

   Steering Group on Undergraduate Medical and Dental Education and Research

4. SGUMDER was established in 1987 to improve the co-ordination and planning of medical education at the national level. Its remit has since been extended to encompass undergraduate dental education and research. The membership brings together all the main bodies with an interest in undergraduate medical and dental education and research to monitor developments and identify and resolve potential difficulties in the NHS/university interface. SGUMDER's most important work has involved developing joint working arrangements between the universities and the NHS (the Ten Key Principles - see Annex B). These principles help to define the shared goals of the two parties.

   Dental Schools and Dental Hospitals Priorities Group

5. This group was established in mid-1998. Its remit is as follows: to consider the implications for undergraduate and postgraduate education and training of the country’s current and future need for dentists, to determine the priorities for dental schools and hospitals in meeting that need, and to make recommendations to appropriate bodies. Whilst not a sub-group of SGUMDER, it will report to that group.

   Academic and Research sub-group of the Advisory Group on Medical Education, Training and Staffing (AGMETS)

6. The Advisory Group on Medical Education, Training and Staffing brings together members of the professions and their regulatory bodies, the academic and research communities, the higher education sector, the NHS Executive, the NHS and patients' interests. Its purpose is to help shape the future direction of medical and dental education, training and workforce policies and to advise the Secretaries of State for Health and for Wales accordingly. The AGMETS Academic and Research Sub-group was established to advise AGMETS on the implications of wider NHS medical education, training and staffing policies on the recruitment and retention of clinical academic and research staff in universities and the NHS, and the effectiveness of education and training in academic and research techniques, methodologies and procedures.

   HEFCE/DH bilateral meetings and task groups

7. There is regular dialogue between HEFCE and DH officers to exchange information and discuss cross-cutting issues. Where necessary, joint HEFCE/DH task groups have been established to improve communication and problem solving in specific areas of overlap in responsibility, and to provide expert advice to the chief executives.

   Regional structures

8. The Fourth SGUMDER Report (1996) reviewed the arrangements for effective co-operation between the NHS and universities at regional level, and agreed that there is a need for flexibility so that regional offices, universities and local purchasers and providers can work together to develop effective arrangements best suited to local requirements and conditions. The report recommended that there should be a formally agreed mechanism, reflecting local circumstances, for bringing together the views of senior representatives of the major interested parties – for example, the vice-chancellor, the dean of the medical and dental school, the medical and dental postgraduate deans, and the NHS Executive regional director, regional director of R&D, and regional director of public health – at least once a year. There is, therefore, variation among regions in the regional structures which are currently in existence, and their success may also be dependent on the commitment and effective personal relationships of specific individuals.
9. The HEFCE Report 'Good Practice in NHS/Academic Links' (March 1999) highlights a number of examples of good practice in existing regional arrangements, including: mechanisms for consensual decision making, such as joint liaison meetings and committees at a variety of levels; partnership in service provision; partnership in financial allocation; the establishment of joint business plans for teaching and joint research initiatives; and the establishment by NHS regional offices of director of education and training posts.

Annex E

Related streams of work

Good practice in NHS/university interactions

1. In 1998, JMAC commissioned a study of good practice in NHS/university relationships. The study, which was undertaken by the Health Services Management Unit at the University of Manchester, was concerned with the ways in which the NHS and universities are dealing with the following three issues:
   • competing pressures on staff time for teaching, research and patient care
   • curricular change and changes in patterns of clinical placement plans
   • issues arising from the implementation of the Culyer Report (DH, 1994) on supporting research and development in the NHS.
2. The study focused on the development of good practice in five study sites (Aberdeen, Cardiff, King’s College London, Liverpool and Sheffield), but also gathered examples from other locations.
3. The report 'Good Practice in NHS/Academic Links', published by the HEFCE in March 1999, provides examples of good practice from the institutions involved in the study. The report has been distributed to heads of UK higher education institutions, heads of UK medical and dental schools, chief executives of UK NHS trusts, and health authorities/health boards. Appendix 3 of the report cites examples of how SGUMDER’s Ten Key Principles are being put into practice in the locations included in the study, and illustrates the approaches being taken to address the three issues central to the study. These approaches include:
   • a joint research and service strategy to align the service needs of the community and the specialist services of a trust with the research strategy of the medical school
   • new ways of gaining and responding to student feedback, including the use of information technology to improve the speed of collection and response to feedback
   • development of teaching in primary care, which has been associated with strong support for service-led innovations and applied research
   • establishment of joint research strategies, across universities, NHS trusts, health authorities and primary care, and the development of research consortia
   • development of joint appraisals for clinical academic staff to be undertaken by the medical director of the appropriate care group and the academic head of department
   • cross-representation of academic and NHS staff at a number of levels and on a number of committees at all the study sites.

The Nuffield Trust's work on putting SGUMDER’s Ten Key Principles into practice

4. The Richards Report on 'Clinical Academic Careers' (July 1997), which was commissioned by the Committee of Vice-Chancellors and Principals, made 35 recommendations, including that ‘more work should be done to explore the concept of the University Hospital NHS Trust’. Following some discussion of the Richards Report at SGUMDER and other fora, Sir Alan Langlands met with the chairman of the CVCP’s Medical Committee and the chairman of the Council of Heads of Medical Schools to discuss their concerns about relationships between medical schools and NHS trusts, and to explore how these might best be taken forward.
5. It was agreed that new structures and radical solutions should be avoided, but that there would be benefit in improving collaboration and joint management processes in line with SGUMDER’s Ten Key Principles. It was agreed to invite the Nuffield Trust to organise and host a small seminar of key players to discuss the development of ground rules to operationalise the Ten Key Principles at local level. The Nuffield Trust seminar was held in November 1998. To inform the discussion, the Trust carried out a survey of medical school deans and teaching hospital chief executives on the interface between medical schools and NHS trusts. The results, which were circulated with the JMAC report on 'Good Practice in NHS/Academic Links' (HEFCE 1999), confirmed that there is scope for improvement in many parts of the country, but also identified some positive initiatives.
6. The seminar in November 1998 brought together a number of chief executives of teaching hospitals, heads of medical schools, and other key players to discuss the results of the survey and to address the interface between the NHS and university sectors. It was agreed to form a smaller working group with the aim of considering a joint strategic approach and producing guidance for its translation into local relationships. The membership of the Nuffield Trust Working Group is as follows:

   John Wyn Owen (Chair)	Secretary, Nuffield Trust
   Professor Colin Bird	University of Edinburgh
   Professor Sir Cyril Chantler	Guys, King’s and St Thomas’ Hospital
   Professor Eric Thomas	Dean of the Faculty of Medicine, Health and Biological Sciences, University of Southampton
   Professor Stephen Tomlinson	University of Manchester
   John Ashbourne	Chairman, University Hospital Chief Executive Forum
   Alec Cumming	Chief Executive, Aberdeen University Hospitals Trust
   Dr Jonathon Michael	Chief Executive, University Hospital Birmingham
   Tim Matthews	Chief Executive, Guys and St Thomas’ NHS Trust
   Secretariat
   Michael Powell	Executive Officer, Council of Heads of Medical Schools
   Tom Smith	Nuffield Trust Associate

7. The November 1998 group will reconvene in October 1999 to consider the working group’s report.

   Dental Schools and Dental Hospitals Priorities Group

8. The Dental Schools and Dental Hospitals Priorities Group was set up in June 1998 with the following membership:

   Mr R Wild (Chairman)	Chief Dental Officer, Department of Health
   Mr D Barnard	Royal College of Surgeons of England
   Mr S Hampton	National Purchasing Unit for Dental SIFT
   Professor W Hume	Council of Deans of Dental Schools
   Mr P Langmaid	Welsh Office
   Mr D Noyce	HEFCE
   Mr S Parry	Morecambe Bay Health Authority
   Mr R Roberts	Association of Dental Hospitals of the UK
   Mr D Rule	Conference of Postgraduate Dental Deans and Directors
   Mr A Seth-Smith	General Dental Council
   Ms M Taylor	NHS Executive
   Professor A Wilson	Committee of Vice-Chancellors and Principals
   Professor N Whitehouse	Council of Deans of Dental Schools

9. The remit of the group is:

   ‘To consider the implications for undergraduate and postgraduate education and training of the country’s current and future need for dentists, to determine the priorities for dental schools and dental hospitals in meeting that need, and to make recommendations to appropriate bodies.’

10. The group is expected to report its findings to SGUMDER and other groups as appropriate in autumn 1999.

Annex F

Transparency review of research in higher education institutions: summary

1. Background

2. A transparency review of research in higher education institutions (HEIs) was initiated as a condition of the extra research funding granted in the 1998 Comprehensive Spending Review. The main driver for the review was the requirement to demonstrate the full costs of research and other publicly funded activities in order to improve public accountability. The requirement is a natural consequence of the case made by the HE sector about the research funding gap, and the fact that it is not easy for the Government to see the link between costs and outputs of research.
3. The Science and Engineering Base Co-ordinating Committee (SEBCC) has overall responsibility for the transparency review of research. To take forward the work, it set up a sub-committee, the Transparency Review Steering Group, with representation from the sector, taking expert guidance from the Joint Costing and Pricing Steering Group (JCPSG).

   Terms of reference

4. The Government’s transparency requirement is to:
   • improve management or activity accounting within HEIs to provide information on research (and teaching) expenditure.
5. This was interpreted in the remit for the transparency review of research as having two main elements:
   1. To account for the use of publicly provided research funds in an auditable manner.
   2. To develop a uniform method to permit universities and colleges to demonstrate true costs to the satisfaction of commercial sponsors, the European Union, and so forth.

   Consultancy study

6. The JCPSG commissioned a consultancy study in February 1999 to draw up proposals for a uniform approach to the costing of teaching, research and other activities in HEIs.
7. J M Consulting Ltd's report to the SEBCC was published in June 1999. The report considered a number of aspects of the new approach to costing and, in each case, recommended an acceptable level of rigour to meet the requirements or standards that institutions’ costing methods would need to achieve. These standards should be regarded as minimum requirements to satisfy the transparency requirement and related requirements for improved costing.
8. The report makes two recommendations specific to the treatment of costs in medical and dental schools. It recommends that, for the present, the sector should work to achieve the best level of public accountability for costs of medical and dental schools incurred in HE accounts, without requiring special exercises within the NHS. Initially at least, this should be delivered by some simple attributions of academic staff costs. Further work should be done during the pilot year to test, refine and improve the options recommended. The report also recommends that, at the local level, institutions should investigate their medical and dental costs, as some have already done, and seek opportunities through local co-operative action with their NHS partners to redress any gross imbalance in costs (thus reducing any adverse impact of informal knock-for-knock cost sharing arrangements on transparency).

   Conclusions

9. The main recommendations in the consultants’ report were accepted by the SEBCC on 24 June 1999. The committee nevertheless recognised that further work needs to be done on specific issues, including methodologies for the allocation of academic staff time. These will be considered in greater detail in drawing up the guidance notes for the sector over the next academic year, and hence the uniform approach to costing should be viewed as the first stage in implementation with more details to follow.