HEALTH AND EDUCATION

Transcription

1 A PICTURE OF HEALTH AND EDUCATION Higher education a core strategic asset to the UK HIGHER EDUCATION IN FOCUS: PROFESSORS AND PATIENTS

2 Foreword Our universities are an indispensible part of the UK s healthcare system. This publication is the first in a series of Universities UK reports depicting the vital connections between higher education and healthcare. It illustrates the virtuous partnership between health providers and universities in supplying and developing the healthcare workforce. It also summarises the education of healthcare staff in terms of demand, supply, and funding and commissioning landscapes. Subsequent UUK publications will focus on research and innovation, and workforce planning. Demands on the UK health system are growing but also changing in nature. Meeting these needs will require flexible, high-quality staff and services. UK universities sustain and enrich our health services not only by supplying and developing the healthcare workforce but also by being the crucibles for service innovation and excellence. Only by drawing on the people and resources in UK higher education, and the knowledge permeating UK universities, will future health challenges be met. Healthcare education in universities engages a population of trainees and teachers equivalent in size to the cities of Edinburgh or Bristol. Some activities are obvious, such as educating our future nurses and doctors, but many equally essential elements such as training the next generation of trainers receive less attention. Yet of the total Department of Health budget, less than one pound in a hundred supports universities contribution to the healthcare workforce. Thus, at a time when the need to invest in education to develop quality staff and agile services has never been greater, universities provide a great deal for the government and the public alike. Following wider health reforms, the management and funding flows of health education in England are changing. These changes are far reaching and may indicate the shape of things to come for other UK nations. This publication provides an opportunity to view these policy changes in the context of public health needs and the current ecosystem of health education delivery. Professor Eric Thomas MB BS MD FRCOG FRCP President, Universities UK Contents Health education in context 2 A portrait of demand The health education system 4 An ecosystem of supply Money and management 6 Funding landscape Money and management 8 Changing commissioning landscapes What are we talking about? In healthcare education we include the initial training of doctors, nurses, midwives and those in allied health professions towards their qualification and also personal development training beyond this. We are not addressing the role of universities in research. Similarly, in relation to finance, while there are other significant sources of income to universities for health education, here we examine the connection only between government health funding the UK departments of health and publicly funded universities. Healthcare staff and students are divided into two categories: medical, concerning doctors and dentists, and non-medical, which includes nurses, midwives and allied health professionals. By healthcare staff, we mean all medical and non-medical that is, clinical or treating staff. This excludes management, finance and support staff. We recognise that there are other employers besides the NHS; this publication, however, explores the virtuous partnership between our public health services NHS-employed staff and publicly funded universities. By healthcare students, we mean those studying graduate and undergraduate medical and non-medical healthcare courses. This excludes management, finance and support staff. By universities, we are referring to the 166 publicly funded higher education providers in the UK. Acronyms and abbreviations AHP Allied health professional CAP Clinical academic pathway CPD Continuing professional development DH Department of Health DHSSPS Department of Health, Social Services and Public Safety (Northern Ireland) GP General practitioner HEE Health Education England HENSE Health and Education National Strategic Exchange LETB Local Education and Training Board MADEL Medical and Dental Education Levy MPET Multi-professional education and training NHS National Health Service NIMDTA Northern Ireland Medical and Dental Training Agency NLIAH National Leadership and Innovation Agency for Healthcare (Wales) NMET Non-medical education and training levy PG Postgraduate PPP Purchasing power parity SHA Strategic Health Authority SHMI Summary Hospital Mortality Indicator SIFT Service Increment for Teaching UG Undergraduate A picture of health and education IN FOCUS 1

3 Health education in context A portrait of demand Health education in context A portrait of demand Health education in context A portrait of demand Health education is about aligning the supply of appropriate healthcare staff with the demand for them. This is a complex balance which rarely, if ever, reaches equilibrium. This picture of health and education begins by painting a portrait of demand for healthcare staff. Demand for healthcare staff is a factor of population care needs, health service provision and configuration, and, crucially, the resources available to train and employ staff. The health education system must take into account the need to meet demand not only now, but also in the future to anticipate changes in public health and service innovation. Population needs With a growing and changing population, and rising expectations, demand for healthcare is high, can only increase, and is evolving in nature. UK population 2030: 71 million UK 2012: 1 in 12 over 75 UK population 2012: 63 million UK 2030: 1 in 9 over 75 UK 2030: 28% over 60 UK 2012: 23% over 60 England and Wales: 75% die from heart disease, cancers or lung disease Service provision and configuration Service provision and configurations never stand still. Changes in demand, best practice and funding ensure services are permanently between one system and another and are constantly asking for new skills. Therefore, the data here is merely the latest snapshot. For future care to be proficient yet prudent, future patterns of provision will depend on flexible resources that focus on prevention while shifting care closer to home. Deploying new service models, and utilising advances such as telehealth and cutting-edge cures, will have an impact on workforce requirements. UK health system - snapshot 1,000,000, ,000 21,000 11,000 11,000 NHS prescriptions NHS hospital beds Registered care homes NHS dental practices GP practices Acute NHS hospitals 1.7m UK NHS workforce breakdown Healthcare support 390,000 Nurses, midwives and health visitors 480,000 United States $7,960 Canada $4,363 Germany $4,218 France $3,978 United Kingdom $3,487 Admin and estates 280,000 = 10,000 employees, headcount Health spend per capita (USD PPP) Scientific, therapeutic and technical 280,000 Other 170,000 Ambulance and emergency 20,000 Resources available UK NHS real-terms expenditure has doubled since 1994 and this has allowed the NHS to expand its workforce and deliver more care. But health education resources have not grown at the same rate and real budget growth since 2009 and looking forward is minimal. Medical and dental 140,000 The English NHS workforce is getting older. 200,000 employees headcount U The proportion of NHS England spend on education is falling. 150, ,000 50, The real UK NHS budget has doubled since But future growth will be minimal. 150,000m 135,000m 120,000m 105,000m 90,000m 5.5% 5% 4.5% 2030: 81% rise in obese adults 2030: 47% rise in adults with diabetes 2030: 72% rise in over 65s with dementia 350 Acute private hospitals Italy $3,137 4% 3.5% 200 $0 $2,000 $4,000 $6,000 $8, A picture of health and education IN FOCUS 3

4 The health education system An ecosystem of supply The health education system An ecosystem of supply The health education system An ecosystem of supply The supply of healthcare staff involves an extensive education ecosystem consisting of flows of people and ideas. This system is diverse, productive and interdisciplinary. It consists of two habitats universities and a range of healthcare providers and engages a population equivalent in size to Edinburgh or Bristol. Like any ecosystem, the stability and even viability of the health education system is dependent on vital stores and interdependent flows, without which it would be destabilised or could even collapse. All students, taught and research 10 out-of-tens Medical/dental students All health students Medical/dental students Ethnicity Non-white Age Over 30 Gender Male Overseas students First degrees Part time Moved to study New entrant Non-medical UG applicants 95,560 Medical UG applicants 25,068 Non-med students All students Other courses Non-med health students Ethnicity White Age Under 30 Gender Female UK students All other courses Full time Study in home region Continuing student UG acceptances 48,023 UG acceptances 9,067 Universities are an interface between clinical academics and students. They provide the principal setting for the early years of medical and dental education before registration, and for roughly half of the training for non-medical health education up to qualification. All universities 166 offer healthcare courses 113 deliver medical education 35 deliver dental education 18 Non-med 30,800 Taught students UG and PG 293,215 University health staff 33,855 Researching students: Med 8,500 Non-med 6,585 Taught students UG and PG 58,335 Universities also offer graduate and undergraduate training beyond qualification, or continuing professional development (CPD), constantly growing staff expertise and disseminating best practice. Healthcare providers are the interface between health professionals and patients. They also provide the principal setting for the later years of medical and dental training, the second (placement) half of non-medical health education, and some CPD training for medical and non-medical staff. Clinical academic pathways (CAPs) bridge service provision and education and are commissioned both nationally and also by local health providers and commissioners. These career opportunities empower health professionals to innovate through research and they inspire the next generation of educators. University qualifications 83,195 Graduates 66,640 (eg Diploma/BSc) University qualifications 15,705 CPD 420 Postgraduate 5,695 (eg PhD/MA) Postgraduate 16,555 CPD 36,915 Graduates 10,010 (eg MBBS) Other hospitals University hospitals National clinical academic pathways: Medical 850 Non-medical 200 Above average SHMI 97% of NHS England staff received training in the last year Virtuous partnership Synergy across both habitats drives innovative, high quality, patient-centred and efficient care. University and teaching hospitals in England have lower mortality ratios than other hospitals. Average or below average SHMI UK NHS employees 1.7m 67% of NHS England staff attended taught courses in the last year 4 A picture of health and education IN FOCUS 5

5 Money and management Funding landscape Money and management Funding landscape Money and management Funding landscape The final piece of the picture concerns commissioning: the process by which education priorities are set and resources are allocated. The UK departments of health are responsible for educating, training and developing the UK healthcare workforce. And, while there are other significant funding streams, it currently invests 5.5 billion per year to this end. The constituent UK nations each allocate and manage these resources differently and through different bodies. UK departments of health education spend: 5,480m Strategic Health Authorities 4,980m 10bn National level budget items In the remaining 900m of SHA resources funded regional health programmes and service quality assurance. 900m As medical university tuition is funded by students, the national funding councils and the NHS bursary, NMET is the only DH education stream to directly reach universities. NMET 2bn NMET funds tuition for nurses, midwives and AHPs as well as the NHS bursary scheme. National education resources are distributed regionally to the 10 SHAs. 2bn 1.5bn In universities in , 805m of NMET paid for non-medical education tuition fees; 169m funded CPD courses offered by universities, including national training priorities; and 20m supported CAPs. NMET also funded the 525m NHS bursary scheme paid to students for maintenance support. 525m 805m 6bn Allocated nationally to SHAs for regional health programmes 5bn 169m 20m NLIAH 90m NIMDTA 50m DHSSPS 100m Welsh Deanery 100m NHS Education Scotland 390m England Scotland Wales Northern Ireland 90bn Allocated to PCTs 106bn planned English NHS expenditure for financial year Included in the total SHA budget was the 5bn in national education resource (MPET) taken from a top slice of the NHS budget. Regional decisions split the education budget into three streams: NMET, MADEL and SIFT MADEL 1.9bn MADEL provides salary support to junior doctors and dentists working in NHS providers. SIFT 950m SIFT funds medical and dental placements by supporting NHS providers. 494m funded CPD offered by NHS providers and salary backfill for NHS staff in training. Of the total English NHS budget, less than one pound in a hundred supports universities contribution to the healthcare workforce. In England, in line with wider health reforms, the health education commissioning structure is changing from These changes are far reaching and may indicate the shape of things to come for other UK nations. The current commissioning and funding landscape is captured here. National Some education volumes and priorities are set nationally by the DH. These include, for example, setting the total number of trainee doctors and dentists, or increasing the supply of health visitors. Regional Decisions, based on local needs, are made by SHAs together with regional deaneries. These decisions concern non-medical health students, bursary support for all health students, NHS staff development, and also in which universities or hospitals education and training will take place. Higher education Universities 6 A picture of health and education IN FOCUS 7

6 Money and management Changing commissioning landscapes Money and management Changing commissioning landscapes In England, in line with wider health reforms, the health education commissioning structure is changing from 2013 and this will dramatically alter funding flows, advisory channels and chains of accountability. From 2013, healthcare providers will be taking the lead in planning and developing the workforce. A picture of health and education is the first in a series of UUK reports depicting the vital connections between higher education and healthcare. Subsequent publications will focus on research and innovation, and workforce planning. Further information on the Higher education in focus series, together with the detailed data and a full list of sources used in this publication, can be found at: The DH will still set the overall education outcomes for the health system. Universities will continue to engage at national level through the Health and Education National Strategic Exchange (HENSE). National oversight for health education will be moving from the DH to a new body, Health Education England (HEE). HEE will consult the NHS Commissioning Board and Public Health England. Groups consisting mainly of regional providers, called Local Education and Training Boards (LETBs), will be absorbing the education functions of the SHAs and deaneries. LETBs will consult local education providers and other local stakeholders. Universities will be involved with LETBs. The level of this involvement may vary by region. 8 A picture of health and education IN FOCUS

7 Higher education in focus Outputs in Universities UK s Higher education in focus series provide an overview of the shape and impact of the UK s higher education sector, using simple and innovative visualisations of data.. This publication has been produced by Universities UK, the representative organisation for the UK s universities. Founded in 1918, its mission is to be the definitive voice for all universities in the UK, providing high quality leadership and support to its members to promote a successful and diverse higher education sector. With 134 members and offices in London, Cardiff and Edinburgh, it promotes the strength and success of UK universities nationally and internationally. Woburn House 20 Tavistock Square London WC1H 9HQ Tel: +44 (0) info@universitiesuk.ac.uk Website: ISBN: Universities UK July 2012 To download this publication, or for the full list of Universities UK publications, visit Designed by Soapbox