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The Parliamentary Under-Secretary of State for Health (Anne Milton)
I congratulate the right hon. Member for Oxford East (Mr Smith) on securing this debate on what I know is an area of great importance. He is right to say that it is about recruitment, skills and the development of the profession. I would also like to thank him for his praise of access officers at Oxford, and for highlighting the summer school. It is important to see universities doing what they can to ensure that participation is widened, and that people who might not have felt able to apply to such universities as Oxford, or who might not have felt that they had the necessary skills, are given the greatest opportunity to do so. It is good to hear the right hon. Gentleman raise the point that this is something that schools have to take on board. We often discuss the issue of universities widening participation, but we also want to ensure that our schools prepare young people, and have the skills to prepare young people, to apply to all universities. Young people should not feel as though they are excluded from any opportunity.
There is no doubt that training for medical students in this country is some of the best in the world, and we want to keep it that way. That means that funding must be at a level that allows for the best training. The consultation paper “Liberating the NHS: developing the healthcare workforce” sets out our proposals for a new framework for education and training, and the right hon. Gentleman raised particular issues that I will come back to in more detail. The proposals would see health care providers take the lead. They would plan and develop their own work force, and take on many of the responsibilities that were previously held by the strategic health authorities. A new statutory body, health education England, would provide national leadership for education and training, with a strong clinical focus from top to bottom. The proposals for health education England have been widely applauded—it is very important to have that leadership in education and in that strong clinical focus. We now have an opportunity to review and reshape our work force and what it is designed to do, so that it can respond to the challenges of the future while still providing excellent care. We sometimes lag behind, trying to solve the problems of tomorrow with the solutions of yesterday.
For patients, of course, but also for staff and students, there must be a secure, diverse work force that has full access to education, training and opportunities to progress. That must be transparent, so that we can see how it is working and help ensure that we all get value for money, students included. The Government have consulted to see how that can happen. We have involved a wide range of people, because the new framework is about giving some of the power to those people. The central pillar is the transfer of greater responsibility to health care providers, escaping the one-size-fits-all approach that has been too prevalent in the past. Those providers will need to work together to co-ordinate the development of their local work force, so that it is tailor-made for the individual pressures of individual areas, which vary widely. That means building strong partnerships with universities and colleges to put the skills of educators to the best possible use and strengthening those relationships, which I do not think have been strong enough. There has been a general recognition among health care providers that those relationships have not been strong enough in the past.
I know that those involved with both the medical profession, including the BMA, and the education sector, want to ensure that medical education is protected and improved. They also want to know that the role of the postgraduate medical and dental deaneries, which currently form part of the strategic health authorities, will continue, so that medical students and trainees continue to be well-supported. Medicine, like many other professions, does not end at the end of training—continuing professional development is an important part of it.
Anne Milton
I am happy to—so that the right hon. Gentleman does not feel I am ducking his questions, I will deal with them once I have finished with the deaneries.
We want to retain and build on the important functions of deaneries as we build the new framework for education and training. We know how important that is, because any transition not only makes the participants feel nervous but is a significant operation for any Government. The transition is when we can let the baby slip out with the bath water.
The right hon. Gentleman raised the issue of bursaries in particular, but I have to disappoint him, in that I cannot make an announcement today. We are acutely aware how long awaited it is. No one could be more frustrated than me with the slowness of government at times, but it is important that we get it right. I thank my hon. Friends the Members for Oxford West and Abingdon (Nicola Blackwood) and for Totnes (Dr Wollaston) for their contributions. My hon. Friend the Member for Totnes also raised the issue of some of the indirect costs of training, to do with the length of the course. We will be making announcements soon but, as I said, it is important that we get it right and that we involve other Departments.
The right hon. Gentleman also asked if I would make representations via the Treasury to other organisations about supporting training schemes. It is important that we continue to do that—perhaps we do not see enough of that in this country. At this point, I should mention that Julie Moore, the chief executive of University Hospitals Birmingham NHS Foundation Trust, is leading some of the work we are doing with the NHS Future Forum, as part of the ongoing listening exercise on the health reforms. Julie will continue the debate started in the consultation, so there will be further opportunity for input. I urge him and the other Members present to get involved, to ensure that their views and the particular issues faced by medical students are taken on board.
Our responsibility is held jointly with the Department for Business, Innovation and Skills, so the right hon. Gentleman should ensure that any comments made today also go as directly to it. The two Departments are working closely together, so that the specifics of medical education can be recognised.
Mr Smith
I wanted the assurance that, as part of the Department of Health’s collaborative work with the Department for Business, Innovation and Skills, the long-awaited higher education White Paper, which it would have been better to have had before the fees increase rather than after, will address the specific position, challenges and opportunities of medical students.
Anne Milton
Very much so. To some extent, the health of the nation rests on the skills of the professions that deal with the consequences of poor health. Medical students and doctors are part of that, so it is important that we get the system right. We need to maintain a competitive edge if we are to continue to produce medical graduates of the highest calibre. We shall not fail in our duty to make representations to other Departments, although working together is not always as easy for government as it sounds. However, we have made significant progress, and I think our words are being heard loud and clear.
As the right hon. Gentleman knows, universities will be able to charge a basic threshold of £6,000 a year for courses, and up to £9,000 a year for some, but subject to much tougher conditions on widening participation and fair access, which he mentioned in particular. There are still many such challenges, not only for universities but for our education system and at a wider societal level, if we are truly to get participation as wide as it can be. We need to look at all sorts of other drivers in the system directing young people to their choices.
We are shifting the balance of contributions from taxpayers to graduates, who benefit most from higher earnings over the course of their working lives. It is important to recognise that, after medical students have gone through the system and become consultants, they are probably among the top few percent of wage earners in this country. Contribution from them, therefore, is important. For poorer students, who might feel that the burden is too high, there is a balance or tipping point at which active participation in a fees scheme becomes a barrier. We have done a lot of work to ensure that that is not the case, and we continue to do so.
Many of the subjects associated with medicine cost more to teach, and we want a system in which anyone with the ability can access university and study such courses without being put off by the cost. That is why we will continue to provide additional funding for science, technology, engineering and medical courses.
The NHS bursary, which is in recognition of the length of time it takes to study medicine, will continue, helping students with their tuition fees and supporting those from low to middle-income families—sometimes, the middle-income families get squeezed in the middle. We have undertaken a review of the bursary, and will make some announcements shortly. In the review, we considered the views of the British Medical Association, which played an active part, ensuring that the perspective of medical students was considered.
In addition to the NHS bursary, last year an additional £890 million were invested by the NHS to provide clinical placements to medical students, ensuring that NHS providers continue to deliver high-quality clinical placements, which are an important part of such training.
The central investment in 2011-12 is £4.9 billion, a 2% increase on 2012-13. It is important that the funding mechanisms provide the right incentives and allow funding to be transparent, to drive quality and to be value for money, supporting a level playing field between providers. Any bursary schemes included should be easy to use and to access—sometimes, the mechanisms by which one can get support are only available to those at the top end of the IQ scale, because they are so complicated. Such complexity can be another significant barrier.
Current funding for clinical education and training is based on local agreements between strategic health authorities and providers. It can result in inequities in the funding of similar placements in different parts of the country. To resolve that, we have been working with others to develop proposals for a tariff-based approach to clinical education and training funding. Such tariffs would enable a national approach to funding all undergraduate clinical placements, including placements for medical students, as well as postgraduate medical training programmes. That will support a much more level playing field between providers. The variation in current funding arrangements means that the introduction of tariffs would have a bigger impact on some providers than others.
Anne Milton
We are looking at that issue at the moment. We have received about 500 consultation responses, so I am sure that it will be highlighted—it is something we need to look at. The other important thing we are looking at is proposed levies on private health care providers. Certainly, when I trained as a nurse—many years ago—that was an issue, and it remains so today.
The tariff ought to mean a more even and equitable system throughout the country. We will continue to work with SHAs and providers, and we will consider all the views expressed, to build understanding of what the tariffs will do and of how to manage the transition.
I assure the right hon. Gentleman that the Government recognise the importance of medical education and of continuing medical education. The new arrangements will take on board many of the issues he has raised, to ensure that we have a health care work force fit for the future.
Question put and agreed to.