Universities
Baroness Finlay of Llandaff Excerpts(1 month, 1 week ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I have the privilege of being an observer on the Medical Schools Council, I have a role at Cardiff University and I am on the advisory council of Brunel Medical School.
The relationship between medical schools and universities goes back centuries, and this report is timely as we face changes. There is a shortfall in our workforce in medicine. Places in medical schools need to expand, and the number of medical schools is expanding, but we have another crisis because of the shortage of clinical academics.
Clinical academics are those doctors who are employed 50% of the time treating patients in the NHS and 50% in research and teaching. They are jointly employed, even though HMRC treats them as though they have a single employment. There are costs associated with the newly agreed contractual arrangements for these doctors. The UK’s future research strength is now jeopardised because, unfortunately and erroneously, the funding for the new contractual arrangements for NHS consultants omitted clinical academics. So I ask the Government whether they are making arrangements to reimburse universities somehow for the estimated additional £20 million of costs that this is going to result in for universities.
These clinical academics are, by and large, the research-active doctors. Academic clinical medicine accounted for 35% of all higher educational institute research grant income in 2022, valued at almost £2.5 billion. When all bioscience-related categories are included, the figure rises to around £4 billion, or about 57% of total research income. However, clinical academics represent a decreasing proportion of the workforce. The proportion aged over 55 doubled from 18% in 2005 to 36% last year, meaning that we have more approaching retirement without the flow of younger academics coming through. Only 4% of consultants are clinical academics, compared to 7% in 2005. These are the people needed to research and teach the next generation of doctors; their contribution to the national economy through money invested in research must not be underestimated. The numbers of clinical academics coming from general practice are tiny, even though they have risen slightly to 0.6% of GPs in the last 10 years.
The work to recruit applicants into healthcare from a broader section of society through widening participation is proving effective. The number of entrants to medical school from the most deprived areas has more than doubled from 6% to 14% in the last 10 years. The proportion of female applicants has certainly increased, up to 63%. Asian applicants increased to 29% and the proportion of black applicants has grown from 6% to 10%.
For those coming from schools in more deprived areas which have no selective intake, it is important to ensure that the entry tariff is appropriately adjusted. University league tables look at the average entry tariff, but those which have adjusted to take students from this broader proportion of the country—that is, deprived areas—risk being relatively downgraded in rankings, yet they are providing the future medical workforce for the most deprived areas in the country. Those responsible for student finance arrangements should consider the impact of the cost of living crisis on medical students, with their slightly longer courses, inability to take on other jobs and difficulty of success in a course that is rigorous and demanding. Will the Government support the recommendation from the Medical Schools Council that organisations publishing university league tables should consider removing average entry tariff from the criteria and include diversity and inclusion? Without diversity and inclusion, we will not begin to redress the imbalance in supply of workforce to these most deprived areas of the country.
The decline in clinical academics risks hampering the sector’s attempt to expand medical school places, as set out in the NHS Long Term Workforce Plan. There is a tension here. Without urgent action to increase the numbers and retain pay parity with NHS colleagues, the commitment set out in the long-term workforce plan will not be met, as we risk losing the vital workforce and the benefits it brings. There is also strong evidence that patients cared for in research and teaching-active institutions can have better clinical outcomes. These are benefits to wider society, not only to the innovative aspects of research in our community.
In 2021, the research excellence framework classified over 90% of clinical medicine research as world leading or internationally recognised. We all recall the Oxford AstraZeneca Covid vaccine, which resulted in 3 billion vaccine doses worldwide. As the House of Lords Science and Technology Committee stated in its recent letter to the Secretary of State,
“we heard concerning evidence that the future of clinical research, and the clinical academic workforce in particular, is under threat”.
Special Educational Needs
Baroness Finlay of Llandaff Excerpts(1 month, 4 weeks ago)
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Baroness Smith of Malvern (Lab)
The noble Lord is right that in an education, health and care plan, the health element is also very important. As my noble friend identified, where there are delays in getting a diagnosis, that can also mean that children and young people are not getting the support that they need in schools or being identified for additional support within those schools, which is wrong. That is precisely why the Government are determined to make the long-term fundamental reform that will support inclusive mainstream schools for the early identification and support of children, and also ensure that where special schools are needed, there is a place in them for the most complex needs.
Baroness Finlay of Llandaff (CB)
At the end of their time at school, many of these people—who are now young adults—have ongoing educational needs to be addressed to allow them to integrate into society and find places of work. Are the Government planning to make sure that they look at continuity, so it does not just end at the age of 18—or whenever they leave—but that educational provision is included right up into their early 20s, to make sure that these children can eventually become well integrated into society and have a prosperous and fulfilling adult life?
Baroness Smith of Malvern (Lab)
The noble Baroness is absolutely right that as good practice for children and young people with special educational needs and disability, we need to prepare them for a healthy and productive adulthood. That is already clear in the SEND Code of Practice. For those with an education, health and care plan, there must be a focus from year 9 onwards on preparing the young person for adulthood, as part of their annual review. That also means that we need the expertise within our further education colleges and higher education as well, where students can receive specific support. This will make sure that the support is there available for them through the education system and onward into fruitful and satisfying employment.
Independent Schools: VAT Exemption
Baroness Finlay of Llandaff Excerpts(3 months, 2 weeks ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare that I am an associate of the Girls’ Day School Trust. I am grateful for the many sacrifices my parents made to allow me to go to Wimbledon High School after I failed my 11-plus pretty badly. I have been the governor of Howell’s School in Llandaff, a Girls’ Day School Trust school.
We should not be pitching one sector against another, but we must realistically acknowledge the unintended consequences of the VAT proposals and the speed with which they are being introduced. Howell’s School, whose pupils come from all walks of life, estimates that 11% of families will no longer be able to afford the fees, causing disruption and distress to those forced to leave a school community where they are happy and established. Howell’s will no longer be able to provide bursaries that have tided children over when disaster struck, such as three siblings I knew well, who were suddenly left orphaned and completely destitute. Continuity of education at the school and care allowed them to achieve, against all odds.
When Ukrainian refugees arrived in Cardiff, the school welcomed eight students aged three to 17 into its community. Some spoke no English; many had experienced significant emotional trauma from leaving behind homes, friends, fathers, brothers and grandparents. All had individualised timetables with extra classroom support and access to a school counsellor.
English lessons were extended to the students’ accompanying mothers and grandmothers, who connected on cultural visits locally as they gradually integrated into the community. The school has, to date, waived £377,000 in fees and incurred an additional £57,000 in expenses to support these girls—and that support is ongoing. Only this week I had a letter from a disabled school leaver, who, with that school’s support, has achieved university entrance to study law. I really doubt that she would have done it without being at the school.
Around 10 % of the school’s applications for places come from children who have struggled in a maintained school because of bullying, anxiety and other mental health problems, a lack of support with additional learning needs, or other reasons. This is similar to figures from across the UK. Parents and grandparents desperate to keep their child going to school do without for the child to have a tailored approach to academic and well-being support, a reduced timetable, and a calm, quiet space of safety.
The fee-paying schools in Wales are integral to their local communities. They are smaller on average than those in England, and they estimate that between 10 % and 36% of pupils will have to move to state schools, suddenly putting pressure on the state sector, with between 3,700 and over 6,500 extra children, and requiring £35 million in pupil funding. Education is fully devolved, but VAT receipts are paid directly to the Treasury. Can the Minister clarify whether the whole of the predicted £1.7 billion revenue has already been allocated for England’s use, or whether it covers England and Wales, and other devolved nations? Can she confirm that funds needed to meet Welsh schools’ needs will come from the additional revenue raised and will include the Barnett uplifts?
I wonder whether the Minister will accept the suggestion made by the noble Lord, Lord Pannick, as outlined by my noble friend Lord Alton, to refer this to the Joint Committee on Human Rights, particularly in relation to devolved nations.
King’s Speech
Baroness Finlay of Llandaff Excerpts(5 months ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I warmly congratulate the Ministers, the noble Baronesses, Lady Smith of Malvern and Lady Merron, on their appointments. We will all miss the wisdom, experience and kindness of the noble Baroness, Lady Jolly. I declare that I chair the Bevan Commission in Wales, was a governor of Howell’s School, Llandaff, and president of the Chartered Society of Physiotherapy, and my palliative care roles.
I welcome the focus in the gracious Speech on prevention in healthcare, its crossover to the well-being of children, and how rehabilitation can prevent further problems when disease or injury strikes. Our previous tobacco control legislation did not go far enough; we never anticipated the advent of addictive vapes. Last year, one in five children used a vape. More than 7.5% of children are current users, mostly of disposable vapes from shops, so new controls are welcome and long overdue.
Some 2.5 million children in England are overweight or obese, setting a lifetime of problems. Good nutrition starts with breastfeeding and support to new mothers in the early years, but despite tackling junk food the gracious Speech failed to mention the addictive calorie-laden product, alcohol, which is closely linked to violence and anti-social behaviours. Will the Government support my Private Member’s Bill on alcoholic beverage labelling?
Yes, the NHS needs transformation. Only yesterday, I encountered an ICB whose risk-averse policies are inhibiting community hospice carers from meeting patients’ analgesic needs. We must shed silly rules and wasted duplication of effort, free staff to care with initiative, and support innovation. A funding formula for palliative care is long overdue.
Rehabilitation is critical to prevention. It reduces pressure on acute and emergency services, reduces social care need, and supports those who want to and can go back into work. Today, one in three people’s health conditions would benefit from rehabilitation, and more than a million emergency department attendances a year could be avoided. Improving cardiac rehabilitation from its current 50% level to 85% could prevent 50,000 admissions in England alone. Each year, 120,000 patients survive critical illness, but 98% of those develop post-intensive care syndrome, with impaired physical, cognitive and psychological functioning and loss of independence, and a third remain care-dependent with major impacts on their families, especially their children.
Specialist rehabilitation programmes starting in ICU are cost effective. There is, for example, a lifetime saving of about £700,000 per patient with traumatic brain injury. Patients can even get back to work, but sadly few such programmes exist. For those who do not survive and who are dying, integrated palliative care can be transformative. Reliance on charity donations is invidious.
For children with serious conditions, rapid early diagnosis and intervention can move them from a life of dependency to a life of independence, yet more than a quarter of a million children are waiting for community health services, with 22% of them waiting over a year. Some 21% of A&E attendances overall are in children from nought to 14 years, and for 40% of those continuity would be better had they been seen in the community.
Finally, I turn to schooling for children with difficulties. Overall, there are 90,000 children with special educational needs in private schools, as well as children who have been seriously bullied, are refusing school, and whose parents or grandparents do without for the child’s supported education. Independent schools estimate that they save £4.4 billion from the education budget. I wonder what will happen to service families whose children have to board. Will we risk the income to the country, already experienced by universities, if we lose many of our 63,000 international schoolchildren? In Wales, if 19 of the 69 independent schools have to close, the Welsh Government will face an £80 million funding gap. Can the Minister reassure us that Wales will receive its proportion of the estimated increased revenue from VAT, in line with Barnett differentials? I hope so.