UK Healthcare Education Advisory Committee

HEFCE HEFCW SFC

UKHEAC Min27

Minutes of the twenty-seventh meeting of UKHEAC held on Thursday 23 June 2016 SFC Offices, Edinburgh

Present: Members: Professor Dame Jessica Corner (Chair) Professor Karen Bryan Professor David Crossman Professor Ieuan Ellis Professor Neil Johnson Professor Saul Tendler Professor Paul Martin Professor Raymond Playford Professor David Adams

Observers: Alan Robson (DH) Andrew Matthewman (HEE) Kate Svedang (BIS) Brendon Edmonds (HCPC) Damian Day (GPhC) Matthew Hill (GDC) Hugh Masters (Scottish Government) Elisabeth Jelfs (CoDH) Heather Payne (Welsh Government

Officers: David Sweeney (Secretary) (HEFCE) Andrew Taylor (Assistant Secretary) (HEFCE) Helene Fouquet (HEFCE) Helen Raftopoulos (SFC) Celia Hunt (HEFCW)

Apologies: Members: Professor Keith Lloyd Professor Irwin Nazareth Professor Farida Fortune

1 Professor Stewart Irvine Professor Anne Greenough Dr Arun Midha Dr Claire Mallinson

Apologies: Observers: Anne Trotter (NMC) Martin Hart (GMC) Catherine Elliott (MRC) Professor Jenny Higham (UUK)

Welcome and opening remarks from the Chair

1. The Chair welcomed members to the twenty seventh meeting of the UKHEAC and introduced Damian Day and Brendon Edmonds who attended for the first time as observers for General Pharmaceutical Council and Health and Care Professions Council.

2. The Chair also welcomed Elisabeth Jelfs from the Council of Deans of Health, and Hugh Masters from the Scottish Government who attended the meeting as guests.

3. Alan Robson, Anna Dignan and Kate Svedang had joined the meeting by telephone but were only able to be present for the first part of the meeting. Due to this availability the running order of the agenda was revised (which these minutes reflect).

Implementation of Education Funding Reforms

Department of Health Consultation

4. The Committee discussed the implementation of education funding reforms and the current Department of Health consultation on “Reforming healthcare education funding: creating a sustainable future workforce”. The Department of Health noted that they are intending to publish an initial response after the consultations close early in the summer, which will hopefully address some of the uncertainties around the funding for students.

5. Members noted concern on the situation for postgraduate pre-registration courses, which will not be eligible for funding under the student loan system and for which bursary funding will no longer be available. The Committee urged greater clarity on what is happening for these courses to be provided as soon as possible for the sake of students who may be considering study in 2017-18. It was noted that without

2 clarity there is a risk of students opting out from this mode of study, which could impact on future NHS workforce.

6. It was reported that the reforms are creating some uncertainty among NHS providers regarding the clinical placements arrangements and how any expansion of numbers might be managed and funded. Members recommended that there needs to be a greater system wide engagement and communication with NHS trusts and other stakeholders on this issue. The risk is that a dual funding approach for placements could cause confusion within NHS Trusts and other placement providers and could lead to difficulties in maintaining parity of quality across all placements.

7. The Committee raised a concern that cuts to post-registration funding by HEE for continuing professional development in mentoring is leading to reductions in the numbers of Mentors in the health education system, which in turn impacts on the quality of placements for pre-registration students. Members recognised the importance of the role that Mentors play in ensuring positive training experiences for students while on placements and noted that this can have an effect on their early career choices. The UKHEAC advised that more support and focus should be given to maintaining good Mentoring models.

8. While discussing the timetable of the reforms, concerns were raised that students who are considering applications for 2017-18 entry are not currently able to get a clear offer from institutions. There is much uncertainty over the terms of any offer that institutions can currently make, along with apprehension for how they could be bound by consumer law. This is leading institutions to ask questions around what their indemnity is in this regard. The Committee strongly recommended that it is important to provide greater clarity for students applying for 2017-18 entry as soon as possible. This will enable students to apply with a more secure understanding of what terms they will likely be offered.

9. There was apprehension from members that the funding reforms will lead to a drop in interest from mature students seeking entry onto health courses. Some early evidence reported at the UKHEAC suggests a 15 percent reduction in interest from mature students in attending open days at one University. If this translates into a similar level drop in applications across the board, it could lead to recruitment problems, particularly for professions that rely on mature students for the majority of their intake (such as Adult and Mental Health Nursing). Members suggested that some form of national advertising campaign to boost interest in nursing and healthcare careers, as well as dispelling some possible misconceptions, might help to offset some of the deterrent to students. The recommendation for clarity on financial support arrangements for students was again raised as an urgent issue. It was noted that mature students in particular rely on accommodation and travel costs

3 for placements, childcare, and maternity leave support more than other students; so these issues need to be clarified to avoid deterring prospective applicants.

10. In regard to the different approaches taken to health education funding in the devolved nations, members recommended there should be clear reciprocal arrangements and cross border agreements in place between all four nations. In particular there should be clarity on fees, available loans and support arrangements for any students seeking to study in a different home nation.

Action: Feedback key points and issues of note from the discussion on the DH consultation into the feedback letter to HENSE

Teaching funding

11. HEFCE reported that they are continuing to develop their approach to teaching funding and are intending to carry out a teaching costing exercise later in 2016 to inform our funding decisions. HEFCE also indicated that it is giving due consideration to health subjects that are considered particularly specialised or vulnerable, in order to ensure continuity of provision under the reformed funding model.

12. HEFCE recognised the sensitivity on student opportunity funding, as well as acknowledging the other aspects of HEFCE funding (such as London weighting) which are being considered when determining what the additional allocation of grant for HEFCE under the reformed model is to cover and how it is to be allocated.

13. The Committee also noted that the new system has some differences to the previous HEE commissioned approach, such as the need for OFFA access agreements under the student loan system, which make direct comparisons of funding rates difficult.

Clinical placements

14. HEE reported that the approach for clinical placements will be informed by the current consultation and an announcement of the expected solution is expected to follow after the initial Department of Health consultation response. It was noted that HEE has had a flat cash settlement, so there is no additional funding available for clinical placements, so any approach will need to work within this limitation.

Minutes of the UKHEAC meeting held on 1 March 2016

15. The minutes were agreed by members to be an accurate record of the discussions.

4 5 Matters arising

Committee membership update

16. The Committee noted the new appointments of observers for the GPhC and HCPC, which means that all the major health professional bodies should now be represented on the UKHEAC.

17. Members agreed with the recommended approach to invite stakeholder interest groups such as the CoDH and MSC to UKHEAC meetings as guests on a meeting by meeting basis (rather than have them as standing attendees).

18. The situation regarding student members on the UKHEAC was reviewed and it was noted that it will be important to get an informed perspective that will help enhance the Committee. Members recommended that views from across all healthcare professions should be sought, so even with only two student appointments, consideration should be given to drawing students from a wider pool than just doctors and nurses, perhaps by alternating the appointments to come from different disciplines.

19. Members also encouraged for there to be a student perspective that reflected the wider UK, including the devolved nations and not just the English perspective, which may be achieved by alternating the nations appointments come from. The Committee also suggested that student appointments could be sought through a student body such as the NUS, as they may also be able to provide support to the students for the duration of their appointment period.

Action: Seek to appoint two student representatives to the UKHEAC, possibly through NUS who may be able to support the students in their appointments.

Implications from the HE white Paper

20. David Sweeney gave the Committee a brief update and overview of the HE White Paper “Higher education: success as a knowledge economy” and discussed some of the implications and next steps for HEFCE and the HE sector, noting the direction for HEFCE to move towards more of a regulation role as the Office for Students, with the greater focus on teaching quality.

21. Members expressed concern over the planned separation of research and education in the White Paper, with the Committee taking the view that it was important to not lose the wider benefits of support for teaching conducted in a research environment. This was raised with particular regard to Medicine, where it was noted that a

6 research environment is not a regulatory requirement of the GMC and there was concern that loss of the research link could have wider implications for growth of new schools.

22. The effect of the TEF on devolved nations was deliberated with members highlighting the risk of a two systems approach developing, with the TEF process being seen as the ‘UK’ system to run alongside any devolved process. The committee recommended that there needs to be greater opportunity for formal input into the development of TEF by the devolved nations with a cross nation agreement and mutual recognition of all systems.

23. Members also raised some concerns about the proposed future development of discipline level TEF outcomes for health subjects. It was noted that health subjects are already well regulated and quality controlled by various professional bodies, and so there is a risk of bureaucracy duplication, along with additional resource implications.

Update on Welsh issues

24. Celia Hunt provided an update to the UKHEAC on Welsh issues.

25. It was reported that HEFCW are considering the implications arising from the White Paper and what it may mean for Welsh higher education. Wales has committed to TEF 1. With regard to TEF2 and beyond, while no decision has been taken it was suggested that Wales is currently minded to accommodate the framework, though it may not suit their requirements that well as currently outlined.

26. With regard to the devolved administration, it was reported that there has been some changes for Wales following the National Assembly elections, with a new health minister and a new cabinet Secretary for Education.

27. It was noted that the final report of the Diamond Review of HE funding and student finance in Wales is expected to be published later in the year.

28. The Hazelkorn Review of post-16 education, published in March, recommended a single post-16 body to replace HEFCW. It is expected that a Government response to the Review will be published in the autumn.

29. It was noted that health care professional education review continues, with further work commissioned to look at models for a single health education body. Colleagues are reviewing the Scottish model for NHS Education, and consulting broadly, to see what good practice or methods may suit Wales.

7 30. There has been no decision made on the funding for Nursing, Midwifery and AHP in Wales. It was noted that there will be issues for student finance and access to loans, as well as other cross border implications for students seeking to study in a different nation.

Action: Further clarity will be needed on the implications from the health funding reforms for cross border student study.

Update on Scottish issues

Current Issues in Medicine

31. Helen Raftopoulos provided a short presentation to the UKHEAC, focussed on the current issues in Scottish medicine.

32. The Scottish Funding Council’s role in medical education was outlined, noting key activities and challenges and setting out national future priorities. Scotland is seeking to increase year on year intake to medicine by 50, which will be targeted at improving widening access and will be linked to the introduction of a graduate entry programme.

33. Rural and remote working was highlighted as a key challenge with only 50% of such places are filled each year. This has been leading to a growing number of GP vacancies in rural Scotland, as well as consultant vacancies in rural hospitals. The SFC are seeking to increase the exposure of medical students in Scottish Medical Schools to rural health care by 50% by 2020.

34. It was reported that Scotland will be introducing an ACT levy on international students, in order for them to contribute towards their clinical placements, to come into effect from August 2016.

Nursing Education in Scotland

35. Hugh Masters gave a presentation to the Committee setting out the vision and strategic aims for the future of nursing and midwifery education in Scotland.

36. The key strategic aims of ‘Setting the Direction’ for nursing and midwifery are to deliver a sustainable approach with embedded NHS values that delivers dynamic and high quality education with strong clinical academic collaboration.

37. The strategy for nursing education will be informed by workload and workforce planning, which determines the Scottish intake targets, which will be set to ensure

8 the right staffing levels and to create stability of planning for higher education institutions.

38. In responses to questions from members, Hugh indicated that Scotland is looking at the apprenticeships model, but they are not ruling anything in or out at this stage. Any development will be a long term process as they want to make sure they have an informed strategic view for the Scottish health education landscape.

Update on Northern Irish issues

39. There was no representative present and there was no update from Northern Ireland at this meeting. DELNI colleagues are still in the process of appointing a new member to represent Northern Ireland at future meetings of the UKHEAC.

Any other business

New Medical Schools

40. The growth of private medical schools was raised by members, with it being noted that there appears to be a lot of pressure on the current system controls with a strong student demand, particularly with regard to the overseas student market. HEFCE funded Medical schools have to operate with a 7.5% limit on the number of overseas students as part of their overall intake target, and it was felt that this is leading to an uneven playing field between private and publicly funded medical schools.

41. The development of private programmes is also putting pressure on the clinical placement system, both in terms of potentially eroding the level of resource per student and in ensuring the continued consistent quality of all placements.

Action: Discussion on the growth of new medical schools and the pressures on clinical placements to be scheduled for the November UKHEAC.

Pharmacy

42. Pharmacy education was briefly touched on, with members noting that while there have not been any significant changes recently, issues around curriculum reform and clinical placements are ongoing. It was agreed that the UKHEAC should return to Pharmacy issues for further discussion at the next meeting.

Action: Discussion on Pharmacy issues to be added to the agenda for November UKHEAC.

9 43. There were no further issues, so the meeting was then brought to a close.

The next meeting of the UKHEAC will be held on 3 November at HEFCE offices in London.