The relationship between higher education and the health service is fundamental, but yet it has received relatively little attention in the ongoing debates on NHS reform.
This relationship is undergoing profound changes. It is not yet clear where these changes will end up, though one certainty is that there are risks and opportunities involved for all parties.
However, the structures which the funding and regulation for healthcare education and training will be delivered are changing. By April 2013, the new national body, Health Education England, and regional bodies, Local Education and Training Boards (LETBs), will take over the responsibility from SHAs for the commissioning, funding, and delivery of healthcare education and training.
The implications could be very significant. Universities have always been core partners in defining and delivering education, but now this is changing. Provision is being opened up to a range of possible providers at local level and more of the funding and influence may be under the direct control of the providers. The impact of higher fees on the supply of students is also uncertain and the involvement of universities in decision-making at local level varies across regions.
A recurring theme in the debate for health service reform is the need for innovation - to develop new services, and to introduce efficiencies into existing services. The interaction between universities and existing NHS staff is often under-appreciated, yet at any one time universities are helping 37,000 healthcare professionals to update their skills and are graduating 100,000 doctors, nurses, midwives and other health professionals. Universities act as the interface for cutting edge research and practical application and, as such, are essential to driving innovation in the health service.
Yet, as we await publication of the authorisation criteria for the LETBs, there are already worrying signs in some areas that universities are being marginalised from decision-making. Universities have reported difficulties in securing representation on local shadow boards and have voiced concerns about the impact the changes may have on the flows of funding for this area of activity. They have seen numbers of commissions reduced in some professions in the vacuum left by the transition from one system of funding and regulation to another.
We must ensure that the strengths of the relationship between higher education and the health service are preserved to make sure that the UK’s health workforce can meet its future challenges.
First, healthcare education and training must remain a predominantly university-led activity. Universities provide the research-led teaching environment essential for developing an agile, innovative workforce. This feeds through into the quality of patient care and the ability of staff to respond to new challenges. Universities should also lead in some of the other complementary health service reforms taking place at the moment: namely, the development of the Academic Health Science Networks and the introduction of the Educational Outcomes Framework.
Second, good relationships at local level are critical for the success of the new system. In many cases these relationships exist and are working well. In other cases they are working less well. Getting them right - based on equal partnership and input into decision-making and influence - affects not only the success of the new system, but will have broader consequences for regional economies.
In many areas of England, universities are among the most significant employers, generating an economic impact which is several times that of their turnover alone. Working with and supporting local healthcare networks, through the provision of education and research, contributes substantially to this regional impact - particularly in areas where the public sector is itself a major employer.
Finally, the impact of the current reforms both on higher education and on the health service must be carefully monitored, to ensure they can meet their intended aims. This transitional period must be negotiated successfully, but one eye should also be kept firmly on the future to ensure that the system as a whole is genuinely capable of meeting the country’s considerable healthcare challenges.
The relationship between health and higher education is too important to get wrong. The current set of reforms brings this into sharp relief. It is in the interests of all parties to work together as closely and constructively as possible to make the new system work to its full potential.
Paul Clark is director of policy for Universities UK