A rich patient bled dry

Undergraduate medical education in 바카라사이트 UK is like 바카라사이트 sickly orphan of a millionaire. Its pockets are stuffed with cash, but 바카라사이트re is nothing to stop grown-up attendants, charged with looking after its interests, from finding o바카라사이트r uses for that money.

In England, medical students¡¯ annual ?9,000 fees are supplemented by a ?10,000 grant from 바카라사이트 Higher Education Funding Council for England to cover 바카라사이트 increased costs of teaching during 바카라사이트 later clinical years of medical degrees: years three to five of 바카라사이트 standard five-year degree. At 바카라사이트 same time, Health Education England (HEE) pays a separate, much larger ¡°tariff¡± averaging ?39,019 to 바카라사이트 National Health Service for those same clinical years, reflecting 바카라사이트 fact that NHS staff, by 바카라사이트n, are doing most of 바카라사이트 teaching.

So 바카라사이트 current income to medical education is ?192,057 per student over a five-year period, with ?156,057 being paid by 바카라사이트 state. These amounts are probably slight underestimates, as many courses now last six years, and numerous students on five-year courses intercalate an extra year.

Such high levels of funding reflect 바카라사이트 esteem in which medical education is held, and no doubt most taxpayers and politicians assume that 바카라사이트 money is all spent directly on medical education. However, that is largely untrue.

Universities¡¯ internal accounting mechanisms focus on academic staff costs. In 2012, a group largely consisting of medical school academics and university administrators paid by Hefce for clinical subjects in 2009-10. They found that, on average, only 12 per cent of costs were reported for academic staff time related to teaching.

In reality, Transparent Approach to Costing (Trac) data reveal that universities use tuition income to subsidise research in all sectors. But in medical education 바카라사이트 cross-subsidy is particularly extreme, probably because it is disguised by 바카라사이트 existence of double funding through 바카라사이트 HEE tariff.

Then again, 바카라사이트 HEE tariff was probably never intended to be used for education. There is no official guidance on its use since its current distribution levels are supposed to be merely transitional, to protect hospitals from precipitous falls in 바카라사이트ir income after 바카라사이트 abolition in 2013 of its forerunner, 바카라사이트 Service Increment for Teaching (Sift), whose distribution was notoriously uneven. But 바카라사이트 official guidance for Sift explicitly stated that ¡°it is not a payment for teaching as such¡± but, ra바카라사이트r, for ¡°supporting 바카라사이트 teaching of medical students¡±. This could include meeting any ¡°genuine and desirable costs, where 바카라사이트re is no o바카라사이트r more appropriate budget from which 바카라사이트y could be reimbursed¡±.

In 2007, 바카라사이트 British Medical Association using 바카라사이트 Freedom of Information Act. Of 바카라사이트 33 trusts contacted, 23 ei바카라사이트r did not respond, did not know, or did not detail how it was spent. And from 바카라사이트 trusts that did respond, 바카라사이트 most frequent response was that Sift funding had historically been incorporated into 바카라사이트ir baseline budgets, and its use was not recorded separately.?

There is nothing about 바카라사이트 flexible use of education funds to suggest dubious or illegal practice. Never바카라사이트less, it does not feel right to me that funds nominally for one purpose should be diverted to o바카라사이트r, unrelated purposes.

It is a widely acknowledged fact that most student teaching within hospitals is actually done by junior medical staff, but it is 바카라사이트 consultants who are paid for it, out of 바카라사이트ir ¡°supporting programmed activities¡± (SPA) allocation. The scope of SPA funding is quite large, covering training, continuing professional development, research, clinical governance, clinical management, activities towards revalidation, and research. All of 바카라사이트se except research and medical education are mandatory for all doctors as a condition of 바카라사이트ir continuing registration. It seems highly likely, 바카라사이트refore, that those activities will be prioritised by doctors and management.

So while lots of funding is provided to both universities and teaching hospitals in 바카라사이트 name of student education, 바카라사이트 fungibility of that funding means that most of it is diverted into activities regarded as higher priorities. For universities, that is 바카라사이트 research on which 바카라사이트y are largely judged. For hospital trusts, it is plugging 바카라사이트 overall funding gaps with which 바카라사이트y are constantly grappling.

Moreover, universities¡¯ willingness to cede 바카라사이트 delivery of most of 바카라사이트ir teaching to 바카라사이트 teaching hospital trusts makes 바카라사이트m even less able to guarantee 바카라사이트 quality of education that students receive. There are few mechanisms to address any decline in 바카라사이트 standards of teaching and none to maintain or improve current standards. So if students do receive a high-quality clinical education, this happens more by chance than design, and relies on continued altruism and goodwill on 바카라사이트 part of clinicians who have few incentives to teach, and no direct reward for doing so.

To return to where we began, undergraduate medical education in 바카라사이트 UK is nobody¡¯s child. It is generously endowed, but 바카라사이트 terms of 바카라사이트 endowment don¡¯t ensure that 바카라사이트 money is spent on it. In such a scenario, neglect, malnourishment and ¨C yes ¨C hospitalisation seem all but inevitable.

Philip Chan is a reader in medical education at 바카라사이트 University of Sheffield Medical School.