Financial pressure is causing havoc in university health service units, Harriet Swain discovers.
THE departure last month of Eric Caines, Nottingham University's head of health service management, has shown that relations between medical professionals and academics are not in the best of health.
The type of university unit headed by Professor Caines shot to prominence following the Government's 1980s National Health Service reforms, when many working in the NHS wanted to acquire management experience.
Heavily subsidised by the health service and largely staffed by its former employees, the units were designed to carry out research and provide short courses for personnel, ranging from doctors to hospital managers. But financial pressures, on the health service and the universities, have encouraged them to concentrate on lucrative consultancy work.
Some health academics argue that the units are not now producing the kind of research they were set up to deliver, and that they have moved too far from the cutting edge to provide effective consultancy. Ray Rowden, former director of the Institute of Health Service Management, said that with one or two exceptions the standard of research coming from university health management centres was poor. "There is a desperate need for more research in NHS management," he said. "Historically, Britain is starting from a low base in terms of having a pool of people with the requisite skills to generate and also undertake original research."
John Spiers, chairman of the Patients Association, said: "I am critical of some of the work that is done because I think it is short-term and politicised, with a view to the next piece of money coming from the Government."
The health care practice and evaluation centre at Sheffield Hallam University, a unit that includes health management, achieved a particularly low score in the recent research assessment exercise, but has vowed to improve.
At Manchester University, the health service management unit has gone a step further and is now talking to commercial consultants in an effort to improve matters. Sir Duncan Nichol, a former NHS chief executive and now head of the unit there, admitted that the research record of his unit could have been better. The university is exploring the possibility of a partnership with Dearden Management that would enable it to concentrate on teaching and research.
Sir Duncan said experience had shown that it was difficult to be an effective consultancy practice and remain strong in research and development. But he denied that the new arrangement was being considered for financial reasons. "We had a good year last year and we expect this one to be much the same," he said.
Academics have also been questioning the research and teaching credentials of senior managers coming into universities through the units. Alan Maynard, professor of economics at York University, made an official complaint about the appointment of Professor Caines. And a shadow has fallen on the work of Keith McLean, a research fellow in health management at Sheffield University. A National Audit Office report found that while general manager of the Yorkshire Regional Health Authority, Mr McLean had behaved "in a manner unacceptable in a public servant". The authority is still considering legal action.
But Philip Hunt, director of the National Association of Health Authorities and Trusts, said that friction occurred in universities because senior managers leaving the NHS were accustomed to much higher salaries than academics. "Some people have ended up in these academic units on dowries from the health service," he said. "But the NHS gets a lot out of links with universities and I wouldn't want to see that broken."
Duncan Nichol, 55, became professor of international health care management at Manchester University in 1994, and was made director of the health services management unit a year later.
Educated at Bradford Grammar School and St Andrews University, he held administrative positions in hospitals in London and Chicago before joining the Manchester Royal Infirmary as assistant group secretary.
He remained in north west England, progressing from district administrator to the level of regional general manager.
Then in 1989 he became chief executive of the National Health Service where he oversaw the radical administration reforms of the past five years.
He left to join Manchester University and at the same time took up non-executive roles as a director of the Prison Service and of the private health scheme, Bupa.
During his career Mr Nichol has served on the NHS training authority and the Central Health Services Council, and was president of the Institute of Health Service Management. He has also contributed to publications dealing with healthcare and management.
Eric Caines, 60, became head of the health service management unit at Nottingham University when it was set up in 1993.
A graduate of Leeds University with a degree in law and a diploma in history of art from London University, Professor Caines appears to have specialised in working for controversial areas of the public sector.
His career has included spells at the National Coal Board, the DSS and the Prison Service, where he was director of personnel and finance until 1987.
He became director of personnel at the National Health Service in 1990, once suggesting that the service could lose 200,000 jobs without much harm.
His appointment to the Pounds 60,000 post at Nottingham caused controversy because he was the only candidate interviewed.
Caines had served on the Sheehy committee on public pay with vice chancellor Sir Colin Campbell, and came with a recommendation from Chancellor Kenneth Clarke, a Nottingham MP.
Keith McLean, 49, became principal research fellow at Shef-field University last April.
After school in York, he served on a number of hospital management committees, graduating from clerical officer posts, to district treasurer and deputy district general manager of North Derbyshire Health Authority.
He worked for Leicestershire and Yorkshire health authorities as a finance director and became regional general manager of Yorkshire RHA between 1991 and 1994. From there, he moved to a similar post at Trent, where he also became a regional NHS director.
Last spring, he was criticised in a National Audit Office report over his three years as general manager at the former Yorkshire RHA.
The report said that the health authority had pushed through NHS reforms "even if the rules were bent or broken". It spoke of "a catalogue of irregular payments, botched deals and sharp practice" and criticised Pounds 450,000 of relocation expenses paid to senior staff to encourage them to the region. Mr McLean received Pounds 67,000 in salary advances and interest-free loans.
The health authority is trying to recover a portion of this money before considering whether or not to take legal action.
The NAO report said, however, that the problems should be seen in the context of the "climate of the time, partly encouraged by Eric Caines, the former NHS director of personnel". At the time, Mr McLean said he would take many of the same decisions again. He said "the climate of the time... encouraged flexibility in the interests of getting the job done".
Brian Edwards, professor of health care development at Sheffield University said Mr McLean was staying on the staff and was working productively. The report's criticisms had not been considered relevant to his work at the university.