Be warned, no one will be able to put health training together again

Scholars must join doctors and nurses to stand against the health and social care bill before it dismantles the NHS, Woody Caan says

January 26, 2012

Credit: Paul Bateman

Last week, the Royal College of Nursing and the Royal College of Midwives declared their "outright opposition" to the government's NHS plans, joining the British Medical Association and many others.

But academics should be just as concerned as doctors and nurses about the government's health and social care bill. NHS contracts are a major source of funding for higher education. Annual income from strategic health authorities alone is worth £5 billion and universities with medical schools get more than half of it.

Universities' links with the NHS are strong. Many health professionals give their time pro bono to teach in universities, while health trusts provide clinical placements and professional mentors to an estimated 100,000 degree students a week. In medicine and nursing, many academics have joint contracts under which NHS trusts or health authorities pay part of their "tenured" salaries.

To declare a personal interest, I have been a health commissioner, trainer and professor, and I collaborate with local authorities that would also be radically affected by the bill if it becomes law, so I have followed its passage closely. Last year, I took part in a frantic Department of Health meeting that examined possible ways of commissioning education and training for the future workforce in a "reformed" NHS, under which "localism" will drive a patchwork quilt of commissions for new and changing service providers, including private sector entrants. More recently, I spoke at a policy breakfast at the invitation of peers who were to debate the bill later that day.

What is clear is that while the bill might benefit a few small academic disciplines, such as environmental health and food safety, my immediate colleagues in academic health promotion are unlikely to benefit at all. In fact, for healthcare academics, the situation resembles that of the unsuspecting Humpty Dumpty sitting passively on the wall.

Removing the 1946 duty of the secretary of state to provide a comprehensive health service for the whole population means that if some arbitrary local decisions are taken - say, that we should not bother providing healthcare in relation to learning disabilities - small disciplines will disappear in a flash.

The extermination of strategic health authorities and the move to local clinical "clubs" with short-term responsibility for workforce planning (an area I have researched for two decades) means that nothing strategic will be decided for years.

Since not every area has a medical, nursing or dental school, historical links between services and education will fragment and the clinician's old school tie will come to dominate. And as private corporations pick up more and more business in a piecemeal pattern, it is unlikely that they will provide the same range of learning opportunities as those currently supplied by NHS providers.

As for existing teachers' joint contracts, the majority of private entrants will not offer such positions, depleting the ranks of senior academic consultants needed for professional training and assessment. And there is no clear national direction about who will pick up the tab for teaching posts at a slightly more junior level (such as lecturer-practitioner or clinical lecturer), which in many cases carry the highest number of student contact hours.

The fragmentation of education and training across organisations and sites will break up Humpty Dumpty in a way that can never be put together again.

Continuing professional development is a key source of postgraduate health income, but this is already shrivelling as current providers hang on to their vulnerable training budgets.

Since the NHS Plan in 2000, several initiatives have sought to bring higher education and the NHS trusts closer together to create interesting clinical careers that include some teaching and research. No one can predict how the bill will affect career plans - but the declared intention of many mature clinicians is to retire early rather than face the oncoming chaos.

In that environment, will promising young professionals choose to risk time doing a doctoral thesis or gaining learning and teaching qualifications? So far, the signs are not encouraging. While one professor cannot speak for all health professionals, in public health the number of entrants into the academic sphere is already too low to sustain the discipline nationally.

This is why I have made my opposition clear: I was one of 500 public health professionals who petitioned the House of Lords to block the bill and earlier this month I joined the final leg of the symbolic "Bevan's Run", which saw two NHS consultants run 160 miles from the statue of Aneurin Bevan, architect of the NHS, in Cardiff to Whitehall. With the bill entering its final stages in Parliament, I would urge others to make a stand.

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