Health takes over as fees are waived

October 10, 1997

Little attention has been paid to the government's decision to move funding for students of medical subjects from the Department for Education and Employment to the Department of Health. The details are as yet unclear. But what is certain is that substantial sums will be transferred. Medical education, broadly defined, accounts for about a fifth of higher education spending. Clinical courses are the most expensive and all courses in this area are in the more expensive bands.

When tuition fees are introduced next autumn, medical and dental students from year five onwards and all nurses, midwives, dietitians, chiropodists, speech and language therapists, orthotists and prosthetists will have their tuition fees paid for them by the DOH. They will also, unlike other students, continue to get means-tested grants (called bursaries), which will be paid by the DOH. They will get loans from the DFEE.

It is easy to see why action is being taken. Education secretary David Blunkett, who hates the tuition fees policy, will not have been hard to persuade that fees could deter students from poorer backgrounds from taking these courses. This has to be avoided for two reasons. First, entry to the medical profession is already skewed to the rich. As Andrew Adonis (page 20) reveals, a 1995 report showed that 55 per cent of medical students went to private or grammar schools and three-quarters were from professional class families. No one wants that bias to increase.

Secondly, nursing is a profession that recruits best in recessions. With the labour market offering wider opportunities, particularly to women, subjects allied to medicine, and nursing in particular, are most likely to suffer any deterrent effect from fees. The move is also needed to end anomalies between those funded by the NHS and receiving bursaries, and university students who would have to pay from next year and will lose grants over the next two years.

What the providers of courses will want to know is whether it is just the student support and fee money which is moving or whether all the money, including research money, for these subjects will be transferred.

There could be advantages in moving the lot. Universities and colleges would have another funding agency to work with. This may sound like a drawback but with increasingly prescriptive control exercised through funding, many masters allow greater flexibility. The higher education funding councils will become more powerful as money paid through local authorities for fees moves to the councils.

Furthermore, nursing has been uncomfortable in higher education because of the pressures of the research assessment exercise. Universities with large nursing schools have found their average research performance pulled down by low scores for nursing. Some of the more ruthless managers have put unacceptable pressures on nursing departments to build up research in ways that many nursing academics do not consider appropriate. It might be a relief to all concerned to find a way out of that rat race.

There may be the beginnings here of the sort of pattern the TECs are considering (page 6) where universities are suppliers of services to many sponsors. On the other hand, if the DOH turned out to be as prescriptive as the Teacher Training Agency, many in higher education would be concerned.

There are also fears that instability, already worrying, could increase. The DOH will inevitably be into manpower planning for these professions. Eachstudent will cost it a lot and with courses offering free tuition, grants and good job prospects, they may be oversubscribed. Using short-term contracts to regulate supply can cause severe problems as happened when nursing tranferred to the universities. Universities and colleges can get left with expensively equipped premises that are suddenly redundant. The position could be worse if contracts are handled through local trusts. Hearts may sink at the prospect.

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