'Opaque' course costs set alarm bells ringing

November 4, 2005

Some universities spend almost four times more per nursing student than other institutions and almost three times more per medical student, according to a report published this week.

The Higher Education Policy Institute report calls for the creation of a single funding body for all health students, from medics and dentists to nurses and physiotherapists. It argues that the current system is inefficient, lacks transparency and is full of unexplained anomalies.

Bahram Bekhradnia, director of Hepi, said: "An enormous amount of money is devoted to the funding of medical and nursing students, yet the funding of these activities is probably the most opaque and least transparent aspect of higher education finance."

A single body could allocate as much as £3 billion a year to 100,000 students. But the proposal received a cool reception from the Higher Education Funding Council for England and the Council of Heads of Medical Schools. They argue that the current system works well, has overseen a massive expansion in medical school places and would be difficult to disentangle.

A spokesman for the Council of Deans of Nursing, however, said that it was "moving in the direction of supporting a single funding body". He noted that nursing students received far less funding than medical students and that there was no direct funding stream for hospital placements.

The discrepancies in funding between different nursing departments are particularly acute. Tom Sastry, author of the report and senior researcher at Hepi, said: "In 2000, the National Audit Office looked at how much different universities received per student - one received just over £10,000 while another received just over £2,000."

The bulk of nursing students are on pre-registration courses - training that leads to a qualification that allows them to practise. Strategic health authorities contract universities to carry out the training for the National Health Service. But each contract is confidential - so the NHS is not able to compare prices across the country.

The Department of Health has tried to establish a national benchmark, but its efforts have prompted fears that universities may quit nursing education if contracts are changed. This happened in July when Sheffield University, one of the largest providers of nursing qualifications, pulled out of talks with South Yorkshire SHA and axed its nursing and midwifery school.

Medical schools are funded via Hefce, but again there are wide historical variations in funding.

University College London tops the national table with an annual cost of Pounds 50,103 per student for 2002-03. Oxford University comes second with Pounds 42,348, followed by Imperial College London with £38,223.

Cambridge University comes 11th and St George's Medical School falls in last place with £16,930, although the report points out that St George's position may be "false" due to the way Hepi has allowed for central expenditures.

Mr Sastry warned that it was difficult to establish precise figures because teaching hospitals were compensated by the NHS for resources they put into student training. In addition, "knock for knock" arrangements exist between universities and the NHS to cover teaching costs.

The Hepi report adds that the variations are too big to be explained by differences in research income. It concludes: "Two things... are clear - first, that the available data suggest that different providers may be doing the same job with very different resources; and, second, that, given the shortcomings of the available information, the Government simply cannot know if it obtains value for the very substantial resources expended on medical education."


Training: gaps and trends

  • The UK has fewer physicians than similar countries and is highly dependent on doctors trained overseas - 31 per cent of practising doctors were born abroad
  • Nurse training has become embedded in higher education without acquiring the profile of a typical subject. The profession it serves continues to admit most entrants on the basis of sub-degree qualifications, and research is a marginal activity
  • Per capita resources available to nursing departments are falling, but they are increasing in medicine and dentistry.

Students see where money goes

Kirsty Lloyd is chairwoman of the British Medical Association's Medical Students Committee and has long been campaigning for greater transparency in the funding of medical schools.

"With the introduction of top-up fees, it is crucial that medical students, who accrue high levels of debt while studying, know that their money is going on their courses," she said.

The tables on expenditure and staff-to-student ratios compiled by the Higher Education Policy Institute will fuel these concerns, she said.

"Students would look at them, as well as all the other league tables, to see where they should study," Ms Lloyd said.

"They will want to know that they are getting value for money."

Ms Lloyd studies at Leicester Medical School, which comes halfway down the Hepi table on expenditure per student.

"Leicester is a new medical school and we are very concerned to ensure that we are being properly funded," she said.

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