Training of doctors and nurses in universities faces funding problems that could further undermine recruitment of clinical academics. Claire Sanders reports.
The future of medical education is becoming "unsustainable" doctors warned this week, as health budget cuts threatened to destabilise medical schools already struggling with plummeting staff numbers.
Leicester Medical School, which is in the constituency of Health Secretary Patricia Hewitt, faces particular difficulties. "We are reaching a critical point," said Michael Rees, chair of the British Medical Association's medical academic staff committee.
"If numbers of teaching posts continue to dwindle, the quality of medical education, as well as the viability of medical schools themselves, will be endangered."
Professor Rees said that medical schools such as Leicester, which had a high reliance on the National Health Service for the funding of clinical posts, faced particular difficulties as strategic health authorities sought to balance the books by cutting "soft" education and training budgets.
"We have pulled Leicester back from the brink," he said, "but it still faces a difficult future."
Katie Petty-Saphon, executive director of the Council of Heads of Medical Schools, said that closures were unlikely and schools were anticipating that this year's cuts were a "blip".
Nationally, medical schools have seen their budget for hospital teaching - known as Sift - cut by between 5 and 10 per cent.
Ian Lauder, dean of the Leicester Medical School, said that the future funding of the school was still precarious and he predicted cuts in student numbers.
"Overall, £12 million of our £25 million budget comes from the NHS, giving us a high level of exposure," he said. "If our local NHS had brought in cuts of 20 per cent, as it planned to last year, it would have been disastrous for us. As it is, the 10 per cent cut means that we have not been able to recruit in the run-up to the next research assessment exercise."
Professor Lauder said that the big question now was what would happen to the budget in April this year.
"If our budget is not restored, this medical school will have a major problem. There would be cuts in student numbers," he said.
Patrick Sissons, head of the Clinical Medical School at Cambridge University, said: "We are also potentially vulnerable here, but the funding is managed in a different way from Leicester, and it has not as yet had a direct impact."
He said that the school was in discussions with the NHS locally on how to stabilise the funding in the current climate.
A spokesperson for the Department of Health said the total education and training budget had not been cut for 2006-07.
"However, within the overall resources allocated, it has been up to each Strategic Health Authority to determine from within their overall budget how much to spend on training and education," he said.
The budget cuts follow falls in the number of clinical academics.
In 2005, their number dropped to fewer than 3,000, with the medical clinical academic workforce standing at 84 per cent of its 2000 level.
Figures for 2006 indicate that the situation has continued to deteriorate, with the number of clinical lecturers particularly low, now at just 50 per cent of 2000 levels. In the same period, student numbers increased from 25,000 to 35,000.
Dr Petty-Saphon said: "In the past two years a number of initiatives have been put in place to try to boost numbers, notably the Walport clinical fellowships. It is too early to assess their impact."
She said that, traditionally, the academic career path had been difficult for medics, who have to take an extra three years to do a PhD on top of lengthy clinical training.
"The new fellowships and clearer career pathways should bring more job security," she said.
The BMA, the CHMS andthe Deans of UK Faculties of Medicine stressed that the numbers of medical students currently being trained was about right, despite reports in the press last week that the NHS was predicting an oversupply of consultants.
WHO GETS WHAT FROM THE NHS
Medical school Funding from NHS
Leicester University 67 per cent
Cambridge University 51 per cent
Leeds University 51 per cent
Birmingham University 45 per cent
King's College London 42 per cent
Queen's University Belfast 46 per cent
Imperial College London 36 per cent
University College London 34 per cent
Larger medical schools with high concentrations of NHS-funded staff
LEICESTER PARTNERS SEE BENEFITS
When Leicester Medical School was set up nearly 30 years ago it was in response to, and in partnership with, local National Health Service needs. Most posts within the medical school are funded by the NHS.
"Leicester has a high Asian population, and 37 per cent of our students are Asian - so they are well placed to respond to the needs of the local community," said Ian Lauder, Leicester Medical School dean. "Our relationship with the local NHS has worked to mutual advantage."
NHS Trusts with links to medical schools are more likely to be awarded excellent-quality-of- service ratings by the Healthcare Commission, according to an analysis by the Council of Heads of Medical Schools.
In 2006, the three university hospitals in Leicester NHS Trust all received an excellent rating from the commission for the quality of their services.