The new Government’s plans to scrap SHAs by 2012 in an effort to slash NHS administration costs will have ‘major ramifications’ for the future of GP training, and could see budgets cut, warns the GMC. From the GP Bulletin, Pulse, 1 June 2010.
As Mark Twain said, rumors of his death, etc. the issue is overstated as always. Fear replaces optimism as vested interests worry that they won’t be getting their education funding. But what was it doing with the SHAs in the first place? The creation of some form of market in health professions education, tied in some way to supply management does not in the end ensure a steady and flexible supply of health professions, any more than a similar system would ensure a reliable supply of geologists or accountants. The higher education system fails to evolve in response to the funding, as it is quite separate from the students or the continuing professional development needs of practising professionals.
It is good, though, to know that some see merit in this change as it will, in the end, clarify the purchaser/provider issues and redefine the necessary oversight of the health system. GPs and other health professions, though, do need to be assured that funding is in place to ensure that the programmes they need are properly funded, and accessible in ways that meet their requirements. It is, perhaps, no surprise that the revalidation argument fell at the final hurdle on the issue of a doctor’s time to do revalidation (having had some involvement in this issue in the past, I had calculated the full-time equivalents required to run the system, as well as the time it would take just to read the documents involved — but no one it seems had actually tried to read the paperwork, conduct the required activities with an eye to a clock!).
In the end, the simplest solution is to put the funding in the hands of both the students seeking the study a health profession, and in the hands of either the self-employed GP or their employer (the hospital) to decide what to do. With a level playing field on the provider side, this would ensure that the free-ride enjoyed by the private sector ended, and that all providers were properly responsible for both professional development generally, and CPD in particular. One benefit would be improved accountability by the higher education institutions that have come to monopolise this area, regardless of the quality of their offerings or not.
Countries sink vast sums of money in higher education. Why?
Universities and colleges are at their root ‘schools’, designed to enable the transfer of knowledge from one generation to another. It is where people go to learn how to be a doctor, lawyer, accountant, chemist, engineer, sociologist, and so and so on. What we expect them to do is deliver this knowledge transfer in an efficient and effective manner, to some degree of reliability and standards over time. To do that well, those who teach in these places are also expected to, in one form another, operate at the front line of their profession or discipline. There is really no point learning to be a lawyer from someone who doesn’t know what the meaning of recent court ruling is for civil liberties. So we expect those people to have an inordinate curiosity to know more than the average person would in order to structure the new knowledge, clean out the old, and ensure that we still get lawyers who can defend you in a court or a doctor who recognises you have a disease and knows what to do.
The research agenda has emerged as a big area of university activity, with many academics, perhaps most, have their careers almost trapped within expectations that they will do research and do it well, and be “published in prestigious international journals” (as a head of a higher education institutions once said to me). Some more senior academics, perhaps the ones with the best understanding of a field, prefer not to teach, but beaver away on their pet research projects, or supervise the energetic activity of their graduate students.
In terms of the demands of the modern world, can the twin objectives of research and teaching co-exist together in the way that have in the past?
In the UK, the various university groups, such as the Russell Group, want greater freedom to set tuition fee levels, so they will get more money — this is the “big idea” that has come from institutions that are supposed to be the elite institutions in the UK, able to think the unthinkable, leap tall problems with a single bound. I am dismayed at such lack of insight, but also at such self-serving indifference to the problems that lie within the academy.
Will this money go to better teaching? This is doubtful, as universities define themselves more through their research agenda than through their teaching agenda. Indeed, the careers of academics are made, not on the quality of their teaching, but on the steady production of research papers published in journals with a global audience of often a few hundred people, and books that embody the assembling of vast storehouses of information, but often fail to produce anything more than a wind-egg of insight.
There is the view, though, that teaching and research are intertwined; no doubt. But in the modern university, the research side rarely benefits the undergraduates (the focus is on the post-graduates), and higher performing academics are allowed to shrug off their teaching responsibilities, so they can concentrate on what interests them. Perhaps all research intensive academics should be on soft money, ensuring that they are constantly focused on producing results from their research; this would also require greater sensitivity on the funding side, though, to ensure that good basic and preliminary or groundbreaking research continues to be funded. But at least it would eliminate the sinecure that protects many academics from accountability. But it would address the academic free-rider problem.
Like any clubby group, the universities see themselves benefiting FROM society, but not fully comprehending how they actually provide benefits TO society.
The solution is to break up the cosy world of higher education, like we would with any cartel. We need more contestability in the market for ideas, for teaching and for research.
That means that if students are to pay higher tuition fees, they should expect to get a higher quality learning experience.
That means professors teaching first year students, and graduate teaching assistants finding something else to do.
That means that we need to be able to decouple research productivity from the university’s teaching mission, enabling more free-standing and autonomous research facilities to exist, without the necessity of also carrying a teaching responsibility. It means that some institutions will concentrate on teaching and not be penalised for not doing research.
That means that some universities should go back to being polyclinics, and perhaps even technical colleges, to provide a more diversified educational system for the learners.
That means that we need more ways for students to learn, without the necessity of huge investment in building overheads and campuses,
That means we need smaller, more flexible learning and research-intensive environments, that can respond quickly and flexibly to areas of priority, such as we have seen with systems biology, conservation medicine, and other ways to integrate knowledge across often dysfunctional and artificial academic disciplines.
The new austerity isn’t only about money, it is also about purpose. Given the massive public investment in higher education, is it too much to ask the higher education sector to remind the hard-pressed taxpayer exactly what they are for?
Want to know more? Some suggestions…
The Marketplace of Ideas by Louis Menand (FT review of his book)
Reinventing Universities, a paper by Gowher Rizvi
We must set our universities free by Terence Kealey in Standpoint
News item in the UK: The sector’s funding body, the Higher Education Funding Council for England (HEFCE), announced (on 1 February 2010) that budgets are to be cut by £449 million for 2010/11. This includes:
* A 1.6 per cent reduction (£215 million) in teaching funding;
* Research budgets will remain the same as last year;
* A 16.9 per cent cut in capital funding;
* A 7 per cent reduction for funding of special programmes and initiatives.
In a letter to vice-chancellors setting out the budgets, HEFCE said it recognised that the reductions will be “challenging” to institutions.
Now what is to be done? Predictably, the higher education sector in the UK is arguing that this will affect perhaps 200,000 students who won’t be able to get a university education. A few weeks ago, the sector argued that the UK’s place as a top tier home of higher learning was at risk — but that came from the elite Russell Group, which represents perhaps the top of the top universities in the UK.
There are a number of possible ways of thinking about this. A few:
- Universities already get a lot of money, and they perhaps could reduce their running costs — think of the disorganised structure of the academic year, think of teaching loads or confused performance management (is it teaching quality, research or publications??), and pretty good employment contracts. (I had one once.)
- There are too many universities trying to do too much, and perhaps it would not be a bad thing if some either closed or merged with another institution. The loss of the old polytechnics deprived the higher education system of a sensible alternative. Since comparisons to the US are frequently made, it is worth noting that some of the US’s top institutions are not called “university”, anyway, but ‘institute’ and indeed ‘polytechnic’. One could also look for new innovative institutions to emerge to challenge much that universities do. For instance, research institutions without university links, or which are focused on compelling issues — check out the Santa Fe Institute, for instance. Universities are not the only fruit!
- Cutting capital funding is not such a bad thing, given the horrendous financing of a state-sponsored capital funding body. Better universities learn how to build collaborative relationships with sources of capital, than expect their funding automatically to come from the state.
- Perhaps too much inadequate research is done, poor deployment of intellectual effort at reaching wider learning communities, responding to new ways of structuring learning beyond the rather tired full or part time dichotomy, and so on.
But of course, the key dilemma remains, what is to be done?
I take an optimistic view, but I would put the challenge at the door-step of the universities.
Rather than complain, prove that 800 years of public and private investment hasn’t been wasted, and come up with sensible solutions that would establish a sustainable approach going forward. I doubt 200,000 or 200 students would be disenfranchised as a result, new ideas would emerge.
A recent book review in the Financial Times of Louis Menand’s The Marketplace of Ideas, would be a good place to begin some fresh thinking. The reviewer, Christopher Caldwell, notes:
Starting in the 1970s, professors, newly alert to injustices in society at large, took aim at credentialism and departmentalisation in every nook and cranny of American life – except, Mr Menand notes pointedly, their own. The professorial hierarchy continued to rest on a system of arduous PhDs (raising high barriers to entry), “disciplinarity” (denying the authority of the non-credentialed to teach or even discuss academic subject matter), and tenure (jobs for life). It was a system well-suited to monopolising bureaucratic power, but less well-suited to the free flow of ideas. Menand cites a 2007 study to show that, in the 2004 presidential elections, 95 per cent of the social science and humanities professors at elite US universities voted for John Kerry and 0 per cent (statistically speaking) for George W. Bush. Monopolies produce smugness and sameness in universities, just as they do anywhere else.
The title of this blog entry takes from a line in the film Independence Day, where the President says to the Geoff Goldblum character, ” And we’ll see if you’re as smart as we all hope you are” It is now time for the universities with their massive subsidised top-tier braintrust put on their thinking caps, stop playing victim and take responsibility for the solution. The university-based economists let us down quite badly with failing models of our economies, and we are all paying for it in one way or other. Let’s not see two in a row.



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