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A private solution to a public crisis

The University of Buckingham Medical School is a much-needed addition to the UK's medical skills pipeline at no cost to the taxpayer.

The University of Buckingham Medical School is the UK's first independent not-for-profit medical school. Buckingham's vice-chancellor and pro vice-chancellor for health sciences John Clapham discuss the unique merits of such an approach. 

Sir Anthony Seldon 

The medical school started at the University of Buckingham is one of the most exciting developments in medical education this century. The first independent medical school since the Victorian era, it was set up despite medical and educational systems and scepticism, and is now a shining beacon amongst the 34 medical schools in Britain.

The achievement was very much the work of Professor Karol Sikora, the son of the Polish army captain who came to Britain during the Second World War. Sikora spent his career as a restless oncologist, challenging orthodoxy wherever he encountered it. My predecessor as vice-chancellor, Terence Keeley, another contrarian was the other person who ensured that it happened, taking its first cohort of 64 students in January 2015. Demand has been considerable, and this September, we recruited over 100 top-quality would-be medics.

A focus on patients and proactive medical care is a particular feature of the medical school. We have heard many times that the NHS is a National Illness Service rather than a National Health Service. Entrenched thinking has made the focus much more dealing with illness once it occurs rather than trying to ensure prevention of illness.

Yet so much illness is preventable if people at large ate more fresh food and less stodge, drank more water and less alcohol, inhaled more fresh air and less smoke, and if we enjoyed recreation more through physical exercise than glued in front of a screen.

Those dispensing medicine need to take better care of themselves too. For several years I have witnessed  with a wife with terminal cancer, and last month at hospitals with a sick daughter, staff who were too tired, distracted or plain rude to converse in a civilised and pleasant way. If medical professionals do not look after their own physical and mental health better, how can they look after patients optimally? So a focus of the Buckingham Medical School is helping to train our doctors to learn to manage themselves more mindfully.

John Clapham

The other defining feature of UBMS is that it receives no state support whatsoever. It exists because of the students who pay the same fee irrespective of whether they are overseas or home students, with home students comprising 60 per cent of our cohorts. From 2019, when our first cohort graduates, we will from then on be producing doctors at no cost to the taxpayer. That’s right, no cost to the taxpayer. Starting with 60 in 2019 building to over 100 from 2022. The whole setup was funded privately by the University of Buckingham.

Our operating model is very simple. We pay from the student fees for all of the elements required for high-quality medical education and for placements we have negotiated directly with the NHS Trusts who take our students. The total cost of our programme is under £170k, compared to some £250k the tax payer has to fork out to produce each doctor. The other things we do is focus solely on delivering high quality medical education and the staff are dedicated to that principle. This attitude is reflective of the whole university which achieved a TEF Gold for its teaching. Our model also means that we can tell our students exactly what we spend their fees on. It is a high overhead, low margin programme so we are not in it for the mega money but as an expression of the pride we have in our university and the kudos of having a medical school.

Half of the revenue from the medical school, despite it being private, goes directly into the publicly funded NHS. In 2018 this will amount to over £5.5m, well over 10 per cent of the entire university’s revenue. This, and partnership with a medical school, brings benefits to hospitals and the communities around them. They can use the money to recruit new consultants to compensate for the time spent on teaching but from a much wider demographic because of the attraction of education to many consultants. Thus the communities around teaching hospitals benefit from the higher calibre applicants for consultant jobs.

We have built up very strong and positive relationships with our Trust partners. Our first partner, and hub hospital, was Milton Keynes NHS Foundation Trust, now Milton Keynes University Hospital. In February 2018, a state-of-the-art Academic Centre, designed by Philip Bodie of Fielden Mawson, was opened on the hospital campus by His Highness the Duke of Kent. Not only will our students benefit from these glorious facilities but also trainee doctors, nurses and allied health professionals working at the Trust. It is a real symbol, and testament, to the relationship that has developed between our school and the hospital. Something, as our medical school develops, we would like to replicate in some way with our other partners.

We do, however, have an Achilles Heel: widening participation. We are desperate to be able to engage with this but because we are not HEFCE-funded we were excluded from bidding for the new medical school places announced by Jeremy Hunt. Given the obvious good we do – enhancing the NHS hospitals we work with and producing doctors, free of charge to the taxpayer, for those hospitals – why, then, can’t the Secretary of State for Health find a novel way of funding a widening participation scheme through us? It would certainly be cost-effective and send such a positive signal that all avenues are being addressed to tackle our shortage of doctors.

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My constituency needs more doctors - a new medical school will help

Boston and Skegness will get one of the five medical new schools recently announced by the government. 

Boston and Skegness is the constituency that – infamously – voted more vigorously than anywhere else to leave the European Union. More than three-quarters of voters turned out for the referendum, and 76 per cent of them wanted to leave. What was the specific reason cited most often for doing so? 

It was either “I can’t get an appointment at my GP”, or “A&E is full to burst”. These answers were proffered as an example of the pressures stemming from immigration, because the lens through which Brexit was seen on the ground was as often as not, the NHS. No wonder, then, that big red bus was so powerful.

On talking to local NHS staff, however, it wasn’t immigration per se that had challenged the system most profoundly: it was the difficulty in recruiting staff to rural and coastal Lincolnshire, and it was the blessing of a population that is living longer and longer. Some pointed out that prior to the surge in immigration, the less and less used maternity unit at Boston’s Pilgrim Hospital was on a trajectory that would have threatened closure as it would have become harder to run safely. Hugely dedicated local NHS staff were being put under increasing pressure, and ultimately the limited number of doctors training in the system were more likely to go to larger hospitals where opportunities to teach or specialise were hugely attractive.

So from even before I was elected in 2015, and well before the referendum, it was obvious that Lincolnshire needed a radical shot in the arm to alter patterns of recruitment for doctors. That, said the universal consensus, was a medical school based in the county.

Still, it was truth be told a campaign I signed up to lead in Parliament with little genuine hope of success. Most recently, in every departmental Health Questions in the Commons, it felt as though every MP in the place stood up solely to say that their constituency deserved a slice of the government’s plan to increase medical school places by 1,500.

The government’s criteria, however, did dictate that it was places that were “under-doctored” that would be given a first look at the new scheme, and there was a particular focus on increasing GP and mental health services. All these the Lincoln University bid did, and by signing up to do the scheme jointly with the well-established Nottingham University Medical School a good deal of bureaucracy was cannily avoided. It was rightly not enough to say that Lincolnshire needs more doctors. Doctors tend to practice near to where they train; ergo we get a shiny new facility. Knowing that Lincolnshire fitted government criteria so well, I was conscious that the role of a local MP must surely be to make sure the bid accurately reflected that reality.

Some 6,000 medical students start their training each year, and Jeremy Hunt’s 25 per cent expansion of that number by 2020, hand in hand with a similar expansion in nursing training, is a transformational exercise for the NHS. It addresses the long-term deficit in doctors that we’ve locally sought to plug with overseas recruitment and a £20,000 golden handshake for GP trainees, and demonstrates that for all the talk of the NHS needing increased investment, the challenges don’t simply require extra cash. Indeed, with more doctors in the system there are likely to be lower bills thanks to fewer locums with their higher wages, and less stress on the existing workforce resulting in sickness and absence. It’s a classic case of investing to save. And on the way there’s a commitment to increase the diversity of medical students, attracting more applicants from state schools and making the typical doctor look a little and sound a bit more like the typical patient.

So alongside Lincoln, Sunderland, Lancashire, Chelmsford and Canterbury each get new medical schools, while other existing ones expand. All this, of course, is only possible if there is the money to fund that expansion, and Conservative stewardship of the economy has delivered that. These are announcements that defy the accusation that the government is consumed by Brexit, and indeed, they also address concerns that leaving the European Union might further challenge recruitment. That, in truth, remains to be told but inarguably expanding medical schools can do no harm. 

Speaking personally, however, there’s a second truth: voters routinely tell their MPs that we achieve nothing for the man or woman on the street, and rural areas each claim to be forgotten counties. Every one of these new medical schools demonstrates not only genuine commitment to the NHS from this government, but also the fruits of huge coalitions of MPs, healthcare professionals, university staff and others, all making a single, local case to Whitehall. This is a plan that will take a number of years to bear fruit, but it is also one that will last for generations – and it’s an example of long-term thinking on healthcare from public servants across the board. More of that, hopefully, is to come soon.

 

Matt Warman is the Conservative MP for Boston and Skegness.