Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what steps he is taking to support the development and growth of smaller and non-London medical schools.
Answered by Philip Dunne
The Government has announced a historic expansion of medical school places in England, with an increase of 1,500 medical school places in England. The first 500 places have already been allocated and will be available to students in September 2018.
The Government response to the recent consultation was published on 9 August 2017, confirming that 1,000 additional medical school places would be available to medical schools in England via a competitive bidding process to be managed jointly by the Higher Education Funding Council for England (HEFCE) and Health Education England (HEE).
It also set out the priority areas bidding criteria would need to focus that include aligning the expansion to local National Health Service workforce need with an emphasis on priority geographical areas, including rural and coastal areas.
HEFCE and HEE are currently finalising the design of the bidding process and will publish details in the autumn.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what steps he plans to take to prevent London medical schools from cross-subsidising the education of international students from their Service Increment for Teaching fund allocated to students from the UK and other EU countries.
Answered by Philip Dunne
The Education and Training tariff guidance document for 2017-18 is clear that funding for placements commissioned by Health Education England (HEE) must not be used to subsidise any element of the cost of placements for non-National Health Service funded students/trainees.
The responsibility for implementing these funding arrangements resides with HEE which commissions the placement activity from the provider.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what steps he plans to take to ensure that additional medical student places are fairly allocated to students from (a) the UK and (b) other EU countries.
Answered by Philip Dunne
The Government has announced a historic expansion in domestic supply of the medical workforce by funding an additional 1,500 medical school places in England available to domestic students from 2018-19. In addition, from 2019-20 English universities will not be limited in the number of international students they can recruit on a full fee paying basis.
For medical school intake targets, the only distinction that is made is between home or European Union students and those from outside the EU. As such, the additional 1,500 medical school places the Government is funding will be available to students from across the United Kingdom and all European Economic Area countries subject to the usual residency requirements.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what estimate he has made of the number of extra UK medical school places that will be made available to international medical students after the removal of the cap on the number of such places.
Answered by Philip Dunne
The Government has announced a historic expansion in domestic supply of the medical workforce by funding an additional 1,500 medical school places in England available to domestic students from 2018-19. In addition, from 2019-20 English universities will not be limited in the number of international students they can recruit on a full fee paying basis.
For medical school intake targets, the only distinction that is made is between home or European Union students and those from outside the EU. As such, the additional 1,500 medical school places the Government is funding will be available to students from across the United Kingdom and all European Economic Area countries subject to the usual residency requirements.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, for what reasons the Service Increment for Teaching funding allocation process is subject to the market forces factor; and what steps he plans to take to ensure that there is not an excessive regional disparity in allocations of that funding between London and non-London medical schools.
Answered by Philip Dunne
The funding for training placements in secondary care is allocated to placement providers by Health Education England using a tariff payment mechanism. These tariffs are calculated on the basis of average costs and do not take into account some features of cost that are likely to vary across the country. The tariffs are therefore adjusted by the Market Forces Factor in order to compensate for the cost differences of providing training placements in different parts of the country.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what assessment he has made of the effect of the capped expenditure process on patient care.
Answered by Philip Dunne
Providers have managed to reduce the deficit from £2.4 billion (in 2015-16) to £791 million this year.
This success isn’t universal. Some areas consistently exceed budgets, requiring increased savings by others.
14 areas have joined a ‘Capped Expenditure Process’ with commissioners and providers working together to achieve budgets assured by their Boards. Their proposals involve patients and staff; placing patient safety and constitutional rights at the heart of decision making.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what assessment his Department has made of the effect on the health service of the reduced capacity of junior doctors to undertake additional shifts or internal locums with their own organisations prior to the implementation of the junior doctors' contract in 2016.
Answered by Philip Dunne
The new Junior Doctor’s contract retains the same maximum requirement for working hours of an average of 48 hours a week or 56 if the doctor chooses to opt out of the working time regulations. The contract also includes a fidelity clause so that trainees wishing to work extra shifts offer them to the National Health Service first.
Further, the General Medical Council has recognised that some trainees that do not work full time may have the capacity to undertake additional shifts and have given their support for those working less than full time to do so. Previous advice was that Less Than Full Time trainees should not undertake additional shifts.
The previous contract allowed patterns of working that junior doctors' representatives told us were unsafe. The new contract is much safer and includes new, stronger limits on working hours and patterns. These include:
- the maximum number of hours worked in a week reduced from 91 to 72;
- the maximum number of consecutive nights reduced from seven to four; and
- the maximum number of consecutive long days reduced from seven to five.
The new contract puts patients first by requiring that these rules apply also to any additional shifts a trainee might choose to work, ensuring junior doctors are not required to work when tired and that their overall working hours, whether they work for their own or another employer remains within safe limits. These are overseen by a Guardian of Safe Working Hours in every trust. Doctors can therefore offer additional hours to the same overall limits as before but must work them within the new safe limits.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, if he will publish (a) the metrics by which the success of the 2016 junior doctors' contract will be measured in the 2018 review and (b) which stakeholders will be consulted in that review.
Answered by Philip Dunne
The intention of the Government is that the review will be undertaken by NHS Employers with the British Medical Association and that metrics and any wider consultation will be agreed then between the parties.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what assessment was made prior to the implementation of the junior doctors' contract in 2016 of the additional financial and administrative cost associated with (a) pay protection, (b) additional hours payments, (c) guardian fines, (d) guardian of safe working hours role and (e) exception reporting management.
Answered by Philip Dunne
The contract will be recurrently cost-neutral with the exception of additional employer pension contributions arising from the increase in basic pay that was agreed with the British Medical Association as a condition for them entering negotiations in 2013 and was honoured by the Government. This is expected to rise to around £25 million per annum recurrently at the end of transition (circa 0.6% of total contract value).
In addition, there are limited non-recurrent costs of pay protection during transition. Upfront assessments of these costs are uncertain.
Additional hours payments and any fines reflect additional work carried out and are therefore outside the cost neutral funding envelope and will depend on how trusts manage juniors locally. Exception reporting is managed through rota management software. The role of the Guardian of safe working typically takes up a portion of the time of one consultant in each trust. This is seen as an investment in improving safe working for trainees.
Asked by: Sarah Wollaston (Liberal Democrat - Totnes)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what assessment was undertaken before the implementation of the new contract of the work-life balance of junior doctors.
Answered by Philip Dunne
An extensive programme of work is being undertaken, developed with the full involvement of the British Medical Association, to address junior doctors’ non-contractual concerns, particularly through Health Education England’s Working Group on improving junior doctors’ working lives:
- reviewing rotations so that junior doctors do not have to change placements more than is necessary and can establish a relationship with a single organisation;
- ensuring that junior doctors beginning rotations know their schedule a month earlier than at present;
- allowing couples to apply to train in the same area;
- offering training placements close to their home for those with caring responsibilities;
- introducing a new catch up programme for doctors who take maternity leave or take time off for caring responsibilities;
- identifying and removing barriers to flexible (part-time) working; and
- reviewing how to make appraisal for junior doctors simpler and less stressful.