The School of Medicine, Medical Sciences and Nutrition – Moving Forwards
Thursday, 20 April 2017
From 1900 to 2100
Professor Steven D. Heys is Head of the School of Medicine, Medical Sciences and Nutrition (SMMSN) and an honorary consultant surgeon in the University of Aberdeen and NHS Grampian (special interest in the treatment of breast cancer). He graduated in 1981 and obtained an MD and PhD at the Rowett Research Institute, investigating aspects of nutrition and metabolism, particularly focussing on malignant disease. During the talk, Professor Heys will be accompanied by other Directors from the SMMSN.
- The President welcomed the company, noted that Sir Ian Diamond was among those sending their apologies, and announced the names of both new members.
- An obituary was read on Dr Geoffrey Gill, Honorary Member and past President of the Society.
- The President intimated that the draft minute of the Special Meeting of the Society held on 30th March would be circulated to all members next week with a view to having these endorsed +/- corrections at the forthcoming Annual General Meeting.
- A reminder about the forthcoming Charity Concert was read out.
- Arrangements for the Heritage event (18th May) and Electives evening (25th May) were also described including details of the catering arrangements secured by the Society arranging late opening of the Tiki Café until 7pm on both dates.
- A reminder was given of the next lecture meeting on 4th May, noting the change in speaker from the original lecture listed in the annual programme.
The President then invited Professor Steven Heys, Head of the School of Medicine, Medical Sciences & Nutrition in the University of Aberdeen to give his talk entitled ‘The School of Medicine, Medical Sciences and Nutrition – Moving Forwards’.
Professor Heys began by welcoming the opportunity to speak and having the chance to explain some of the many and radical changes occurring in the areas of his jurisdiction since the beginning of 2016. He first described some important aspects of the changing environment in higher education. The plan to increase medical student places by 1500 in England will increase competition in attracting UK and overseas students to Scotland where already Scottish Universities are unable to generate tuition fee income for home students, and the Government has recently added a £10k/year tariff on medical tuition fees for non-EU students. The demographic change which will see a fall in population in the UK of those of ‘typical student age’ will compound the problem of student recruitment.
There are also considerable challenges around research funding. The proposed ‘flat cash’ funding will, through inflation, see a considerable real terms drop in income and there will be reduced income from various funding sources, made worse by the costs of pension changes and staff salary increments/promotions. This could result in a cumulative deficit of £10-12M. The additional complications of political changes were addressed such as the potential effects of Brexit, with the School currently in receipt of £6-7M/yr EU funding, and potential impact of insecurities about the ongoing employment/access rights of EU nationals within the UK: 10% of School staff are non-UK EU nationals along with over 300 students. Increasing international competition for staff and students is also going to come from places such as Russia and China where there has been major investment in higher education.
Professor Heys went on to explain how the new integrated School had been formed from the three semi-autonomous University groupings on the Foresterhill site – the School of Medicine & Dentistry, the School of Medical Sciences and the Rowett Institute of Nutrition and Health. The new School of Medicine, Medical Sciences and Nutrition with 890 staff and around 2000 undergraduate and postgraduate students was brought together to avoid administrative duplication, enhance constructive collaboration and increase focus on areas of major strength in teaching and research. It would also preserve strong brands including the Rowett, the Health Services Research Unit, the Health Economics Research unit and highly lauded areas of teaching. The collective activities would also be more easily aligned to the University’s strategic plan around excellence in teaching, research and supporting people.
The establishment of the School first required detailed analysis of the prevailing situation across the relevant departments. This showed issues with lower growth and income than expected in some areas, with limited research quality and falling research income in others against an awareness of falling overall availability of national and international research funding. The relatively low position of the University of Aberdeen (29th of 32 Medical Schools) in the Research Excellence Framework was seen as unlikely to be helpful. The tactics around presenting smaller amounts of high quality research output or larger amounts of lower quality output were explained as some mitigation of the low ranking. The fact that the University came 5th for impact of research on clinical practice was seen as a more positive outcome. An additional challenge was finding ways around an annual core funding deficit of some £4M, or 5% of total income. Teaching had areas of excellence, but also some less successful aspects. There had been less growth, and even falling numbers in some areas and often poorly developed links between teaching, research and NHS functions. There had been little or no development on provision of distance and online learning opportunities.
So work began on redefining the strategies of the new School, and making better use of integration potential of the various establishments on their shared site. Systems of supportive line management were put in place with 40 individuals trained to take on this role. A Business Manager was appointed to oversee professional services and development of support structures for researchers and teachers. Workload models were established and a Framework for Academic Expectations was also introduced, both helping to create constructive work plans for each academic staff member. A consultative process led to the first School Strategic Plan which addressed financial sustainability, reduction in operating costs, increased income and ideas on how to address national and international competition. Teaching requirements of the various courses were described and then resourced by ensuring their appearance in staff job plans with a view to defining and matching capacity. Certain areas that were less productive, or had limited future, were targeted for disinvestment and voluntary severance/early retirement. This led to a reduction in total academic staffing complement of around 4%. Some staff members were redirected to, and supported in, different areas of work and so far there has been no compulsory redundancy.
Research has been refocussed across all of the constituent institutes and plans were laid down to create research groupings with international aspirations and acclaim. The MRC Medical Mycology Unit was the first established and is already the biggest group in Europe. A centre for Arthritis and Musculoskeletal Medicine has also been developed, as has Healthcare Education, Research and Development. A Centre for Women’s Health will be established later this year and a Centre for Obesity, Metabolism and Cardiac Health will hopefully gain MRC recognition within the next two years. In addition the former institute for Applied Health Sciences, additionally supported by a Public health Nutrition strand, will head up a Centre for Population Research (incorporating HERU and HSRU) and these areas already have Scottish Government Funding. It is important also to facilitate new and emerging research areas as part of institutional sustainability and accordingly a number of so-called ‘protocentres’ will be supporting additional areas of research across the School.
Developments to date have resulted in 90% of necessary financial savings being realised, rising research income, increasing undergraduate and postgraduate student numbers, and the development of distance learning (Masters courses in Public Health, Health Economics and Nutrition with further masters courses in clinical specialties in development. Work is being undertaken in collaboration with the University Development Trust, a fundraising operation, to secure additional resources, particularly for clinical academic areas such as Oncology and Women’s Health. There is also a move to re-establish clinical academic excellence. On a background of a loss of 10 professors (representing 10% of Clinical Academics), work is being undertaken with the NHS and NHS Education for Scotland in attempts to put academic careers and opportunities back into the mix for postgraduate clinicians. Several joint UoA/NHS appointments are in progress and academic training lectureships are increasing in numbers and clinical specialties.
A separate dimension embraced by the School is around widening access, particularly to medical training, for those from depirved backgrounds. The vulnerability of Aberdeen to a Government policy that will withdraw funds where less than 20% of students come from homes in ‘deprivation areas’ (common in the Central Belt but almost unknown in the North of Scotland) has been recognised. Funding has been secured for a cohort of 20 individuals from poorer backgrounds to attend a pre-medical school course, satisfactory completion of which will allow progress to MBChB enrolment. Discussions are ongoing about potentially reserving places for medical students from schools which ‘never’ produce doctors. Consideration is being given to removing Chemistry from the mandatory entry requirements as those schools unable to offer this would otherwise prevent any of their pupils taking up a career in medicine; an appropriate ‘remedial’ chemistry course prior to medical school entry may be a solution.
International developments are also under way. While collaboration will continue with the International Medical University in Malaysia, a new partnership arrangement with Curtin University Medical School in Perth, Western Australia has recently been established, initially to facilitate shared teaching. Various Masters programmes are being promoted in Indonesia, China and the Middle East. Plans are under way to establish an overseas medical school, perhaps as soon as 2018, subject to satisfactory quality of on-site clinical teaching facilities.
Profesor Heys then invited Professor Rona Patey, Director of Institute of Education for Medical and Dental Sciences, to summarise some of the ongoing changes to the undergraduate MBChB course which would be of particular interest to the Med Chi audience. Professor Patey described the recent review of the Year 4 teaching programme and the subsequent revision that is now under way which will see substantial changes from 2019 with students having longer clinical attachments covering all of the important themes in clinical practice but not necessarily attending the current, very high number of departments. She then described the impending General Medical Council inspection of undergraduate and postgraduate teaching and training across the whole of Scotland in autumn 2017. Then she described the challenges of the GMC’s Recognition and Approval of Trainers project and its challenges for both undergraduate and postgraduate medical training; the combined approach taken in Scotland by the Medical Schools and NHS Education has made great progress and left Scotland ahead of much of the rest of the UK on this topic. Finally, she spoke of the possibility, or even probability, of the introduction of a national Medical Licensing Examination to be taken by all medical graduates at the end of their studies (and separate from the degree examinations) designed to establish a common, minimum standard achievable by all UK doctors on at least one day in their professional lives. She anticipated the complexity and cost of this exercise and encouraged those interested to respond to the GMC’s consultation on the matter.
There followed a question and answer session addressing topics including the place of General Practice in the School and in medical training, the balance of teaching done by NHS and academic clinicians, the vision for the generalist versus specialist debate in training and practice, the degree of confidence in the School that the new ways are working, and the concerns around the proposals for a licensing examination.
The President proposed a vote of thanks and the meeting was adjourned.