Money, Money, Money – the Cost of Education Health Education North Central and East London Helen Jameson Deputy Managing Director

Content Education and Training Spend Types of Spend Tariffs Tariff standardisation Local Education Investment Strategy

NHS Funding Treasury (£105bn) Health Education England (£5bn) Education and training of : Undergraduate medical students Postgraduate Medical students Non Medical students NHS England (£28bn) Provision of primary care (Dentist, GP etc.) and specialist services CCGs (£63bn) Provision of: Secondary care Tertiary care Community care Mental Health services Ambulance services Public Health England (£5bn) Provision of Public Health services Other ALBs (£4bn)

HE NCEL Funding £000s% Training Funding (Programme) 439, % Admin Funding6,1971.4% Total Funding445,917 Admin funds the management and commissioning costs of HE NCEL This shouldn’t exceed 1.47% of total spend in 2014/15 It is expected that at least 20% saving will be required by 2015/16 Innovation and redesign of systems will be required to continue to identify savings

Who do we Pay? 5

Training Funding

Policy That Determines LETB Education And Spending Care Bill Part 3 relates to HEE HEE Mandate - Outlines key deliverables for MPET investment Health Visitors Apprentices Investment in band 1-4 workforce Dementia training and end of life care Broadening Foundation Training Increased GP numbers Transparent and equitable funding across the country Francis report (290 recommendations) Investment in pre qualification nursing experience Transformation to an affordable workforce

Align Investment to local service priorities Current workforce profiles and skill shortages Reconfigurations – Royal Free Specialist healthcare facilities - GOSH New developments in technologies - Proton Beam therapy Demographics - NCEL’s geography is marked by pockets of deprivation sandwiched by relatively wealthy communities. Life expectancy at birth varies from 75-89; this variation illustrates major health inequalities Local requirements that drives LETB spend index of multiple deprivation scores North Central and East London

MPET funding is distributed through: Local tariffs - individual to each LETB GP placement tariffs (£20m) Less than full time trainees (£10m) Public Health trainees Postgraduate medical trainees in Primary Care Undergraduate medical students in Primary Care Undergraduate dental students Non medical salary support for students (£20m) Workforce Development funding (£20m) Block/fixed payments National activities (£15m) Direct Training Funding

National tariffs (67% future workforce funding) – varied by MFF/London weighting only Undergraduate medical placement tariffs (£80m) Non medical placement tariff (£7m) Postgraduate placement fee & salary tariff (£104m) Tuition benchmark price tariff (BMP, £40m) Bursary/student loan fees (£35m) Direct Training Funding

Moving from Local tariffs to a national tariff system Current tariffs the first step on the journey NHS Placement providers 5 national tariffs HEE contracts with more providers for placements HE NCEL paid c20 providers local SIFT tariff now pays over 100! HE NCEL paid c15 providers local non medical tariff now reimburses over 70! Education Resource Group - moving to up to c200 tariffs depending on agreed currencies Tariff standardisation

Outcomes Transparency and equity of funding ERGs should more accurately reflect the cost of education and training Funding follows the student/trainee – low volume, high value tariff system vs service tariff which is high volume, low value? Will help to improve quality More complex system to administer – leading to more back office costs Tariff standardisation

Local Education finance strategy With an ever shrinking budget but increasing demands how does HEE afford to deliver both national and local priorities? 50% GP expansion – 1 GP trainee = 2 Postgraduate trainees per annum = 10 nursing students per annum To invest in training we will need to disinvest in other courses Alternatively costs may be transferred to Providers – this doesn’t help the system The system needs to look at the lifetime cost of education and training – PLiCs and SLR for education to enable strategic investment decisions