1. Training and development Money money money Working out the true cost of education and training at University Hospital Southampton NHS Foundation Trust 2014

2. Training and development What do I know about money? Nothing

3. Training and development Am I interested in money? No

4. Training and development £6,000,000 What might motivate me?

5. Training and development University Hospital Southampton University of Southampton – 230 medical students intake per year Wessex Deanery – 530 trainees, includes 116 Foundation Doctors 630 consultants – around 520 wte, highly variable contract status eg with UoS, neighbouring Trusts etc 217 Trust doctors at last count Other UG and PG students

6. Training and development Medical Education Money SIFT + MADEL+ NMET Salaried and non salaried = £6,000,000 deficit for UHS

7. Training and development The New World – transitional tariffs Programme TypePre-Transition Funding Basis (based on 2012/13) Transitional Placement Funding* Non salaried medicalFunding was split between 22% for placements (based on FoM activity) and 78% facilities funding. Placement tariff of £34,623 plus 9% MFF per wte Salaried medical100% basic for FY1 and ST3+ and 50% for all others 50% for all posts + £12.4k placement fee Non salaried non- medical Adhoc projects£3,175 per wte Salaried non-medicalAgreed salary per programme * Transitional funding was based on the funding available to the DH and not on any real estimate of costs as there was a lack of costing data available

8. Training and development Costing projects 2008 –Questionnaire to consultants- designed by McKinsey 2012 –Questionnaires to consultants, trainees and data collected from non medical staff 2014 –Questionnaire to consultants, trainees and data collected from non medical staff e.g ANPs

9. Training and development What is service, what is education? Different depending on who you ask - where does service stop and education start? They clearly overlap, how do we account for this in costing? Overheads is an example – how do you attribute these between service and education? We wrote the How To guide on Trust Overheads for DH after our work.

10. Training and development 2012 Consultant questionnaire – Finance dept designed based on McKinsey one Minor modifications ( DME and ADF) – also done for Juniors. DME chasing up ++ 18 SIFT - 435 ( 80%) –e.g How much longer do ward rounds take when you are with undergraduate students compared with when there are no undergraduate students? Then another - 36 questions MADEL – 322 ( 52%) –e.g When a trainee is in clinic with you, how many fewer patients do you personally see per outpatient clinic (compared to the number you can get through when on your own in clinic)?

11. Training and development Questionnaires How many fewer patients do you see? became How many hours a year in clinic? What percentage of the time do you have student with you? What percentage of that time is spent teaching them?

12. Training and development 2014 One questionnaire designed by DME/Div DMEs with Associate Director of Finance 114 questions - 366 returns – 57% –In the LAST YEAR, how many hours have you spent in clinic work? –What PERCENTAGE of your time in clinics do you have medical students attending? –When you have medical students with you in clinic, what PERCENTAGE of your time is spent engaged in activity you consider relates to their learning rather than pure service.

13. Training and development What did we find? Non salaried Salaried Benefits Further work

14. Training and development Non salaried All non medical progammes same cost as med students yet still only attract 10% of transitional tariff Undergraduate – we always thought that SIFT funding was supporting other educational activity, subsidising it – this proved to be the case. Actual costs for undergraduate medical education are broadly in line with funding at end of transition ( within £100K). Undergraduate curriculum roles not specific to our organisation but to university course function e.g year co-ordinators. We had been paying for these for the university out of SIFT income. Now will be top sliced from all Trusts and given to the University

15. Training and development Salaried The income matches the trainees time spent in training activity, not service at all. There is no contribution to consultant time to support education and training and cost is approx equal to the income we receive for the trainees time. Assumes all done in core hours – we know this is not the case A lot of our trainees are very senior and are on high incremental points so we support their salaries to a greater extent We found that more senior trainees take up more consultant time and training accounts for a higher percentage of their time as they start to specialise.

16. Training and development Benefits? Huge piece of work but starting to see benefits. Good understanding of what costs we now incur for education – most of which we are not getting funding for – e.g MSc allergy students, EU trainees on fellowships, Advanced Practitioners from other Trusts/GP practices, Podiatrists, ECPs on placement etc Overseas students - getting into detail about who is within NHS funding and who is outside the 7.5% closed loop (which allows overseas students onto UK medical programmes) and should attract different funding. Using the information to negotiate a practice agreement with the university which outlines the services provided and cost under tariff to provide the placements.

17. Training and development Further work PLICS ( patient level costing system – service reference cost submissions) – UHS is the only organisation to date that has managed to strip out our E&T costs from our service costs. Our methodology is being tested by small number of pilot organisations to see if it can be rolled out nationally. Thinking about further questionnaires and rolling out and cleaning data – keeping people engaged! UG placement content and costs OH – not clear about what is covered in the tariff ( all) Links with AUKUH ( association of UK university hospitals) Further involvement with data collection methodology. Represented on DH working group Represented on DH costing and tariff advisory group

18. Training and development Acknowledgements Natalie Jupp Natalie.Jupp@uhs.nhs.ukNatalie.Jupp@uhs.nhs.uk Brian Dempsey Alison Trennery Suzi Oh The Div DMEs

19. Training and development Thank you!