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New Ways of Shirking: £1m of mental health funding under threat at NSFT after medical education failure

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The papers for last week’s Norfolk and Suffolk NHS Foundation Trust (NSFT) Board meeting report:

SIFT and provision of medical undergraduate teaching. On 29th April the UEA wrote to NSFT to highlight the poor performance of teaching for Undergraduates provided by NSFT, the concerns about the length of time it has taken to make changes and the plan by UEA to reduce placements and therefore funding to NSFT for provision of teaching.

A key risk to the Trust’s finances and reputation is the concern from UEA about the poor performance of NSFT’s teaching to medical undergraduates. There is a proposal by UEA to remove students, therefore funding, away from NSFT to other providers. Significant funding and organisational restructure is expected by UEA. NSFT is considering how to undertake this restructure.

Back In January 2016, UEA told NSFT:

Concerns were raised by Professor Richard Holland about the quality of teaching provided by NSFT for medical undergraduates. Whilst there had been a slight improvement in feedback scores during early 2015, the scores for the last quarter were lower. The Mental Health module is the lowest rated course in the teaching programme. The plan attached addresses the concerns that UEA have about NSFT teaching – that doctors do not have enough capacity to deliver high quality teaching and a valuable experience for students.

This issue is incredibly serious. The University of East Anglia (UEA) gives NSFT about £1 million per year of Service Increment For Teaching (SIFT) funding. That’s a lot of money and doctors. UEA has had enough of subsidising local inadequately-funded mental health services at the expense of its medical students. This is a financial as well as a reputational crisis. Sadly and yet again, we have been warning NSFT about this, publicly and privately, for years.

Medical students at UEA have been rating the quality of mental health teaching below any other speciality and far below an unacceptable level. UEA has been complaining to NSFT for a long time.

UEA expects its SIFT money to be spent on ‘backfill’ – additional medical staff – so that NSFT’s doctors have the time to teach the doctors of tomorrow about mental health. This has not happened.

How does NSFT plan to recruit the psychiatrists of the future from UEA when the quality of teaching is so poor?

So, what has happened?

Firstly, NSFT has largely ignored UEA’s complaints over many years.

Secondly, NSFT decided to spend a very large chunk of the SIFT money it received on two largely administrative and non-teaching Deputy Medical Directors. We have written before about A Tale of Two Deputies and the Director of Research post.

Thirdly, NSFT no longer has ‘medical budgets’, so the money has largely ‘disappeared’. The SIFT money certainly isn’t focused on providing support to those who provide medical education.

Fourthly, as a result of the savage ‘radical redesign’ cuts, many clinicians who took their duty to provide safe front line mental health services seriously found they did not have the time to teach medical students without backfill and, except for a chosen few, NSFT refused to take teaching workloads into account during the radical redesign. Hence, many clinicians were forced to give up teaching undergraduate medical students.

Finally, the chosen few, coincidentally frequently those with private work and the public backers of the ‘radical redesign’, received backfill, additional sessional payments, clinical excellence awards, ‘protected time’ and ‘timeshifting’ which was only realistic with a Tardis. They have failed to deliver acceptable teaching. Disgracefully, they have not been held to account.

For example, two years ago, NSFT was told at the highest level about a consultant psychiatrist who was regularly using his ‘protected time’ for leisurely swimming at the UEA Sportspark and long lunches in the Sainsbury Centre restaurant with a companion during working hours, week after week after week. This is still happening and the issue has again been raised. Still, nothing much is done about this obscene waste of public money and the bringing of NSFT into disrepute. Medical education is failing, NSFT’s reputation and finances are endangered, the consultant’s service has a significant waiting list. This one doctor costs NSFT £17,500 PER MONTH plus ‘expenses’ which can rival the take-home wages of ordinary staff.

How is NSFT ‘well-led’?

Shameless. Shameful.

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