Volume 3

Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology.

  • Great Britain. Parliament. House of Lords. Science and Technology Committee.
Date:
1995
Catalogue details

Licence: Open Government Licence

Credit: Medical research and the NHS reforms / House of Lords, Select Committee on Science and Technology. Source: Wellcome Collection.

    12/404 (page 110)
    17 January 1995] [ Continued [Chairman contd.] support on the one hand and grant money on the other? (Professor Laird) I believe we could. Lord Gregson] It would be possible, Lord Chairman, to include other sources of funding as well. 252. Indeed. Other sources of money, and by which we mean commercial organisations, the European Union and charities, yes, of course. (Professor Laird) We will collect such information. Earl of Selborne 253. Once we have got these figures what we would like to be able to determine is where your core funding is coming from at the moment, the different sources you described, and how this compares with what you might call the soft money? Could you meanwhile give us some feel as to how successful the dental schools have been in retaining adequate core funding in the past, bearing in mind your concern that future procedures are likely to cause you some concern? (Professor Laird) 1 would like Professor Smith to give you some figures on that in relation to the last HEFC exercise which will be helpful. (Professor Smith) I am sorry, Chairman, I cannot do that immediately. ‘254. You told us in your evidence that you believe that if these recommendations are implemented you will want a safety net, you will need to see there is a ring fenced element until 1996 at least. (Professor Smith) Yes. 255. It suggests that while you are presumably not satisfied with the amount of core funding you have at the moment you are concerned that new arrangements are going to be even worse. I wonder if you could describe what your fears are based on? (Professor Ashley) If I may answer this. We have been subjected, as you know, as the universities have been subjected, to cost efficiency savings and as with most universities and hospitals our major expenditure is on staff. So if say a decision was taken that less than five per cent of our SIFTR income is in the R category as opposed to 25 per cent of the medical SIFTR income even that is a substantial amount for a dental hospital. In my own case I think my total SIFTR income is in the order of about four million pounds. So if you take out five per cent of that suddenly and put it into another pot which we have to compete for this can produce instability. Now obviously it produces opportunities but if you have winners you have losers in that situation and we are really saying that as the changes in the research income on the university side have been managed these would have to be managed so the changes in one year would not be greater than any institution could cope with. That is the point we were trying to make there. _ 256. It does suggest the R element of SIFTR, while it is not adequate for your purposes, it is still quite important. (Professor Ashley) The most recent press release said that it has been set at 25 per cent of the medical SIFTR but the dental component was a matter for further investigation. (Professor Smith) If I may, Chairman, the important point is that a very high proportion of the funding of dental hospitals comes through SIFTR. The notional national average is 85 per cent. Even if the R component is as low as five per cent, which is inadequate but if it is that, then five per cent of 85 per cent is a fairly high proportion of one’s funding compared with, say, a district general hospital which might receive ten per cent of its funding through SIFTR, of which the R component is 25 per cent. Chairman 257. Can we clarify in relation to that the source of the patients who come to your dental hospitals? You are not faced with the same kind of purchaser/provider system, or are you? (Professor Brook) Yes. 258. Well, now in that case how many patients just come in off the street seeking treatment and how many are referred for special treatment by dental practitioners in the community? (Professor Laird) I do not think we could give you exact figures on that, my Lord, obviously, but a substantial number of patients come in simply off the street for primary care treatment which is carried out by our students under supervision. Indeed most dental hospitals would see themselves as a large dental practice serving an area—a very large area obviously but nevertheless a dental practice serving an area. We have also secondary care patients who are referred to us from general dental practitioners. These patients may or may not be treated by dental hospital staff, either a consultant grade or in a training grade. They may also be treated by students if the type of treatment which is required is deemed to be suitable for teaching purposes. So there is a substantial number of patients who simply come in off the street, a very high proportion, much higher than the numbers that are referred for secondary care. 259. Just to clarify this, one of the problems we have been told about in medicine is that in highly specialised units the tertiary referrals, meaning referrals from district general hospitals to centres of excellence, have been under threat because the purchasers will not pay the additional service costs required for such referrals. Is this a problem you have encountered in dentistry? Is there any reduction in the number of referrals from dental practitioners? Who pays for those specialised referrals? (Professor Hume) These are very complicated issues, my Lord Chairman. 260. Yes. (Professor Hume) The internal market in my opinion has not been applied successfully to the running of dental schools and dental hospitals. The Department of Health and the NHMSE currently have working groups looking at the whole question of the funding of dental hospitals. The difficulty is compounded by the fact that the Government’s document “Improving NHS Dentistry” has still not led to a conclusion as to how dentistry in the high street is going to be funded. We are gradually—and I