Service increment for teaching (SIFT) stakeholder briefing

Introduction

The Department of Health is engaged in a major policy review of the multi-profession education and training (MPET) levy[1] which includes the undergraduate medical and dental component ‘service increment for teaching’ (SIFT).

“Each year several billion pounds are spent on central funding of education and training for NHS staff through the Multi-Profession Education and Training levy, in addition to investment by NHS organisations in their own staff. A top-down management approach led by the Department of Health does not allow accountability for decisions affecting workforce supply and demand to sit in the right place. It is time to give employers greater autonomy and accountability for planning and developing the workforce, alongside greater professional ownership of the quality of education and training” (Department of Health, 2010).

The present system mitigates against using SIFT for quality improvement due to the ways in which funding flows, and expenditure is accounted for.[2]  All stakeholders in medical and dental education are encouraged to contribute to the consultation to ensure that there is an emphasis on the interests of student education, and that the new funding formulae contain incentives for improving quality. A longer discussion of SIFT is available from the British Medical Association.[3]

What is SIFT? 

Funding for medical education comes from three streams; student fees, Higher Education Funding Council (HEFCE) allocations for teaching to the medical schools, [4] and SIFT to hospitals and GPs. The largest stream is SIFT, amounting to £728 million in 2005.[5]_,[6] Historically the costs of teaching hospitals were greater than the costs of district general hospitals (and research initially; SIFT-R was divided into SIFT and NHS R&D in 1996).[7],[8]

Policy documents define SIFT as funding “the costs to the NHS of supporting the teaching of medical…undergraduates. It is not a payment for teaching as such”.[9] It is a sum of money paid by the Department of Health (administered in England by the strategic health authorities (SHA)), to hospital Trusts and general practices to offset the service costs associated with teaching. Similar schemes are administered by the Scottish Parliament (additional cost of teaching (ACT)), Welsh Assembly Government (SIFT) and Northern Ireland Assembly (supplement for undergraduate medical and dental education (SUMDE) which was reviewed in 2009). SIFT is a component of the multi-professional education and training levy (MPET), which also comprises MADEL (postgraduate medical), D-SIFT (dental), NMET (nursing and allied health professions) and some other clinical specialties.[10] Care must be taken to consider SIFT in the overall context of healthcare education.[11]

What is SIFT for and how is it administered?

SIFT is traditionally divided into two elements; facilities (around 80%) and clinical placements (around 20%).[12] “Facilities may include tangible assets (space, libraries, equipment) and human resources (richer skill mix, higher staff to patient ratios, higher pathology costs, medical illustration) within an environment of clinical excellence”,[13] and to complicate things further clinical placements may also be a form of facility.9 Clinical placement budgets are required to justify clinical placement payments which are based on student weeks, and the payment per student week varies, both within and between regions.[14] For example, in 2000, the clinical placement budget per student week in acute hospital Trusts varied from £174 (Bristol) to £361 (Sheffield) and for GP placements, from £62 (Birmingham) to £381 (average for London).

The SHA (or equivalent in Scotland, Wales and NI) has a learning and development agreement with most recipients of SIFT money, which specifies the number of students and weeks, and may (but often does not) specify how SIFT is allocated within that institution “It is important to ensure that SIFT follows the student, enabling more teaching to be supported outside traditional teaching hospitals, but these changes need to be carefully managed to ensure that trusts are not destabilized” (HEFCE/Department of Health, 1999).14

The universities who bear responsibility for the quality of undergraduate medical education (together with the General Medical Council)[15] review the SIFT learning agreement on a yearly basis, and report on the standard of delivery from the Trusts involved, but their ability to influence expenditure varies. This creates a quality management gap whereby those who provide excellent practice placements and facilities for undergraduate student education are rewarded to the same extent as those who do not.