Problem postcards

Each year money is given to the NHS to ensure that undergraduate medical education is properly supported and those hospitals and practices hosting medics do not do so at a cost to their normal service budgets. This funding is called SIFT--service increment for training (in England and Wales), ACT--additional cost of teaching (in Scotland), or SUMDE--supplement for undergraduate medical and dental education (in Northern Ireland). In regions with several medical and dental schools it can amount to hundreds of millions of pounds. In England and Wales the funding falls into two broad categories: facilities and placements. Facilities represents payments to trusts to recognise the general impact of providing teaching and teaching facilities at a hospital. This funding is normally a predictable amount year on year. Too many fluctuations would make planning difficult. Placements is funding per student attachment and as such may vary from year to year as the numbers of students on placement might increase or decrease.

The good news is that funds can be spent on improving existing accommodation, such as furnishings, decorations, and bathroom facilities. The bad news, however, is that the money has to pay for lots of things, such as compensating for staff time lost to undergraduate teaching and improving library facilities. Money cannot be used for capital projects--for example, building new rooms for students on attachment.

If you were a doctor things would be different. There are national accommodation standards--agreed between the BMA Junior Doctors Committee and the government. They are detailed and cover furnishings, fittings, and facilities. They can be enforced by regional postgraduate deaneries. Failure to meet the standards can lead to the removal of accreditation from training posts. This takes funding for doctors' salaries away from the trust and might lead to difficulties recruiting doctors to the hospital. There is no such specific agreement for students.

If you have to stay at a placement (because you need to be on call or you cannot travel home each night) check what normally happens. If these arrangements are not acceptable (do not expect 4* quality) ask if alternatives are possible. Some schools, for example, give students an allowance to arrange bed and breakfast accommodation. In the long term you can lobby placement officers, medsoc officers, staff student liaison committees, and student representatives on faculty committees for improvements. Tell the BMA student rep at your school too. Every medical school has at least one placement which is renowned because it is difficult to travel to and horrible to stay at. Many of these have been that way for years. Go and get improvements made. The money is there and if students can influence how it is spent and not just on accommodation, the more likely the use of these funds will improve the quality of undergraduate training.

Ian Urmston, senior marketing executive, BMA
Email: iurmston@bma.org.uk


studentBMJ 2001;09:305-356 September ISSN 0966-6494