The medical service increment for teaching (SIFT): a  400m anachronism for the English NHS?

Abstract

In 1997-8, over £400m ($640m) of NHS money was designated as the medical service increment for teaching (SIFT). 1 The manifest purpose of SIFT is to ensure that the NHS supports quality and innovation in undergraduate medical education. This includes supporting the increasing role of teaching in hospitals other than the main university hospital affiliated with each medical school, general practices, and other community settings.2 3 SIFT is designed to be paid in addition to income gained by medical schools for teaching medical students. The latent purpose of SIFT, which paradoxically dominates its distribution, is to ensure a "level playing field" in the healthcare market by covering "historic infrastructure costs, whether or not they are currently required for education."2 As designed, SIFT is thus in conflict with one of the aims of the government's white paper, The New NHS, which sought to end the way in which instability in the healthcare market resulted in "shoring up the status quo rather than creating the space to plan and implement major improvement." 4 Allocations of SIFT are based on the product of the annual SIFT rate (about £36 000 for institutions outside London and £39 000 in London) and the number of whole time equivalent students who are in the last three years of the five year curriculum, which are traditionally the years of clinical teaching.2 Thus a medical school that has an annual intake of 150 students will have about £16m in SIFT funding available for distribution to healthcare trusts and general practices that teach students. In 1996-7, nearly 90% of SIFT funds were allocated to the main acute teaching trusts (or teaching hospitals); most of the £170m allocated to the Thames regions is spent in London.1 Details are not published, but income from SIFT for the main university hospital may exceed £10m annually (and may also be its second most important source of income after the local health authority).This paper examines the way in which rates of SIFT funding have been estimated and interprets the results of these allocations. It does not consider the allocation of SIFT for dental students. This paper argues that current policies conflict with the objectives of equity and efficiency expressed in The New NHS. 4 Excess costsExcess costs of main university hospitals There are three troubling facts about the costs of running the main university hospitals. Firstly, simply dividing total hospital costs by the total number of cases shows that the main university hospitals have high unit costs; thus, they seem to be inefficient. The most recent published empirical basis for the current SIFT allocations, compiled for the 1988 review of the Resource Allocation Working Party 5 by Foote et al,6 reported that the costs per case at the main university hospitals in 1984-5 were about 30% higher than those in non-teaching hospitals. These excess costs may be accounted for by the costs incurred in teaching medical students, supporting research, the further training of doctors, and for providing specialised ...

Influence of anaesthesia resident training on the duration of three common surgical operations

“…In the UK, this is in part recognised by the system of funding known as the Service Increment Fund for Teaching (SIFT), which provides teaching centres with an additional budget that is estimated to meet these costs [19]. Whether SIFT meets these aims or not is questionable [20], but in Germany, university departments (which deliver student as well as resident education) are funded in broadly three different ways [21, 22]: (a) funding of scientific research via government funding and intramural grants to the university, which encompass scientific training of students and residents, (b) direct funding for student teaching which supports teaching staff salaries and facilities, but which does not meet costs of resident training, (c) clinical care of patients via health insurance company (and government insurance) payments, which are directly related to the DRG code with no additional weighting for resident training. Thus our study has important implications for how German teaching hospitals might (or might not be able to) meet their additional teaching costs for residents (and/or students).…”

Comparing NHS Hospital Unit Costs

“…For example, the revenue hospitals receive for providing undergraduate teaching is probably an inaccurate reflection of the costs incurred (Bevan, 1999). Those teaching hospitals that are over-compensated for their undergraduate teaching costs will be able to report lower costs of service provision than those of their peers that are under-compensated.…”

The impact of teaching and research on hospital costs

“…To briefly summarize their results, they present the following characteristics. According to Bevan [1], such differences persisted much later, but with a large variance, from 43 % of excess for the costliest hospitals, to 4 % less for the cheapest teaching hospital. Linna et al [8] found that the overall impact of research and teaching on hospital costs varied between 0% and 25% according to studies.…”