T E R T I A R Y E D U C A T I O N R E P O R T : P R O P O S E D N E W M E D I C A L S C H O O L I N T H E W A IK A T O R E G I O N
Recommendations
Rt Hon John Key, Prime Minister
It is recommended that you:
1.
Note the information in this briefing for your meeting with representatives of the University of
Waikato and Waikato District Health Board (DHB) on 3 November 2016 to discuss their
proposed new medical school in the Waikato region.
Tim Fowler
Chief Executive, Tertiary Education Commission
31 October 2016
Rt Hon John Key
Prime Minister
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Purpose
1. This briefing provides you with background information for your meeting with Professor Neil
Quigley, Vice-Chancellor of the University of Waikato and Dr Nigel Murray, Chief Executive of
the Waikato District Health Board, on Thursday 3 November 2016 to discuss their proposed
new medical school.
2. You may also meet Professor Alan St Clair Gibson who is Inaugural Dean of the newly
created Faculty of Health, Sport and Human Performance at the University of Waikato.
3. Biographies for Professor Quigley, Dr Murray and Professor St Claire are included in
Appendix 1.
4. Potential questions for you to ask at this meeting are attached as Appendix 2.
5. Detailed information about the University of Waikato can be found in Appendix 3.
Summary of the proposed new medical training programme
The proposed new medical school will focus on training general practitioners for the rural
Waikato region…
6. The University of Waikato (Waikato) and the Waikato District Health Board (DHB), ‘the
parties’, are proposing to establish a new medical school based in Hamilton with clinical
education and training centres located throughout the central North Island.
7. The proposed programme is a four-year graduate entry programme specifically targeting
individuals who already have a degree in any field and who, from the outset, are more likely to
choose rural general practice. Waikato and the DHB indicate there are currently shortages in
rural general practice and associated specialities.
8. Commencing in 2020, the proposed programme intends to enrol up to 60 students a year,
many of whom will be Māori to reflect the demographics of the Waikato region.
9. Over a 10-year period, the capital expenditure is estimated to be between $58m and $70m
and operating expenditure between $142m and $240m. At this point they are hoping to
secure capital funding from the Crown, although we intend suggesting they look at a range of
ways to finance developments (e.g. borrowings, Public-Private Partnerships etc). Operating
revenue would come through the usual TEC funding source, however the quantum of funding
that would be required is unlikely to be able to be fully accommodated within the current
funding envelope.
Background
There are two existing medical training programmes at the Universities of Auckland and
Otago…
10. Both Universities of Auckland and Otago offer medical training. The six-year programme is
primarily focussed on enrolling school-leavers. At both universities, prospective medical
students undertake their first year in health sciences along with other students seeking
admission to other programmes such as pharmacy and physiotherapy in their second year.
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11. Following their first year in health sciences, successful students continue on for a further five
years to complete the Bachelor of Medicine and Bachelor of Surgery (MB ChB). The final year
is an apprenticeship-style year known as the Trainee Intern year.
12. There is a graduate entry pathway at both universities for those who already have an
undergraduate degree. Successful applicants enter the second year of the training
programme to complete the five years MB ChB programme.
13. The Deans of Medicine of the existing medical schools and their Vice-Chancellors have
written to Minster Joyce to express their concern about the establishment of a third medical
school in New Zealand. They are primarily concerned about the potential increased pressure
on the number of clinical training placements available to their students, particularly those at
Waikato Hospital in Hamilton. They have also highlighted that they are already addressing the
current workforce needs (as identified by Waikato) that drive the medical training pipeline.
The proposed new medical school in the Waikato region differs from the existing
programmes…
14. The proposed new medical programme differs to the existing programmes in that it is a four-
year graduate entry programme. This is one year shorter than a graduate-entry pathway into
existing programmes.
15. Unlike the existing programmes, the proposed programme is focussed primarily on recruiting
students who, from the outset, are more likely to choose rural general practice. Furthermore,
being graduate entry only, the new programme will focus on attracting a different cohort of
students – those who already have a qualification and have chosen to pursue a medical
career later in life, rather than school-leavers.
16. The new programme will be primarily delivered in Hamilton, but, unlike existing programmes,
it will have clinical education and training centres throughout the central North Island to
enable students to undertake a high proportion of clinical placements in community settings
outside the main centres.
There have been previous proposals to establish a third medical school which have not
gone ahead …
17. In the mid-1990s, the University of Canterbury and the University of Otago proposed
establishing a joint graduate entry medical school in Christchurch. However, the University of
Otago subsequently decided to consolidate its medical training within its own existing facilities
and programmes. Therefore, this proposal was not formally submitted to the government for
consideration.
18. In 2013, Victoria University of Wellington presented Minister Joyce with a business case for a
new graduate entry medical school. At the time, there was no compelling rationale to justify
the creation of a third medical school in New Zealand so the school was never established.
Next steps
Last week, the parties presented an early stage business case to Ministers Joyce and
Coleman…
19. Minister Joyce and Minister Coleman met with Professor Quigley and Dr Murray on Monday
17 October 2016 to discuss an early stage business case for the new programme. The
Ministers indicated they were interested in the idea but would have to give it further
consideration.
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The concept is innovative and addresses the current shortage of general practitioners in a
novel way but requires further development…
20. Overall, the TEC thinks the early-stage business case has some merit in that it provides a
different and innovative approach to medical education, focussing on general practitioner
training and rural health. It seeks to address a much discussed issue - the ability to attract
and retain doctors in rural and provincial areas.
21. However, in the TEC’s view, the business case requires a more work before it will comply with
Treasury's Better Business Case guidelines, and to answer all the questions that Ministers’
might have before making any decisions to proceed or otherwise. Therefore, we have
recommended to Minister Joyce that he asks the parties for a revised business case (an
Indicative Business Case, IBC) addressing the shortfalls and gaps in the current business
case.
22. It is possible that by the time you meet with the parties on 3 November 2016, that they have
received a letter from Minister Joyce outlining the suggested revisions to the business case. A
draft version of this letter provided to Minister Joyce can be found in Appendix 4.
The parties will be encouraged to engage more deeply with stakeholders, in the first
instance…
23. The TEC will encourage Waikato and the DHB to meet with the relevant government
departments in the first instance, to deepen their engagement and ultimately reach a common
understanding of the medical workforce problem in New Zealand and the likely solutions.
24. Once the IBC is produced, the TEC will take the lead to work with the Ministry of Health,
Treasury, MoE and Department of Prime Minister and Cabinet to assess both the IBC and an
independent quality assurance report in order to provide further advice to relevant Ministers
accordingly.
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Appendix 1: Biographies
Professor Neil Quigley – Vice-Chancellor, University of Waikato
Professor Quigley became Vice-Chancellor of the University of Waikato in early
2015. Before taking up his position as Vice-Chancellor, he was employed at
Victoria University of Wellington for 19 years, originally as Professor of
Economics, and more recently as Deputy Vice-Chancellor (Research) and
Provost. Prior to that, he was Assistant Professor of Economics at the
University of Western Ontario in Canada. In 2013, he received an honorary
doctorate from the University of Economics in Ho Chi Minh City, Vietnam.
Earlier this year, Professor Quigley was made Chair of the Reserve Bank of
New Zealand’s Board of Directors, and also a Director of the New Zealand
Qualifications Authority.
Dr Nigel Murray – Chief Executive, Waikato District Health Board
Dr Nigel Murray has been Chief Executive of Waikato District Health Board
since July 2014. Prior to taking up his role at the DHB, Dr Murray was
President and CEO at Fraser Health Authority in Canada. He has previously
held roles as CEO of Southland DHB and held management positions at
Auckland DHB.
He has worked with the United Nations Special Commission in Iraq where he
was responsible for establishing and maintaining health and safety systems
towards the end of the first Gulf War. His work involved ensuring the safety
of diplomats and health officials who decommissioned Iraq’s weapons of mass destruction. He
also worked in Bosnia on rebuilding its health system following the Civil War.
He completed his medical training at the University of Otago and whilst in the New Zealand Army
he gained a Masters of Occupational Medicine from Harvard University’s School of Public Health.
He was awarded an MBE in the 1995 Queens Birthday Honours for services to health in the New
Zealand Defence Force.
Professor Alan St Clair Gibson – Dean of the newly created Faculty of Health, Sport and
Human Performance, University of Waikato
Professor Alan (Zig) St Clair Gibson joined the University of Waikato in July 2016
as the Inaugural Dean of the Faculty of Health, Sport and Human Performance.
Prior to this, he was Head of the School of Medicine at the University of Free
State in South Africa from 2014-2016. Before this he was first Director of
Research and Chair of Integrative Neuroscience, and then Head of
Department of the Department of Sport, Health and Rehabilitation at Northumbria
University, in the United Kingdom, from 2006-2014.
He graduated from the University of Cape Town with an MBChB in 1990, a PhD
in 1997 and a MD in 2002. After starting his career as a Medical Doctor in rural hospitals in South
Africa, he went on to hold positions as an Associate Professor at the University of Cape Town,
and a Research Fellow at the National Institutes of Health, in Washington DC in the USA.
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Appendix 2: Potential questions regarding the business case
Below are some possible questions you may wish to ask at the meeting:
1. What are the likely socio-economic benefits of the proposed new medical school for the
Waikato region?
2. In their view, why is there a shortage of rural general practitioners? Is this area of practice
not considered a desirable career path or are there just not enough doctors in New
Zealand?
3. How will they ensure graduates will enter in to general practice in rural regions in New
Zealand?
4. In time, do they intend to expand the supply of graduates to the rest of rural New
Zealand?
5. What go other key stakeholders, such as Iwi and neighbouring District Health Boards,
think of the proposal?
6. How does the new model of education delivery (graduate entry only, a high proportion of
clinical placements in community settings) compare with other similar international
models? What has been the success of these programmes?
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Appendix 3: General information about the University of Waikato
Waikato was founded in 1964 and is the second smallest university in New Zealand,
delivering approximately 10,000 equivalent full-time students (EFTS) each year.
It has the highest proportion of Māori EFTS of all universities.
Waikato recently revised its areas of distinction to include civil and environmental
engineering, freshwater, health and sports science.
In 2015, Waikato did not meet some of its Investment Plan targets for its educational
performance indicators (EPIs). Compared to Waikato’s performance in 2014, results for
most metrics decreased with the exception of Māori and Pasifika qualification
completions.
Waikato is in the process of establishing a new campus in Tauranga. The University of
Waikato-led campus will be shared with other parties in the Bay of Plenty Tertiary
Education Partnership, Te Wānanga o Awanuiārangi and Toi Ohomai Polytechnic. The
proposed design concept for the tertiary campus development was approved in October
2016, and construction is set to commence next year. It’s expected to open by 2020. This
project is in part funded the Bay of Plenty Regional Council and the Tauranga Energy
Consumer Trust ($15m each) with the balance being funded by Waikato. Tauranga City
Council is providing the land.
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a 10 year financial model. This should be used to assess the affordability and sustainability of
the proposed model.
5. A stronger management case should be included that outlines a high-level project plan
describing the critical pathway from conception to implementation, and the risks associated
with the project.
The TEC will be in contact to discuss the next steps with you, and will be able to help facilitate
engagement with the other government agencies with an interest in the proposal.
The revised business case should then undergo an independent quality assurance (IQA) review
and the subsequent IQA report made available to government. I expect you to discuss the terms
of reference for the review and the selection of a suitable IQA provider with TEC officials.
I wish you all the best with these next steps and look forward to hearing from you again in due
course.
Sincerely,
Hon Steven Joyce
Minister for Tertiary Education, Skills and Employment
Cc: Rt Hon Jim Bolger, Chancellor, the University of Waikato
Cc: Mr Robert Simcock, Chair, Waikato District Health Board
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