Tertiary Education Report:
Meeting with the Deans of the
University of Auckland and
University of Otago Medical Schools
Date:
2 December 2016
TEC priority:
Medium
Security level: In Confidence
Report no:
B/16/01276
Minister’s office No:
ACTION S OUGHT
Action sought
Deadline
Hon Steven Joyce
note the information in this briefing 2 December 2016
Minister for Tertiary Education, Skills prior to your meeting with the Deans
and Employment
of the University of Auckland and
University of Otago Medical Schools.
Enclosure: No
Round Robin: No
CONT ACT FOR TE LEP HONE DIS CUSSION (IF RE QUIRE D)
Name
Position
Telephone
1st contact
s9(2)(a)
Manager, University Investment
s9(2)(a)
s9(2)(a)
Deirdre Marshall
Acting Deputy Chief Executive
s9(2)(a)
s9(2)(a)
THE FOLLOW ING DEP ARTMENTS/AGE NCIES HAV E SEE N THIS RE PORT
CERA
DPMC
ENZ
ERO
MBIE
MoE
MFAT
MPIA
MSD
NZQA
NZTE
TEC
TPK
Treasury
Minister’s Office to Complete:
Approved
Declined
Noted
Needs change
Seen
Overtaken by Events
See Minister’s Notes
Withdrawn
Comments:
T E R T I A R Y E D U C A T I O N R E P O R T : M E E T I N G W IT H T H E D E A N S O F T H E U N I V E R S IT Y O F A U C K L A N D A N D
U N I V E R S IT Y O F O T A G O M E D IC A L S C H O O L S
Recommendations
Hon Steven Joyce, Minister for Tertiary Education, Skills and Employment
It is recommended that you:
1.
Note the information in this briefing prior to your meeting with the Deans of the University of
Auckland and University of Otago Medical Schools.
p.p.
Deirdre Marshall
Acting Deputy Chief Executive, Tertiary
Education Commission
2 December 2016
Hon Steven Joyce
Minister for Tertiary Education, Skills and Employment
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Purpose
1. We understand that you will be meeting with the Deans of the University of Auckland
(Auckland) and University of Otago (Otago) Medical Schools on 6 December 2016 to discuss
the joint University of Waikato and Waikato DHB proposal (the Waikato proposal) to establish a
third medical school.
2. This briefing provides background information for your meeting. Appendix 1 includes some
questions that you may wish to ask. Biographies of the Medical School Deans are provided in
Appendix 2.
3. We have previously provided advice to you regarding the Waikato proposal (B/16/01142
refers). Our advice was that the proposal has merit and warrants further consideration, but that
Waikato’s business case requires revision to comply with Treasury's Better Business Case
guidelines. A letter was drafted to be sent by yourself and Minister Coleman requesting a
revised business case, which meets the requirements of an Indicative Business Case (IBC).
The letter also encourages Waikato and the DHB to engage with relevant stakeholders in
developing its proposal.
4. Health Workforce New Zealand is undertaking its own detailed review of the draft business
case. It is the TECs intent to work closely with several government departments once the IBC
is received, and also consult with other interested parties including the Auckland and Otago
Medical Schools. This will enable us to provide you with further advice on the issues raised by
the Waikato proposal.
Prior correspondence with the Deans of the Medical Schools
5. The Deans of the Auckland and Otago Medical Schools have written to you on two occasions
regarding this proposal. The first letter (August 2016) requested a meeting to express their
concern about the Waikato proposal (M/16/00944 refers). The letter indicated that a third
school will bring increased pressure on the number of clinical training placements available to
students, and highlighted that they are already addressing issues with the medical training
pipeline that have been identified in the proposal.
6. The second letter (October 2016) reiterated Auckland and Otago’s commitment to educating
New Zealand’s medical workforce and included a letter from the Waikato DHB indicating that, if
the Waikato proposal is successful, the DHB will be looking to reduce the number of Auckland
students undertaking clinical placements in its hospitals.
The impact of the Waikato proposal on Auckland and Otago
If the cap is increased it is unlikely to affect demand at Auckland and Otago, but may affect
the availability of clinical placements in public hospitals
7. Medical provision is considered high-cost and the amount of delivery is therefore capped on
the first-year EFTS intake. The cap currently sits at 565 SAC 3+ funded EFTS. Auckland and
Otago work together to agree the distribution of the cap, which is currently split 275 EFTS at
Auckland and 290 at Otago. Demand for places exceeds availability at both Auckland and
Otago.
8. The Waikato proposal indicates enrolment of up to 60 students a year from 2020. If this is in
addition to the existing EFTS cap, it is unlikely to affect demand at Auckland and Otago, but it
may affect the availability of clinical placements in public hospitals since Auckland and Otago
have provided anecdotal evidence that these are already stretched.
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9. There is a risk that if additional EFTS are added to the cap, students at Auckland and Otago
may be unable to complete their qualification due to a lack of clinical placements. Waikato
DHB has already informed the Auckland Medical School that if the Waikato proposal is
successful, it will look to reduce the number of Auckland students placed in the DHB. In
addition, both Auckland and Otago have reported issues securing enough clinical placements
for their students.
Distributing the cap is an alternative, but will affect revenue and possibly viability for the
schools
10. If the Waikato provision forms part of the existing cap, the number of clinical placements will
likely be sufficient, but Auckland and Otago will need to reduce their first-year intake. This will
result in reduced revenue for both institutions. To offset this, the Universities may increase the
number of students admitted to uncapped aligned degrees eg pharmacy and physiotherapy.
11. As medical provision is ‘high-cost’ it may be argued that reducing the cap at Auckland and
Otago will affect their viability. Although this is unlikely to directly affect these established
medial schools, or the institutions overall, there may be an indirect effect on other provision that
is subsidised by the excess revenue the Medical Schools attract.
A combination approach is also possible
12. In the event that the Waikato proposal is supported, consideration should also be given to
partially raising the cap and partially redistributing current allocations. This combination
approach would reduce the effect of educed medical EFTS at Auckland and Otago and relieve
pressure on clinical placements.
13. It is expected that any further development of the Waikato proposal will include full consultation
with all stakeholders including Auckland and Otago and show that students will not be
compromised.
The Waikato proposal is different to existing provision
Waikato proposes a 4-year graduate entry programme aimed at increasing the number of
GPs in rural practice and the cultural diversity in the medical workforce
14. Waikato’s proposed medical programme differs to the Auckland and Otago programmes in that
it is a four-year graduate entry only programme. Waikato has indicated that the new
programme will focus on attracting students who already have a qualification and have chosen
to pursue a medical career later, rather than school-leavers.
15. The new programme will be primarily delivered in Hamilton, but, will have clinical education and
training centres throughout the central North Island. This will enable students to undertake a
high proportion of clinical placements in community settings outside the main centres.
16. The Waikato proposal indicates that capital funding of between $58 million and $70 million is
required, and operating expenditure between $142 million and $240 million over a ten-year
period. We have suggested in our earlier advice that the proposal looks at other sources of
funding – in particular for the capital expenditure, rather than relying on the Crown.
Auckland and Otago offer six-year programmes with a five-year graduate entry pathway
17. Auckland and Otago both offer six-year programmes primarily focussed on enrolling school-
leavers. At both universities, prospective medical students enrol in a Bachelor’s qualification in
their first year, along with students seeking admission to other aligned programmes such as
pharmacy, dentistry and physiotherapy.
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18. In 2015, Auckland delivered over $44.5 million SAC3+ funded provision to just over 1100 EFTS
at level 7 (and above) in years 2-6 its Bachelor of Medicine/Bachelor of Surgery qualification.
In 2015, Otago delivered over $52 million to just over 1300 EFTS at level 7 (and above) in
years 2-6 it’s Bachelor of Medicine/Bachelor of Surgery qualification.
19. The first-year acts as a ‘weeding-out’ process to ensure students progressing to the medical
programme are academically equipped. Following this, successful students continue for a
further five years to complete their medical qualification. Students undertake clinical
placements throughout the programme. The final year of study is the Medical Intern year in
which students complete a preparation year of clinical attachments – learning the skills to
become a house surgeon.
20. There is a graduate entry pathway at both universities for those who already have an
undergraduate degree. This pathway allows those with a prior degree to progress straight into
the second year. About 30% of students commencing the second year of the medical training
programme enter as graduates from another degree programme. It is noted that it would be
cheaper for both government and these students to gain a medical qualification via the Waikato
route.
The shortage of rural practitioners and Māori in the medical workforce
21. The Waikato proposal has highlighted issues with New Zealand’s health workforce including
increasing demand for GPs (together with an aging GP workforce), a lack of Māori graduates,
and a lack of graduates willing to enter and remain in rural GP practice.
22. The Waikato proposal attempts to address these issues by focussing recruitment on students
who are more likely to choose a career in rural general practice. The School would also
leverage Waikato’s high level of Māori participation and the regional demographic to attract
more Māori students into medical training.
Auckland, Otago and Heath Workforce New Zealand have implemented initiatives to
address these issues
23. Auckland and Otago operate three preferential admission schemes – Māori, Pacific and rural.
Both Auckland and Otago are now preferentially enrolling Māori at demographic equity with a
completion rate of over 90%. Both Universities report similar success for Pasifika.
24. The Rural and Regional Admissions Scheme aims to attract students from a rural background.
These students are more likely to seek a rural career path and the universities report that 50%
of students admitted under the scheme (103 students in 2016) move into rural practice but
there is little information on how long they remain there. Both universities have established
training options in rural and regional settings and report a significant number of students
undertaking these options.
25. The Deans of the Medical Schools have also highlighted that Health Workforce New Zealand
has increased funding for GP training and indicate that there are approximately 40% more
students undertaking GP training in 2015/16 compared to 2012/13.
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Appendix 1: Questions you may wish to ask regarding current medical
provision at Auckland and Otago
• Are Auckland and Otago planning to implement any additional initiatives to ensure there is an
adequate supply of GPs in New Zealand rural practice?
• In light of Waikato’s proposal, do Auckland and Otago plan to review their graduate entry
schemes, for example to reduce their graduate entry programme from five years to four years?
• Were there any measures or initiatives put in place to mitigate the impact on the Otago
programme when the Auckland medical school was established? What effect did the
establishment of a second programme at Auckland have on Otago and how have the two
schools worked to develop complementary provision?
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Appendix 2: Biographies
Professor John Fraser – Dean, University of Auckland Medical School
John Fraser gained a BSc with Honours at Victoria University of Wellington followed by a PhD at
the University of Auckland, both in biochemistry.
His ground-breaking research in molecular aspects of the immune response began at Harvard
University, where his work led to the investigation of the structure, function and role in disease of
super-antigenic toxins. Professor Fraser’s research resulted in the now widely accepted model of
how super-antigens work.
Professor Fraser is a former deputy director of the Maurice Wilkins Centre for Molecular
Biodiscovery and is a Fellow of the Royal Society of New Zealand.
Professor Peter Crampton – Pro-Vice-Chancellor, Health Sciences (and Dean, Otago
Medical School)
Peter Crampton graduated from the University of Otago Medical School and then worked as a
general practitioner before training in Public Health Medicine. His PhD thesis was on aspects of the
delivery of primary health care.
In 2002–2003, Peter went to John Hopkins University in the United States on a Harkness
Fellowship in Health Policy.
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