The Anglo-European College of Chiropractic

Submission to the National Committee of Inquiry into Higher Education (1996)

1WHAT SHOULD BE THE AIMS AND PURPOSES OF HIGHER

EDUCATION OVER THE NEXT TWENTY YEARS?

  • Certification of achievement is a key aim and purpose
  • Career development and career change will be features of higher education over the next twenty years, and the structure and funding must support this.
  • Recognition that higher education has a cultural and an economic dimension
  • Education and training and especially retraining for the world of work has to remain a significant component
  • The scope encompasses first qualification, as well as postgraduate and/or continuing personal and professional education
  • Health professions generally, (including complementary medicine) are relatively new entrants to degree level work
  • The complementary therapies, especially chiropractic, have recruited from a distinctive socio-economic background different from school leavers. Mature career-changers are the norm.

2WHAT FEATURES ARE, OR SHOULD BE, DISTINCTIVE OF HIGHER

EDUCATION AS OPPOSED TO OTHER LEVELS OR FORMS OF EDUCATION OR TRAINING?

  • Transmission and advancement of knowledge and understanding are distinctive of higher education
  • Work-based training is an important feature of clinical professions, especially at postgraduate/continuing professional development levels
  • Vocational higher education has to have a role, especially health care professions
  • Clinic and community-based first qualification training for primary contact health professions is an emerging fact of life (medical education is moving out of hospitals, and into the community).
  • Professions and employers have always narrowed intellectual horizons.

3WHAT FORMS OF HIGHER EDUCATION PROVISION WILL STUDENTS

NEED ACCESS TO OVER THE NEXT 20 YEARS?

  • Curriculum models for many professions are not negotiable, and may be backed by statute
  • The General Chiropractic Council (GCC) will have a pivotal and statutory role in curriculum models for chiropractic. Existing primary contact clinical programmes authorised by General Medical Council/General Dental Council do not recognise/allow part-time provision
  • No place for sub-degree level work in health care professions generally, and especially chiropractic
  • Manpower planning has never worked: leave it to the market
  • Distinction between first qualification and postgraduate/continuing professional development - perhaps with different levels and types of funding support
  • Psychomotor skills, impossible to deliver by anything other than full time study
  • Do not let professions “gatekeep” numbers

4WHAT KNOWLEDGE, SKILLS AND APTITUDES WILL THOSE LEAVING

HIGHER EDUCATION NEED OVER THE NEXT 20 YEARS AND HOW CAN THESE BE BEST DELIVERED?

  • General transferable intellectual skills will remain essential, both in their own right and to complement specialist knowledge, principles and practices in vocational courses.
  • Balance of general versus specialist skills may be met through US-style model, general BSc and MSc specialist. This will need funding support and a political and economic expedient which has been proposed is a “free” Associate degree, with students meeting fees for Masters programmes. This model makes the Masters the new entry point for (recognised) professions.
  • A creative tension between vocational and general needs is a positive feature.
  • The higher education context for professions is essential to enhance scholarship and the “reflective practitioner” concept, and to move professions forward.
  • Do not give power exclusively to one stakeholder, curriculum for vocational courses must be shaped by an iterative process.
  • The European context is important, especially for recognised professions.

5HOW CAN EFFECTIVE TEACHING AND LEARNING BE IDENTIFIED

AND HOW SHOULD THEY BE ENCOURAGED?

  • Higher education should have its own professional accreditation, with tutors required to have a recognised appropriate rigorous higher education tutors qualification. All tutors should have this and/or appropriate postgraduate qualifications.
  • Salary increases on merit and achievement, not timeserving increments
  • Multi-media based learning resources will expand and facilitate distance learning where appropriate, especially for postgraduate work and continuing professional developments.
  • Stakeholder input helps to characterise good teaching and learning.
  • Networking has proved invaluable and should be encouraged.

6WHAT IS THE PLACE OF SCHOLARSHIP (AS OPPOSED TO TEACHING

AND RESEARCH) IN HIGHER EDUCATION?

  • Scholarship is an absolutely essential professional activity for higher education tutors.
  • Chiropractic, like many professions, is committed to the concept of a “reflective practitioner”, and this has a match with the more broadly-based concept of scholarship.

7HOW CAN THE STANDARDS OF DEGREES AND OTHER HIGHER

EDUCATION QUALIFICATIONS BE ASSURED AND MAINTAINED?

  • External peer review coupled with networking is essential to maintain and enhance academic standards.
  • In the context of chiropractic moving to a graduate status there has been a marked increase in standards.
  • The College is aware of some very shoddy validations of degrees in complementary medicine, as well as some very rigorous events. There is no place for poor standards of validation in clinical work - patients will suffer.
  • There is a significant role for professional bodies in vocational higher education work. There is also a European Directive on recognised professions (The General Approach Directive, 89/48/EEC), HEFC/HEQC are not the only players.

8WHAT PROPORTION OF HIGHER EDUCATION RESOURCES IS IT

REASONABLE TO USE TO VERIFY STANDARDS OF AWARDS AND THE QUALITY OF PROVISION?

  • Very, very little higher education teaching provision has been found to be unsatisfactory. Is the time, effort and cost therefore justified? Does verification of standards lead to improvement?

9HOW SHOULD RESEARCH CARRIED OUT IN HIGHER EDUCATION

INSTITUTIONS FIT WITH THE WIDER SPECTRUM OF RESEARCH UNDERTAKEN IN THE UK?

  • Many professions rely on higher education for contributing to knowledge and understanding, and for taking forward the professions
  • The diversity of teaching provision which is such a great strength of higher education should be matched by a diversity of research, scholarship and related professional activities.
  • Research provision needs to be reinforced for institutions whose graduates are entering emerging professions whose potential to provide decisive solutions to social problems has been recognised.
  • The context of health technology assessment needs to be re-evaluated in the light of current evaluative reports in this area.
  • Funds for pump-priming and applied research should be available to the private sector.
  • Distinctions between basic, strategic and applied research are not seen as meaningful in the clinical context.

10HOW SHOULD PUBLIC FUNDING FOR RESEARCH IN HIGHER

EDUCATION INSTITUTIONS BE DISTRIBUTED?

  • The arrangements for evaluation of bids at Research Council level should be reconsidered in the light of the emergence of new specialties with a view to including experts from these specialties in the evaluation process.
  • Eligibility for Research Council grants should be extended to private sector higher education institutions and judged on merit without the pre-requisite of a university lead partner.
  • From the point of view of the private sector, the Research Assessment Exercise (RAE) is laughable. Is the “research transfer market” enhancing standards? The RAE appears to be neither fair nor accountable.

11HOW SHOULD THE ORGANISATION OF RESEARCH ACTIVITY BE

DEVELOPED OVER THE NEXT TWENTY YEARS?

  • In most higher education institutions research and teaching are almost inseparable in an organisational sense. There is, however, confusion over the “tension” that should exist between them.
  • The academic contribution of research to teaching should be monitored so that the two are complementary to the educational experience. Processes for making academic appointments should anticipate this.
  • The involvement of teachers in research should also be monitored so that full recognition and resourcing is given were contributions are made.
  • Where the development of the profession which a graduate is entering is heavily influenced by new evidence-based policies, the teaching and research functions within the organisations should make it a priority to ensure that their roles are co-ordinated.
  • Educational policy should distance itself from excessively heavy teaching loads in favour of the quality of learning. It should be a part of the monitoring and accreditation processes for both the research and teaching arms of institutions to indicate their methods and levels of integration between teaching and research.

12HOW CAN THE QUALITY OF RESEARCH IN HIGHER EDUCATION BEST

BE MAINTAINED AND ENHANCED?

  • There should be no place for academic pretension in training for research leading to a Doctorate. If it is to flourish, it must continue to be better orchestrated.
  • There is a developing demand for “practitioner Doctorates” - DEng, DEd, DClin Psychol., for example. These are relevant to the world of work.
  • For emerging professions such as chiropractic, a demonstrable commitment to research over years in an institution should qualify the institution for consideration as a Centre of Excellence.
  • For such institutions provision should be made for pump-priming to allow a transition to be made from department level to that of unit or institute.

13WHAT SHOULD BE THE PARTICIPATION RATE FOR HIGHER

EDUCATION IN THE CONTEXT OF CHANGES IN SOCIETY, THE ECONOMY AND THE LABOUR MARKET OVER THE NEXT 20 YEARS?

  • Participation rate must be disciplined by the market and what the higher education system can deliver.
  • Chiropractic is one of a number of “special cases”, in that there is no public sector provision, and access is restricted by socio-economic determinants (total fees to qualify as a chiropractor recognised for BCA registration are £29,750 at 1996 prices).
  • There is no public sector provision for chiropractic
  • The ratio of chiropractors : patients in the US is 4000:1, and to reflect this ratio the chiropractic profession needs to expand from c 1000 to 10,000. Student numbers may be accommodated within the public sector by expansion, or by displacing non-recruiting areas such as physical sciences and/or within an expanding and more fairly funded private sector.
  • Access to chiropractic education has to be facilitated by a sympathetic funding system, either for first qualifications or career change.

14WHAT FACTORS SHOULD DETERMINE THE APPROPRIATE LEVEL OF

PARTICIPATION IN HIGHER EDUCATION?

  • The level should be determined by the market.
  • We note that student demand for medicine, veterinary surgery and dentistry is enormous, but the professions “gatekeep” numbers. Why not let student demand and the labour market shape the level of provision?
  • First qualifications need to be distinguished from continuing professional development.
  • Continuing professional development is a sensible if not statutory requirement for a clinical profession.
  • For recognised professions, there is a European dimension to the size of the labour market, with student demand and language being significant determinants.
  • Lifelong learning will increase participation. A sympathetic funding (or tax) system will be needed to facilitate this.

15HOW DO YOU EXPECT THE STUDENT BODY OVER THE NEXT 20

YEARS TO DIFFER IN AGE, BACKGROUND, EDUCATION, EMPLOYMENT, EXPERIENCE AND MOTIVATION, APTITUDE AND LIFESTYLE FROM TODAY?

  • Career development and career change will be normal expectations.
  • This should not be planned around eighteen year old school leavers. The student body will be very diverse in terms of age, nationality, study mode, and use of work-based learning.

16WHAT SHOULD BE THE REQUIREMENTS FOR ENTRY INTO HIGHER

EDUCATION?

  • Expect more diverse minimum requirements, tempered by aptitude, ability, ambition (and possibly by competition).
  • For clinical professions, academic excellence or potential may not, by itself, be appropriate.
  • Currently, professions have a key role in selection, and this is likely to continue.
  • Generally, barriers to access should decrease (NB: financial barrier for private sector).

17HOW SHOULD THE ADMISSIONS PROCEDURE BE ORGANISED FOR

ENTRY INTO HIGHER EDUCATION?

  • Will UCAS handle career changers?

18HOW DIVERSE SHOULD THE HIGHER EDUCATION SECTOR BE

ACROSS INSTITUTIONS OVER THE NEXT TWENTY YEARS?

  • Diversity is an immense strength. However, there will always be a place for specialist colleges as outliers on the spectrum of provision.
  • Specialist colleges offer distinctive provision.

19WHAT SHOULD BE THE BALANCE BETWEEN DIFFERENT PROVIDERS

OF HIGHER EDUCATION?

  • A private sector can only flourish with fairer student funding.
  • The playing field is not level for chiropractic or other specialist providers. As a recognised profession it is going to be difficult to compete by offering non-standard “fast track” programmes acceptable to an international community, and to the patients the graduates will have to treat.
  • Chiropractic is within your category of “other providers”. This is an historic anomaly and may not continue.

20HOW SHOULD HIGHER EDUCATION INSTITUTIONS THEMSELVES

DEVELOP?

  • Electronic mail, internet, and CD-ROM-based media are already having an impact. For a profession based on psychomotor skills, the impact will be greatest in continuing professional education.

21HOW SHOULD THE SHAPE AND STRUCTURE OF THE HIGHER

EDUCATION SECTOR BE DETERMINED?

  • Let the market decide. Government has always got it wrong. However, quality of provision must be assured.

22WHAT REQUIREMENTS ON INTERNAL GOVERNANCE IN

INSTITUTIONS OF HIGHER EDUCATION SHOULD THERE BE AS A PRE-REQUISITE FOR RECEIPT OF PUBLIC FUNDS?

  • Commitment to open, due process and to accountability.
  • Led by academic and professional needs, and disciplined by financial resources.
  • Business-like, rather than businesses.

23WHAT LOCAL AND REGIONAL ROLE SHOULD HIGHER EDUCATION

INSTITUTIONS HAVE OVER THE NEXT TWENTY YEARS?

  • There is a European context to much higher education provision generally. AECC has a European mission. This is likely to continue. There is a place in the wider higher education context for the cultural diversity this develops.
  • Higher education colleges generally, and AECC specifically, are significant employers locally. Colleges have a marked economic multiplier effect.
  • The AECC is a significant local community health resource.

24HOW CAN UK HIGHER EDUCATION CAPITALISE ON THE FACT THAT

HIGHER EDUCTION IS AN INTERNATIONAL ACTIVITY?

  • The present funding model for designated private sector courses advantages continental students and disadvantages UK students. Continental students can usually obtain loans and/or grants to cover full fees, UK students cannot. This has introduced a bias towards continental recruitment as opposed to UK recruitment, and is an imbalance. The model, and the socio-economic barrier it presents to access, must change.

25WHAT SHOULD HIGHER EDUCATION SEEK TO CONTRIBUTE TO THE

SOCIAL, CULTURAL, MORAL AND SPIRITUAL LIFE OF THE NATION?

  • Graduation from a higher education institute should reflect values expected of personal and professional behaviour.
  • Graduates should swear an oath, which would structure, inform and underpin broad cultural, ethical and moral values.
  • Failure to comply with the graduation oath should result in the qualification being withdrawn.

26HOW CAN INSTITUTIONS WHICH OFFER HIGHER EDUCATION BEST

ENSURE THAT THEY HAVE AN EXPERT AND EFFECTIVE WORKFORCE?

  • Higher education should be businesslike.
  • Automatic annual increments should be abolished, to be replaced by increments on merit and affordability. Performance should be measured against criteria in the public domain.
  • Rewards for academic staff should be commensurate with their academic/professional qualifications, and have regard for the fact that they must also have a teaching expertise.
  • An accreditation scheme for higher education tutors should be mandatory.
  • Posts and promotions should reflect the needs of the institution.
  • In the AECC, RPI + 1% has been paid for the last ten years, and Profit Related Pay has been introduced for 1996/7. It can be done.

27WHAT FURTHER MEASURES MAY BE AVAILABLE TO INCREASE

THE COST EFFECTIVENESS OF INSTITUTIONS OF HIGHER EDUCATION WITHOUT REDUCING THE QUALITY OF TEACHING AND RESEARCH?

  • Higher education should be business like (see above).
  • Evening and weekend and vacation use of mainstream resources should be encouraged, reflecting more diverse attendance patterns of students in the future.
  • The core activity of higher education institutions is teaching, and it is this activity which should bring in the bulk of funds. Diversified revenue streams from entrepreneurial activities are valuable contributions to financial vigour, but should not replace income from teaching, research, consultancy and related professional activities.
  • Fee paying students, as major stakeholders, exert a significant effect on quality, value for money and effectiveness.

28WHAT FACTORS SHOULD BE TAKEN INTO ACCOUNT IN

DETERMINING THE LEVEL AND PROPORTION OF PUBLIC EXPENDITURE SPENT ON HIGHER EDUCATION?

  • It is a political and economic reality that the present public funding model cannot continue to support adequately higher education provision. Times have changed; to impartial observers it is clear that the proportion of State funds spent on higher education has reached a plateau. The system has reached a political and economic watershed.
  • Students should see higher education as an investment in themselves, and expect to contribute more to it. Higher education should be seen by individuals for what it is - a very good investment in future earning potential.
  • The AECC has ample evidence that students will invest in their higher education, and that banks will lend money for such investment if security/collateral is available.

29WHO SHOULD PAY FOR THE COSTS OF TUITION AND STUDENT

MAINTENANCE?

  • Currently, tuition fees are effectively “top-ups” (albeit capped) to HEFCE core funding.
  • The totality of income has to be at a level which will maintain and enhance quality of provision. Top-up fees are logical. Private sector designated courses already have to charge significant top-up fees.
  • Students should borrow to cover maintenance. The maintenance grant should be withdrawn and replaced by a loan.
  • Students should borrow to cover tuition fees (in whole or in part).
  • Availability of loans should go beyond full time, first degrees. (E.g. Expand CDL?).
  • The present funding model is untenable and must change if the entire higher education sector is to flourish. Government can no longer afford the cost. Students must contribute more.
  • A loan system for both maintenance and tuition fees is recommended as a way forward., linked to an income-contingent repayment scheme administered by Government through income tax or National Insurance to minimise default.
  • Free higher education is a myth. It does not exist for hundreds of thousands of part-time students or postgraduate students or private sector students.
  • A model for funding which is equally fair regardless of whether students wish to enter the private or public sector is absolutely essential.
  • Private sector higher education cannot maximise its contribution unless the proportion of funding attached to students is made more significant and equitable.
  • There are a very few special cases where courses incur premium fees, e.g., medicine, dentistry, osteopathy, chiropractic, veterinary studies.

30HOW SHOULD SCHOLARSHIP (AS DISTINCT FROM RESEARCH OR