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University of London

IMPACT OF GOVERNMENT’S POLICY

On Dec. 7 Lord Annan, Vice-Chancellor of the Univer-sity of London, replied to a letter from the UniversityGrants Committee about resources up to 1983-84 andGovernment changes in fee levels for overseas students.We reproduce below some extracts from his letter.

THE University is unable to forecast what its financial pos-ition is likely to be in 1984. This is not merely because we can-not guess how many overseas students are likely to apply underthe new fee policy. It is also because we cannot forecast thevalue of our resource base-line. The effect of cash limits is un-

predictable because we do not believe the assurances we havebeen given concerning "level funding". On our analysis "levelfunding" looks like a substantial cut.

I must stress as vividly as I can the specially disastrousplight of London. As the University of the capital city it hasalways attracted a particularly high percentage of overseas stu-dents. As the mother of so many Commonwealth Universitiesit contains institutions geared specially to teach and train post-graduates of other countries. So many of its colleges areoriented to research. The costs of its Schools and Institutes are

inescapably high. They reflect the expense of working in thecapital: London Allowance alone absorbs more than /12m ayear.The Government’s policy with regard to overseas student

fees has on the U.G.C. arithmetic put 30m at risk for Lon-don. Moreover the pronouncement about minimum fees hasbeen to London’s disadvantage. Even if every place at presentoccupied by an overseas student were to be filled by one in thefuture, fees substantially higher than the minima would haveto be charged if the 30m were to be recovered. We are notonly a university with many overseas students. We are rela-tively a high-cost university. The minimum overseas fees sug-gested by Government are far below for London what Govern-ment calls the "economic" fee.London is unlike any other university. It is a federation of

exceedingly heterogeneous States. The general medical schoolswill of course suffer from the general cuts but may not ingeneral be too seriously affected by the policy on overseas stu-dents. But most Schools will be hard hit by the overseas feepolicy. The national average of full-time overseas students is13%. The London average is 19.3%.There are three Schools which, unless the Government is

prepared to make special provision, will almost certainly haveto close within two or three years. The London School of

Hygiene and Tropical Medicine with 74% full-time overseasstudents; the Royal Postgraduate Medical School with 47%;the School of Oriental and African Studies with 35%. Thereis no conceivable way in which by the rest of the Universitytightening its belt these three institutions can be saved. Nor isthere any way in which most of the Institutes can still continueto operate in the British Postgraduate Medical Federation,which overall has 45 % of its students from overseas.The specialised institutions, and particularly in the British

Postgraduate Medical Federation, fear that the overseas stu-dent fee policy will put at risk the large amount of income de-rived from outside sources and agencies. If an Institute sud-denly has to contract because overseas students fail to apply,it will no longer be able to attract outside money for theresearch which is the main purpose for the Institute’s exis-tence.

This prognosis is not an attempt by the University to takethat course of action which will embarrass Government mostin the hope of inducing a change of heart. This is not black-mail. It simply recognises the fact that Government over many

years has encouraged the University to foster what were

always known to be "uneconomic" institutions.The reason why London University cannot "save" the spe-

cialised institutions by rejigging its finances is because so manyof its Schools, large and small, believe that they will soon beon the verge of bankruptcy. Every non-medical School expectsto be in deficit at the end of this year; and on the three assump-tions which we were asked by the U.G.C. to consider the defi-cits mount. Virtually all Schools expect to have to make staffredundant under the most favourable assumption and on theleast favourable they forecast a change of such magnitude thatthey would be unrecognisable as the places they now are.

Above London hangs a particular avalanche and we have notools to dig ourselves out. This is the avalanche of academicstaff redundancies. If it is Government policy in the light of thecountry’s disastrous economic plight to cut higher educationremorselessly, then a national policy for redundancy will haveto be formulated at once-for Schools are already runninginto deficit which under the cash limits policy appears to beirretrievable. No single University can on its own set the termsof redundancy payments. The U.G.C. must get the best termsit can from the Department of Education and Science; and itis inevitable that such terms will be tested in the industrial tri-bunals. We cannot wait leisurely to debate this matter. Actionis required at once.

I therefore plead as poignantly as I can, for the U.G.C. toadvise the Government of London’s special difficulties. Let meassure the U.G.C. that the University will not sit idly wringingits hands. The Flowers working party on medical educationwill be succeeded by another working party to consider howbest to meet this crisis in the non-medical Schools and Insti-tutes. We recognise cuts are inevitable and we shall makethem.

Cannot the U.G.C. and the Government provide somespecial form of funding to sustain those research and teachinginstitutions particularly in medicine which play a national roleand fear a massive loss of fee income until the effect of the newoverseas student fee policy can be seen? Can the U.G.C. alterthe technical basis of their resource reduction calculations to

recognise various features in the present arithmetic which

penalise the University of London disproportionately? TheU.G.C. uses full-time students alone as the student numbersbase-line for the estimation of the "economic" cost and in con-sequence the income to be derived from overseas students. Thisdenies London the arithmetical benefit in cost terms of the

large number of part-time students taking normal Universitycourses.

The University hopes that in the next round of their arith-metic the U.G.C. will use 1979-80 student numbers and notthose for 1978-79. There has already been a significant reduc-tion in the numbers of overseas students in London institutionsthis year, in advance of the introduction of the new fee levels.Then again the U.G.C. has used a formula of 40%, 40%,

and 20% for the incidence of the financial "benefit" of charg-ing economic fees and consequentially for determining thedegree of risk. This is untypical for many institutions in Lon-don. May we also hope that the U.G.C. will recognise anotherspecial feature in London, namely, the existence within theUniversity of national institutes and activities which have noregistered students at all and therefore no student income?

It may be that Schools have overestimated the deterrenteffect of the higher fees for overseas students. They may besurprised at the resilience of the market. But what must bealarming is the size of the deficit they will incur if their fearsare realised. One School has argued that, as the Governmentdemands that universities should test the market, only 75% or80% of the estimated fees should be deducted from the grant:if the market proves to be buoyant the full fee could bededucted in years to come. In any case we ask the U.G.C. toobtain an assurance from the Government that they willreview their policy after the first year of operation.

But, even if every overseas student place was filled, the Uni-

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versity of London would still be in the gravest difficulties, andmanv institutions will be forced to make academic staff redun-dant. They will change for the worse; and a few will either dis-appear or become mere shadows.

We asked the Dean of the London School of Hygieneand Tropical Medicine for his comments.

As Lord Annan has said, if the Government’s proposals, tomake overseas students self-financing within three years, wereapplied without modification to the London School of Hygieneand Tropical Medicine (LSHTM), it would amost certainlyhave to close within two years or so. But the School is deter-mined to survive by stringent economies, hoping that theGovernment, recognising its special position and functions,can yield a sufficient measure of flexibility, in a policy surelynot designed for the destruction of such a unique national andinternational asset.The U.G.C. "planning exercise" to which Lord Annan was

responding was based on very crude (not to say naive) arithme-tic. The formula is to take the U.G.C. grant of an institution,divide it by the number of full-time students only, multiply theresult by the number of overseas students and substract 40%of that proportion in 1980-81 and 40% and 20% respectivelyin the two following years. This arithmetic applied to theL.S.H.T.M. means a reduction of about 30% in the 1980-81grant, with further 30% and 15% reductions in 1981-82 and1982-83 respectively. However, the L.S.H.T.M. has threetimes as many part-time students as full-time and almost bydefinition part-time students are mostly home students. If theU.G.C. arithmetic had followed the normal head-countingmethod of full-time equivalents, the percentage reductionswould be approximately 23%+23%+12% over the three yearsof cuts. However, the U.G.C. arithmetic also completelyignores the intensive research element in a postgraduate centreof excellence. The research grant income of the L.S.H.T.M.has been growing rapidly (increased by 25% in 1978-79) andnow exceeds the U.G.C. grant income. Research grants are, ofcourse, generally based on the time-honoured-but now time-expired-principle of "dual support" in which a University isexpected to provide "a well-found laboratory"; and grants areto cover only additional research expenditure. It would be dif-ficult to separate research and teaching expenditure in an insti-tution where the two functions are indivisable. But it would bereasonable (perhaps conservative-sic!) to suppose that thewell-found laboratory element costs the L.S.H.T.M. at least20% of its research grant income. If that were deducted fromthe U.G.C. grant before calculating student costs, the proposedcuts over the next three years would fall to about 18%, 18%,and 9% respectively. Thus, only slightly more sophisticated(and certainly more logical) arithmetic might provide a basisfor possible survival, although with inevitable impairment ofthe standards of teaching and research.The L.S.H.T.M. accepts the current national need for

economies in University expenditure and even that overseasstudents should pay a higher proportion of the cost of theireducation. The most stringent economies consistent with main-taining a high standard of teaching and research (withoutwhich the School cnanot, need not survive) will be institutedimmediately. The School would expect to be allowed (indeedencouraged) to use its judgement as to the rate of increase offees which the market (and particularly the fellowship budgetswhich the School cannot, need not survive) will be institutedtry to maximise income from overseas students without killingthe goose that lays the golden egg and without grossly increas-ing unit costs.

So much for arithmetic. But, for the L.S.H.T.M., overseasstudents are not numbers nor even golden eggs. They are abso-lutely essential to its teaching and research whether in theU.K. or abroad. The L.S.H.T.M. is a school of internationalhealth, teaching the teachers, researchers, and senior healthadministrators of the immediate future. For such students no

aspect of health can be taught in narrow parochial terms andour experienced and knowledgeable students, who comeannually from, around 85 countries, provide a unique andessential basis of learning, as important to U.K. students as toothers. Moreover its wide-ranging, collaborative, and interna-tional research (whether on the planning of hospital services,on the risk factors in coronary thrombosis or on parasitic dis-eases) is more often than not based on long-term relationshipswith former students who form a very extensive network, afternearly eighty years. It should be remembered that all its over-seas students do not come from tropical developing countries-in 1978-79, 18% of the full-time overseas students camefrom industralised countries in Australia, Europe, NorthAmerica, and elsewhere.The question has been asked-what would the U.K. lose if

the School had to close down? Apart from those aspects I havementioned and the large number of part-time U.K. studentstaught, the most important national postgraduate resource inseveral essential subject areas of preventive medicine and com-munity health would disappear-and if reestablished in frag-mentary fashion elsewhere would be greatly vitiated and quiteunable to provide the quality of teaching which their combina-tion on one site can. These subjects include epidemiology,human nutrition, medical demography, medical statistics, occu-pational medicine and hygiene, and also major postgraduatecourses in community medicine, medical microgiology, andparasitology. All departments serve both U.K. and overseas in-terests in teaching and research-in varying proportions-andwithout this unique combination of disciplines and interests,the L.S.H.T.M. contribution to community health and preven-tive medicine in the U.K. would be gravely if not fatally in-paired.

This argument of course ignores the immense contributionwhich the L.S.H.T.M. makes to improving health in the ThirdWorld and to the study and treatment of tropical diseases inLondon; but, in the context of the Government’s proposals, itseems more important at this moment to stress the importanceof the School to national interests.The School wishes it clearly understood that it will certainly

be open and effective next year and that it is most importantfor its survival that intending students should not be deterredfrom applying for courses in 1980-81 because of rumours ofclosure. Despite increase in fees, the School hopes to attract asmany or more students, both home and overseas, for next year.

London School of Hygieneand Tropical Medicine,

London WC1E 7HT C. E. GORDON SMITH

I believe that sometime in the near future there is going tobe a move back towards personal accountability for personalaction. When that happens an exhausted medical professionand an impoverished government may not be particularly in-terested in the ever so deep reasons why human beings need

. to run from reality.I can envisage the introduction of a series of penalties for

those who wilfully disregard their own health. A patient whoarrives at a clinic or hospital will face a doctor who is readyto make a Culpability Calculation that measures how muchthe patient’s own carelessness has been responsible for the ill-ness. The doctor will consider the degree to which this dis-regard contributed to the illness and the length of time thepatient had persisted with these activities. Provided the patientknew of the risk and provided he had persisted despite thisknowledge, penalties would be imposed.What form could the penalties take? At its most Prussian,

a simple refusal of treatment. That is unlikely. The more pro-bable penalty would be an economic one-an increased chargeon the patient’s bill; a health insurance loading; a decreasedrebate, or perhaps the positive incentive of a no-claim bonusfor those who maintain their health.-A. R. Moore. The Stu-

pidity of Patients._7Med Ethics 1979, 5: 207-08.