Tag: providers

  • Parents, Medical Providers, Vaccine Experts Brace for RFK Jr.’s HHS Takeover – The 74

    Parents, Medical Providers, Vaccine Experts Brace for RFK Jr.’s HHS Takeover – The 74


    Get stories like this delivered straight to your inbox. Sign up for The 74 Newsletter

    While Robert F. Kennedy Jr. ‘s Senate confirmation to head the Department of Health and Human Services was not unexpected, it still shook medical providers, public health experts and parents across the country. 

    Mary Koslap-Petraco, a pediatric nurse practitioner who exclusively treats underserved children, said when she heard the news Thursday morning she was immediately filled with “absolute dread.”

    Mary Koslap-Petraco is a pediatric nurse practitioner and Vaccines for Children provider. (Mary Koslap-Petraco)

    “I have been following him for years,” she told The 74. “I’ve read what he has written. I’ve heard what he has said. I know he has made a fortune with his anti-vax stance.”

    She is primarily concerned that his rhetoric might “scare the daylights out of people so that they don’t want to vaccinate their children.” She also fears he could move to defund Vaccines for Children, a program under the Centers for Disease Control and Prevention that provides vaccines to kids who lack health insurance or otherwise wouldn’t be able to afford them. While the program is federally mandated by Congress, moves to drain its funding could essentially render it useless.

    Koslap-Petraco’s practice in Massapequa Park, New York relies heavily on the program to vaccinate pediatric patients, she said. If it were to disappear, she asked, “How am I supposed to take care of poor children? Are they supposed to just die or get sick because their parents don’t have the funds to get the vaccines for them?” 

    And, if the government-run program were to stop paying for vaccines, she said she’s terrified private insurance companies might follow suit. 

    Vaccines for Children is “the backbone of pediatric vaccine infrastructure in the country,” said Richard Hughes IV, former vice president of public policy at Moderna and a George Washington University law professor who teaches a course on vaccine law.

    Kennedy will also have immense power over Medicaid, which covers low-income populations and provides billions of dollars to schools annually for physical, mental and behavioral health services for eligible students.

    If Kennedy moves to weaken programs at HHS, which experts expect him to do, through across-the-board cuts in public health funding that trickle down to immunization programs or more targeted attacks, low-income and minority school-aged kids will be disproportionately impacted, Hughes said. 

    “I just absolutely, fundamentally, confidently believe that we will see deaths,” he added.

    Anticipating chaos and instability

    Following a contentious seven hours of grilling across two confirmation hearings, Democratic senators protested Kennedy’s confirmation on the floor late into the night Wednesday. The following morning, all 45 Democrats and both Independents voted in opposition and all but one Republican — childhood polio survivor Mitch McConnell of Kentucky — lined up behind President Donald Trump’s pick.

    James Hodge, a public health law expert at Arizona State University’s Sandra Day O’Connor College of Law, said that while it was good to see senators across the political spectrum asking tough questions and Kennedy offering up some concessions on vaccine-related policies and initiatives, he’s skeptical these will stick.

    “Whatever you’ve seen him do for the last 25 to 30 years is a much, much greater predictor than what you saw him do during two or three days of Senate confirmation proceedings,” Hodge said. “Ergo, be concerned significantly about the future of vaccines, vaccine exemptions, [and] how we’re going to fund these things.”

    Hodge also said he doesn’t trust how Kennedy will respond to the consequences of a dropoff in childhood vaccines, pointing to the current measles outbreak in West Texas schools.

    “The simple reality is he may plant misinformation or mis-messaging,” he said.

    During his confirmation hearings, Kennedy tried to distance himself from his past anti-vaccination sentiments stating, “News reports have claimed that I am anti-vaccine or anti-industry. I am neither. I am pro-safety … I believe that vaccines played a critical role in health care. All of my kids are vaccinated.”

    He was confirmed as Linda McMahon, Trump’s nominee to head the Department of Education, was sitting down for her first day of hearings. At one point that morning, McMahon signaled an openness to possibly shifting enforcement to HHS of the Individuals with Disabilities Education Act — a federal law dating back to 1975 that mandates a free, appropriate public education for the 7.5 million students with disabilities — if Trump were to succeed in shutting down the education department.

    This would effectively put IDEA’s $15.4 billion budget under Kennedy’s purview, further linking the education and public health care systems.

    In a post on the social media site BlueSky, Randi Weingarten, president of the American Federation of Teachers, wrote she is “concerned that anyone is willing to move IDEA services for kids with disabilities into HHS, under a secretary who questions science.”

    Keri Rodrigues, president of the National Parents Union and a parent of a child with ADHD and autism, told The 74 the idea was “absolutely absurd” and would cause chaos and instability. 

    Kennedy’s history of falsely asserting a link between childhood vaccines and autism — a disability included under IDEA coverage — is particularly concerning to experts in this light.

    “You obviously have a contingent of kids who are beneficiaries of IDEA that are navigating autism spectrum disorder,” said Hughes, “Could [we] potentially see some sort of policy activity and rhetoric around that? Potentially.”

    Vaccines — and therefore HHS — are inextricably linked to schools. Currently, all 50 states have vaccine requirements for children entering child care and schools. But Kennedy, who now has control of an agency with a $1.7 trillion budget and 90,000 employees spread across 13 agencies, could pull multiple levers to roll back requirements, enforcements and funding, according to The 74’s previous reporting. And Trump has signaled an interest in cutting funding to schools that mandate vaccines.

    “There’s a certain percentage of the population that is focused on removing school entry requirements,” said Northe Saunders, executive director of the pro-vaccine SAFE Communities Coalition. “They are loud, and they are organized and they are well funded by groups just like RFK Jr.’s Children’s Health Defense.”

    Kennedy will also have the ability to influence the makeup of the committees that approve vaccines and add them to the federal vaccine schedule, which state legislators rely on to determine their school policies. Hodge said one of these committees is already being “re-organized and re-thought as we speak.”

    “With him now in place, just expect that committee to start really changing its members, its tone, the demeanor, the forcefulness of which it’s suggesting vaccines,” he added.

    Hughes, the law professor, said he is preparing for mass staffing changes throughout the agency, mirroring what’s already happened across multiple federal departments and agencies in Trump’s first weeks in office. He predicts this will include Kennedy possibly asking for the resignations “of all scientific leaders with HHS.” 

    Kennedy appeared to confirm that he was eyeing staffing cuts Thursday night during an appearance on Fox News’s “The Ingraham Angle.”

    “I have a list in my head … if you’ve been involved in good science, you have got nothing to worry about,” Kennedy said.


    Get stories like these delivered straight to your inbox. Sign up for The 74 Newsletter

    Source link

  • Degree Apprenticeships in England: What Can We Learn from the Experiences of Apprentices, Employers, and Education and Training Providers?

    Degree Apprenticeships in England: What Can We Learn from the Experiences of Apprentices, Employers, and Education and Training Providers?

    By Josh Patel, Researcher at the Edge Foundation.

    Degree Apprenticeships (DAs) were launched in 2015, as a novel work-based learning route to obtaining a degree. On their introduction, then Prime Minister David Cameron said they would ‘give people a great head start, combining a full degree with real practical skills gained from work and the financial security of a regular pay packet’. Since then, they have taken the higher education sector by storm. Their growth has been the key factor in the expansion of higher apprenticeships from 43,800 starts in 2015/16 to 273,700 in 2023/24, a rise from 4.8% to 35% of all apprenticeships. They have stimulated innovative models of delivery and new and productive relationships between employers and providers. Former Skills Minister Robert Halfon remarked that ‘Degree Apprenticeships’ were his ‘two favourite words in the English language’.

    DAs have, however, recently come under scrutiny. Concerns persist that the growth of DAs and their high cost – reported in the media as growing from 2% of the apprenticeship budget in 2017/18 to 21% in 2021 – might crowd out opportunities for young entrants to the workforce, as DAs are primarily taken by existing employees. The suitability of DAs as instruments to improve upward social mobility has been contested. Meanwhile, the government is drawing up plans to increase the flexibility of the Apprenticeship Levy through which Degree Apprenticeships can currently be funded, asking employers ‘to rebalance their funding for apprenticeships… to invest in younger workers’.

    Our report, ‘Degree Apprenticeships in England: What Can We Learn from the Experiences of Apprentices, Employers, and Education and Training Providers?’, written in collaboration with colleagues from the Universities of Bath, Huddersfield, and Oxford, was published on Tuesday and is a timely intervention into these discussions. Here, we present the evidence for some our policy recommendations, gathered from nearly 100 interviews with stakeholders including large employers and SMEs, providers, degree apprentices, and policymakers.

    Engaging employers

    The government needs to consider a more systematic approach that serves to rationalise the way that employers are supported to offer a wide range of work-based opportunities. As Edge has identified in other programmes, such as T Levels or plans to provide universal work experience through the government’s Youth Guarantee, DAs are restricted by the number of employers willing to engage. We repeatedly heard evidence of the difficulties ‘resource-poor’ employers had in engaging with the design of apprenticeship standards and participating fully in collaboration with providers. As one SME told us contributing to the design and development of a DA ‘doesn’t give me any benefit now, and I’m impatient’.

    The government needs to develop a coherent strategy for DAs with a particular focus on support for SMEs, including improved awareness of levy transfer schemes. Involvement in DAs is often based on being ‘in the know’ and contacts with providers and local authorities. In our ‘Learning from the past’ stream of work, we reviewed Education Business Partnerships, as an example of intermediary organisations, noting both their strengths and shortcomings, which could inform effective initiatives for supporting employers.

    Reducing complexity

    With the creation of Skills England, the government should take the opportunity to review and simplify the process of design, delivery and quality assurance for DAs, and ensure regulatory elements work together. DAs currently draw in a large number of bodies including the OfS, IfATE, regulatory bodies, professional bodies and Ofsted. Providers told us that this had created a complex landscape of ‘many masters’ where lines of accountability are blurred and innovation is stifled. Providers described ‘overregulation’ as limiting ‘our ability to go off-piste’, and while the process could be constructive, providers were unconvinced of its added value. ‘Does that add to the quality?’ one provider asked. ‘I don’t think it necessarily does’.

    Skills England’s remit includes shaping technical education to respond to skills needs, and its incorporation of IfATE has already begun. As a first exercise, it could review the regulatory requirements to remove any duplication and contradictions and then consult with the sector to devise a simpler, clearer mechanism for providers to report.

    Increasing flexibility

    These difficulties meant that, while we found examples of excellent integration of academic learning and the workplace, concerns persisted as to the vocational relevance and obsolescence of learning, particularly in fast-moving sectors such as IT and mental health provision. One employer involved in delivery said they told their apprentices: ‘we have to teach you this so you get through your apprenticeship, but actually in practice that is not the way it’s done any longer’.

    In other countries, such as the Netherlands, a proportion (up to 20-25%) of an apprenticeship standard is kept flexible to be agreed between the employer and provider so that it can take better account of the current and changing situation in that particular industry, location and employer – such flexibility could be piloted in the UK.

    …without compromise

    The government’s commitment to adapting the levy into a ‘Growth and Skills Levy’, offers opportunities to improve DA delivery. Diversification was not a major consideration for the majority of employers when recruiting, though we certainly did hear evidence from those with a strong sense of their social corporate responsibility. As one SME put it:

    there are too many people in the IT industry that are like me. So we’re talking middle-aged white guys. […] Now, DAs allow people who don’t necessarily, wouldn’t consider getting into this industry from a variety of backgrounds, creeds, colours…

    We recommended in our Flex Without Compromise report that the government should take a measured approach to levy reform to minimise the risk that a broadening of scope diminishes the opportunities available particularly for younger people and newer entrants to the labour market. It should consider modelling the impact of differentiating levy funding available for DAs by either or both age and staff status, and diversification of the workforce. This could be a powerful mechanism to encourage employers to focus DA opportunities on younger people and on new recruits but would need to be considered carefully to allow for continued expansion of DAs.

    These initiatives might help address existing challenges and enhance the efficacy of Degree Apprenticeships in fostering equitable access and meeting the needs of learners and employers.

    To find out more about Edge and to read the report in full, visit www.edge.co.uk

    Source link

  • An early look at 2023–24 financial returns shows providers working hard to balance the books

    An early look at 2023–24 financial returns shows providers working hard to balance the books

    In most larger UK providers of higher education, the 2023–24 financial year ended on 31 July 2024.

    Five months and two weeks after this date (so, on or before 14 January 2025) providers are obliged to have published (and communicated to regulators) audited financial statements for that year.

    I’ve got a list of 160 large, well known, providers of higher education who should, by now, have made this disclosure – 43 of them are yet to do so. Of the 117 that have, just 15 (under 13 per cent) posted a deficit for that financial year (to be fair, this includes eight providers in Wales, where the deadline – for bilingual accounts – is the end of the month). This was as of the data of publication, there’s been a few more been discovered since then and I have added some to the charts below.

    If you’ve been aware of individual providers, mission groups, representative bodies, trade unions, regulators, and politicians coming together to make the case that the sector is severely underfunded this may surprise you. If you work in an institution that is curtailing courses, making staff redundant, and undergoing the latest in a long series of cost-cutting exercises, the knowledge that your university has posted a surplus may make you angry.

    But these results are not surprising, and a surplus should not make you angry (there are plenty of other reasons to be angry…) Understanding what an annual account is for, what a surplus is, why a university will pull out all of the stops to post a surplus, and what are the more alarming underpinning signals that we should be aware of will help you understand why we have what – on the face of it – feels like a counter-intuitive position in university finances.

    Why are so many results missing?

    There’s a range of reasons why a provider may submit accounts late – those who are yet to publish will already be deep in conversation with regulators about the issues that may have caused what is, technically, a breach of a regulatory condition. In England, this is registration condition E3. which is underpinned by the accounts direction.

    If you are expecting regulators to get busy issuing fines or sanctions for late submissions – you should pause. There’s a huge problem with public sector audit capacity in the UK – the big players have discrete teams that move on an annual cycle between higher education, NHS, and local government audit. You don’t need to have read too much into public finances to know that our councils are under serious pressure right now – and this pressure results in audit delays, hitting the same teams who will be acting as external university auditors.

    That’s one key source of delay. The other would be the complexities within university annual accounts, and university finances more generally, that offer any number of reasons why the audit signoff might happen later than hoped.

    To be clear, very few of these reasons are going to be cheerful ones. If a provider has yet to publish its accounts because they have not signed off their accounts, it is likely to be engaging with external auditors about the conditions under which they will sign off accounts.

    To give one example of what might happen – a university has an outstanding loan with a covenant attached to it based on financial performance (say, a certain level of growth each year). In 2023–24, it did not reach this target, so needs to renegotiate the covenant, which may make repayments harder (or spread out over a longer period). The auditor will need to wait until this is settled before it signs off the accounts – technically if you are in breach of covenant the whole debt is repayable immediately, something which would make you fail your going concern test.

    We’ve covered covenants on the site before – a lender of whatever sort will offer finance at an attractive rate provided certain conditions are met. These can include things like use of investment (did you actually build the new business school you borrowed money to build?), growth (in terms of finances or student numbers), ESG (are you doing good things as regards environment, society, and governance?) and good standing (are you in trouble with the regulator?) – but at a fundamental level will require a sense that your business is financially viable. If covenant conditions are breached lenders will be keen to help if they hear in advance, but your cost of borrowing (the interest rate charged, bluntly) will rise. And you will find it harder to raise finance in future.

    This is an environment where it is already hard to raise finance – and in establishing new borrowing, or new revolving credit (kind of like an overdraft facility) many universities will end up paying more than in previous years. This all needs to be shown in the accounts.

    Going concern

    When your auditor signs off your accounts, you would very much hope that it will agree that they represent a “going concern” – simply put, that in most plausible scenarios you will have enough money to cover your costs during the next 12 months. If your auditor disagrees that you are a going concern you are in serious trouble – all of the 117 sets of accounts I have read so far have been agreed on a going concern basis.

    This designation tells everyone from regulators to lenders to other stakeholders that your business is viable for the next year – and comes into force on the day your accounts are signed off by the university and external auditor. This is nearly always for a specific technical reason – additional information that is needed in order to make the determination. For some late publications, it is possible that the delay is a deliberate plan to make the designation last as far into the following financial years as possible. This year (2024–25) is even more bleak than last year – anything that keeps finance cheaper (or available!) for longer will be helpful.

    Breaking even and beyond

    So your provider had a surplus last year – that’s good right? It means it took in more money than it spent? Up to a point.

    In 2023–24 we got the very welcome news that Universities Superannuation Scheme (USS) has been revalued and contributions reduced for both members and employers. From the annual accounts perspective, this will have lowered staff costs (very often one of the most significant costs, if not the most significant cost, for most) in USS institutions. Conversely, the increase in Teachers Pension Scheme (TPS) contributions will have substantially raised costs in institutions required by law (yes, really!) to offer that scheme to staff.

    That’s some of the movement in staff costs. However, for USS, the value of future contributions to the current calculated scheme debt (which is shared among all active employers in the scheme) has also fallen. Indeed, as the scheme is currently in surplus, it shows as income rather than expenditure This is not money that the university actually has available to spend, but the drop shows out in staff costs – though most affected separate this out into a separate line it also shows up in the overall surplus or deficit (to be clear this is the accounting rules, there’s no subterfuge here: if you are interested in why I can only point you to BUFDG’s magisterial “Accounting for Pensions” guidelines).

    For this reason, many USS providers show a much healthier balance than accurately reflects a surplus they can actually spend or invest. This gives them the appearance of having performed as a group much better than TPS institutions, where the increase in contributions has made it more expensive to employ staff.

    Here I show the level of reported surplus(deficit) after tax, both with and without the USS valuation effect. Removing the impact of valuation puts 35 providers (including big names like Hull, Birmingham, and York) in deficit based on financial statements published so far.

    [Full screen]

    And here I show underlying changes in staff costs (without the USS valuation effect). This is the raw spend on employing staff, including pay and pensions contributions. A drop could indicate that economies have been sought – employing fewer staff, employing different (cheaper) staff, or changes in terms and conditions. But it also indicates underlying changes in TPS contributions (up) or USS contributions (down) with respect to current employees on those schemes.

    [Full screen]

    Charts updated 11am 27 January to remove a handful of discrepancies.

    Fee income

    For most universities the main outgoing is staff costs, and the main source of income is tuition fees. Much has been made of the dwindling spending power of home undergraduate fees because of a failure to uprate with inflation, but this line in the accounts also includes unregulated fees – most notably international fees and postgraduate fees. The full name of the line in the accounts is “tuition fees and educational contracts”, so if your provider does a lot of bespoke work for employers this will also show up here.

    Both of these areas of provision have seen significant expansion in many providers over recent years – and the signs are that 2023–24 was another data point aligned with this trend for postgraduate provision. For this reason, the total amount of fee income has risen in a lot of cases, and when we get provider level UCAS data shortly it will make it clear that just how much of this is due to unregulated fees. International fees are another matter, and again we need the UCAS end of cycle data to unpick it, but it appears from visa applications and acceptances that from some countries (China, for example) demand has remained stable, while for others (Nigeria, India) demand has fallen.

    Here I show fee income for the past two years, and the difference. This is total fee income, and does not discriminate between types of fees.

    [Full screen]

    One very important thing to bear in mind is that these are figures for the financial year, and represent fees relating to that year rather than the total amount of fees per student enrolled. For example, if a student started in January (an increasingly common start point for some courses at some institutions) you will only see the proportion of fees that had been paid by 31 July shown in the accounts. If you teach a lot of nursing students who start at non-traditional times of the year this will have a notable impact, as will a failure to recruit as many international students as you had hoped to do in January 2024 (though this will also show up in next year’s accounts).

    And it is also worth bearing in mind that income from fees paid with respect to students registered at the provider but studying somewhere else via an academic partnership, or involved in a franchise arrangement (something that has seen a lot of growth in some providers) shows up in this budget line.

    Other movements

    Quite a number of providers have drawn down investments or made use of unrestricted reserves. This is very much as you would expect, these are very much “rainy day” provisions and even if it is not actually raining now the storm clouds are gathering. Using money like this is a big step though – you can only spend it once, and the decision to spend it needs to link to plans not to need to spend it in the near future. So even if your balance looks healthy, a shift like this speaks eloquently of the kinds of cost-saving measures (up to and including course closures and staff redundancy) that you may currently see happening around you.

    Similarly, a provider may choose to sell assets – usually buildings – that it does not have an immediate or future use for. The costs of running and maintaining a building can quickly add up – a decision to sell releases the capital and can also cut running costs. Other providers choose to hang on to buildings (perhaps as assets that can be sold in future) but drastically cut maintenance and running costs for this reason. Again, you can (of course) only sell a building once, and a longer term maintenance pause can make it very expensive to put your estates back into use. I should note that the overall condition of university estates is not great and is declining (as you can read in the AUDE Estates Management Report) , precisely because providers have already started doing stuff like this. If the heating seems to be struggling, if the window doesn’t open, that’s why.

    In some cases we have seen decisions to pause capital programmes – not borrowing money and not building buildings as was previously planned. Here, the university makes an on-paper saving equivalent to the cost of finance if it was going to borrow money, or frees up reserves for other uses if it was using its own funds. Capital programmes don’t just include buildings – perhaps investment in software (the kind of big enterprise systems that make it possible to run your university) has been paused, and you are left struggling with outdated or unsuitable finance, admissions, or student record systems.

    Where we are talking about pausing building programmes it is important to remember that these exist to facilitate expansion or strategic plans for growth. The “shiny new building” is often perceived as a vice chancellor’s vanity project – in reality that new business school and the recruitment it makes possible may represent the university’s best hope of growing home fee income faster than inflation.

    What’s next?

    We see financial information substantially after the financial year ends – and for most larger providers this comes alongside the submission of an annual financial return to their regulator. We know for instance that the Office for Students is now looking at ways of getting in year data in areas where it has significant concerns, but financial data (by dint of it being checked carefully and audited) is generally historic in nature.

    For this reason what is happening on your campus right now is something that only your finance department has any hope of understanding, and there may be unexpected pressures currently driving strategy that are not shown (or even hinted at) in last years’ accounts. Your colleagues in finance and planning teams are working hard to forecast the end of year result, to calculate the KFIs (Key Financial Indicators) that others rely on, and to plan for the issues that could arise in the 2025 audit. The finance business partners or faculty accountants – or whatever name they have where you work – will be gathering information, exploring and explaining scenarios, and anticipating pressures that may require a change in financial strategy.

    The data I have presented here is drawn from published accounts – the data submitted to regulators that eventually ends up on HESA may be modified and resubmitted as understanding and situations change – for this reason come the early summer figures might look very different than what are presented here (I should also add I have transcribed these by hand – for which service you should absolutely buy me a pint) – so although I have done my best I may have made transcription errors which I will gladly and speedily correct.

    However scary your university accounts may be, I would caution that the next set (2024–25 financial year) will be even more scary. The point at which the home undergraduate fee increase in England kicks in for those eligible to charge it (2025–26) feels a long way off, and we have the rise in National Insurance Contributions (due April 2025) to contend with before then.

    There are a small but significant number of large providers looking at an unplanned deficit for 2024–25, as you might expect they will already be in contact with their regulator and their bank. Stay safe out there.

    If you are interested in institutional finances, I must insist that you read the superb BUFDG publication “Understanding University Finance” – it is both the most readable and the most comprehensive explanation of annual university accounts you will find.

    Source link