Universities are the unsung heroes of the National Health Service. They work with it to provide all undergraduate medical education. They provide most of the research which the NHS will use to treat patients in the future. Their senior clinical academic staff provide a third of the consultant care for patients in teaching hospitals. Four per cent of the United Kingdom academic pay bill goes on time spent looking after patients. In return, the NHS finances various units and clinical academic posts in universities.

Yet in the brawl of NHS politics the universities rarely get a mention. If a hospital runs out of beds the disaster is widely covered in the media. If top researchers take flight from London the public links them with crucial hospital research projects -- not with the universities.

University medical schools are facing some serious problems. The first is a result of the never-ending rationalisation of hospital services around the country as a result of the NHS reforms.

Major cities are making their messy decisions about which hospitals should close and which should be moved. But it is not just hospitals that are affected. If a teaching hospital is told to shift then what happens to the medical school with which it is enmeshed?

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Who will pay the Pounds 1 million bill to shift a university's medical school to the other side of a city? The ÖйúAƬ Funding Council for England says it will not. Neither will the Department for Education.

The second problem arises from a Bill to be processed in this parliamentary session. It is expected that the 14 regional health authorities will be abolished and replaced by eight offices of the NHS Executive. Two other NHS authorities -- district and family health services -- will be merged.

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Again, superficially, this appears to have nothing to do with universities. But universities have a place on the present decision-making bodies. They are in a strong position to influence planning at district and regional levels. These powers will soon disappear. There is a lot of anxiety about what sort of powers universities will have under the new system.

The third problem arises from the Culyer report, which seeks to solve some of the difficulties for research that were caused by the NHS reforms. The report is widely welcomed. The chief problem for universities is how it will be implemented. It is potentially a serious problem. Professor Culyer has recommended streamlining the myriad funding sources for research, an idea which has been warmly received.

One of these sources goes towards the service, or background, costs of research (the "R" element of Service Increment For Teaching and Research funding). This is a large sum of money for some research centres. At Birmingham, for example, it is worth Pounds 5 million. If this money were suddenly to be taken away it would be disastrous for university research -- even if it is returned later under another name.

This week's announcement that more money is to be ringfenced for teaching and research means that there will be Pounds 130 million of SIFTR money for research floating around in the university hospital system next year all the more reason for future changes to be sensitive and to take into account the views of universities.

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These problems have a common theme: universities need a strong voice. They need a higher profile in discussions about hospital reorganisation in cities. They need to be heard so that they can insert themselves into the new layers of NHS management. They need influence over the arrangements for implementing the Culyer report.

In the NHS politics game there are players who have power because they evoke the emotions of the public and there are big spenders such as the medical research charities. These are the loud voices. At the moment the university voice is the quietest but it is one of the most important.