The University of St Andrews cannot currently hold exams and award degrees in medicine and dentistry. This is in paragraph 17, schedule 6 of the Universities (Scotland) Act 1966.
The Bill as introduced will let the University of St Andrews (jointly with the University of Dundee) award undergraduate Primary UK Medical Qualifications to Scottish Graduate Entry Medicine (ScotGEM) students. ScotGEM is Scotland’s first graduate-entry programme for medicine. It is jointly delivered by the universities of Dundee and St Andrews.
You can find out more in the Explanatory Notes that explains the Bill.
Why the Bill was created
The 1966 Act reconstituted Scotland’s "ancient universities" (Aberdeen, Edinburgh, Glasgow and St Andrews). It also created the University of Dundee. The University of Dundee took over the clinical part of the medical degree that the University of St Andrews had previously delivered.
The Bill was created to remove part of the 1966 Act so the University of St Andrews can hold exams and award degrees in medicine and dentistry.
You can find out more in the Policy Memorandum that explains the Bill.
Where do laws come from?
The Scottish Parliament can make decisions about many things like:
- agriculture and fisheries
- education and training
- health and social services
- justice and policing
- local government
- some aspects of tax and social security
These are 'devolved matters'.
Laws that are decided by the Scottish Parliament come from:
MSPs – this is a
groups of MSPs called committees – this is a
a person, a group or a company – this is a
These are Bills that have been introduced by the Scottish Government. They are sometimes called 'Executive Bills'.
Most of the laws that the Scottish Parliament looks at are Government Bills.
These Bills are suggested by the Scottish Government.
As well as having an impact on a general (public) law, they could also have an impact on organisations' or the public's private interests.
The first Hybrid Bill was the Forth Crossing Bill.
These are Bills suggested by MSPs. Every MSP can try to get two laws passed in the time between elections. This 5-year period is called a 'Parliamentary session'.
To do this they need other MSPs from different political parties to support their proposed law.
These are Bills suggested by a group of MSPs called a committee.
These are Public Bills because they will change general law.
These are Bills suggested by a person, group or company. They usually:
- add to an existing law
- change an existing law
A committee would be created to work on a Private Bill.
The Scottish Government sends the Bill and related documents to the Parliament.
Related information from the Scottish Government on the Bill
Why the Bill is being proposed (Policy Memorandum)
Explanation of the Bill (Explanatory Notes)
How much the Bill is likely to cost (Financial Memorandum)
Opinions on whether the Parliament has the power to make the law (Statements on Legislative Competence)
The Presiding Officer has decided under Rule 9.12 of Standing Orders that a financial resolution is not required for this Bill.
Stage 1 - General principles
Committees examine the Bill. Then MSPs vote on whether it should continue to Stage 2.
Stage 1 timetable
Who examined the Bill
Each Bill is examined by a 'lead committee'. This is the committee that has the subject of the Bill in its remit.
It looks at everything to do with the Bill.
Other committees may look at certain parts of the Bill if it covers subjects they deal with.
Who spoke to the lead committee about the Bill
First meeting transcript
The Convener (Lewis Macdonald)
Good morning and welcome to the 32nd meeting in 2020 of the Health and Sport Committee. We have received apologies from Alex Cole-Hamilton. I ask all members and witnesses to ensure that their mobile phones are on silent and that all other notifications are turned off during the meeting.
The first item on the agenda is a stage 1 evidence session on the University of St Andrews (Degrees in Medicine and Dentistry) (Scotland) Bill. It is for the Health and Sport Committee to consider the bill at stage 1 and to report to Parliament accordingly. I welcome to the committee Professor Sally Mapstone, principal and vice-chancellor of the University of St Andrews; Professor David Maguire, principal and vice-chancellor of the University of Dundee; Callum George, deputy chair of the British Medical Association’s Scottish medical students committee; and Andrew MacFarlane from the Scottish graduate entry medicine student cohort. Welcome to you all and thank you very much for joining us.
We will move directly to questions. I have read the views that have been submitted by the different interested parties, and I noted Professor Mapstone’s comment about the re-establishment of the primary medical qualification in “an unfettered manner”. I thought that it might be good to start simply by asking what you have in mind when you say, “an unfettered manner”. What are the fetters that you are trying to resist?
Professor Sally Mapstone (University of St Andrews)
Good morning, everybody. Thank you very much for inviting me to the Health and Sport Committee this morning.
The University of St Andrews (Degrees in Medicine and Dentistry) (Scotland) Bill will enable the University of St Andrews to fully support a fit-for-purpose national health service in the 21st century by enabling us to graduate the kind of adaptable, compassionate and informed workforce that Scotland needs now more than ever.
To respond directly to your question, the bill will remove an anachronistic prohibition, which has unnecessarily been in place for the past 50 years, that prevents the university—even though it has a thriving medical school—from granting degrees in medicine. That prohibition came into force through the Universities (Scotland) Act 1966, which reorganised Scotland’s universities and enabled the establishment of the University of Dundee, which is now a great and thriving university.
At the time, the prohibition on the University of St Andrews giving degrees in medicine was clearly intended to be only temporary but, unfortunately, it has remained in place and it now, significantly and uniquely, prohibits the University of St Andrews—unlike any other university in Scotland or, indeed, in the United Kingdom—from offering degrees in medicine. Therefore, the legislation that is now being proposed would remove those fetters and enable the university, which has a thriving medical school, to be able fully to serve the NHS.
Thank you very much. Clearly, the immediate prompt for the bill is the ScotGEM cohort and the intention that they should graduate with qualifications from both universities. That would be one of the immediate outcomes of the bill. Is it the long-term intention of the University of St Andrews to award full degrees in medicine independently of the University of Dundee?
As you point out, the immediate trigger is the ScotGEM degree, which is Scotland’s only graduate entry medical degree. It was put together and proposed, and is now run, jointly by the University of St Andrews and the University of Dundee. It recruited its first students to start in 2018, and it is now in its third year. It is an unusual and remarkable degree, which is fully supported by the Scottish Government, in that it enables people who have come from previous professional walks of life, who have degrees in other subjects such as pharmacology, to train over four years in a graduate entry medicine course to enable them particularly to serve as generalist general practitioners in remote and rural areas of Scotland. It is a flagship programme. We are proud of it, and it is doing really well. That is our priority at the moment, and that is what the bill will directly enable us to go forward with.
I apologise—I would just like to address the second part of your question. Any further plans that we might have in the future to go for other degrees in medicine would, of course, themselves be contingent on agreement through the Scottish Funding Council and the General Medical Council. Although the bill would put us in the position of being able to put in place those proposals, it would not itself immediately enable that as a possibility. That is not our initial or immediate intention.
That is understood. The SFC and the GMC would have to approve any such step. Were you to reach the point where you wish to do that, is there anything else that you would require, besides their support and the change in legislation?
Manifestly, places in medicine are controlled places, so if we were to seek that kind of fulfilment, it would need to be the case that we would have to have full support for an increase in numbers for the running of a degree and for the opportunity for placements to be available for those students. There would obviously need to be a full consultation and work would need to be done with relevant health boards.
Thank you very much. I call Brian Whittle.
Brian Whittle (South Scotland) (Con)
Good morning. I will ask questions about the impact on other medical schools and potential NHS recruitment, which Aberdeen health and social care partnership has expressed concerns about. It has noted that if St Andrews university were to increase its numbers and to become a medical school in its own right, that would have an impact on the partnership’s ability to attract, train and maintain medical students, given the rurality of the area and the location challenges that exist there. Do you share Aberdeen health and social care partnership’s concern?
Professor David Maguire (University of Dundee)
Good morning, everybody. Thank you for inviting me to the meeting today.
Yes, I do indeed share the concerns expressed by the Aberdeen partnership. Unfortunately, if St Andrews university were to gain a PMQ for undergraduate medical degrees, I am afraid that it would not be a zero-sum game—it is highly likely that that would have an impact on the other four medical schools that currently exist in Scotland.
As far as the University of Dundee is concerned, at present, roughly 20 to 25 per cent of our students have their placements in Fife. If St Andrews university were to expand in that area, we would be concerned that that would impact on our ability to place our students in Scotland.
We do not think that Scotland needs another medical school at undergraduate level. Scotland currently educates more students per 100,000 of the population than the rest of the UK. Indeed, as a consequence of the additional qualified students who have come through following the recent exam season, the existing medical schools have expanded by 100 places across Scotland. Many of those places have been taken up by students from low-participation areas and by students who have disadvantaged backgrounds. Dundee university excels in that.
Since 1966, nothing has really changed. The medical facilities and the teaching hospital are still in Dundee, the staff remain in Dundee, and we do not see that there is a need to expand in this area, although I am sure that you will have observed that we support the case that St Andrews university has made to gain short degree-awarding powers solely for ScotGEM.
We are aware that there is a shortage of medical professionals across the board in Scotland. For GPs, there is a limited number of places for Scottish students, even those with qualifications. Would it not be to the advantage of the NHS generally in Scotland to be able to take on more medical students?
Yes, I think it would be. The existing medical schools are perfectly capable of expanding their capacity to take on more medical students, as has been shown in the current application round, in which, collectively, we have taken more than 100 students. It is possible for the existing four medical schools to scale up the existing provision.
I will bring in Sally Mapstone.
Thank you for giving me the opportunity to comment.
I remind the committee that the numbers for the ScotGEM course are already in the system, so we are not talking about new numbers there. I also remind the committee that, in last year’s programme for government, the Scottish Government put forward proposals for the establishment of a new medical school in Scotland. Those proposals are currently stayed, but they may of course come back on the table. The University of St Andrews has a proposal—a bid—within that round.
It is absolutely understandable that every university will say that, if there are to be more numbers on the table, they will want them for themselves. The nature of our engagement with medicine across the piece—as you can see from the ScotGEM programme—is that we see ourselves as working collaboratively in a hub-and-spoke manner with health boards across the country. It is already evinced by the ScotGEM programme that our approach is a collaborative and very collegial one.
I again remind the committee of what the bill does. It essentially levels the playing field. If it is enacted, it will remove from the University of St Andrews a restriction that no other university in Scotland or the UK currently labours under. We would say that that is an unfair and unnecessarily prohibitive restriction. In the event that our bid for a medical school were to be successful, if the bill were not to be enacted, we would be back here again. That seems to me not a very good use of parliamentary time.
For absolute clarity, in response to my question I think that you said that St Andrews university had no plans to provide a PMQ other than through the ScotGEM process, but you have just said that you are preparing a bid for a new medical school. Which is it? Are those things compatible or are they contradictory?
I am taking absolutely nothing for granted. If we were to be successful in our bid for a medical school, various things might fall from that, but given where the process is at the moment, our current intention is to focus on ScotGEM and then see where we might go beyond that, depending on whether the bill is enacted and depending on whether our bid for the medical school were to be successful.
The University of Dundee has indicated a preference for a partial removal of the prohibition. Would the University of St Andrews have any objections to that line of travel and, if so, why?
Yes, we would, for the reason that I have just given. We think that the levelling of the playing field and the establishment for us of an opportunity fully to participate in the provision of a fit-for-purpose NHS in the 21st century is better enabled through passing the bill as it is currently drafted than through doing so in a partial way, which responds only to the immediate situation.
I believe that the 1996 act was amended in 2002 to allow St Andrews university to award a postgraduate medical degree. It would seem to me that it would be possible to amend the current act to support the awarding of degrees for ScotGEM alone, which would be a position that the University of Dundee supports.
I am looking to see whether our student representatives Callum George and Andrew MacFarlane have any views that they would like to put into the discussion at this stage.10:15
Callum George (British Medical Association)
Good morning and thank you for inviting me.
Something that has not been included in the BMA’s written submission on the bill, but which I can mention today, is that it is the unanimous feeling of the elected representatives from the medical student bodies of all Scotland’s medical schools, including Dundee, and from the non-ScotGEM body at St Andrews, that the bill should go ahead, very much for the same reasons that Professor Mapstone has mentioned. Of course, for students such concerns are perhaps a bit above our heads when we are focusing on our studies, but I just wanted to mention that that is the unanimous feeling of the elected student representatives at the BMA from the medical student bodies across Scotland.
Andrew MacFarlane (Scottish Graduate Entry Medicine Student Cohort)
Good morning and thank you for having me.
I echo what Callum George said. This is a bit beyond the students. I am here to speak about my colleagues and my peers in my year group and the other year groups. Our focus is on making sure that we graduate with a degree from both universities that merits the spirit of the course that we are on. Whether the restriction should be partially repealed is not something that we properly asked the students. We asked them a bit more informally, and we did not receive any concerns.
On a more personal note, the only thing that I can think of that would have an impact on the students’ thoughts about a partial repeal of the restriction would be if it was a private medical school that was to be developed, but if the decision was based purely on a sense of fairness, as Professor Mapstone said, I think that the students would be in support of the restriction being fully repealed.
As Professor Mapstone also said, student places are controlled by the Government, and awarding them would be based on the merit of the proposal that the university has put forward, not on the 50-year-old laws that are in place.
Sandra White and Emma Harper have supplementary questions.
Sandra White (Glasgow Kelvin) (SNP)
Professor Mapstone, in answer to the convener, when you talked about the proposed new medical school and ScotGEM and so on, you mentioned various things that might fall from that. I want a wee bit of clarification on that particular point. Does that mean that the remit would expand into other areas?
What I meant was that, given that we are facing the greatest health crisis that any of us has ever known, we need to regroup and think about how we offer healthcare in the 21st century. My firm view on that is that the more creative, engaged, focused and community-aware forms of medicine that we can offer the better. We have shown through the ScotGEM programme that that is the kind of healthcare that we are capable of offering at the University of St Andrews, with a particular focus on those who might find it difficult to access healthcare, those in poverty and those in remote and rural areas. That is the basis of the ScotGEM degree, and it is the basis of the kind of compassionate, adaptable and flexible healthcare that we believe will be necessary in the post-pandemic world and in the 21st century.
In relation to our bid for the possible medical school, if we were to gain additional numbers—I repeat that any bid that we might make for numbers on the basis of gaining a medical school would need to be approved by the SFC and the GMC—we would look to roll out more of that kind of healthcare and possibly, in the fullness of time, to set up other degree courses that would respond to that. Obviously, that is all in the future. I am giving you a sense of the kind of medicine that we want to offer, which we believe is incredibly important to healthcare in Scotland in the 21st century and in the post-pandemic era.
I have another small supplementary question. Concerns have been raised by other universities, as you have heard and will have read in the written submissions. If, as you said, you might look to go further in the future, do you not agree that those concerns are merited?
I am afraid that I simply think that those concerns are exactly what you would expect some other medical schools to say. I understand that everybody is concerned about their numbers, but I am asking us to look a bit more broadly and to ask what kind of healthcare we think that we will need in this century and how much more broadly based it will be. Will it not involve working with health boards across the country, which we can already demonstrate that we can do with ScotGEM?
Although I understand the concerns, I am concerned that the bill should not be seen as some kind of relatively new power grab. The University of St Andrews has had a medical school for the past 50 years. It has built a great reputation for research and teaching and for serving medicine in Scotland. It is simply seeking the opportunity in the future, if it should avail itself of that, to be able to do so from an even playing field position, which is currently available to all other universities in Scotland and the UK that wish to offer medical degree courses.
I repeat that we are the only university in the country that has a legal prohibition that prevents us from doing that. I ask members of the committee whether, in this day and age, that seems especially fair.
Emma Harper (South Scotland) (SNP)
I have a question for Professor Mapstone on widening access. As a South Scotland regional MSP, I am keen to get more doctors recruited into Dumfries and Galloway, and ScotGEM has been doing great for us in the south-west. A new medical school would not necessarily need to use a model in which everybody had to be onsite at St Andrews. Would a hub-and-spoke model be part of any consideration for a new medical school, through which campuses could be based offsite but work together?
Thank you for that question, which is much appreciated. It might interest the committee to know that, at the moment, ScotGEM has students in placements in about 72 GP surgeries and bases spread across the country. One thing that we have found through our programme is that, because we have two dedicated virtual platforms, we can bring in the expertise of people who are based right across the country to help us and to participate in our teaching.
We would be keen to roll out more broadly the hub-and-spoke method that you mention. As you might know, ScotGEM already works in association with not only the University of Dundee but the University of the Highlands and Islands. On the widening access point, since we have been recruiting for the programme, we have found that a greater number of people from the index of multiple deprivation 40 per cent most deprived areas apply to and are successful in gaining admission to the programme. At the moment, 35 per cent of those who apply and 28 per cent of entrants come from IMD 40 areas, which is about twice the normal rate in other subject areas. We are showing that our programme is not only working for those in disadvantaged areas but is appealing to those who, at the age of 18, reside in areas of multiple disadvantage.
David Torrance (Kirkcaldy) (SNP)
Submissions to the committee detail the effect that prohibition has had on St Andrews university’s research ratings. What practical difference will the ability to grant primary medical qualifications make to the university’s research ratings?
Thank you for broadening the questions to include research. The university is already seeing the value of all the resource that we have put into the medical school. In last year’s Complete University Guide ratings, it went up from 17th to eighth. However, not being able to award primary medical qualifications impedes us in applying for certain research funding, for example. It also prevents us from recruiting lecturers through SCREDS—the Scottish clinical research excellence development scheme. Those lecturers are employed to undertake research, and a university can employ them only if it awards PMQs.
We have absolutely no doubt that the capacity to award primary medical degrees would increase and improve still further our research capacity and would broaden the base of those whom we can employ. I emphasise that we see the issue very much from an evidence-based perspective. Our particular expertise in St Andrews is in evidence-based medicine and early diagnosis. Over the past year, we have seen that early diagnosis will in future become an increasingly important aspect of medicine in Scotland.
Will the bill make a difference, given that St Andrews will still not be able to grant primary medical qualifications independently of Dundee?
I am not sure that I entirely understand your question. The ScotGEM degree is a joint degree, which we are extremely proud of and which we are keen to award jointly with the University of Dundee, as has been the nature of the proposal all the way through. Any further degree-awarding powers that we might gain for other degrees that we might wish to award in the future would not have to be in association with the University of Dundee. In the event of our wishing to put other courses together, we would apply for those courses separately.
As I said in my response to an earlier question, the University of Dundee supports the lifting of the restrictions for the purpose of the ScotGEM degree, but it is clear from the arrangements that, were that restriction not to be lifted, the fallback is that the degrees would be awarded by the University of Dundee under our current PMQ.
If I may, I will comment on the importance of widening access to medical students in Scotland, on which the University of Dundee leads the field by quite some margin. A large proportion of our students—about 80 per cent—are Scotland domiciled, and a significant proportion of our students come from IMD 20 postcodes. We are the leader in that area. If the Scottish Government wishes to expand its medical provision in that area, that is something that our university is particularly adept at doing.
I have a question for Andrew MacFarlane. If the bill is not passed, ScotGEM students will be awarded their degrees from the University of Dundee, but Andrew MacFarlane’s written submission outlines that a survey of ScotGEM students found that 97.5 per cent were in favour of having both university badges on the degree certificate. What benefits will the joint degree bring?
As I said, when we were first approached on the issue, we surveyed the students about what they thought. Getting students—let alone medical students—to agree unanimously on something is pretty difficult, but they were overwhelmingly in favour of the proposal.
As I said, it reflects the spirit of the course. Developing medical students is not easy and developing a new course is even harder. There really is a joint approach. The first two years, which I have already done, are managed by St Andrews. I am in my third year now and I am based in a GP practice in Thurso, which is where I am phoning you from today. I am here for 10 months. This year is managed by Dundee university and my next year will be managed by Dundee, too. Looking after students and medical students, especially in the current times, is no easy task, and a considerable amount of resource goes into it.10:30
If we had only the University of Dundee badge on our certificate, that would not really match the course that we are on or how we feel as students. I said in my submission that we are often asked if we see ourselves as St Andrews or Dundee students because we are members of both from day 1, and we quite often say that we are ScotGEM students, because the course is a different way of teaching medical students and providing medical education as a whole. The degree should reflect that. If it did not, it would be a bit of a failure in terms of what the students signed up for and how they feel as students.
It is important to remember that, as was said, we are talking about students who have done a degree before—I did pharmacy previously. Some of the students are much older and have children and families, and some were very high up in their previous fields and have sacrificed a lot to do the course. Some have also taken the optional bursary from the Scottish Government, which means that, for each year that they take it, there is a return of service of working in Scotland. There is an awful lot of good will around the course, and it has been great so far. How the issue is handled is important to how the students feel. We are definitely in favour of both universities being on the degree certificate. The students fully expect that.
I mirror Andy MacFarlane’s comments. Like him, I am a third-year ScotGEM student, but I am speaking to you from Campbeltown. It is the view of BMA members who are also ScotGEM students that there are many attractive and interesting things about ScotGEM that caused them to apply and that make the programme unique. One of those was the fact that the joint award was offered; that was almost expected wholesale by the people who applied to the course. I think that the number of people who applied to ScotGEM because of the possibility of a joint award could have offset the number of people who might not have applied to a medical programme that was relatively unproven and is still undergoing GMC validation, which is obviously yet to complete.
To reiterate what Andy MacFarlane said, the ScotGEM students largely support the proposal. We have found from our members that the vast majority want the joint award, because it is the University of St Andrews that looks after us for the first two years. We spend a lot of time there; we spend a lot of time with the staff in Fife and working alongside the students from the non-ScotGEM cohort. Even though the University of Dundee primarily manages the course in the subsequent two years, we feel that something would be missing from the final degree if it were to come solely from Dundee, in the same way as the remainder of its undergraduate body receive their degrees.
Might there be an effect on future intakes if a joint degree could not be awarded?
The honest answer is that I am not sure. I think that it would take a lot of momentum out of the course. As I said, the way that the current students feel is important. Students who are on the course will have peers in the professions that they came from before, and they and other students will approach them and ask, “What is your course like? How are things going?” For students who are applying to medical school, those are important metrics about what they are applying to. If the good will of the students on the course is affected by a decision to not let them graduate with both degrees, and if they feel that the course that they signed up for is not what they are undertaking, that could have an effect on the advice that they give to people who are considering applying.
My experience of ScotGEM in Dumfries and Galloway, including from my recent meeting with Dr Fiona Graham, is that it is excellent: the feedback is good and the students are performing very well. I wonder how many future intakes of ScotGEM are expected. Will the course have an end date?
The course will continue. There is an annual intake of around 55 students. We are led to believe that there is an intention to continue with that and we hope that that will be the case.
David Stewart (Highlands and Islands) (Lab)
Good morning to our witnesses. I would like to follow up with some questions about ScotGEM. Just to declare an interest, as a Highlands and Islands MSP, I work very closely with the UHI and I have been to see the ScotGEM course at the centre for health science, so I might have met Callum George and Andrew MacFarlane in the past.
When I meet GPs, particularly in rural and very rural areas, they explain how difficult it is to retain and recruit GPs. A Thurso practice told me that the best way to solve the recruitment problems is to ensure that more Highlands and Islands young people study medicine. Do you agree with that? Is ScotGEM the way forward for our workforce planning—[Inaudible.]
We got the gist of that, although not the last couple of words. Perhaps I will ask both principals; David Maguire first and then Sally Mapstone.
I agree with the central point, in that it is important for Scotland to increase the number of medical practitioners and that the best way to do that is to recruit Scotland-domiciled students. Indeed, 80 per cent of the University of Dundee’s regular annual intake is from Scotland and we pride ourselves on the fact that we train people to go into the local workforce.
The numbers in ScotGEM are slightly smaller, but a goal of that programme is to recruit and train medical professionals who will reside in Scotland and support the Scottish population.
Andrew MacFarlane mentioned the bursary scheme associated with ScotGEM, which is a bonding arrangement. For every year that someone takes the bursary, they commit to working in Scotland, and 94 per cent of students on the scheme thus far have opted for the bonding arrangement, thereby guaranteeing that we will see more GPs working in remote and rural areas. That has been one of the many success stories of the scheme, as presented.
The exposure that it gives students to working in GP practices gives them that sense of the value and importance of working in those locations and of the different kinds of general practice that is often necessary in those communities.
So far so good, I would say. When you listen to the students, you hear what a big difference it makes to them.
I do think that we need to work harder with the UHI to ensure that we get the throughput from their undergraduate medical courses to ensure that students who have graduated from UHI can, should they wish, qualify to apply for ScotGEM.
I agree. A big part of the ScotGEM course is the rotation through different health boards. I am from the town of Paisley and I had barely been to Inverness, never been to Dumfries, and I think I had been to Thurso once, although I was too wee to remember it. I spent months in different practices in Dumfries and Inverness last year, and now I am in Thurso for 10 months. In my first year, I was in rural places in Fife. The thinking behind the course is that the more time the students spend in such places, the more comfortable they are with the idea of working there. The idea is that people become more open to the idea of working rurally because they have spent time training there.
Although it is important that we get students from the Highlands and Islands, I think the important part of the ScotGEM is that it exposes students to areas that they would not usually go to. When a student graduates, finishes their training and has the idea of working in the Highlands or Dumfries or somewhere rural, the step of thinking, “Oh, I’ve never been there before” has been eliminated because they have. That is an important factor to consider when we think about how we train doctors in the future and ScotGEM is a new way of doing that. There are definitely things that we can work on as we go forward, but it is an important aspect for the future.
I had an interest in remote and rural medicine that attracted me to apply to the course, but it was never a guarantee; it was never a 100 per cent surety that that is what I wanted to do, so it was the exposure that Andy MacFarlane talked about that cemented it for me. I know that other members of the cohort had working rurally on their list of possibilities and it was certainly an option for them, but having been exposed to that environment as a normal day-to-day experience on ScotGEM also cemented it for them.
Has there been any survey of career intentions among the student cohort?
We engage regularly with the cohort. I think the answer that I gave to your previous question is relevant here. The fact that students who are bonded with their bursaries have taken up that bursary opportunity gives a clear indication that 94 per cent of them are fully committed to working in Scottish GP practices.
We surveyed the cohort for their sense of the course and for their intentions, and the responses were extremely positive, as you have heard from Andrew MacFarlane and Callum George, both in what they have experienced thus far, and in how their eyes have been opened up to the future of general practice work.
I reiterate that the course is aimed at producing generalist practitioners, which I think is a bit of a public relations thing that we are working on. However, it is not just for producing GPs; it is any doctor who sees a patient without any clinical diagnosis in front of them, so that could be a GP, a doctor in accident and emergency, a pre-hospital care doctor, a general medical hospital doctor, or rural practitioners as we have up here. The return of service bursary is purely for those who will work and train in Scotland after graduation, and that can be in any domain—surgical, medical or otherwise—not just in general practice. Part of the course is based in general practice and the thinking behind that is that the more that people are exposed to it, the more chance there is that they fall in love with it and want to be a GP afterwards. The course is not for producing GPs exclusively, although it is an aim of the course.
I understand that there are places for 55 students per year in the current ScotGEM course. Have there been any discussions between Dundee and/or St Andrews with the GMC, the SFC or the Scottish Government about increasing the number of funded places?
Yes, there have been some outline discussions about that. I think both universities would welcome the additional places but, as you are probably aware, medical undergraduate student numbers are controlled currently, so we have not been able to increase the intake.
[Inaudible.]—really detailed question, but I am interested in ScotGEM, as I am still a nurse. Just hearing about how medical professionals are now expanding into PMQs is interesting. However, one of the challenges for us in Dumfries and Galloway is that there is a 50-mile limit from their primary site on where trainees can be assigned to do general practice. That prevents trainees from going to Stranraer because it is 75 miles away from the Dumfries and Galloway royal infirmary. Is that being looked at or could it be looked at so that recruiting into somewhere rural such as Stranraer could be achieved, for instance?10:45
I am afraid that I cannot answer the detail of that, but I can certainly say that we would be happy to see whether it is possible to examine placements in practices in Stranraer.
It would be interesting to see the detail on that. I am based within the NHS Highland health board area and the primary site or regional general hospital for that health board is Raigmore hospital in Inverness, but my year 3 placement as a student of ScotGEM is in Campbeltown, so that is well over that distance, I should think. It would be interesting to see some clarity on that.
Callum George, would you say that the limit that Emma Harper has mentioned might not apply in practical terms, from your experience?
I see Professor Mapstone might have something to say about that, but yes, that is beyond the limit for Highland. I do not know whether it is something that specifically applies to the agreement with Dumfries and Galloway.
For information, I understand that that restriction was partly put in place to protect students’ travel time, but it is under review, so the fact that Emma Harper raises it is very timely.
I am keen to have some further detail on that, because I think the ScotGEM programme seems to be very positive and many folks that I know across my region welcome it.
The committee would welcome any update on ScotGEM from either or both of the universities that are involved and have been here with us today.
Thank you to our witnesses. That has been quite an informative session. We will take further evidence next week, when we will hear from the Scottish Government on the bill. We will now move on to the next matter under consideration.
1 December 2020
Second meeting transcript
Agenda item 4 is a stage 1 evidence session on the University of St Andrews (Degrees in Medicine and Dentistry) Bill. It is for the Health and Sport Committee to consider the bill at stage 1 and to report to Parliament accordingly.
Last week, we took evidence on the bill from key stakeholders. This week, we will hear from the Cabinet Secretary for Health and Sport, Jeane Freeman, who is accompanied by Scottish Government officials. Carmen Murray is the bill team leader; Stephen Lea-Ross is head of workforce practice; and Magdalene Boyd is a solicitor in the legal directorate. I welcome all of you.
I invite the cabinet secretary to make an opening statement on the bill.
The Cabinet Secretary for Health and Sport (Jeane Freeman)
Good morning to the committee, and thank you for inviting me to give evidence on the University of St Andrews (Degrees in Medicine and Dentistry) Bill.
I heard with interest the evidence that was presented to the committee in last week’s evidence session. I am grateful to those who have given evidence and to all those who have responded to the committee’s call for views.
The bill, which is technical in nature, has a single purpose: it seeks to remove an archaic, unfair and, arguably, anti-competitive prohibition that prevents the University of St Andrews from awarding medical and dentistry degrees. That prohibition was intended to be temporary, and it is no longer needed. It was put in place in the 1960s as a transitional provision in order to give immediate effect to the separation of Queen’s College in Dundee from the University of St Andrews to form the University of Dundee. It is clear that that purpose has been achieved.
No other higher education institute in Scotland or in the United Kingdom is prohibited by primary legislation from awarding degrees in any discipline, and it is clear that the Universities (Scotland) Act 1966 did not intend to prevent future competition between the University of St Andrews and any other higher education institute in Scotland or, indeed, the UK. The bill will embed a fairer higher education sector and enable all our valued institutions in Scotland to maximise the options that they offer to students.
The timing of our introduction of the bill is to enable the University of St Andrews to award jointly with the University of Dundee primary medical qualification medical degrees to Scottish graduate entry medicine programme students in advance of the first cohort graduating in 2022. ScotGEM is Scotland’s first graduate entry programme for medicine. It formed part of a package of initiatives that the Scottish Government announced in 2016 to enhance the national health service workforce of the future, and it is delivered in collaboration with the University of the Highlands and Islands and a number of partner health boards. It has a specific focus on general practice and remote and rural working, and it aims to retain as many doctors as possible within NHS Scotland following their graduation.
I heard concerns being raised in last week’s evidence session. I clarify that, although the University of St Andrews may well have the ambition to offer its own PMQ medical degree in the future, the bill will neither determine nor provide for that. Whether any higher education institution is able to offer a degree in either of the controlled subjects of medicine and dentistry and, if so, the number of places that it might be able to offer are matters that are subject to separate financial and regulatory controls and decision-making processes that involve the Scottish Government, the Scottish Funding Council, NHS Education for Scotland and the General Medical Council, and which take account of the views of our boards. The prohibition is therefore not required in order to prevent the university from awarding its own medical degree.
As the University of St Andrews, together with the University of Dundee, has already been awarded the Scottish graduate entry medicine programme, the immediate effect of the bill would be to allow for those universities jointly to award the ScotGEM primary medical qualification degree. As I know that the committee heard last week, that is clearly the expectation of students who enrolled for this special course and who hope to graduate shortly. The committee heard how passionately ScotGEM students feel about their unique identity as students of both universities. It is fair and right that they should be able to graduate with a jointly awarded degree that reflects the studies that they have undertaken and the incredible work that has been done at both Dundee and St Andrews to establish such an innovative programme.
That is all that I have to say at this point, convener. Of course, I will be happy to take any questions that committee members might have.
You mentioned that you had listened to the evidence that the committee received last week. You also said that the bill neither authorises nor provides for the University of St Andrews to go beyond the training and higher education that it currently provides and offer its own PMQ. That is true, but it enables that to happen. As we heard clearly last week, the context for that was the proposition that there should be a new medical school somewhere in Scotland.
Among the evidence that we heard, two concerns struck me most clearly. The first was raised by Professor David Maguire, the principal of the University of Dundee, who felt that Scotland did not need another medical school. We also heard from Aberdeenshire health and social care partnership, whose concern was that if a new medical school was established in the central belt, it would have an impact on the recruitment and retention of medical graduates in the north of Scotland. How do you respond to those concerns?
You are quite right, convener. The passing of the bill would remove the prohibition on the University of St Andrews, which is the only institution in the whole of the UK on which there is such a prohibition. That would then enable the university, if it wished to do so, to put forward a case that, should the Scottish Government introduce a new medical school, in line with its 2019 programme for government, it could house that school and provide such an offer, either alone or jointly with another institution that offers undergraduate medical education in Scotland. Removing the prohibition, as the bill seeks to do, would simply allow the University of St Andrews to be part of that discussion on the same basis as all the other higher education institutions in Scotland that have medical schools.
Although I am aware of Professor Maguire’s argument on the current bill, I also know that, with his colleagues from other institutions, he has argued for the provision of additional medical undergraduate places. He is therefore not arguing against the fact that we might want to have such places; rather, he is simply arguing that they should go to his university or one of the others. On the contrary, the principal and vice-chancellor of the University of Edinburgh sees no such difficulty or problem with how the bill might affect how his university would be placed as a deliverer of quality medical undergraduate education, nor have such concerns been expressed by our other medical schools.
As for the concern expressed by Aberdeenshire health and social care partnership, my officials have had long discussions with it. As I know that the committee knows, the process of establishing another medical school or having an institution go through the process to become approved to deliver a medical degree is a long one. The degree programme has to be developed, funding has to be secured for the additional controlled places, clinical placements need to be secured that do not—the GMC is very particular about this—detract from what else is offered by established medical schools, the GMC needs to accredit a new medical school and there is obviously on-going GMC regulation. Therefore, it is not immediately in the offing for any of our higher education institutions.11:15
We had begun the work to look at what propositions might come forward—all were invited to give us those—but, inevitably, we had to pause that work as we had to respond to the Covid pandemic. Because we are still in the middle of the pandemic, we have not yet finalised when we can pick that work up again and make progress on it to honour the 2019 programme for government commitment.
If we remove the prohibition, the University of St Andrews—on its own or alongside another institution—could make a case that any new medical school should be housed with it and offer a programme to that effect. However, that is not inevitable; it would have to meet all the requirements that I have mentioned, and the Government of the day would have to take a view as to whether what was offered there was better compared with what was offered by other medical undergraduate courses and institutions.
Can you briefly explain why the Scottish Government’s preference is to create an additional medical school rather than additional places at existing medical schools? Also, what do you anticipate that the impact on recruitment and retention in the north of Scotland might be if a new medical school were established elsewhere?
In response to the latter point, the University of the Highlands and Islands has expressed an interest in being part of discussions about the possibility of a new medical school. Therefore, we should not assume that, should there be a new medical school, the school will go anywhere in particular.
Partly in the spirit of what we have seen in ScotGem—although no one should take that to imply that we favour either Dundee or St Andrews for any future location, should there be one—we were interested in finding out whether more could be offered either from existing medical schools or from a combination of them. The University of the Highlands and Islands, the University of St Andrews and the Crichton campus in the south-west were all in that discussion about whether we could widen access to Scotland-domiciled students in remote and rural areas and encourage them to work for the NHS in Scotland once qualified.
You will know that the ScotGEM course has a bursary aspect to it. That is given on the condition that the student works for the NHS in Scotland in their foundation year, and it is a test to see whether doing so would put students off; evidently, it has not. Therefore, it gives us information and evidence to decide whether that might be something that we would consider in the future as part of any increase in the number of medical undergraduate places.
Very briefly, can you explain why a new school should be created rather than those other options?
The programme for government says that we would like to have a new medical school. However, clearly my mind was open to how we might achieve an increase in the number of medical undergraduate places and what we would secure from that to address some of the issues relating to the medical workforce across the country.
My officials and I had discussions with the current medical schools as well as with the Crichton campus, the University of the Highlands and Islands and the University of St Andrews. They all made propositions and the existing medical schools argued the case that any additional places should go to them. We had not got beyond that before we had to pause the work and begin the response to the Covid virus.
Can you explain why a partial removal of the prohibition was ruled out?
There are two reasons. First, it is very clear that the prohibition was always intended only to be temporary. I am simply following through on that intention. Secondly, the prohibition, either in full or in part is fundamentally unfair. It is unfair for any academic institution to be prevented from offering a degree in a controlled subject that their counterparts elsewhere can offer. I think that I made the point about the additional implications that prohibition has for the capacity to undertake research in those areas. We know that Scotland is well placed in medical and life sciences research and I do not want one of our institutions to be prevented from playing the fullest possible part that it can in that. I see no reason for a partial removal when a full removal opens up opportunities in research and removes an unfair fettering of one of our institutions compared to its counterparts elsewhere in the UK.
Could the prohibition be amended for the purposes of ScotGEM and then amended further in the future if need be?
Technically, it could. However, I do not see any reason why we would go to all that fuss and bother given that I have heard no good argument that we should remove the prohibition in part. Either we remove it in full or we do not remove it at all. My argument is that it was never meant to be in place for as long as it has been—it was always intended to be transitional. We should follow through on that and we should remove the prohibition in its entirety, because I have heard no good reason why we should only remove it in part.
Good morning, cabinet secretary—[Inaudible.]
It appears that Mr Stewart’s connection is a little awry. We will go to Emma Harper and then come back to David Stewart if we can.
I listened with interest to the discussion about a new medical school. The cabinet secretary has mentioned the Crichton campus a couple of times, which I welcome, because I know that there is a lot of interest in establishing a new medical school affiliated with one of the established ones and placing it in a rural area such as Dumfries and Galloway. Professor David Maguire said that 80 per cent of the students who attend the University of Dundee come from deprived areas. I know that widening access is very important—it is for me in Dumfries and Galloway. What are your thoughts on whether the inclusion of the University of St Andrews, with its prestige as one of Scotland’s ancient universities, could limit progress on widening access by attracting a different demographic to the ScotGEM programme, for instance?
The bill is not about a new medical school; it is about removing a prohibition so that, should the current Government or a future Government make significant moves beyond those that I have initiated but necessarily paused towards a new medical school to provide for additional medical undergraduate places, St Andrews can compete equally in that field with any of our other medical schools that currently exist. It is not about a new medical school; it is about removing a prohibition that currently cuts out one of our higher education institutions from that discussion.
To go back to the convener’s earlier question about why the Government thinks that a new medical school is something to be discussed, part of that is about an understanding that widening access is about more than ticking a box on which areas of deprivation undergraduates come from; it is about taking practical steps that make participating in higher education more feasible for people. That is clearly the case for some of our very able students in Ms Harper’s area, in my constituency and, I am sure, in Mr Macdonald’s and Mr Stewart’s areas—in other words, in our more remote and rural areas outwith the central belt of Scotland. It is about more than simply looking at the area that a student comes from; it is about how practically to make it more likely that they can enter that degree of higher education and sustain their participation.
That is why, in the early discussions on the issue, I was keen to involve the University of the Highlands and Islands to hear what it had to say and to hear what the Crichton campus had to say. That is the way to understand what widening access is. To be completely frank, none of our institutions—I have said this to all of them when I have met them—has as good a track record as I would want on widening access to medical undergraduate courses. We need to do more. However, it is not simply about putting the burden on the institutions to tick the right boxes; it is about thinking creatively about how to deliver an undergraduate medical degree in ways that widen access to all potential students. ScotGEM is an aspect of that, but it cannot be the exclusive one.
Thank you for that clarification.
The feedback that I have had so far on the ScotGEM course is that it is doing really well and the students are great in engaging with the coursework, the learning and everything else that is part of the programme. I know that the ScotGEM students come from different backgrounds and include pharmacists and dieticians. Do we have a breakdown of those who are currently undertaking the course so that we can encourage more healthcare professionals who already have degrees to participate in ScotGEM in future?
We have that breakdown, but I do not have it with me. I am happy to ensure that it is made available to all committee members. Another aspect of the ScotGEM course is the involvement of general practitioners as clinical educators. I know that the students on the course and the GPs value that highly, and that they are keen for us to consider that in other aspects of medical undergraduate education.
I once again call David Stewart.
I apologise, cabinet secretary—I have put a pound coin in the meter, so I hope that I will be able to speak to you now.
You might have heard my point about my bid for a new medical school in the Highlands and Islands, in conjunction with UHI, Dundee and St Andrews, but that was more an observation.
I am enthusiastic about ScotGEM and I believe that it will have a vital role in the attraction and retention of rural GPs in the Highlands and Islands and across Scotland. You will be aware of the student survey in which nearly 98 per cent supported the idea of the degree coming from both institutions. What do you think of the students’ views on that?11:30
Yes, I have seen that. The students take a perfectly fair and reasonable position, which is that when they secured their place—that is not straightforward to do—and enrolled on the ScotGEM course, they did so on the basis that it was a joint award from both the University of Dundee and the University of St Andrews. They are enthusiastic and, as you heard, passionate about the quality of the education that they experience and the position that the award should be a joint award, because that is, in part, the basis on which they entered the course. I am keen to ensure that the prohibition is removed in order for that to be possible.
As I said to Mr Torrance, I do not see the point of, if you like, footering around with partial removal and then maybe full removal at some point in the future. That does not seem to me to get the fundamental point that it is unfair that a prohibition that was put in place to be transitional is not removed in full so that one of our institutions can then compete on an equal footing with their colleague institutions elsewhere in Scotland and the UK.
Is it fair to say that having it as a joint degree is a remarkable selling point for it and that, if we do not get the bill through, that could affect demand for the course in the future?
I have no absolute, hard data to confirm my response to that, but I think that what we have heard from successive student enrolment makes it pretty clear that the high calibre of students who are being attracted are attracted because of the nature of the programme, which comes from it being a joint exercise. The students are attracted by potentially being graduates of both universities. All of that would therefore make me think that, if it was not a joint award, that would have an impact on its attractiveness to future students.
Although you cannot make forward commitments to the committee, the course is a great success. The Scottish Funding Council would obviously have a view if the course numbers were going to be increased, but what is your general view on that? It is a Scottish success, so could the numbers be increased? That would help with the supply of not just GPs in general but GPs in rural areas in particular.
You are absolutely right that I cannot make forward commitments, but I can tell you that I am hugely enthusiastic about the ScotGEM course and how it has played out since it was introduced. It has a number of innovative aspects that are working well, not least the conditional bursary and the clinical educators from our GP community. One of the things that we are seeing anecdotally in feedback, which we will be able to track more definitively as we go forward, is that the ScotGEM undergraduates undertaking their clinical practice in GP practices in remote and more rural areas become hugely enthusiastic about the opportunities for exercising and increasing their skills as young doctors in those remote and rural practices. We always want to try to overcome the notion that the only place where it is exciting to practise as a GP is in an urban setting. Undoubtedly, that is exciting, but I am a firm believer that there is a range of enticing intellectual and skill challenges to doctors in remote and rural areas. ScotGEM is helping us demonstrate that.
Thank you. We have a bit more on the same question from Stephen Lea-Ross. [Interruption.] There seems to be a technical problem. If that is resolved before the end of the evidence session, we will come back to him. We move to Brian Whittle just now.
Much of the focus of the bill is on degrees in medicine, but the bill would also allow the University of St Andrews to award degrees in dentistry. Neither the bill’s policy memorandum nor any written submission explores the potential impact on dentistry. Why is dentistry included in the bill?
Perhaps one of my colleagues can explain that. The bill deals with medicine, dentistry and midwifery. That is taken from the 1960s act that imposed the prohibition in the first place. Generally speaking, midwifery at that time was about obstetrics—that is how it was described. Obstetrics is now part of the undergraduate degree as a whole; we do not offer a separate degree, although there are specialisms and so on. Dentistry is part of what was prohibited and is therefore covered by lifting the prohibition.
Carmen Murray (Scottish Government)
I echo what the cabinet secretary said. The full prohibition that is contained in the 1966 act relates to medical and dentistry degrees, both of which are controlled subjects. The rationale for removing the prohibition and its not being determinative of the university’s ability to award either medical or dentistry degrees applies.
The cabinet secretary has explained to the committee that we have heard no reason to leave any part of the prohibition in place, because it was intended to be transitional and it no longer serves a purpose in today’s context. The bill will put the University of St Andrews on the same footing in law as any other university in Scotland. It makes sense to remove the prohibition in its entirety rather than leave any part of it in place.
I presume that consideration has been given to the potential benefits to medicine and dentistry of lifting the prohibition. Will the cabinet secretary shine a little light on the benefits to dentistry in Scotland?
The potential benefits are the same as those for undergraduate medicine. The bill allows the University of St Andrews to move in that direction if it wishes to. However, as the bill team leader said, dentistry is a controlled subject, so significant effort, regulation and work are needed to get to the point at which any institution is considered an awarding body for dentistry. The same applies to medicine.
All that the bill does is remove the current prohibition on the University of St Andrews from considering whether to offer a medical or dentistry undergraduate degree in full. Even if it wished to do that, there are steps that it would need to go through and requirements that it would need to meet, including consideration of the impact of any additional places in those areas on other, existing dentistry or medical schools. It is about not just places but opportunities for the necessary clinical practice in the field, which is part and parcel of what students need to go through in order to graduate. As with medical places, it is a separate question. All that the bill does is take away the current block on the University of St Andrews from being part of that consideration, if it wishes to, alongside its counterpart institutions in the rest of the country.
The outcome that we are looking for will be to the benefit of medical and dentistry degrees in Scotland. Last week, we heard concerns about the impact on other medical schools in respect of the recruitment and retention of doctors. We have discussed such matters at length in the chamber, including the set quota of local medical students who can be recruited into those universities. One of the concerns that I heard last week was that the effect might be to simply spread the same number of health professionals across more universities. Will you comment on that and on whether those concerns about the impact could also be applied to dentistry?
There is quite a detailed process for determining the number of places in what have been described as “controlled subjects”. That process includes the Government’s consideration of our anticipated workforce requirements for doctors and dentists. We do the same exercise for nurses and other members of our health professions. We then look at what undergraduate places we have, what the flow through will be, and what is going out at the other end of the profession through people retiring and so on, and we try to balance those factors to ensure that we get both an increase in numbers—as we have done in recent years—and a reasonable flow through.
In those circumstances, all the medical schools want to maximise the number of places that they have, which is perfectly understandable. That is why the existing medical schools made the case to me that the additional places that may go to a new medical school—they would prefer that there was not a new medical school—should go to them as existing medical schools. That is a perfectly reasonable case for them to make. For all the reasons that I described earlier, no decisions were reached.
We have two interests in considering that request as well as whether we should have a new medical school instead. First, we have to make sure that we have the right number of undergraduates going in to meet our anticipated flow through. It takes a while to produce doctors and dentists, so we need to anticipate the flow through so that we can offer the clinical placements that they need as part of their undergraduate education and, at the other end, get the right numbers out and working in Scotland in order to meet our anticipated workforce demands.
Secondly, we have to ask whether, as a Government, we can do more with the levers that we have to widen both access and the throughput into the areas of our country that traditionally struggle to recruit and retain doctors. I am talking about GPs in remote and rural areas, and doctors in particular specialisms, for example. The committee will know how we try to use the information that we publish about the traineeships to fill gaps that are anticipated because of retiral numbers or because we are putting a greater emphasis on mental health, for example.
That is the process and exercise that we go through to ensure that we put into medical and dentistry education the numbers that we anticipate that we need to come out the other end to meet our workforce requirements. We have increased medical undergraduate education, and we pulled back a little before on undergraduate education for dentistry. Each year, we consider how we need to flex the numbers. However, this year, we have said that there are more medical undergraduate places as a consequence of the decisions that were made on the higher results. We have also said that, in funding those places, the additional numbers are not at the expense of any young people who are coming through school this year and applying to go to medical school.
We will have increasing numbers as we go forward, because the age profile balance of our medical workforce is such that I anticipate that we will need to steadily increase our medical undergraduate numbers.
The short answer is that, should we have an additional medical school, we will not spread the same number across a bigger patch.
Finally, there is a lot of chat about the potential for a new medical school in Scotland. Would that also include a new dental school?11:45
Not necessarily. A case has not been made to me that we need a new dental school in Scotland. As you know, we have dental schools in Glasgow and Aberdeen, and the one in Aberdeen is relatively new within the course of devolution. I have not seen a case for a new dental school, although that does not mean that one does not exist.
Colleagues need to appreciate that, although it was my hope that, following the 2019 programme for government commitment, we would undertake the initial discussions that I described, receive proposals, have a good look at them and take a view on whether we needed to put in additional places in a new school, all of that has been paused. Although I intend to pick that up and move it on a little, the time that is left in the current parliamentary session is so limited that I do not anticipate that we will reach a final view before Parliament rises for the next set of elections.
The cabinet secretary said that no case has been made for additional undergraduate dental places. I add that our workforce planning has not shown a need for such places. We have dental undergraduates at work across Scotland, as part of their clinical placements, in Stornoway, Campbeltown, Inverness and Dumfries. There is no evidence at present that there is a requirement for additional dental places.
Stephen Lea-Ross wants to respond to David Stewart’s question about the future of ScotGEM.
Stephen Lea-Ross (Scottish Government)
The number of places allocated to ScotGEM has increased from 40 to 55 in recognition of the contribution that that programme is making across the board. We are convening the medical undergraduate group to establish undergraduate intake recommendations for 2021-22. They will go to the cabinet secretary in the new year. Thereafter, we will undertake further discussions with the SFC about the total number of places and their distribution across relevant courses in Scotland. Final decisions on individual institutions rest with the SFC, but future growth in ScotGEM places will be under consideration.
Thank you. That is helpful additional information.
That concludes the committee’s oral evidence taking on the bill. We will report to Parliament accordingly. I thank the cabinet secretary and her officials for their attendance this morning.
We will move into private session and resume our meeting on a different platform.11:48 Meeting continued in private until 12:17.
8 December 2020
1 December 2020
8 December 2020
What is secondary legislation?
Secondary legislation is sometimes called 'subordinate' or 'delegated' legislation. It can be used to:
- bring a section or sections of a law that’s already been passed, into force
- give details of how a law will be applied
- make changes to the law without a new Act having to be passed
An Act is a Bill that’s been approved by Parliament and given Royal Assent (formally approved).
Debate on the Bill
A debate for MSPs to discuss what the Bill aims to do and how it'll do it.
Stage 1 debate on the Bill transcript
The Presiding Officer (Ken Macintosh)
Thank you, colleagues. The next item of business is a debate on motion S5M-23946, in the name of Jeane Freeman, on the University of St. Andrews (Degrees in Medicine and Dentistry) Bill, at stage 1. I invite all members who wish to contribute to the debate to type “R” in the chat box.
I call the Cabinet Secretary for Health and Sport, Jeane Freeman, to speak to and move the motion.
It looks like I spoke too soon. I will have to suspend the meeting until we make sure that the cabinet secretary has a proper connection.15:39 Meeting suspended.
15:47 On resuming—
The Presiding Officer
Welcome back, colleagues. We will try again. Our online meetings would not be the same if we did not have a few connectivity issues.
I remind members that the next item of business is a debate on motion S5M-23946, in the name of Jeane Freeman, on the University of St Andrews (Degrees in Medicine and Dentistry) Bill at stage 1. I invite all members who wish to speak in the debate to put an “R” in the chat box, so that I can make sure that everyone is on board.15:48
The Cabinet Secretary for Health and Sport (Jeane Freeman)
I am pleased to open the debate on the general principles of the bill. I thank the Health and Sport Committee for its careful scrutiny of the bill and for its support for the bill’s general principles. I also thank the Finance and Constitution Committee for its consideration of the bill.
I am grateful to the organisations and individuals who provided evidence to the Health and Sport Committee. The committee has delivered a fair report on the bill and the evidence that it received. The Government’s response to the report has been provided to Parliament; I hope that members had the opportunity to review it, ahead of the debate.
This technical single-purpose bill has been welcomed and supported by the majority of stakeholders. The bill’s purpose is to repeal an archaic, unfair and, arguably, anticompetitive prohibition that prevents the University of St Andrews from awarding medicine and dentistry degrees. The prohibition, which was put in place more than 50 years ago, was always intended to be transitionary, so it is no longer appropriate for it to remain in law. It was put in place by the Universities (Scotland) Act 1966 in order to give immediate effect to the separation of Queen’s College in Dundee from the University of St Andrews, so that it could form the University of Dundee. That purpose has clearly been achieved; the University of Dundee has long since become a reputable and well-established higher education institution.
The University of St Andrews has educated students and has contributed to the rich tapestry of our higher education world in Scotland for more than 600 years, but no other higher education institution in Scotland or the United Kingdom is prohibited by primary legislation from awarding degrees in any discipline. It is clear that the 1966 act did not intend to prevent future competition between the University of St Andrews and any other higher education institution in Scotland or the UK. By removing the prohibition, the bill will create a fairer higher education sector and will enable all our valued institutions to maximise the options that they offer to students in Scotland.
The bill has been introduced to enable the University of St Andrews to award, jointly with the University of Dundee, primary medical qualification degrees to students on the Scottish graduate entry medicine programme—ScotGEM—in advance of the first cohort graduating in 2022. ScotGEM is Scotland’s first graduate entry programme for medicine, and formed part of a package of initiatives that were announced by the Scottish Government in 2016 to enhance the national health service workforce of the future.
It was always intended that the degree would be jointly awarded; as such, it is highly valued by its students, as the committee heard. The degree is delivered in collaboration with the University of the Highlands and Islands and a number of partner health boards. It has a specific focus on general practice and remote and rural working, with the aim of retaining as many doctors as possible within NHS Scotland, following their graduation.
I acknowledge that a small number of stakeholders have raised concerns about what they consider to be the potentially negative impact on the University of St Andrews being able to offer its own PMQ degree in the future. Those concerns are precisely why medicine and dentistry are controlled subjects. It is so that policy decisions can be made by the Government of the day, in collaboration with others, on the number of undergraduate medicine and dentistry students there are at any time, and on distribution of those students across higher education institutions and across clinical placements in the NHS.
Although the University of St Andrews might well have the ambition to offer its own PMQ degree in the future, the bill neither determines nor provides for that. I am pleased that the Health and Sport Committee’s stage 1 report acknowledges that important point. The question of a higher education institution being able to offer a degree in either of the controlled subjects of medicine or dentistry—and, if so, the number of places that it is able to offer—is subject to separate financial and regulatory controls and to decision-making processes that involve the Scottish Government, the Scottish Funding Council, NHS Education Scotland, the General Medical Council, our health boards and others.
Given that the University of St Andrews, together with the University of Dundee, has already been awarded the ScotGEM programme, the immediate effect of the bill will be to allow St Andrews university to award the ScotGEM PMQ jointly with Dundee university. During stage 1 evidence, we heard that that is the clear expectation of ScotGEM students. We also heard how passionately they feel about their unique identity as students of both universities.
Once again, I thank the Health and Sport Committee for its scrutiny and its agreement that it would be fundamentally unfair for any part of the prohibition to be retained, given that it was only ever intended to be transitionary.
Scotland’s higher education sector faces significant challenges, given the constraints on immigration, the consequences of European Union exit and the likely decrease in the attractiveness of studying abroad that will result from the coronavirus pandemic. There are also significant challenges to overcome in creating and growing a more sustainable medical workforce.
Removal of the prohibition will allow greater flexibility in addressing those challenges, by creating a fairer higher education sector, thereby enabling all Scotland’s valued higher education institutions to maximise the options and opportunities that they offer to students in the future. It is fair and right that ScotGEM students will be able to graduate with the jointly awarded degree that they believed they were studying for, reflecting both their studies and the incredible work that has been done by the universities of Dundee and St Andrews in establishing such a successful and innovative programme.
That the Parliament agrees to the general principles of the University of St Andrews (Degrees in Medicine and Dentistry) Bill.
The Presiding Officer
Before I call the party spokespeople to give their opening speeches, I call Lewis Macdonald, who is convener of the Health and Sport Committee.15:55
Lewis Macdonald (North East Scotland) (Lab)
I am pleased to speak in the debate as convener of the Health and Sport Committee as we consider the bill at stage 1. As we have heard, this is a fairly straightforward single-purpose bill and our report, which supports its general principles, was agreed to without division.
I thank all those who assisted the committee with our scrutiny, those who responded to our call for views and those who gave oral evidence. We were particularly pleased to hear directly the views of students on the Scottish graduate entry medicine, or ScotGEM, course, whose impending graduation next year prompted the introduction of the bill at this time.
As we have heard, the bill seeks to remove a legislative prohibition that prevents the University of St Andrews from holding qualifying examinations or awarding degrees in medicine or dentistry. The ScotGEM course that prompted the introduction of the bill provides for Scotland’s first graduate entry medicine degree, which is completed over four years and results in a primary medical qualification as a bachelor of medicine and bachelor of surgery or MBChB. It is aimed at graduates who are interested in a career in general practice and provides a focus on rural medicine and healthcare improvement—areas where there is an acknowledged shortfall in meeting future needs.
As we have heard, the course is jointly provided by the University of St Andrews and the University of Dundee, in collaboration with the University of the Highlands and Islands, and the first cohort of students is set to graduate in 2022.
We heard from their representatives that ScotGEM students enrolled on their programme of study with the clear expectation that their degree would be jointly awarded by the University of St Andrews and the University of Dundee. We heard that, for a number of students, that joint award was an important factor in their decision to apply. If the bill were not to be passed, the ScotGEM students’ degree would be awarded by the University of Dundee only.
It was striking that some of the greatest reservations about the bill were expressed by the principal of the University of Dundee. While ScotGEM is a promising example of collaboration between Dundee and St Andrews, the roots of the ban on St Andrews awarding primary medical qualifications lie in the complex and long-standing relationship between the two neighbouring seats of learning—at times as partners and at times as competitors.
That complex relationship will no doubt continue to evolve after the passage of the bill, but the committee was encouraged that the ScotGEM initiative would produce positive outcomes next year and beyond. Under the initiative, students can receive a bursary of £5,000 a year for up to four years, as long as they commit an equivalent number of years to working for the NHS in Scotland. It would be interesting to know how many years of service have been committed to by the current cohort of students in exchange for that financial support.
Beyond ScotGEM, the bill’s policy memorandum highlights—as the cabinet secretary has just done—that the University of St Andrews and seven other institutions have submitted bids to
“develop proposals for a new medical school”
as part of a process that has been put on hold as a result of the Covid pandemic.
The question of where any new medical school should be located was clearly not one for us to consider in the context of the bill, although it will no doubt be of great interest to future health committees. While the bill is necessary for St Andrews to be considered in that context, it does not automatically enable the university to award primary medical qualifications beyond the current ScotGEM programme. As we have heard, doing that would also require both regulatory approval and financial support, as is the case for existing medical and dentistry schools.
The cabinet secretary told the committee that she would expect future consideration of proposals for a new medical school to look at undergraduate numbers, anticipated flow for associated clinical placements, issues of access and skills retention and workforce demands.
The committee heard concerns about the potential impact that a new medical school at St Andrews might have on the viability of existing schools, especially regarding clinical placements for students. Although such a process does not arise directly from the bill, we have recommended that any future consideration of proposals for a new medical school should take into account the wider evidence that we heard on NHS recruitment and retention and on widening access to medicine.
The committee unanimously supports the general principles of the bill and looks forward to seeing it progress to stage 2.16:00
Donald Cameron (Highlands and Islands) (Con)
I am delighted to open for the Scottish Conservatives. We support the general principles of the bill. Although its subject matter is more technical than in most health debates, it is important, for reasons that I will come on to.
The bill intends to amend the Universities (Scotland) Act 1966 to remove the provision that prevents the University of St Andrews from awarding degrees in medicine and dentistry. That will allow those on the ScotGEM course to receive a joint degree in medicine from both the University of St Andrews and the University of Dundee. That course was created as a result of shortages of general practitioners and shortages in rural medicine.
The bill seeks to right an historical anomaly. The prohibition was intended to be temporary and originated when the University of Dundee was created as a separate institution in the 1960s, when the clinical school previously used by the University of St Andrews became part of the new University of Dundee.
The bill will allow students taking the ScotGEM course to receive a joint degree from both institutions. It is worth remembering that the ScotGEM course is run in collaboration with the University of the Highlands and Islands. It is generally believed that, by removing the prohibition, the bill will create a fairer higher education sector and enable all of Scotland’s institutions to maximise the options and opportunities that they offer. That is significant in and of itself and shows that the bill is not merely about a technicality.
The ScotGEM course is important because it was initiated to address workforce shortages in rural areas, which face difficulties in recruiting and retaining GPs. As a member for the Highlands and Islands, I am aware of the issues that we face in my region. Scotland has always had a higher number of GPs per capita than in other parts of the UK, due to our unique geography of sparsely populated rural areas and high-density urban ones. Both require more GPs per head than might normally be the case.
This is where I must strike a more critical note. The Scottish National Party Government has presided over a GP crisis. A hard-hitting report by Audit Scotland in 2019 said that the Government was ill-equipped to sort out Scotland’s GP crisis and would struggle to meet its commitment to recruit an extra 800 family doctors in the next decade. Between 2009 and 2019 there was a reduction in the number of GP practices, while the size of the average practice patient list increased.
That is a long-standing problem. In 2008, the British Medical Association warned Nicola Sturgeon, who was then health secretary, that Scotland faced a severe shortage of GPs. There is still a significant shortage of GPs in Scotland. It is no wonder that the Royal College of General Practitioners in Scotland predicts that there will be a shortfall of 856 full-time-equivalent GPs this year.
Others have mentioned the concerns that were raised about the bill, which it is worth acknowledging. There is a fear that the bill might lead to the University of St Andrews setting up its own medicine degree. The Aberdeenshire health and social care partnership is concerned about the effect that that could have on the recruitment and retention of school leavers and graduates in the north-east.
Others have argued for a partial, rather than a complete, removal of the prohibition on St Andrews awarding medicine degrees. The University of Dundee has argued that an independent medicine degree at St Andrews could have a negative impact on teaching capacity in the area. Those concerns should be recognised.
Scottish Conservatives agree with the Health and Sport Committee’s view that the bill is important. We support it at stage 1 and look forward to seeing how it progresses through Parliament. It is important to acknowledge some of the concerns that stakeholders have raised at stage 1, as well as the worrying context of Scotland’s continuing shortage of GPs.16:04
Alex Rowley (Mid Scotland and Fife) (Lab)
I am pleased to be speaking in this debate on the University of St Andrews (Degrees in Medicine and Dentistry) Bill. Labour welcomes the bill’s introduction. I thank the Health and Sport Committee for its work on the stage 1 report that it produced and thank respondents for all the evidence submitted on the bill.
I have had the privilege of visiting the school of medicine at St Andrews on a number of occasions and have seen at first hand the excellent facilities there and spoken to some of the exceptionally talented researchers and scientists working for the school. The facilities at the university are first class, and students from all over the world are well placed to start their careers in medicine from St Andrews.
As members will no doubt be aware, the University of St Andrews was founded in 1411 and is the oldest university in Scotland and one of the oldest in the world. It plays a major role in the Fife community, being one of the largest employers in Fife and providing over 2,500 jobs directly in the region. That is coupled with the fact that it made over £152 million in export earnings for Fife in 2018-19, a figure that is equivalent to nearly 8 per cent of all Fife exports.
The bill before us today is a positive one in that it will rectify an issue that resulted in the university not being able to confer degrees in medicine directly. This Fife university is one of the most prestigious in the world and it will be able to confer medicine and dentistry degrees directly, in partnership with the University of Dundee, for the ScotGEM programme, which I hope will attract more students, researchers and academics from all over the world to Fife, benefiting the local community and generating money for the wider local economy.
The bill’s policy memorandum states:
“Scotland’s higher education sector is facing significant challenges given the constraints on immigration, the consequences of EU exit and the likely decreased attractiveness of studying abroad as a result of the public health pandemic. There are also significant challenges to overcome in creating and growing a more sustainable medical workforce. Removing the prohibition entirely allows greater flexibility in addressing these challenges, by creating a fairer higher education system and enabling all of Scotland’s valued institutions to maximise the options and opportunities they offer to students in Scotland.”
I largely agree with that rationale. Given that the bill will allow the University of St Andrews to play a key role in the ScotGEM programme, which is aimed at increasing careers in general practice and has a focus on rural medicine and healthcare improvements, I believe that it is a welcome move for Scotland.
If the pandemic has taught us anything, it is surely to recognise the vital role of our NHS and its medical practitioners and the need to attract more medical professionals and general practitioners. That might be one of the biggest takeaways from these turbulent times. I welcome the stage 1 debate today and look forward to the bill making its way through Parliament.16:08
Willie Rennie (North East Fife) (LD)
In essence, the bill is a simple one that will bring the school of medicine in the University of St Andrews more in line with the other medical schools across Scotland. Its purpose is to correct an unintended consequence from 55 years ago. The bill is a sensible measure that is almost administrative, but it is certainly the right thing to do.
Probably constituted by the issuing of a papal bull in 1413, the University of St Andrews is today a thriving and successful global university where students from all over Scotland mix with students from across the globe. As the MSP for North East Fife, I see that myself weekly. The university is an amazing institution.
Today, we are correcting the unintended consequences of the Universities (Scotland) Act 1966, which separated the University of St Andrews from Queen’s College in Dundee, which formed the University of Dundee. As there was no major teaching hospital in the St Andrews area, the logical step to take was to award the clinical part of the medicine degree offered at the time to the new university across the Tay. Therefore, the 1966 act removed the power to grant undergraduate and postgraduate degrees in medicine, midwifery and dentistry by default.
The University of St Andrews continued to offer a three-year undergraduate BSc in medicine, which is then used to gain entry to three further years of training at universities with full medicine degree awarding abilities. Therefore, a major part of students’ training is undertaken at the University of St Andrews.
With such a long and prestigious heritage, it is only right that the University of St Andrews should be able to move forward. I argue that it should be able to operate on an equal basis with other universities in relation to any current or future developments, or commissions, for a new medicine or dentistry degree provider. This change would support the development of the medical workforce in Scotland and give students a choice of universities.
One of the first steps would be for the university to be able to award, as we have heard, the ScotGEM primary medical qualification jointly with the University of Dundee, which would, in effect, renew the partnership of 55 years ago in a new way. ScotGEM students enrolled to their programme of study with the clear expectation that that would happen. It is the right step to take and it is the fair thing to do.
Through the bill, we will be able to resolve the anomaly that exists. The University of St Andrews is the only academic institution in the UK that is legally barred from awarding primary medical qualifications.
Let us progress the bill. It is the right thing to do. It gets rid of the anomaly—a mistake, effectively—from 55 years ago. That is why I support the bill.16:12
Emma Harper (South Scotland) (SNP)
I welcome the opportunity to speak in this important stage 1 debate on the University of St Andrews (Degrees in Medicine and Dentistry) Bill. I thank all who gave evidence to the Health and Sport Committee and the committee clerks.
As the cabinet secretary said, this technical bill will, by repealing a section of the Universities (Scotland) Act 1966, remove an unfair and anti-competitive prohibition that prevents the University of St Andrews from awarding medicine and dentistry degrees. That is welcome, as it affords the University of St Andrews equality of competition and educational opportunity.
As the deputy convener of the Health and Sport Committee, I participated in the scrutiny of the bill. The committee produced a short report in which we overwhelmingly supported the principles of the bill.
We had only one recommendation. Although discussions around proposals for a new medical school have been postponed due to the Covid-19 pandemic, the committee considers that it would be prudent, when those discussions resume, that consideration is taken of the wider evidence that we heard on NHS recruitment and on helping to support widening access to medicine degrees.
On that point, I would like to raise awareness of the local campaign work across Dumfries and Galloway for a new medical school for Scotland to be located in the region, possibly at the site of the Crichton campus, which is already home to the University of Glasgow and the University of the West of Scotland. I ask the cabinet secretary to keep that in mind as we move forward, and I will continue to engage with her and local campaigners on the issue.
The bill will allow the University of St Andrews to award a joint degree with the University of Dundee for the purposes of the ScotGEM programme, which other members have spoken about. ScotGEM, which I have discussed in the chamber and in committee previously, is operational across Dumfries and Galloway and other parts of Scotland, and is being provided by the University of St Andrews and the University of Dundee, in collaboration with the University of the Highlands and Islands.
It is Scotland’s first graduate entry programme with a strict focus on rural medicine. The first cohort of students is expected to graduate in 2022. If the bill is not passed, their degree will be awarded solely by the University of Dundee. The timing of the Scottish Government’s introduction of the bill is therefore welcome, as will it enable the universities of St Andrews and Dundee jointly to award the degree to ScotGEM students.
It is simply unfair for any academic institution to be prevented from offering a degree in a controlled subject that its counterparts elsewhere can offer. Indeed, it is only fair to implement the bill for the ScotGEM students who are currently on the programme, who signed up on the promise of gaining a unique degree that would be sponsored by both universities. In the committee’s first evidence session on the bill, the health secretary said that it is
“clearly the expectation of students who enrolled for this special course and who hope to graduate shortly”—[Official Report, Health and Sport Committee, 8 December 2020; c 22.]
that they be awarded a degree from both universities jointly.
I again welcome the bill and its very real implications for the University of St Andrews and for ScotGEM students, some of whom are currently learning and practising across Dumfries and Galloway. I also emphasise the importance of providing greater access to medicine for students across Scotland, and I support any work that is being done to bring a medical school to Scottish rural areas, including Dumfries and Galloway, in the future.16:16
Liz Smith (Mid Scotland and Fife) (Con)
I welcome Alex Rowley’s earlier comment that if ever there were a time for us to be reminded of the importance of our medical professionals, it is now. The Covid-19 pandemic has demonstrated their outstanding contributions as public servants, through the exercise of their professional skills in an ever more challenging world and through their dedication to their patients and colleagues.
The pandemic has also exposed the huge pressures under which those people have often had to operate, and the need for Scotland to train more doctors, dentists and other medical professionals. In particular, we want doctors and dentists who are schooled in our universities to have more job opportunities once they have graduated—including, of course, in Scotland, which involves ensuring that we update the relevant legislation.
The Covid-19 pandemic has shown the benefits of our outstanding university research programmes, which is another reason why this particular legislative change is welcome. Top-class research must be accompanied not only by much greater collaboration in higher education but by universities working with other sectors and with their local economies, including in rural areas.
The legislative change that we are considering will provide significantly greater benefits for the whole of Fife, by delivering better primary care and providing new incentives for clinical research in the life sciences. In the longer run, when Covid-19 is controlled effectively and—we hope—one day eradicated, there will be debates and inquiries about the structure of our health services. However, it is already certain that there must be a much greater focus on the delivery of primary care. Fife has already experienced more than its fair share of challenges in that respect. The issues with out-of-hours services in St Andrews a couple of years ago highlighted that accessibility to primary care is a key issue, especially in our most rural communities.
If the bill is passed, full medicine degrees will still require ScotGEM and GMC accreditation, but the change will make for much greater fairness and will ensure that there will be a level playing field on which the University of St Andrews can participate equally with other PMQ-awarding universities. That was acknowledged by the cabinet secretary herself, during the committee’s recent evidence sessions, and it is very much in line with the views of the principal of the University of St Andrews, Professor Sally Mapstone. The cabinet secretary also acknowledged that the bill aims to take practical steps to make participation in higher education feasible for more people, which is in line with the Scottish Government’s agenda on widening access.
There is no doubt that higher education faces immense challenges, and not just because of Covid-19. Last week’s budget briefing from Professor Gerry McCormac and Universities Scotland, which I and other members attended, laid bare the extent of the financial challenges in Scotland, most especially when it comes to funding support for teaching. I hope that the Scottish Government recognises those ahead of the budget on Thursday. The briefing also exposed the challenges that Scotland faces on our outstanding record in attracting research funding, which we must not lose. St Andrews has always been a key part of such research, which is another reason why the bill is so important. I am therefore happy to support it.16:19
Daniel Johnson (Edinburgh Southern) (Lab)
It gives me great pleasure to speak to the motion, and I will vote in favour of the bill. As members may know, I take a great interest in St Andrews—such a great interest that I sometimes wonder whether Willie Rennie thinks that I am planning an annexation.
My interest largely extends from the fact that I am a St Andrews graduate, but I am also the grandson of a St Andrews graduate. My grandmother graduated from St Andrews with an MBChB in 1945, having also been one of the first female presidents of the Bute Medical Society in St Andrews. What is all the more remarkable—if being a woman doctor in 1945 was not sufficiently significant—is that she did so having completed a modern languages degree at St Andrews by the age of 19. In some ways, the bill is correcting a historical anomaly; my grandmother could have benefited from it.
However, the wider point is that St Andrews has a long and well-established tradition of delivering medical education. Medicine was founded at St Andrews in 1897 by the Marquess of Bute, the then rector. It was only in 1967 that that was interrupted, but St Andrews continued to offer medical education by offering degrees that conferred a BSc in Medical Sciences, with students then going on to complete their medical training in Manchester.
In response to the concerns that some have raised that the bill may lead to competition, I would say that, in a sense, the current situation has led to medical graduates being lost from Scotland. With medical students starting their medical training in St Andrews and then moving to Manchester, we lose doctors, which we can ill afford to do. St Andrews has a long-established—and largely continuous—heritage in medical training.
St Andrews also has a reputation for innovation, which the ScotGEM degree programme is an example of. Helping people to change careers and move into medicine is a good idea. When people leave school, what they want to do is not always obvious to them; certainly, academic excellence at school is not necessarily the best indicator of who is suited to a career in medicine.
Moreover, we need more doctors, and not just in general practice. In Scotland, the number of doctors per capita is lower than it is in most other Organisation for Economic Co-operation and Development countries. The average across the UK is 2.9 doctors per 1,000 people, and Scotland is slightly ahead of that figure. However, the average across the OECD is 3 per 1,000, and in Germany and Austria, it is approaching 5. Quite simply, we need more doctors, including GPs. Therefore, enabling St Andrews to train more doctors is undoubtedly a good thing and not something to be cautious about.
As I have said, St Andrews has established itself as a centre of innovation, not just historically but in more recent times. For such a small university, it has a number of innovations, such as the combined heat and power centre that it has established in Guardbridge, along with business incubators. The innovation that we see with the degree programme stands in that context.
We should be seeking to enable St Andrews to innovate more across all its subject areas, but in particular in medicine. The bill enables the university to continue to innovate in the future. It is clear that we must support the bill so that we can have more doctors entering the profession through more routes, and more flexible routes, and so that we can support the continued innovation in medicine and other subjects at the University of St Andrews.16:24
George Adam (Paisley) (SNP)
I am a member of the Health and Sport Committee and I am pleased to take part in the debate. This is the very first time that I have had to deliver a speech remotely, so I apologise in advance if anything should go wrong.
The debate has been interesting. Daniel Johnson almost took on a Stewart Stevenson-esque tone in the part of his speech when he went through his family tree and spoke about those who were alumni of the University of St Andrews.
Donald Cameron is a member of the Health and Sport Committee, so it was surprising to hear him say something a wee bit different from what the committee discussed. In effect, we agreed that the bill is a way forward to ensure that we can get more GPs to work in our communities, particularly in rural areas, so that was a surprising speech from Mr Cameron.
As others have said, the bill is very technical. As the cabinet secretary said, it seeks to remove an archaic, unfair and anti-competitive prohibition that prevents the University of St Andrews from awarding medicine and dentistry degrees. I could stop there and save us all three or four minutes of our lives, but I will endeavour to go a little further.
As has been said, the prohibition was created in the mid-1960s to accommodate the separation of Queen’s College from the University of St Andrews so that Queen’s College could form the University of Dundee. That happened before I was even born. I am now 51 years old, and I assume that the bodies have achieved everything that they wanted to achieve by doing what they did way back in the 1960s. I know that the world of academia does not like change but, surely, after half a century, an argument can be made to look at things a wee bit differently and move forward.
One important point is that no other higher education institution in Scotland or the United Kingdom is prohibited by primary legislation from awarding degrees, in any discipline. It is clear that the Universities (Scotland) Act 1966 did not intend to prevent future competition between the University of St Andrews and any other higher education institution in Scotland or the rest of the UK. The bill will embed a fairer higher education sector and enable our valued institutions in Scotland to maximise the options that they offer students.
The Health and Sport Committee considered the bill at stage 1 and supports the principles of the bill. Repealing the provision in the 1966 act will allow the university to award a joint degree with the University of Dundee for the purposes of the ScotGEM degree.
The Scottish Government has timed the introduction of the bill to enable the University of St Andrews to award jointly with the University of Dundee medicine degrees to Scottish graduates from the medicine programme in advance of the first cohort graduating in 2022. Surely that is a good thing.
In my opinion, it is wrong to prevent any academic institution from offering a degree in a controlled subject in which its counterparts elsewhere can offer degrees. The committee heard evidence from other institutions, which, from what I could see, feel a bit threatened by the University of St Andrews getting involved in the field. However, the idea of competition and further options for students is a good thing.
Sometimes, we all broadly agree a way forward for a bill. Those times do not come around very often, but this should be and is one of them. I believe that the bill presents a positive way forward for the institutions involved. I encourage colleagues to agree with the bill’s general principles and to vote for that at decision time tonight.
The Presiding Officer
We move to the closing speeches.16:28
Claire Baker (Mid Scotland and Fife) (Lab)
I am pleased to close the debate for Labour and to support the stage 1 report and the general principles of the bill. The bill is a short one with a clear intent, and it has our full support. It has been interesting to read and listen to members talk about why St Andrews is in the unique position of not granting degrees in medicine or dentistry.
The cabinet secretary will know that I have raised the difficulties that come from a shortage of GPs. There are shortages in Kirkcaldy in particular, but there are challenges with recruitment across Fife and other parts of Scotland. The difficulties that health boards and integration joint boards face in recruiting and retaining GPs and primary care staff are well known. There has been a steady flow of retirals and resignations in Fife, and it is proving very difficult to replace those people.
In Fife, a number of GP practices operate with closed lists and a number have had to come under the control of NHS Fife. Too many practices rely on locum cover and are described as being high risk. The situation has also led to difficulties in delivering out-of-hours services in local hospitals. Other members have referred to the situation in St Andrews and to the closure of a palliative care ward in Methil when a responsible medical officer could not be identified.
There are a number of solutions and responses to the crisis in GP numbers. In response to the questions that I have raised, the cabinet secretary has often highlighted the ScotGEM programme. As a Mid Scotland and Fife MSP, I am pleased that the course—which is the first graduate entry medical degree that is aimed at graduates who are interested in a career in general practice—has been developed. The focus on rural medicine and healthcare improvement is welcome, and I support the financial incentive that is offered. We are competing in an international market for healthcare staff, and I hope that graduates of the ScotGEM programme decide to commit to the NHS on graduation.
The model that has been created at St Andrews and Dundee universities is innovative, and I welcome the fact that the first students are due to graduate in 2022. It is interesting to see the students’ background, the different workplaces that they have come from and the variety of experience that they bring to the course. Their expectation is that they will graduate with a joint degree in medicine from St Andrews and Dundee, and the short bill before us will enable that to happen.
As other members have highlighted, the repeal of the legal prohibition on the awarding of medicine and dentistry degrees is broader than the intention and aim of the bill. During the evidence stage, that raised questions about the interest that the University of St Andrews has expressed in awarding medicine degrees, in addition to the joint degree that graduates of the ScotGEM programme will be awarded.
The Aberdeenshire health and social care partnership and the University of Dundee have expressed a preference for a partial removal of the prohibition. The partnership between Dundee and St Andrews universities has led Dundee university to express concerns about training capacity for its students if St Andrews university were to start awarding medicine degrees, and about its ability to place students in local hospitals. In other words, it is concerned about capacity and competition. The AHSCP is concerned about the impact on the retention of school leavers and graduates in the north-east if St Andrews university were to change its offer.
St Andrews university has argued—rightly, I think—that complete removal of the prohibition is needed to address the issue of fairness and to allow it to compete with other institutions. The policy memorandum says that the prohibition
“is unfair, anti-competitive and serves no legitimate purpose in today’s context.”
As the cabinet secretary said, she does not support a partial removal of the prohibition. She argues that it was always intended to be temporary, and that it is unfair. It is unclear whether the ScotGEM programme was the catalyst for that change or whether that argument had already been had and won.
Although the bill will allow St Andrews university to award medicine and dentistry degrees, a number of measures will have to be taken first: the GMC must approve such institutions, and there are financial restrictions. St Andrews university has made its intention clear and has submitted a bid as part of the open competitive commissioning process to develop proposals for a new medical school that was set out in the 2019 programme for government. While that process is currently suspended, the bill will allow St Andrews to pursue its plans.
When any decision is made, it will be important to consider the points that have been made on widening access, NHS recruitment and the potential impact on the north-east. However, such decisions are outwith the immediate concerns of the bill. I fully support what the bill seeks to achieve as regards the ScotGEM programme, and I think that there is a positive case for St Andrews university to expand its offer in the future.16:32
Brian Whittle (South Scotland) (Con)
I am very pleased to close the debate on behalf of the Scottish Conservatives and as a member of the Health and Sport Committee.
I would like to start by reflecting comments that Liz Smith and others have made about how pertinent the bill is. It is true that Covid has focused all our attention on the importance of our healthcare sector. We cannot say enough that we are eternally grateful. Liz Smith also talked about the important work that universities do in research and innovation. The University of St Andrews has always been to the fore in that regard.
As others have said, the aim of the bill is to remove a legislative prohibition that prevents the University of St Andrews from holding qualifying exams and awarding degrees in medicine and dentistry. The reason for taking action at this time is to allow the university, jointly with the University of Dundee, to award undergraduate primary UK medical qualifications to Scottish graduate entry medicine students.
The first set of students are due to complete their four-year course and graduate in 2022. The premise of the bill, as set out in the policy memorandum, is that the prohibition is unfair and anti-competitive and no longer serves a purpose and that, therefore,
“In removing the prohibition, the Bill creates a fairer higher education sector and enables all of Scotland’s ... institutions to maximise the options and opportunities they offer to students in Scotland.”
The bill’s importance is evident from the well-documented background, which is that Scotland is generally short of general practitioners. Donald Cameron rightly raised that issue, suggesting that we are about 850 GPs short of the number we need. Therefore, any move to tackle that long-standing issue should be given due consideration, especially for people in rural communities. That is a situation that the Scottish Government has presided over. On the lifting of the prohibition being targeted specifically at the lack of GPs in rural areas, I note that my area, like Donald Cameron’s, suffers from that.
There was widespread general support for the repeal of the prohibition in both written submissions and oral evidence. One of the main reasons for that support was that it would bring the University of St Andrews into line with other medical schools in Scotland and allow it to award the ScotGEM PMQ jointly with the University of Dundee. As our convener said, ScotGEM argued that students enrolling in the programme of study were given a clear expectation that their degrees would be jointly awarded by the University of St Andrews and the University of Dundee.
The University of Dundee, however, supported the prohibition being removed only partially, for the purposes of ScotGEM, with it remaining in place for all other degree-awarding purposes. According to the policy memorandum, that was on the basis that there would potentially be adverse and unintended consequences for the education and training environment in Scotland. The committee explored that issue, asking, in effect, whether the bill would serve only to dilute the number of graduates across more universities. The cabinet secretary gave us assurances that that would not be the case.
We support the ScotGEM programme and we support the removal of the prohibition in order to allow the University of St Andrews to award degrees in medicine and dentistry. We recognise that the prohibition is unfair and that it was not intended to remain in place permanently. For that reason, a partial removal of the prohibition would not be appropriate. The issue of whether the University of St Andrews will compete to establish a new medical school is not provided for in the bill and it does not require additional legislative changes.
Discussions about proposals for a new medical school have been postponed, but we consider that it would be prudent, when they resume, for them to consider the wider evidence that we heard on NHS recruitment and the widening of access to medicine during our scrutiny of the bill.
We will support the bill at stage 1 at decision time this evening and we look forward to it progressing to stages 2 and 3.16:36
I am grateful to members for their contributions. I found them all very interesting. They included a degree of history and a degree of insight. I am particularly grateful for the level of support that members are offering the bill at stage 1.
As colleagues said, it is a single-purpose bill. I emphasise that so that we are all clear that the passing of the bill, once it has gone through stage 2 and come back to Parliament at stage 3, will neither be determinative nor provide for the University of St Andrews to offer a full PMQ medicine degree on its own. That is a matter for future discussions. Claire Baker set out clearly what will need to happen should we have another medical school that is separate from the existing medical schools.
I want to single out a few points that have been made. I particularly agree with the points that Alex Rowley made in expressing his support for the bill. Willie Rennie made the point, again in support of the bill, that the University of St Andrews is the only higher education institution in the whole UK that is barred from offering a degree in a discipline. What we are trying to do, as members have acknowledged, is simply to remove a prohibition that was never intended to be anything other than transitionary and whose continuance is unfair on the particular institution but also on higher education across Scotland as a whole.
Emma Harper made an important point about the importance of rural medicine, which I will return to, and Liz Smith made an important point with respect to research.
On rural medicine, I agree with Daniel Johnson’s point. I would never gainsay the challenges that we have in general practice and other areas of our NHS, and there is a lot of work for us to do in rebuilding our health service following the pandemic. I hope that that will not necessarily be done exclusively on a business-as-usual basis but will involve some of the innovative thinking and delivery with which we have seen our health service respond to the pandemic.
However, I make the point in passing—I am sure that Mr Cameron could not help himself—that Scotland has more GPs per 100,000 of the population than any other part of the United Kingdom. Of course, we seek to increase that and improve on that position.
That brings me to ScotGEM, which is a very innovative programme that is designed and delivered by both the University of St Andrews and the University of Dundee. They are to be congratulated on that. It has a number of special elements, such as the use of general practitioners as clinical teachers and a focus on rural practice and rural medicine. In my two years as health secretary, I have understood very clearly that there is much about the delivery of rural medicine that is important for those in more urban settings to learn from.
I was asked about the bursary. For every year of bursary, students commit to working for NHS Scotland for one year, on graduation. Ninety-four per cent of the current ScotGEM cohort of 165 students have made that commitment. It is clear to me that those students will be retained by NHS Scotland for at least an initial period—and, I am sure, for much longer.
Daniel Johnson made well a point about ScotGEM offering us an insight into the widening ways in which people can access routes into medicine, and I hope that we will see more such innovative approaches to medical undergraduate education.
In conclusion, I repeat my thanks to members. The bill has a single purpose but is very important. I am grateful for members’ support. I hope that Parliament will agree later to support the general principles of the bill at stage 1, and I look forward to stages 2 and 3.
The Presiding Officer
That concludes the debate on the University of St Andrews (Degrees in Medicine and Dentistry) Bill. As the cabinet secretary has said, the vote on the bill will come at decision time. I warn members that we are running about 25 minutes late, following the earlier connectivity issues.
26 January 2021
Vote at Stage 1
Vote at Stage 1 transcript
The Presiding Officer (Ken Macintosh)
There are two questions to be put as a result of today’s business. The first question is, that motion S5M-23946, in the name of Jeane Freeman, on the University of St Andrews (Degrees in Medicine and Dentistry) Bill at stage 1, be agreed to.
If members disagree, I ask them to put an “N” in the chat box function of the BlueJeans app. There is no need to indicate if you agree.
There is no disagreement, so we are all agreed.
Motion agreed to,
That the Parliament agrees to the general principles of the University of St. Andrews (Degrees in Medicine and Dentistry) Bill.
The Presiding Officer
The next question is, that motion S5M-23803, in the name of Gil Paterson, on the Post-mortem Examinations (Defence Time Limit) (Scotland) Bill at stage 1, be agreed to.
Again, I ask members to put an “N” in the chat box if they disagree.
That is not agreed. There will be a division. In order to vote, we must temporarily suspend the broadcast to allow members to access the voting app.17:42 Meeting suspended.
17:50 On resuming—
The Presiding Officer
Thank you, colleagues. We will move straight—[Inaudible.] I think that you were having difficulty hearing me, but you should be able to hear me okay now.
We move to the vote on motion S5M-23803, in the name of Gil Paterson, on the Post-mortem Examinations (Defence Time Limit) (Scotland) Bill at stage 1. This will be a two-minute vote.
The vote is now closed. I encourage any member who was not able to vote to let me know in the chat box.
A couple of members would like to make points of order. I will call them shortly. I ask any other members who had difficulty voting to let me know in the chat box. I can assure Gil Paterson that his vote was registered.
I call David Stewart to make a point of order.
David Stewart (Highlands and Islands) (Lab)
I had some difficulties with voting, Presiding Officer. I would have voted yes.
The Presiding Officer
Thank you. You will be added to the voting register.
Baillie, Jackie (Dumbarton) (Lab)
Baker, Claire (Mid Scotland and Fife) (Lab)
Beamish, Claudia (South Scotland) (Lab)
Boyack, Sarah (Lothian) (Lab)
Fee, Mary (West Scotland) (Lab)
Findlay, Neil (Lothian) (Lab)
Finnie, John (Highlands and Islands) (Green)
Grant, Rhoda (Highlands and Islands) (Lab)
Gray, Iain (East Lothian) (Lab)
Greer, Ross (West Scotland) (Green)
Griffin, Mark (Central Scotland) (Lab)
Harvie, Patrick (Glasgow) (Green)
Johnson, Daniel (Edinburgh Southern) (Lab)
Kelly, James (Glasgow) (Lab)
Lamont, Johann (Glasgow) (Lab)
Leonard, Richard (Central Scotland) (Lab)
Macdonald, Lewis (North East Scotland) (Lab)
Marra, Jenny (North East Scotland) (Lab)
McNeill, Pauline (Glasgow) (Lab)
Paterson, Gil (Clydebank and Milngavie) (SNP)
Rowley, Alex (Mid Scotland and Fife) (Lab)
Ruskell, Mark (Mid Scotland and Fife) (Green)
Smith, Elaine (Central Scotland) (Lab)
Smyth, Colin (South Scotland) (Lab)
Stewart, David (Highlands and Islands) (Lab)
Wightman, Andy (Lothian) (Ind)
Adam, George (Paisley) (SNP)
Adamson, Clare (Motherwell and Wishaw) (SNP)
Allan, Dr Alasdair (Na h-Eileanan an Iar) (SNP)
Arthur, Tom (Renfrewshire South) (SNP)
Balfour, Jeremy (Lothian) (Con)
Ballantyne, Michelle (South Scotland) (Reform)
Beattie, Colin (Midlothian North and Musselburgh) (SNP)
Bowman, Bill (North East Scotland) (Con)
Briggs, Miles (Lothian) (Con)
Brown, Keith (Clackmannanshire and Dunblane) (SNP)
Burnett, Alexander (Aberdeenshire West) (Con)
Cameron, Donald (Highlands and Islands) (Con)
Campbell, Aileen (Clydesdale) (SNP)
Carlaw, Jackson (Eastwood) (Con)
Carson, Finlay (Galloway and West Dumfries) (Con)
Chapman, Peter (North East Scotland) (Con)
Coffey, Willie (Kilmarnock and Irvine Valley) (SNP)
Constance, Angela (Almond Valley) (SNP)
Corry, Maurice (West Scotland) (Con)
Crawford, Bruce (Stirling) (SNP)
Cunningham, Roseanna (Perthshire South and Kinross-shire) (SNP)
Denham, Ash (Edinburgh Eastern) (SNP)
Dey, Graeme (Angus South) (SNP)
Doris, Bob (Glasgow Maryhill and Springburn) (SNP)
Dornan, James (Glasgow Cathcart) (SNP)
Ewing, Annabelle (Cowdenbeath) (SNP)
Ewing, Fergus (Inverness and Nairn) (SNP)
Fabiani, Linda (East Kilbride) (SNP)
FitzPatrick, Joe (Dundee City West) (SNP)
Forbes, Kate (Skye, Lochaber and Badenoch) (SNP)
Fraser, Murdo (Mid Scotland and Fife) (Con)
Gibson, Kenneth (Cunninghame North) (SNP)
Gilruth, Jenny (Mid Fife and Glenrothes) (SNP)
Gougeon, Mairi (Angus North and Mearns) (SNP)
Grahame, Christine (Midlothian South, Tweeddale and Lauderdale) (SNP)
Greene, Jamie (West Scotland) (Con)
Hamilton, Rachael (Ettrick, Roxburgh and Berwickshire) (Con)
Harper, Emma (South Scotland) (SNP)
Harris, Alison (Central Scotland) (Con)
Haughey, Clare (Rutherglen) (SNP)
Hepburn, Jamie (Cumbernauld and Kilsyth) (SNP)
Hyslop, Fiona (Linlithgow) (SNP)
Halcro Johnston, Jamie (Highlands and Islands) (Con)
Kerr, Liam (North East Scotland) (Con)
Kidd, Bill (Glasgow Anniesland) (SNP)
Lindhurst, Gordon (Lothian) (Con)
Lochhead, Richard (Moray) (SNP)
Lockhart, Dean (Mid Scotland and Fife) (Con)
Lyle, Richard (Uddingston and Bellshill) (SNP)
MacDonald, Angus (Falkirk East) (SNP)
MacDonald, Gordon (Edinburgh Pentlands) (SNP)
MacGregor, Fulton (Coatbridge and Chryston) (SNP)
Mackay, Rona (Strathkelvin and Bearsden) (SNP)
Macpherson, Ben (Edinburgh Northern and Leith) (SNP)
Maguire, Ruth (Cunninghame South) (SNP)
Martin, Gillian (Aberdeenshire East) (SNP)
Mason, John (Glasgow Shettleston) (SNP)
Mason, Tom (North East Scotland) (Con)
Matheson, Michael (Falkirk West) (SNP)
McAlpine, Joan (South Scotland) (SNP)
McArthur, Liam (Orkney Islands) (LD)
McKee, Ivan (Glasgow Provan) (SNP)
McKelvie, Christina (Hamilton, Larkhall and Stonehouse) (SNP)
McMillan, Stuart (Greenock and Inverclyde) (SNP)
Mitchell, Margaret (Central Scotland) (Con)
Mountain, Edward (Highlands and Islands) (Con)
Mundell, Oliver (Dumfriesshire) (Con)
Rennie, Willie (North East Fife) (LD)
Robison, Shona (Dundee City East) (SNP)
Ross, Gail (Caithness, Sutherland and Ross) (SNP)
Rumbles, Mike (North East Scotland) (LD)
Russell, Michael (Argyll and Bute) (SNP)
Scott, John (Ayr) (Con)
Simpson, Graham (Central Scotland) (Con)
Smith, Liz (Mid Scotland and Fife) (Con)
Somerville, Shirley-Anne (Dunfermline) (SNP)
Stevenson, Stewart (Banffshire and Buchan Coast) (SNP)
Stewart, Alexander (Mid Scotland and Fife) (Con)
Stewart, Kevin (Aberdeen Central) (SNP)
Swinney, John (Perthshire North) (SNP)
Todd, Maree (Highlands and Islands) (SNP)
Tomkins, Adam (Glasgow) (Con)
Torrance, David (Kirkcaldy) (SNP)
Watt, Maureen (Aberdeen South and North Kincardine) (SNP)
Wells, Annie (Glasgow) (Con)
Wheelhouse, Paul (South Scotland) (SNP)
White, Sandra (Glasgow Kelvin) (SNP)
Whittle, Brian (South Scotland) (Con)
Wishart, Beatrice (Shetland Islands) (LD)
Yousaf, Humza (Glasgow Pollok) (SNP)
Neil, Alex (Airdrie and Shotts) (SNP)
The Presiding Officer
The result of the division on motion S5M-23803, in the name of Gil Paterson, on the Post-mortem Examinations (Defence Time Limit) (Scotland) Bill at stage 1, is: For 26, Against 90, Abstentions 1.
Motion disagreed to.
The Presiding Officer
That concludes our business this evening. We will be back in a hybrid meeting of Parliament tomorrow.Meeting closed at 17:56.
26 January 2021
Stage 2 - Changes to detail
MSPs can propose changes to the Bill. The changes are considered and then voted on by the committee.
Changes to the Bill
MSPs can propose changes to a Bill – these are called 'amendments'. The changes are considered then voted on by the lead committee.
The lists of proposed changes are known as a 'marshalled list'. There's a separate list for each week that the committee is looking at proposed changes.
The 'groupings' document groups amendments together based on their subject matter. It shows the order in which the amendments will be debated by the committee and in the Chamber. This is to avoid repetition in the debates.
How is it decided whether the changes go into the Bill?
When MSPs want to make a change to a Bill, they propose an 'amendment'. This sets out the changes they want to make to a specific part of the Bill.
The group of MSPs that is examining the Bill (lead committee) votes on whether it thinks each amendment should be accepted or not.
Depending on the number of amendments, this can be done during one or more meetings.
Meeting at Stage 2
No amendments were submitted at Stage 2
Meeting at Stage 2 transcript
The next item of business is stage 2 consideration of the University of St Andrews (Degrees in Medicine and Dentistry) Bill. I welcome the Cabinet Secretary for Health and Sport, Jeane Freeman, who is the minister in charge of the bill. No amendments have been lodged, so I invite the cabinet secretary to make a brief statement to put our formal consideration into context.
The Cabinet Secretary for Health and Sport (Jeane Freeman)
Thank you, convener, for the opportunity to make a brief statement on the bill. As colleagues are aware, this is a technical single-purpose bill. I will recap. The bill’s purpose is to repeal an archaic, unfair and, arguably, anticompetitive prohibition that prevents the University of St Andrews from awarding medicine and dentistry degrees. The prohibition was not intended to last for any significant length of time.
The bill has been introduced at this time to enable the University of St Andrews to award, jointly with the University of Dundee, primary medical qualification degrees to Scottish graduate entry medicine—ScotGEM—students in advance of the first cohort graduating in 2022.
I welcome and appreciate the Scottish Parliament’s unanimous support for the bill at stage 1 and for the committee’s scrutiny of the bill and its support for the ScotGEM programme as a whole, which is Scotland’s first graduate entry programme for medicine.
As no amendments have been lodged for consideration at stage 2, I have nothing further to add.
Thank you very much, cabinet secretary. The only requirement for the committee this morning is to consider and dispose of the three sections of the bill and the long title.
Sections 1 to 3 agreed to.
Long title agreed to.
That concludes our stage 2 consideration of the bill. I thank the cabinet secretary for attending the committee and members for their attention. No doubt we will have the stage 3 debate on the bill in the next wee while.11:51 Meeting continued in private until 12:02.
23 February 2021