Health and Sport Committee

Meeting date: Tuesday, December 1, 2020

Official Report 610KB pdf

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University of St Andrews (Degrees in Medicine and Dentistry) (Scotland) Bill: Stage 1

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?

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.

Indeed—

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.

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?

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  

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.

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 reflects 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.

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.

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.

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.

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.