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Chamber and committees

Meeting date: Tuesday, January 26, 2021

Meeting of the Parliament (Virtual) 26 January 2021

Agenda: Time for Reflection, Business Motion, Topical Question Time, Covid-19, Scotland’s Vision for Trade, University of St. Andrews (Degrees in Medicine and Dentistry) Bill: Stage 1, Post-mortem Examinations (Defence Time Limit) (Scotland) Bill: Stage 1, Decision Time


Contents


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

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.

I move,

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 to working an equivalent number of years 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—the ScotGEM degree programme is an example of that. 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 it 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’ backgrounds, 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 reiterating 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  

Jeane Freeman

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.