What’s the University of St Andrews (Degrees in Medicine and Dentistry) Bill all about?

The first scheduled piece of higher education legislation for 2021 is a delight. David Kernohan describes the complex past of medical provision in the Kingdom of Fife.

David Kernohan is an Associate Editor of Wonkhe

Imagine a government hiving off half of an ancient university to found a new one, and then forbidding the old one to offer competing degrees.

Had the university been destroyed two centuries ago, we should not have regretted it; but to see it pining in decay and struggling for life, fills the mind with mournful images and ineffectual wishes

A medieval university that had been painfully described thus by Samuel Johnson once found a new spirit by embracing the Humboldtian rush to science and solvency in the form of a challenger provider in a growing town a few miles to the north. That challenger provider eventually gained degree awarding powers in its own right – and now the government must rule on a half-century old legislative bar to competition.

A curious restriction

The University of St Andrews has a well-regarded medical school, but since the promulgation of the Universities (Scotland) Act 1966 it has been forbidden to award medical degrees. Though it currently offers a BSc in Medicine, students must leave St Andrews to study at another provider in Scotland (Aberdeen, Dundee, Edinburgh, or Glasgow) or even England (Manchester – where all overseas students must complete their studies, or Queen Mary University of London). The University of St Andrews (Degrees in Medicine and Dentistry) Bill seeks to address this discrepancy, at least with regard to one specific course.

The 1966 Act prohibited St Andrews to grant medical degrees in order to give the fledgling University of Dundee a chance to establish its own medical provision. What’s fascinating is that the University of Dundee was created from the old St Andrews Queens College, which itself was formerly known as University College Dundee. There was a period in the early twentieth century when Queen’s College – including the medical school – was as large as, and was growing faster than, the original institution.

By order of the First Minister

Among the four “ancient” universities of Scotland St Andrews is unique in this regard. Nobody else in Scotland has to rely on other providers to train doctors. But it has taken until 2021 to rectify this because St Andrews now wants to award graduate entry medicine (ScotGEM) degrees for practitioners interested in general practice in underserved areas, with the first cohort due to graduate in 2022. This unique course is offered jointly with – you guessed it – the University of Dundee medical school, with the University of the Highlands and Islands supporting links to the NHS in the Highlands and Dumfries and Galloway.

Primary legislation in Scotland is not the only hurdle this course needs to overcome – the graduate entry programme also awaits approval from the General Medical Council, which is expected in 2022 following a detailed quality assurance process specific to the joint programme. It all feels a bit late in the day for a programme that was an initiative announced by the First Minister in 2016. Students shouldn’t worry however, the fallback position is for only the University of Dundee (which already holds GMC approval) to award the degree. But they do – the 60 or so students signed up for a joint degree, and expect one.

Should St Andrews fancy kicking off a traditional medical or dental degree it would face another problem, even if this legislation passes – medicine is a controlled subject in Scotland, so permission from the Scottish Funding Council would be required. St Andrews actually had a bid in to SFC to seek this permission – assessment was postponed in March 2020, and further progress now looks less likely as a wider assessment of provision is likely to be needed after the pandemic has been controlled.

“Not a zero-sum game”

The University of St Andrew (Degree in Medicine and Dentistry Bill) may feel like a long overdue change to some outmoded legislation, but a consultation saw one competitor provider argue for a partial repeal. That provider – of course – the University of Dundee.

Dundee claims that the ScotGEM programme was originally to be awarded by the University of Dundee only but that it was asked to revise the application (one assumes by the Scottish Government) so the degree would be awarded jointly by both providers. St Andrews disputes this, but Dundee maintains it agreed to the condition on the basis it would support the reinstatement of medical degree awarding powers to St Andrews for the ScotGEM programme only. In the stage one committee interim Principal of Dundee David Maguire said, explicitly

We do not think that Scotland needs another medical school at undergraduate level.

Why? Medical schools compete not just for funded places but for placements within the NHS. As Maguire noted, medical education is not a zero-sum game – a new undergraduate medical school (on the geographical doorstep of Dundee, with which it would be a clear local competitor – nationally no other university has raised a concern) would compete for both and leave less to go round everyone else. Maguire advocated for the partial repeal of the 1966 rules to allow for the ScotGEM programme to run, but was clear that the unique legislative restriction on medical provision at St Andrews should continue outside of ScotGEM and existing BSc and postgraduate courses.

Just to recap, we have a university formed from a former college of another university, awarding a joint degree with that same university while complaining about the requirement to pass broad primary legislation to allow that same university to do so, and acting as the backstop should the legislation not pass. Only in Scotland.

We can only be grateful that there has never been a case in England of a successful medical school being split from an older provider into a new university in the 1960s. Well, only one – but at least Durham can still technically award medical degrees in competition with Newcastle. Which it did, until 2017, when the Durham University School of Medicine, Pharmacy and Health (based largely at the Queen’s College campus in Stockton-on-Tees was transferred into Newcastle University Medical School.

You can watch proceedings today from Holyrood.

4 responses to “What’s the University of St Andrews (Degrees in Medicine and Dentistry) Bill all about?

  1. A good summary, David. Interestingly the university is also prohibited from awarding degrees in “Midwifery” – which, it seems, is essentially obstetrics – as there were no degrees in midwifery in 1966 – but that was also part of the debate. Of course midwifery is also a controlled subject, so it still can’t do that without permission from SFC.

  2. Durham isn’t able to award medical degrees. The medicine programme (‘Diploma in Medical Studies’) was Phase i of a degree where students transferred to Newcastle for Phase II and award of degree. It was carefully constructed to comply with the 1963 Act.

  3. “Only in Scotland.” I think this misses the point that the location of the University of St Andrews as an ‘ancient’ university was dictated by ecclesiastical principles rather than the need to serve a population. There are less than 20,000 people living in St Andrews itself – it’s a big village. Dundee is Scotland’s fourth largest city and is only 13 miles away. Medical Schools are a hugely expensive investment for the taxpayer and do need to have proper access to NHS facilities and centres of population. Unlike the English tradition, there has been a more rational approach to planning in Scottish HE, over decades, and of course Scottish-domiciled undergraduates pay no fees so it is an important element of public spending. I see nothing wrong with the Scottish Parliament/Government, and before it the Scottish Office Education Department, attempting to bring some rational organisation and planning to the training of medics rather than leave everything to the vagaries of the market. Hopefully agreement can be reached between the various parties that provides cost effective and sustainable medical training that produces value for money for the taxpayer like me stumping up for it – we are going to need it in the future.

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