Scottish Ministers appear to have a template press release which opens with the words: “We will not take any lectures from . . .”. The blanks are then filled in to dismiss critics and the alleged failures of the day.

This week, for example, Fiona Hyslop was “not taking any lectures from” those who drew inconvenient attention to the fact that an announcement made by the First Minister, with the usual fanfare 18 months ago, about creating “trade hubs” around Europe has so far yielded nothing.

I don’t expect Ministers to be any more willing to “take lectures from” political opponents about the latest NHS statistics. Unlike “trade hubs”, however, this is an issue involving life, death and injustice which cannot be batted away with bluster.

Fewer students from lower and mid-income backgrounds are graduating from medical school. Picture: Chris Ison/PA Wire

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Realistically, given the prevailing mindset, any acknowledgement of policy shortcomings and their implications is more likely to be in response to sources who cannot be accused of “lecturing” for political gain. That is why, in a spirit of festive conciliation, I commend to Ms Sturgeon and her colleagues a BBC Radio Scotland interview from last Sunday morning.

There could be no less political context than a fine conversation between Richard Holloway and Dr Gavin Francis about the latter’s work as a GP and travel writer. Asked for a view on why there are now fewer entrants to the medical profession from backgrounds like his own, Dr Francis gave a thoughtful response to which all Scottish politicians might usefully listen.

He had been “astonished” to learn that the five Scottish medical schools now “have a poorer record than English medical schools in attracting students from comprehensive schools”. In his day, a lot of Scottish kids aspiring to enter medicine could do so with “three As and two Bs”. For many years, that criterion had been retained precisely in order to “encourage a greater diversity and that is no longer the case”.

The knock-on effect of there being fewer medical students from state schools is that a lower proportion of the intake become GPs and an even smaller number want to work in the communities that need them most. Dr Francis quoted recent research from Dundee University which backs up these conclusions, so Shona Robison need not travel far to find it.

At this point, I should make clear that my quotes from Dr Francis are at an end and the extrapolations of thought are entirely my own, so we are back in “won’t be lectured by” territory. But for heaven’s sake, surely some reflection is needed, no matter who is pointing out such basic structural deficiencies and their social impacts.

A chain is not difficult to identify. University entrance leads to fewer medical students from state schools. Fewer medical students from state schools leads to a GP shortage, particularly in deprived communities. A GP shortage in deprived communities contributes to Scotland’s massive “health gap” and increases pressure on A&E… There is no point pretending these issues are not interlinked.

So where does one begin? I have long believed the Scottish approach to university funding is building up problems, undermining standards and should be urgently reviewed as a whole, rather than round the edges. At present, “free tuition” is a totem rather than a policy, yet the consequences are far-reaching and often counter-productive.

How can it be that England, where tuition fees exist, now has a better record than Scotland in attracting medical students from comprehensive schools? How, by the same token, can the English system, which allows tuition fees, be more successful than our own in offering university places to youngsters from less well-off backgrounds?

If “free tuition” did what it says on the tin then these outcomes should be impossible. But, of course, it does not – for free tuition is only one piece of a jigsaw. Other obvious ones are student debt and the entrance qualifications which Scottish universities operate in order to ensure they have as many foreign fee-paying students as possible. Both work against youngsters from lower and mid-income backgrounds.

It is usually thrown back at people like myself who grew up in a fees-free era that we want to deprive the current generation of the same advantage. This is the opposite of the truth. I am 100 per cent in favour of students who need the most support being free of fees, in receipt of grants and free of debt. Each of these elements is as important as the others, and the crucial point is that universalism fails to deliver them all for anyone.

Ostensibly at least, there is a broad consensus within the Scottish Parliament on the objectives for Higher Education. The downsides which the current system produces are inescapable – the inequalities surrounding access, the denial of opportunity to a significant number of Scottish students who could benefit from a university education (not least in medicine) and the financial crisis for which most of Scotland’s universities are heading.

Should it not be possible for there to be a grown-up debate on the future funding of Scottish higher education without it being strangled at birth with cat-calls about wanting to charge poor students £9000 a year which nobody, to my knowledge, has ever suggested? Probably not – but the longer that debate is delayed, the more unsustainable the status quo will become.

At this point, we are likely to hear about Brexit which is supposedly the new source of all evil. How will Scotland deal with its skills gaps (for example, in doctors and other medical staff) if we are deprived of immigrants from the EU?

This line of argument is undermined by the fact that recruitment problems exist in the here and now, before Brexit impinges upon anything.

I am all in favour of labour mobility, but is there not something morally dubious in assuming our caring services must depend on importing skilled workers from countries which probably need them at least as much as we do – especially when we have our own young people who, given the opportunity, are as capable of doing the jobs as in any generation past? That’s not a lecture. It’s a rhetorical question.

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