Fault lines are emerging between England and post-devolution Scotland in higher education and health, according to the principal of Dundee University.
Sir Alan Langlands, former chief executive of the National Health Service in England, gave the Queen Elizabeth the Queen Mother fellowship lecture, "Synchronising Higher Education and the NHS", for the Nuffield Trust in London last week.
Divergent routes were being taken north and south of the border, he said.
England was introducing top-up fees in 2006 while the Scottish political parties rejected this, and England was creating foundation hospitals while Scotland was abolishing NHS trusts.
He said it was crucial for the NHS and higher education to work together to tackle the nation's health and to meet the needs of the local population.
Universities must try to align their research portfolios with national and local health-service priorities. Both sectors faced similar short-term challenges of dealing with a legacy of underspending and developing facilities, employment policies and competitive salaries to attract and to keep high-quality staff, Sir Alan said.
There would be enormous pressure on Scottish politicians to match the higher funding levels fuelled by top-up fees. But he believed the opportunities from changes in policy should outweigh the threats.
"Higher levels of funding, improved information systems for patient care and research and the way in which more explicit service and professional standards now inform the education of doctors, nurses and the allied health professions are all very positive signs," he said.
"With the drive to achieve better value for increasing investment in health, it is reasonable to challenge the beneficiaries, including medical schools, to demonstrate the contribution they are making to better health and more effective services."
Sir Alan added that medical schools' social accountability should not begin and end with local responsibilities. "There is an urgent need for continuing effort to upgrade the skills and capability of healthcare professionals in the poorer countries of the world. The response from the developed world should not be to recruit from these countries but to provide support."
Dundee is one of the key institutions behind the International Virtual Medical School (Ivimeds), which aims to give medical students throughout the world access to international expertise through a combination of e-learning and local clinical experience.