Specialty Medical Training

Baroness Blake of Leeds Excerpts

Thursday 17th July 2025 Grand Committee

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I thank the noble Lord, Lord Lansley, for instigating this debate and the noble Baroness, Lady Finlay, and noble Lords for their contributions. We have had a rich discussion. I will not be able to answer all the points raised, as I am sure noble Lords are aware, but this is extremely topical and essential to determining the way forward through the 10-year plan and the workforce plan, as noble Lords have referred to. To pick up on what the noble Baroness, Lady Finlay, said, at a time when morale is quite low across the piece, for reasons we do not need to go into now, focusing on how we harness potential and make entry into these professions fit for purpose, exciting and rewarding must be at the heart of everything we do.

We must be honest that the Government have inherited a system where competition for specialty training posts has grown significantly in recent years. In 2024, there were 4.7 applications per training post, an increase from 2.4 in 2020. That is a significant change. We recognise the frustration this has caused resident doctors and that their career progression is becoming a lot more complicated. I reassure the noble Lord, Lord Lansley, that we are committed to tackling this.

There are multiple reasons why competition ratios have grown. As a result of changes to the Immigration Rules in 2020, international graduates have been able to apply on equal terms with domestic graduates. We are also seeing more people graduate from UK medical schools, as we have heard. More domestic graduates are entering training, a number of private medical schools have opened and some UK universities now run medical courses at overseas campuses. All this creates a perfect storm. Like the noble Lord, Lord Lansley, we welcome the increase in the number of graduates, but we need to work on managing the process of dealing with it.

As a Government, we have consistently acknowledged the concerns of resident doctors and are actively working to address them. As set out in the 10 Year Health Plan for England published on 3 July, we recognise that we need to work across government to prioritise UK medical graduates for foundation training. We will also prioritise UK medical graduates and other doctors who have worked in the NHS for a significant period for specialty training. We recognise that internationally trained staff remain an important part of the workforce, but there is an explicit understanding that we have become overreliant on them and must address this, as the noble Baroness, Lady Finlay, mentioned.

We are aware of the concerns about specialty places, particularly in certain specialties. Without doubt, the NHS and universities must do more to get doctors into the specialties where the NHS and patients—we must remember patients’ needs throughout this—need them. As I said, the Government will address this head-on. As the noble Baroness, Lady Finlay, mentioned, the flow of this is critical.

To respond to the noble Lord, Lord Rennard, our 10-year health plan commits to creating 1,000 new specialty training posts over the next three years, with a focus on specialties where there is greatest need. I will have to write to the noble Lord, Lord Lansley, on his point about this. We cannot make specific geographic commitments, but we recognise that this is an issue. That is why the 10-year plan focuses on neighbourhood planning, bringing together all the experts in an area.

The 10-year workforce plan will be published later this year to create a workforce ready to deliver a transformed service. This is becoming a bit repetitive, but I have to say to the noble Lord, Lord Kamall, that I cannot pre-empt the outcome of that work. However, it is significant. We recognise the comments on bottlenecks and emergency medicine and the comments of the noble Lord, Lord Kakkar, on locally employed doctors—a fundamental part of the picture—and the need for clarity. That absolutely runs through the work we are doing.

So the workforce will be more empowered, more flexible and more fulfilled. The whole basis running through the 10-year workforce plan is to ensure that the NHS has the right people in the right places with the right skills to care for patients when they need it. I emphasise to the noble Lord, Lord Rennard, that social care runs through this. We absolutely recognise that it is critical that we deal with this. We want to make sure that the noble Baroness, Lady Casey, is allowed to get on with the work. She is committed to working cross-party and bringing all the experts together to tackle this. I did not know about the work that the noble Lord, Lord Kamall, was doing with Lord Lipsey, and I am grateful for his comments.

The noble Lord, Lord Kakkar, asked about how this will be done. It is a huge amount of work, and he is absolutely right to focus on how it will be done. The important thing is that we are asking the question. Given our reform plan, what workforce do we need? What should they do? Where should they be deployed? What skills should they have? This is reflected in the three shifts in the 10-year plan. We will use a range of methods to determine this, including traditional modelling, of course, and in discussion with those who deliver these services, local system leaders and planners, higher education institutions, which are absolutely critical in this, and, of course, the royal colleges. It is critical that our whole workforce is fit for the future, and we are determined to make that happen.

Interesting comments were made about a portfolio approach. The medical training review was launched in February, the consultation has come back in and we are looking forward to the report.

The Government have also committed to training thousands of new GPs. Perhaps I should have declared that my son is a GP—he got through—so I have had some personal experience in this area. It is important that we all pool our collective experience. We are committed to training thousands of new GPs and are already well on the way, having recruited an additional 1,900, and there will be an additional 250 later this year. But it is critical that we then address how they will be employed in the current estate, for example. That of course is addressed in the 10-year plan.

I want to reassure all noble Lords who mentioned concern about clinical academic roles. We will reverse the decline through a collaboration between the Government and major charity funders. The collaboration will fund a year-on-year increase in these roles over the next five years. We are also encouraging additional funders to support clinical future leader fellowships as the scheme develops. We agree that this needs to be a co-produced piece of work across the patch.

As I said, the Government understand the high level of competition. It comes at a time when many doctors are already feeling unhappy with their experience in work and in training. That is why we have laid out the 10-year health plan and the 10-year workforce plan, working together to address these issues.

We have been listening to doctors to make their working lives better. There is much more to do, but the NHS has been making good progress. We want our trainees to stay in this country. We recognise that a number of them go abroad, but many of them come back. We need to be very careful when we analyse the statistics in front of us. We are making progress with the improved exception reporting system, for example, reviewing rotational working and reducing mandatory training, which has been something of a nightmare. NHS England is also delivering the retention programme, working with trusts so they better understand why staff have left.

I thank noble Lords again for their time today. I know it is frustrating at this moment not to be able to answer all the specific questions, but I hope all noble Lords will recognise the significant pieces of work going on—

[Lord Lansley (Con)]

Just to return to a point I mentioned about supporting professional activities as part of consultant job plans, I think it would be very helpful if the Minister would say that, notwithstanding the prioritisation of delivering on things such as waiting list targets, consultant job plans must make provision in their contracts for them to commit their time to training activity.

[Baroness Blake of Leeds (Lab)]

I would be surprised if that was not already under consideration and, when the pieces that have been out to consultation come back in, I would expect that that would be part of the consideration. I certainly recognise the significance of the noble Lord’s comments.

I just want to reinforce that, as well as being in delivery mode, the Government are in listening mode. Over too many years, there has not been enough listening and enough recognising that people out there in the workplace have a lot of the solutions to some of the problems we are facing. It is complex and challenging, but the prize at the end of this work is well worth striving for and I look forward to updating noble Lords as we go forward.