Medical Training (Prioritisation) Bill

Debate between Baroness Finlay of Llandaff and Lord Mohammed of Tinsley

Report stage
Monday 23rd February 2026 Lords Chamber

[Lord Mohammed of Tinsley (LD)]

My Lords, both amendments in this group are in my name. I start by saying that, despite the fact that we have had a short break since we discussed this previously, we have all had a lot of emails and commentary on the Bill as it has been going through your Lordships’ House. One point that people have queried, particularly around Amendment 3, is this: “Why is Lord Mohammed doing this? He must have some declarations of interest. He must have some personal gain to do what he is doing”.

For the record, I have three children. One works for Northern rail; the second, despite our best efforts, his mother’s in particular, to get him to go to medical school—we failed—went on to become a paramedic, and at the moment he is absolutely loving it. So it is highly unlikely that this Bill will affect him, and my daughter is not studying medicine or anything related. Therefore, the purpose of and the motive for me moving this amendment are around fairness and equity.

This would be a modest postponement. In rejecting this policy, we are not doing so outright. It is a necessary safeguard to ensure fairness for those who have already applied under the rules that existed when the current application cycle opened. As we heard in Committee, the core purpose of the Bill is to prioritise graduates with strong links to the UK, and NHS experience, as the noble Baroness, Lady Finlay, said earlier. It has broad support and is rooted in legitimate concerns about the balance between health, workforce supply and demand. However, the Government’s own planning documents indicate that for the 2026 recruitment, prioritisation is applied only at the offer stage because shortlisting has already occurred and the posts need to be filled by August; in other words, the legislation would apply part way through an active application cycle.

It is this timing that gives rise to the compelling fairness concerns at the heart of my amendments. Medical applicants make decisions in advance—far in advance. They invest years of study, financial cost and personal sacrifices based on published criteria. To change the criteria mid-application, with potential effects on eligibility, shortlisting, scoring or final offers, risks penalising those who complied fully with the rules as they stood when they applied. They cannot rewind their applications. They cannot be judged against a different standard. This is not theoretical. I have been contacted directly, as have many Members of your Lordships’ House, by candidates who face exactly this prospect under the current system. The core principle of procedural fairness and legitimate expectation is well established. Legislation, however well motivated, should not disadvantage applicants who acted in good faith. It should not reshuffle the deck once the cards have already been dealt.

A delay until 2027 would allow for clarity and proper stakeholder engagement and would ensure that no doctor is unfairly caught between two regimes. I emphasise that my amendment would not delay the policy indefinitely nor dilute its intention. It would simply align implementation with a natural application cycle. Therefore, I really hope that the Minister responds favourably.

Amendment 7 would replace the Government’s proposed immigration status criteria in the prioritisation framework with a test based on completion of

“at least two years of training or employment in a medical capacity within the National Health Service”.

The intent of the Bill to prioritise those who have strong links with UK medical training and the health service is not controversial, but to use indefinite leave to remain and other immigration categories as proxies for NHS experience is deeply problematic for me—and, I am sure, for many others. It risks both unfair outcomes and loss of clinical value for patients. In Committee, we heard detailed arguments about the unsuitability of immigration status as a measure of meaningful NHS experience, not least because it does not reflect who actually worked, trained or contributed here in the UK.

Under the Government’s current drafting, international medical graduates with indefinite leave to remain, settled status or citizenship would be prioritised irrespective of whether they have ever worked in the NHS—experience counts only if it fits within residency categories. Yet many doctors who arrived earlier on shorter visas have worked for years in the NHS, delivering front-line care throughout the pandemic pressures and workforce shortages. Their contribution is real, sustained and beneficial.

The British Medical Association has repeatedly emphasised that specialty training prioritisation should reflect clinical experience in the NHS, not simply legal residency status. The BMA has set out its position that international medical graduates who are GMC-registered and practising in the NHS and have at least two years’ experience should be prioritised.

This amendment aligns with that evidence-based and professionally grounded approach. Two years’ experience is clear, objective and legitimate, and a demonstrated threshold of contribution that is far more meaningful than a stamp in your passport. It would recognise those who have already invested in the UK system, who understand our clinical pathways and workforce needs, and who have delivered care for our patients. Critically, it would also avoid the injustice noted in Committee by several noble Lords about the category for either arbitrarily including or excluding applicants with negligible NHS ties. Doctors who arrive with ILR but have not delivered NHS care should not be automatically advantaged ahead of colleagues with years of service here. That simply cannot be justified on the grounds of fairness or workforce planning. Nor would the amendment prejudice the aim of prioritising UK medical graduates. It would supplement the Bill with additional criteria that would strengthen how NHS experience is recognised, supporting, not undermining, the long-term sustainability of the training pipeline.

The amendment strikes the right balance between policy ambitions and practical fairness. It would honour people’s contributions, support retention and strengthen the NHS workforce. I urge noble Lords to support it, and I hope the Minister will speak in favour of it.

[Baroness Finlay of Llandaff (CB)]

My Lords, I will go back to the question of Oriel and the prioritisation processes. It collects a full employment history from graduation and requires applicants to confirm whether each post was paid NHS experience. I hope the Minister will be able to recognise that some have worked in a voluntary capacity before they were able to get paid employment in the NHS, and that some people, in trying to build up their criteria for eligibility to apply, have worked in non-medical posts in order to gain the background NHS experience that they need.

I have been sent a copy of a response that was sent by the Department of Health and Social Care to a query about specified immigration status, which states:

“In 2026 the Government is using these immigration statuses as a proxy to capture applicants who it believes will be most likely to have significant experience of working in the health service in the UK”.


It goes on to state that that prioritisation

“will be applied at the offer stage because shortlisting is already underway”,

which, of course, creates a lot of problems for people. I can see that there are difficulties in postponing this, because all the applicants are already in such a state of turmoil that to have a second year of turmoil may not be helpful to them in any sense.

There was a worrying sentence at the end of the second paragraph, saying that the Government

“will be aiming to have regulations in place for the autumn 2026 application round (subject to parliamentary timetable)”.

I hope the Minister will be able to assure us, given that this has been emergency legislation, that the regulations will be treated with a similar degree of urgency to remove any uncertainty for the next round of applicants.