Terminally Ill Adults (End of Life) Bill

Baroness Gerada Excerpts

Committee stage
Friday 24th April 2026 Lords Chamber

[Baroness Mattinson (Lab)]

I am speaking very briefly so, if the noble Baroness does not mind, I will continue. Many of those stories have been told very movingly here today.

The point is that 52% of us have cared for or witnessed a family member who was terminally ill and suffering at the end of their life. Unsurprisingly, experience of this rises with age, up to 66% in the 50 to 64 year-old age group, and higher as you get beyond that. Research—for example, England’s first ever citizens’ jury, so more qualitative and deliberative research—tells us that support for law change grows the more that people understand the issue and hear about it.

Meanwhile, the backdrop to this debate is that trust in our democracy has never been lower. Too often, the public do not feel listened to. Confidence in this unelected Chamber is at its lowest ever: a desultory one in five has confidence in the House of Lords to do its job. At the end of last year, YouGov found that just 2% had a lot of confidence in the House of Lords and only 17% had some confidence. Some noble Lords have quoted a poll that suggests that the public would like to see us doing better scrutiny. Yes, in abstract, they absolutely would, but, with reference to this particular Bill, a YouGov poll recently found that 58% disagreed with the way the Lords has dismissed the Bill while only 17% found it acceptable. Again, public opposition rises, as you would expect, with greater experience by age, consistent with the lived experience of the impact and pain of the alternative.

As this debate draws to its close, we should all be aware that the way the Bill has been treated by this Chamber risks having profound implications for the Chamber itself and its reputation, as well as the absolute tragedy of ignoring the passionately held public view for assisted dying.

[Baroness Gerada (CB)]

My Lords—

[Baroness Lawlor (Con)]

My Lords—

--- Later in debate ---

[Baroness Gerada (CB)]

My Lords, I remind the House that Harold Shipman was a murderer convicted of 15 life sentences plus four years. He did not provide an assisted death. I would like that to be on the record.

I stand here as a general practitioner with over 40 years’ experience and, as I have said many times, as president and chair of the Royal College of GPs. Over the decades, I have had the privilege, though not always an easy one, to care for patients at the end of their lives. For some, I have been present at the moment when life passes to death. It is an extraordinary moment—not, as it is often portrayed, bleak or clinical or purely tragic, but something far different. When death is well supported, when it is anticipated and when it is held by family and those who care, it can be a moment of stillness, connection and a sense of peace that feels unexpectedly profound. It is one of the most powerful experiences I have ever had as a doctor. In those moments, one thing is always clear: the patient is at the centre. Their wishes, relationships and dignity all shape how that final phase of care unfolds when it goes well.

However, that is not the whole truth. I have also cared for many patients whose deaths have not gone well: patients who have refused treatments or have starved themselves rather than endure what lies ahead; patients who, sadly, have ended their own lives, unable to bear the weight of their diagnosis; and patients whose illnesses have taken away from them the ability to make their own decisions, and whose deaths have been placed into the hands of others—families, clinicians and the systems acting in their place.

That brings me to the heart of this debate. The question is simply, though uncomfortably: whose death is it? For decades, medicine has placed patient autonomy at the centre, bounded by capacity, consent, clinical judgment and protection from coercion. We speak of choice, dignity and the individual’s right to determine what happens to their own bodies; we have built systems, laws, safeguards and languages all around that. Yet, at the moment when autonomy might matter most—the manner and timing of one’s own death— it is withdrawn. At that point where a patient is dying, we say, “Not here. Not you”. To my mind, that is not just a tension but an inconsistency that demands reflection, which is what I have been doing over the last few months.

I say with respect that much of what I have heard in this House has strongly focused on risk, even today, but risk is not unfamiliar territory in medicine. It is our daily working environment. We do not eliminate uncertainty; we manage it. We make complex decisions every day about treatment, capacity and withdrawal of care under conditions of imperfect knowledge, guided by safeguards, judgment and professional accountability.

Alongside this focus on risk, there has been a tendency, again as I have heard today, to imagine worst-case scenarios and to construct arguments at their point of failure rather than their point of function— the “what if?”—and to build in increasing complexity to cover every possible scenario that might come up to manage these hypothetical fears. We have even heard today about the 100 languages that are spoken. How do we manage learning disability? How do we manage people who are disabled? We do this every single day, a million times per day.

Even the Chief Medical Officer, Sir Chris Whitty, warned in his oral evidence that we are

“layering layer upon layer of complex bureaucracy on top of one another”,

and, in my mind, expecting the dying patient to jump through endless hoops, be that having to see their GP six times in six months, living at the same address for 12 months or having repeated assessments. We have heard powerful testimonies about relatives who have died. Can you imagine, at the moment of their death, asking them to do repeated serial sevens—that is, counting backwards from 100 in sevens—or to draw a clock face to assess capacity?

Let me take my own profession: general practice. Listening to some of the debates here, one might think that when a patient receives a terminal diagnosis general practice fades away—that we retreat or that care fragments. This is not my experience, nor that of many of my colleagues. When a patient enters their final phase of life, general practice leans in. We intensify care; we place patients on dedicated pathways; we ensure rapid access to benefits; and we maintain continuity with a named clinician, who is more likely than not a GP. We co-ordinate care with community teams, palliative care specialists and families and we ensure that we do our best to provide continuity in and out of hours. We organise ourselves around the patient. We do not move away. Instead, we gather more closely. Are there failures? Yes, of course—no system is without them—but end-of-life clinicians across disciplines try, often beyond expectation, as I have, to keep the patient at the centre and to get it right.

Cancer Outcomes in the UK

Baroness Gerada Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Gerada (CB)]

My Lords, I am grateful to contribute to this debate, and I too thank the noble Lord, Lord Patel. I declare my interest: I am a practising GP just across the river, and, over the past 40 years, I have diagnosed and cared for many tens of thousands of patients with cancer. We currently use AI to help us: we use it with our e-consultation system, which can identify red flags. Together with our electronic medical records, that explodes at us and asks, “Have you thought of cancer?” We already have the brightest and the best; they are just located in general practice. As has been alluded to, I disclose that I am a former chair and president of the Royal College of General Practitioners.

I agree with many of the contributions that have already been made. In the contributions that I have made already in my short time here, I have drawn attention to the mounting pressures facing general practice and the implications for patients and the wider NHS, and I will focus briefly on that. I worry that initiatives such as the national cancer plan, which rightly place primary care at the forefront of early diagnosis and referral, are in danger of overestimating what general practice can realistically deliver in its current state for the patients we serve.

Without addressing the underlying constraints in the workforce, funding and capacity, we risk placing further pressure on a system that is already under real strain, as has been mentioned. In so doing, we may undermine the very ambitions that the plan is trying to achieve. These pressures are compounded in some areas by outdated or inadequate premises, which further restrict GPs’ ability to expand capacity and to do what is expected of us.

The Royal College of General Practitioners has repeatedly warned that general practice has not received a sufficient share of NHS funding to match rising demand. Without increased investment, the shift of care into the community will not be sustainable. The King’s Fund, which has been mentioned several times today, has highlighted a persistent structural imbalance in the NHS, with a higher proportion of funding and staff allocated to hospital services than to primary and community care.

Despite general practice being the front door of the NHS, the workforce remains heavily concentrated in hospital services. As highlighted in the Health Service Journal—HSJ—last week, the proportion of NHS doctors working as GPs has fallen significantly, from one in five a decade ago to closer to one in seven today. Less than 15% of the workforce—GPs and nurses—are now located in primary care, with 80% of the nursing and medical workforce now working in hospital settings. This cannot be right, given that evidence published over the past 70 years, both in this country and across the water, shows that placing GPs at the front door of any health service results in more accessible, higher-quality and more cost-effective care, including cancer care. Moreover, evidence from the Royal College of General Practitioners shows that strengthening continuity of care—the bedrock of my profession—can reduce avoidable hospital admissions and improve cancer diagnosis, treatment and prevention. Patients prefer continuity of care.

Recent figures published in Parliament, and highlighted in the Health Service Journal just last week, show that the share of NHS spending on general practice has fallen to about 8%—its lowest level in the past decade, down from 9% around five years ago. It always amazes me that there are currently 360 million consultations per year—GPs are about 180 million of those—for an average cost of £150 per patient per year. Noble Lords can do the maths: every man, woman and child on average consults six to seven times per year with their GP for £150. These figures reflect a long-standing structural imbalance in how care is resourced and delivered, and it is becoming increasingly difficult to ignore. To me, that raises a very clear implementation risk for the cancer plan, which relies heavily on GPs for early diagnosis and cancer pathways. Without adequate investment in primary care capacity, we will not be able to do that.

We need more GPs. Health Foundation modelling indicates that we need an additional 6,500 GPs by 2030 to meet the needs of our ageing, increasingly complex population. We need more GPs spending longer with their patients and communities to achieve the ambitions laid out in the cancer plan. I would be grateful to hear from the Minister how the Government intend to address the current imbalance, whereby general practice receives a relatively small share of NHS funding while delivering a substantial proportion of patient contacts.

Delays in accessing primary care risk translating directly into delays in cancer detection, where, as we have heard, earlier diagnosis is often critical to outcomes. Ultimately, if we expect earlier cancer diagnosis to be delivered through general practice, we must ensure that general practice has the capacity to deliver it.

GP Contract

Baroness Gerada Excerpts

Tuesday 17th March 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, the new GP contract appears to be baking in access over continuity: my GP, when I want to see him. How will the Government protect continuity of care, which is after all what keeps the NHS safe and provides value for money, and which patients welcome?

[Baroness Merron (Lab)]

We have already said that through our 10-year plan, and this contract very much ties into the main pillars of the plan. We found GP services in a very difficult and challenging state, as I know the noble Baroness will be more than aware. We regard GP services as the front door. We want to see that continuity of care and we expect GPs to organise it accordingly. We all understand that it is not always possible, but clearly the best form of care, whether in the community or in hospital, is on a continuous basis and wrapped around the patient’s needs, not the other way around.

Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

3rd reading
Wednesday 25th February 2026 Lords Chamber

[Lord Kamall (Con)]

My Lords, although this was emergency legislation, we have had detailed and constructive debates on prioritisation. We have also had the opportunity to debate some of the deeper issues around the supply of medical specialty training places, and I am grateful to the Minister for her letter. We will continue to hold the Government to account on the delivery of these places over the coming years. As we have said previously, the Bill is not a complete solution to the problem, as the Minister graciously acknowledged. We accept that it is a step forward.

During our debates, we touched on a number of issues, including whether UK citizens who are graduates of UK medical schools should be given first priority. We discussed the issue of international medical graduates who chose to contribute to the UK system of healthcare rather than go to another country, but who may now find themselves at the back of the queue. We discussed graduates of overseas branches of UK medical schools, some of which follow the same curriculum as UK medical schools, and whether some could be granted so-called grandfather rights. We also pressed for secondary legislation to be subject to the affirmative procedure. We understand why the Government have come to their position and why Ministers have not been able to take action on these points in this emergency legislation. However, given more time, I hope Ministers will continue their work to resolve these concerns, which were eloquently set out by a number of noble Lords from all Benches.

There was some debate about whether this was really emergency legislation or whether, in reality, it was simply giving the Secretary of State a bargaining chip in negotiations with the BMA. That may be no bad thing in itself, but the question remains of whether emergency legislation should be used to give Ministers bargaining chips.

Before I sit down, I thank the Minister and her officials for all their engagement throughout the Bill. As His Majesty’s loyal Opposition, we look forward to working closely with the Minister as the Government press ahead with its implementation.

[Baroness Gerada (CB)]

My Lords, I know it is not normal to speak at this stage, so I will be brief. I thank the Minister and everyone who has worked on this Bill, but I want to raise one or two anxieties which have already been touched on.

I believe that the Bill fundamentally challenges one of the principles that I have always held dear, which is fairness. It is unfair to international medical graduates, who we have entreated to come to this country for the last two decades—we have even paid for them to come —to work in hard jobs, in places where UK graduates did not want to do them. Now that we have more people than places, we are basically pulling the rug from under them. We are jeopardising their careers, their futures, their families and their visas.

It is also unfair to those UK nationals who chose, again in good faith, to study overseas and now have been treated like international medical graduates, when they are not. Finally, it is unfair to the commitment that the Department for Education has made around transnational undergraduate and postgraduate education. This Bill, I am afraid, takes away that commitment and says that we do not really mean what we say.

However, I look forward to working with Ministers and officials to see whether we can address some of what I fear will be the unintended and, I suspect, intended consequences of this Bill.

Tobacco and Vapes Bill

Baroness Gerada Excerpts

Report stage
Tuesday 24th February 2026 Lords Chamber

[Lord Bethell (Con)]

If my noble friend is correct, I will absolutely and humbly correct myself. Maybe we could have a drink afterwards and compare notes on that.

On the question of freedom, I too am a passionate believer and fighter for freedom. However, the freedoms I care about are not only the freedom of choice but the freedom not to be impoverished by taxes and not to see my nation, my country, ruined by the health, welfare and productivity costs of carcinogenic, nasty toxins such as cigarettes. The financial cost on ourselves, and particularly on our children, of this industry is absolutely enormous and is still growing, even if the numbers have stalled. So the freedom from addiction and debt should be included in any discussion of what the freedoms are. For those reasons, I will be voting against this package of measures.

[Baroness Gerada (CB)]

My Lords, I am also against these amendments. I will disclose a conflict of interest: I started smoking when I was 16—and 33 years later, like many of us who start to smoke at that age, because it is a childhood disease, I gave up.

We know and have heard about all the health effects of smoking, but we also have to realise that smoking is an easy addiction to start. I have looked after every addiction—heroin, cocaine, alcohol—and smoking is the easiest. You need only two cigarettes for 80% of people to be addicted, like me, for 33 years, and many people, like me, try to give up.

It is not just addiction that is the problem. It is not even about death, although death is a bad outcome to have. It is also about all the other complications. Like many smokers, I have lost many of my teeth. Our eyesight goes. We have skin problems. Smoking causes all sorts of things.

As a GP for nearly 30 years, I am pleased that I have seen a massive reduction in people with smoking-related diseases. My surgeries used to be full of what we call blue bloaters and pink puffers and full of people with premature heart disease. It is not an accident that I no longer see that in my consulting room; it is because of the hard work of our Chief Medical Officers, the Department of Health, ASH and many others to stop normalising smoking.

On the issue of the black market, there is of course a price differential. Wherever there is a price differential you will get a black market, whether it is diesel, cigarettes, alcohol or whatever. But the Bill is about stopping people starting—as the noble Lord said, preventing the next generation that has not even been born from starting. We have to focus on prevention, which is what the Bill is about.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Lord, Lord Rennard, called this a world-leading policy. It is world-leading, because no one else in the world has chosen this policy. One wants to know why. At least the noble Lord, Lord Stevens of Birmingham, admitted that this was novel and therefore untested. Can we at least have a little humility by admitting that the Bill is an experiment? It is a risk.

How you do age verification, as rather wittily described by the noble Lord, Lord Clarke of Nottingham, is a bit untested. How will we cope with the 84 year-old versus the 85 year-old—will there be a scrap? It is said that it is not going to happen for many years, but I thought the idea of legislators was that you were meant to think about the future, not just tomorrow, and the long- term implications of policies that pass.

Let us be honest: there is no good practice to copy with this Bill. There is no evidence about exactly how it will work or whether it will work. The claims on its behalf are largely based on modelling and speculation, and that is not evidence; it is not scientific. Therefore, the moral high ground and the sense of certainty deployed by those who are enthusiastic about the Bill, and the disdain towards those of us who are sceptical about it, are just a little misplaced.

I therefore request that, as we go through the very short Report stage, because a lot of us have been through a longer Committee stage, we are honest about things such as cost-benefit analysis—what is lost, what is gained—and, rather than moral righteousness, consider whether this is actually fit for purpose, even the purpose of those people who are putting the Bill forward. Whatever the intentions of those promoting the Bill, many of the clauses in it are counterproductive.

I know we are not on this section yet, but as an ex-smoker who started vaping, I am utterly distraught that we now have a Bill that, to all intents and purposes, treats vaping and tobacco as interchangeable, despite a denial by the Government. I do not think that there will be the health gain that is claimed.

My final point at this time—because I will be back —is that it is a little rich to sneer about freedom. Saying the word “libertarian” gives certain people a thrill; they can feel as though they are morally virtuous. I do not consider myself to be a libertarian, despite what Wikipedia says. However, I fully embrace living in a free society. I do not think that freedom is something I should be embarrassed about, nor that saying that people should be given choices about their lifestyles makes you to the right of Genghis Khan, or whatever it is that people are implying—or, worse, in the pay of big tobacco, which is the inference of many of the contributions. At some stage relatively soon, lots of adults—the 84 and 85 year-olds, because these kids do grow up to be adults—will be denied a choice. This Bill affects adults.

People can make choices about whether they take risks in their health. I suspect that practically everyone I know is using those weight-loss injections. To me they are a bit risky—I think, “Are they safe?”—but I am not mounting a campaign yet, because half this House would be out. People say it is worth the risk. A lot of people do daft things such as going skiing—mad; too risky for me. There are all sorts of things. People have been known to have the odd extra pint or eat the odd greasy breakfast. People take risks and make choices about their health all the time.

I do not want more people to smoke, but I also think that, in a free society, we have to give a certain degree of room for people to make choices—even the wrong choices. We live in a free society. Deciding the right and wrong choice is what happens in authoritarian regimes, but in a free society we say, “I don’t think you should do that, but I’m not necessarily going to legislate so that you can’t do everything I personally disapprove of”. We should not even say, “You shouldn’t do that, because I know best for your health what you should and shouldn’t do”. In medical ethics, there are times when you go to your doctor, who says, “Take this”, and you say, “I decline to take that medication; I do not want that intervention”. In a free society, a doctor cannot force you to do what you do not want to do—even the virtuous health professional who we are all meant to revere.

As we carry on this Report stage, can we all show a bit of humility? Living in a free society puts before us difficult moral decisions. There is no necessarily right or wrong. We are allowed to scrutinise a Bill that is put before us without being accused of somehow being evil because we do not go along with the Bill. Just because the Conservative Government, when they were in, and the Labour Government now agree—if that is the basis on which we should not scrutinise, we might as well all go home. I am sad to say that, for some of us, the Conservative Party has had far too much agreement with the Labour Party over recent decades.

Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

Report stage
Monday 23rd February 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, as probably the only person in this Chamber who has headed up a royal college not once but twice—the Royal College of General Practitioners—I feel the urge just to defend them and correct what is been said three times in this Chamber. The royal colleges set the standards and the curriculum; they do not oversee workforce planning, funding, or what the actual training looks like once you get into an organisation. I have to correct those speakers by saying that that is not the job of the Royal College of GPs. I do not disagree that there needs to be reform; absolutely, it is a complete mess—

[Lord Hunt of Kings Heath (Lab)]

My Lords, does the noble Baroness accept that the royal colleges certainly can give moral leadership? I also refer her back to the last junior doctors dispute, about 10 or 11 years ago. As she will remember, the Academy of Medical Royal Colleges, I think it was, set up a group to look at all these issues, and the outcome of that was very disappointing in terms of tangible results in improving the situation.

[Baroness Gerada (CB)]

I thank the noble Lord very much. I have to also tell your Lordships that for the last 20 years I have led what is called the practitioner health programme, which has looked after the mental health of the medical workforce—I no longer lead it. To date, about 40,000, mainly doctors, have passed through that service, most with mental health issues relating to burnout, depression and anxiety, and some with a new diagnosis which I call NHS-itis.

I know about the endless reviews that were done. It is not just the Academy of Medical Royal Colleges, Health Education England, the General Medical Council and the CQC; many of the individual royal colleges looked at the issues of the decline in mental health. Some of these have been raised here, around firms, loss of control, training and the intensity of the workload. Fundamentally, we do not make it easy for any of these doctors—and, by the way, we do not make it easy for the international medical graduates either, who have always fared worse. I agree with the noble Lord that there are solutions, so we do not need another review. The answer is blowing in the wind—we have the solutions—and I am very happy to discuss that at a further time.

[Lord Clement-Jones (LD)]

My Lords, we ought to thank the noble Lord, Lord Patel, for having stimulated such an interesting and important conversation about how terrible our workforce planning in the NHS has been to date, and we have had some very wise words around the House on that subject. It is clearly not fit for purpose, and that is why we are where we are.

On these Benches, we have consistently accepted the Government’s central premise for the Bill: that where the British taxpayer invests heavily in training a doctor at a UK medical school, there is a logic in prioritising that graduate for employment to ensure a return on that public investment. However, although we sympathise with the desire of the noble Lord, Lord Patel, to ensure that UK graduates are prioritised—indeed, a lot of that derives from the fact that our workforce planning system is not fit for purpose—we must be careful not to make the legislation so rigid that it removes any flexibility for the system to function effectively, as we will argue in later groups.

By creating strict statutory tiering that places UK graduates above all other priority categories in every instance, we risk creating a system that cannot respond to realities on the ground. We have received correspondence from many doctors, as I am sure almost every other noble Lord in this House today has done, warning that absolute exclusion or rigid tiering could leave rotas empty in hard-to-fill specialties such as psychiatry and general practice, which rely heavily on international talent.

Prioritisation is a necessary tool for workforce planning but we must ensure that it does not become a blockade that damages the wider delivery of NHS services. As the noble Lord, Lord Stevens of Birmingham, said, we need answers about the future of workforce planning. What will the numbers be for training places? The Government need to answer that as we go through this Bill.

--- Later in debate ---

[Baroness Lister of Burtersett (Lab)]

My Lords, Amendment 11 would add to the list of priority groups people who have been recognised as in need of international protection, who have arrived as a Hong Kong British national or who have arrived on a safe and legal humanitarian route. I will speak simply to this amendment, but I have some sympathy for the amendments in the name of the noble Baroness, Lady Gerada.

I apologise for popping up at this late stage of the Bill’s passage. This issue was brought to my attention by the Refugee Council, which recently spotted that, as it stands, the Bill will exclude those recognised as refugees from prioritisation for medical training posts. This will potentially make it harder for people with medical backgrounds who have been displaced and given protection in the UK to contribute fully to the NHS. This resonates with me because my father, as a young man with a medical qualification, came to the UK in the 1930s as an early refugee from Nazi Germany. He was able to requalify at Glasgow University and, after the war, eventually went on to have a long career as a medical officer in Manchester in what was then the DHSS. As such, he contributed to British society in a way that would now be difficult for medically qualified refugees.

Programmes such as the Refugee Council’s Building Bridges programme support qualified refugee doctors and other health professionals to utilise their skills and experience in the UK. These programmes are based on close collaboration between charities and the NHS. This is beneficial for the refugees themselves, as well as for the UK. That support can include helping refugees to pass the necessary language requirements and get professional registration in the UK. Some refugees will also progress to accessing medical training posts. This has included foundation programmes specifically designed to support refugee doctors into the NHS workforce.

During Second Reading in the other place, the Secretary of State said that the UK

“must break our over-reliance on international recruitment”.—[Official Report, Commons, 27/1/26; col. 803.]

This amendment does not run counter to that aim. Refugees have not come to the UK because they have been recruited. First and foremost, they have sought protection and have been given it. My amendment would simply ensure that those refugees who are also doctors would be able to put their medical backgrounds to good use and continue to develop their expertise for the benefit of the wider community, as well as for themselves.

At the same time as the Bill is progressing through Parliament, the Government are proposing significant changes to settlement for refugees as part of the earned settlement plans. Ministers have said that these changes are supposed to incentivise integration and ensure that settlement is earned. Ensuring that refugee doctors are not placed at a disadvantage because of this Bill would help the Government meet those aims.

At Second Reading, my noble friend the Minister explained:

“Internationally trained doctors with significant NHS experience will continue to be prioritised for specialty training, recognising the service that they have given. This year, immigration status will be used as a practical proxy for NHS experience in order to allow prioritisation to begin swiftly. For following years, we have taken powers in regulations to enable us to refine this approach in consultation with key partners. I have been asked by noble Lords what this means for those with refugee status. This status is not a stand-alone priority group, although refugees will be prioritised for specialty training in 2026 if they fall within another priority category, such as holding indefinite leave to remain or having completed the foundation programme. Refugees who do not fall within a prioritised group may still apply for specialty training posts and the Bill will not change their eligibility to apply for locally employed doctors’ roles”.—[Official Report, 4/2/26; col. 1648.]


The noble Lord, Lord Patel, responded positively with particular reference to Ukrainian refugees. I am not sure that my noble friend’s response was quite as reassuring as he perhaps thought, especially as Ukrainians who have arrived on the Ukrainian scheme will not be in any of the priority groups. If I understand the proposals correctly—this relates to the previous amendment—indefinite leave to remain is being used for places on specialty programmes in 2026 as a quick proxy for recognising doctors who have been trained abroad but who have been employed within the NHS for some time. It is not such a useful proxy for anyone who, like those on the Ukrainian schemes, have no route to settlement or who, under the proposed earned settlement changes, could have to wait 10 years, or even longer, to qualify for indefinite leave to remain.

My amendment also addresses the impact of the Bill on doctors who have come to the UK as part of the Hong Kong BNO visa scheme. As with other refugee doctors, they have sought safety in the UK. Indeed, the scheme is frequently described by the Government as a safe and legal route. The case for their inclusion has been put to me eloquently in an email from an anaesthetic registrar who is a BNO visa holder and is currently working in the NHS. Like many colleagues in a similar position, he migrated to the UK for political reasons before completing his training and now regards the UK as his permanent home, where he wishes to dedicate his career to the NHS. They argue that

“deprioritisation to the point of exclusion would leave us without any pathway to complete training, despite our qualifications and NHS contributions, effectively ending specialist careers for a group formally invited to settle here”.

They also point out that BNO doctors in the NHS form a small, finite cohort. Their main argument is that,

“unlike many other International Medical Graduates who can return home to complete training, those of us on the BNO scheme face unique barriers. Due to the political situation in Hong Kong, returning is not realistic nor possible for many of us. The UK is now our only place to practise medicine and pursue specialist training”.

Although their situation is not quite the same, the argument also applies to other displaced persons covered by this amendment.

At a time when the Government are making it much more difficult to achieve refugee status, should they not at the very least ensure that those who are so recognised and who are medically qualified are able to requalify and use their medical expertise to the benefit of our society? I hope my noble friend will be able to accept this amendment, but I suspect she will not. At the very least, I ask her to give a commitment to further consultation with a view to giving serious consideration to including the groups specified in the amendment, even if only in modified form, in the regulations to which she referred at Second Reading and which were mentioned earlier today. I beg to move.

[Baroness Gerada (CB)]

My Lords, I speak to Amendments 12, 13 and 15 in my name and that of the noble Lord, Lord Mendelsohn. I repeat my conflicts of interest: I am of Maltese heritage, I am a doctor and I am co-chair of the APPG. My amendments are narrow, they are practical and they respond directly to the concerns raised by the Minister in Committee. I respect the Minister and am grateful for the time that she has given me, for her letter and for engaging seriously with this issue.

I fully accept that we must find a solution to the difficulties faced by UK medical graduates, as so eloquently pointed out by the noble Lord, Lord Patel. In doing so, however, we must ensure that we do not unfairly disadvantage a small, specific group of students, do not strain valued relationships with an EU member state and Commonwealth partner or inadvertently undermine a long-standing transnational higher education commitment. That is the purpose of my amendments.

This is not about opening floodgates, nor is it about creating a new route for offshore medical schools. I am speaking here about just two long-established UK universities with overseas campuses: Queen Mary University of London in Malta and Newcastle University in Malaysia. They are the only two that, upon Royal Assent, will meet the criteria for delivering UK primary medical qualifications overseas—the same curriculum, the same examinations, the same degree and, until now, the same eligibility for the UK foundation programme. Historically, there was a third, City St George’s, which is now teaching its final cohort of seven students in Cyprus; that arrangement is closing. In reality, therefore, we are speaking about two mature, well-governed partnerships with capped, predictable numbers of no more than 190 students per year.

Let me address Malta, which I obviously know best. Since 2009, Queen Mary has operated a British medical school in Malta on the understanding that its graduates would be treated in the same way as its London cohort for entry into the UK foundation programme. That reassurance was reaffirmed as recently as 2024. Each year, about 90 students enrol at the university. Many of them are UK nationals, often with a clear intention of serving in the NHS. They are students such as Michael, who comes from Essex; he is a final-year medical student who worked as a nurse during the pandemic before deciding to train as a doctor at QMUL Malta. He is not a rich kid but someone who has dedicated his life to working in the NHS, and has worked, saved and borrowed money to achieve his passion of becoming a doctor. What can he hope for now? If we imply that a UK degree somehow becomes less UK because a lecture theatre is in Malta rather than Whitechapel, we send an unfortunate signal not only to those students but to a close education and historic partner.

The Minister has quite properly raised concerns about NHS exposure and it is true that most clinical placements take place in Malta, but almost all the students undertake NHS attachments. The health challenges they face are strikingly similar to ours—much more so, I would attest, than the health challenges in Iceland, Liechtenstein or Norway. Non-communicable diseases dominate: diabetes, cardiovascular disease and obesity. There is a growing burden of mental illness, especially among children and young people. Its population is ageing and its society is increasingly diverse. The weather may be warmer, but the medicine is not fundamentally different.

This is not merely an assertion. QMUL now has four completed cohorts—147 graduates who have transitioned safely into the NHS and are performing exceptionally well. Why would they not? More than half of them are UK nationals. All are fluent in English, and all have been trained to practise in the NHS. These doctors or students seek no advantage. They only ask not to be disadvantaged because the campus of the UK university is overseas. The numerical impact on domestic graduates would be negligible. The Government’s target competition ratio of two applicants per foundation place would still be met.

Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

Moved by

[Baroness Gerada]

15: Clause 4, page 3, line 2, at end insert “, unless they hold a primary UK medical qualification issued by a UK registered institution, operating on the date of 1 January 2026, which is identical in character to a qualification undertaken in the British Islands and recognised as such by the UK General Medical Council.”

[Baroness Gerada (CB)]

My Lords, I shall speak to Amendments 15, 16 and 19. I want to disclose an interest that I did not have at Second Reading: I am now co-chair of the Malta APPG—and I remain of Maltese heritage.

Amendment 19, in my name and that of the noble Lords, Lord Clement-Jones and Lord Mendelsohn, seeks to add Malta to the list of countries in Clause 4(4). It is precise and proportionate, and it would correct a narrow but serious unintended consequence in the Bill, as I will explain. Of course I acknowledge the need to prioritise UK graduates for training but, as the Minister of Health and Active Ageing of Malta put it in a letter to the Secretary of State for Health and Social Care, the Bill risks

“undermining two centuries of proud tradition and the dissolution of a strong bilateral relationship in healthcare, care, and the training and specialisation of Maltese graduates”.

At Second Reading, I spoke about the unique medical training partnership between the UK and Malta, which dates back two centuries. For example, Maltese surgeons have held licences from our own royal colleges since the 1830s. This is therefore not a recent convenience but a deep historic alignment. It is a relationship that has shaped both systems for generations, creating an instinctive alliance in training, practice, standards and expectations.

The Maltese education system is modelled on the UK system and aligned to British clinical and ethical standards. Training is delivered in English, and the Maltese healthcare system closely mirrors the NHS. That is why my father was able to come to this country in 1963 and devote his working life to serving patients in the east of England, and why others from Malta have done the same, performing well above their weight in serving patients in this country.

Furthermore, postgraduate membership and fellowship remain aligned with the British royal colleges, reflecting a deep and enduring professional loyalty. Indeed, many of these doctors have become trainers, educators and examiners, helping to uphold the quality of UK postgraduate education—some have had daughters who became presidents of royal colleges. Malta and the UK are therefore historically, culturally and educationally linked.

I turn to the comparison of the Malta foundation programme, an affiliated programme to the UK foundation programme, and I shall reflect on the free trade agreements that the UK holds with the countries in Clause 4. Government documentation for the UK’s free trade agreement with these countries requires regulators to

“recognise qualifications or relevant experience of a professional who applies for recognition and possesses comparable professional qualifications”.

The language in that documentation, which recognises reciprocal arrangement, strongly aligns to the UK-Malta affiliate programme and, on that basis, it should be treated no less favourably than these other nations.

Since 2009, our foundation programmes have been formally aligned, sharing the same curriculum and e-portfolio. This alignment was renewed in 2024, confirming that the Malta programme met the same standards and outcomes as the UK foundation programme. To the best of my knowledge, no other country anywhere in the world has that level of mutual recognition.

At the centre of this is Queen Mary University of London’s campus in Malta, a UK public university delivering an identical UK GMC-approved MBBS degree to that which it delivers in its east London campus in Tower Hamlets. The students follow the same curriculum, complete the same statutory mandatory training, take the same UK national qualification exams and graduate with the same UK primary medical qualification. They are registered by the GMC as graduates of Queen Mary University of London.

During Second Reading, the Minister, the noble Baroness, Lady Merron, addressed Malta as a distinct case, and indeed it is. The QMUL training programme is a UK programme delivered overseas under a framework recognised by and supported by the UK Government. More than half the students are UK citizens. The equivalence of training between the UK and Malta is complete, not approximate. It is not close; it is identical. Even the patient profile is the same. Malta’s population, diversity, healthcare system and disease patterns share extraordinary similarities with the UK, particularly compared with any other international training environments. Moreover, most students undertake NHS attachments during their training. These graduates enter the UK workforce fully prepared for UK foundation training, trained at no cost to the UK taxpayer.

The impact of a medical school goes beyond the students. QMUL has made a not insubstantial professional and financial investment in the campus and the Government of Malta have invested in the school’s construction. This aligns with the UK Government’s wider objective of developing international UK university campuses, as outlined in the recent strategy document from the Department for Education. This Bill, if not amended, puts this at risk.

The numbers are small, as the foundation years are capped at between 50 to 70 graduates. This is less than 0.6% of the UK foundation programme places. This is simply no workforce threat, no substitution effect or planning distortion. There is, however, a real risk of unfairness in the Bill as it stands. These students have a legitimate expectation, grounded on 15 years of consistent government practice, and the experience of all preceding QMUL medical graduates, that they should be treated comparably with other holders of UK primary medical qualifications. The Bill as drafted removes that status and places these graduates behind Norway, Iceland, Liechtenstein and Switzerland—jurisdictions whose graduates do not hold a UK primary medical qualification, do not sit the medical licensing or prescribing exams and are not trained on an NHS-aligned curriculum. This is difficult to explain, let alone to justify. This amendment simply corrects this anomaly. It protects a uniquely successful partnership, anchored in history, quality and equivalence.

Going beyond foundation years, a few Maltese doctors come to the NHS every year to fill gaps in their own medical training—so-called finishing school. These are in non-numbered posts. Malta provides 70% of their pay and these doctors are contractually required to return to Malta. This is not a pipeline of overseas doctors displacing domestic graduates. It is a small group, maybe 30 or 40, who meet our standards, all of whom have been examined and trained specifically in UK practice.

Finally and briefly, I turn to Amendments 15 and 16 again in my name and the names of the noble Lords, Lord Clement-Jones and Lord Mendelsohn. These suggests a carefully defined exception in Clause 4 for UK universities operating overseas campuses that deliver an identical UK-approved medical degree as in the British islands. These are exceptionally narrow amendments confined, to the best of my knowledge, to only two programmes in the world—Queen Mary University of London’s campus in Malta and Newcastle University Medicine Malaysia.

At Second Reading, the Minister referred to

“almost 300 applicants from … overseas campuses”,—[Official Report, 4/2/26; col. 1679.]

and noted that the Government need to control this number to “avoid opening the floodgates”. I stress, as I have already said, that the number of QMUL graduates applying for UK jobs is capped by the University of Malta at between 50 and 70, with around 120 from Newcastle University Medicine Malaysia bringing the total to 190. These caps would enable the Government to control the number of overseas applicants.

I also want to make clear my support of the amendment in the name of noble Lord, Lord Forbes, which provides a similar solution. Only institutions operating overseas campuses that meet the criteria set out in the amendments and that are in operation at the time the Act is passed should be included. I beg to move.

--- Later in debate ---

[Baroness Merron (Lab)]

I am happy to set it out in a letter, but I can say immediately that graduates of the Royal College of Surgeons in Ireland’s Bahrain campus are not necessarily prioritised just because part of their programme takes place in Ireland. The Bill is clear that prioritisation applies to graduates of Irish medical schools who complete the majority of their medical education in Ireland, but I am happy to add to that in my letter.

[Baroness Gerada (CB)]

I am grateful to the Minister for the care with which she has addressed my amendments. I will be very brief. I must say I am disappointed, and I have a few points.

I will address Malta first. These are not international medical graduates; these are UK-trained doctors training in a UK university, albeit overseas. As I said, they are trained for the NHS. The Minister mentioned several times that it is not exclusion, it is prioritisation. I have already had emails from two doctors, one of whom is being excluded from applying for a postgraduate examination until the UK cohort has applied. I will not say their specialty, because it might identify them, but it means that the tiny island of Malta will not have this particular specialty because this doctor cannot finish his training until he does that. They are already being excluded from fellowship posts that have been long standing over decades—that is of last week.

Given the fact that the Bill is being taken through the House at such pace, as well as writing a letter—which I understand we will get in our post next week—would the Minister be willing to meet me and several Peers who have already raised some amendments so that we can explore this in more detail and work constructively towards a solution? I am sure these issues will be considered further on Report but, in the light of the Minister’s reply today, I beg leave to withdraw the amendment.

Amendment 15 withdrawn.

Terminally Ill Adults (End of Life) Bill

Baroness Gerada Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

Experts and charities say that the Bill does not contain any provision to prevent individuals with eating disorders being classified as terminally ill. They support the amendments to make the Bill safer, all of which were rejected in Committee in the other place. I ask that noble Lords think carefully about the amendments before the House and support Amendments 89, 91, 92, 101 and 103.

[Baroness Gerada (CB)]

My Lords, I am completely in favour of Amendment 87. I have permission to use the name of my patient, Melanie Spooner, who died from anorexia nervosa—she died from taking her own life. The end point of anorexia nervosa is often that the patient wants to die. As such, it is a terrible mental illness, and I think that not conflating and excluding this group is absolutely the right way forward.

One other issue has been bothering me ever since I have been coming to these Fridays: it is the conflation of the words assisted suicide with assisted death. For a decade now, I have been looking after those bereaved following the death by suicide of their loved ones, and I have about 100 people whom I care for. Suicide is often a violent act; it is often an act done alone and it is often done to punish people—I am terribly sorry if anyone here knows people who have killed themselves. It is a very prolonged bereavement, and a very complicated grief that affects up to 60 to 70 people in its wake.

Assisted death, as we have heard from the group that came from Australia, can sometimes be filled with hope and sometimes with joy, with family around for those last moments. It affects both groups: those whom I look after, who have been bereaved following suicide, and the relatives of those who have taken voluntary assisted death. It is such a small thing, but it really grates, and it is one of the most inappropriate and irresponsible ways of conflating the language.

[Baroness O'Loan (CB)]

Before the noble Baroness sits down, can I ask her whether she is aware that recent research has shown that 42% of people think that assisted death is actually the provision of palliative care, and that it is actually quite important to distinguish between the two?

[Baroness Gerada (CB)]

I was not aware of that research. The evidence shows, and we heard it from the Australian group, that where voluntary assisted death is in place, the provision of palliative care is improved. In Australia, a great deal more resource was put in to providing palliative care. My point, however, is: please can we no longer conflate the language of assisted suicide with that of voluntary assisted death.

[Lord Moore of Etchingham (Non-Afl)]

My Lords, I of course agree with the noble Baroness, Lady Gerada, that there are many different motives for killing yourself, but we are talking about making a law here. It is very important that the natural and ordinary meaning of words is established and preserved. Suicide means killing yourself, and what is proposed in the Bill is killing yourself with assistance. It is very important to keep explaining that to people, because otherwise they will be permanently misled about what is actually happening.

NHS: Corridor Care

Baroness Gerada Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Merron (Lab)]

I agree with the need for more adult social care, but there is a whole range of factors that affect discharge delays, including the number of people who present. What the noble Lord outlined was not right and not the way in which his mother-in-law should have been dealt with. I know he would not expect me to comment further on individual circumstances, but if somebody is being considered for corridor care, that should be appropriately risk-assessed by clinical teams. The exact point he made is something that I have asked about. There should be a named nurse, and the provisions he talked about, such as food and drink, should have been there.

[Baroness Gerada (CB)]

My Lords—

[Lord Swire (Con)]

My Lords—

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

We will have the Cross Benches and then we will come to the Conservative Benches.

[Baroness Gerada (CB)]

We know from evidence that you can avoid hospital admission by improving continuity of care by general practitioners. When will the Minister redress the imbalance whereby GPs are funded from only 8% of the NHS budget yet deliver 70% to 80% of its care?

[Baroness Merron (Lab)]

We very much appreciate the role that GPs play. Corridor care is related to a whole range of factors, not only the position of GPs. I have heard what the noble Baroness has said and will gladly relate it to my ministerial colleague.

Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

2nd reading
Wednesday 4th February 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, I also congratulate the noble Lords, Lord Roe and Lord Duvall, on entering this House. As a newbie myself—I have been here only about six weeks—I know that it is an enormous privilege, as well as incredibly hard work.

The principle at the heart of this Bill is the right one: UK-trained medical graduates should be properly prioritised for the foundation programme and subsequent specialist training. No one can dispute that it is wrong that UK graduates, educated at a cost of billions to the taxpayer, are forced to compete with overseas students, pushing many doctors abroad and depleting the talent pool that should be powering the NHS. I am grateful to the Minister for engaging with me over the last few days both personally and in meetings.

However, I have some serious concerns. The first, as has been alluded to, relates to Malta. As the only Member of this House to have Maltese heritage— I thank the noble Lord, Lord Stevens, for reminding me that I have two George Crosses, one from having Maltese nationality and the other from working in the NHS—this is especially important to me. Like many noble Lords, I have received letters and concerns, but I have also received representation from all quarters in the UK and in Malta about the impact of the Bill on Malta, including from its Minister for Health and Active Ageing. He wrote a letter to our government health team where he said:

“Whilst acknowledging the supreme interest of ‘home-grown’ graduates, this development raises serious concerns for this Ministry and the people of Malta. Aside from risking to undermine two centuries of proud tradition and the dissolution of a strong bilateral relationship in healthcare, this strategy puts the training and specialisation of Maltese graduates in jeopardy”.


This matters because Malta has a long, deep and historic relationship with the United Kingdom, and not just in medicine, although I will stick to that. For nearly 200 years, since the first Maltese doctor received their licence to practise from the Royal College of Surgeons, British and Maltese medicine have grown side by side: the same language, the same exams and, for many years, the same training programme. This is why it has been possible for doctors such as my father, who came to this country in 1963, to dedicate their professional lives to the service of the NHS. This is a small group of doctors but they have had an enormous impact—tonight I should have been at a conference celebrating the power and impact that Maltese doctors have had—from revolutionary surgery treatment for Parkinson’s to revolutionary, innovative treatments for cancer.

Nowadays, each year around 50 doctors complete their specialty training in the NHS, under a special arrangement in which the Maltese Government cover 70% of their salary, with a contractual agreement that these doctors return to Malta. It is a so-called finishing school; they come here to do parts of the training that they cannot get in Malta, such as for sickle cell in haematology. It is a win-win. The NHS gets talented, skilled doctors, often working in hard-to-fill non-training grade posts, at very little cost to it.

This Maltese-UK relationship has been strengthened in recent years, as we have heard, with the establishment in Malta of a UK-based medical school, Queen Mary University of London. This is a multi-million pound initiative of QMUL and the Maltese Government. Since 2009, QMUL has delivered an integrated training programme, awarding an MBBS degree that is academically and regulatorily identical to the UK London programme. These are not rich kids buying a medical degree; they are hard-working students, among the top performers across the MBBS exam. The diversity of the campus in Malta mirrors that of the UK: 80% are from Black and minority-ethnic groups, 20% are disabled and 65% are women. Their training is aligned to NHS principles and practice. Nearly 80% of them do part of their training in a UK NHS hospital. Of course they understand the NHS—nearly 70% of these students are British nationals or have indefinite leave to remain in the UK. Deprioritising these doctors risks abandoning a small, committed cohort without a fallback, simply because they choose to fund their own training. This seems unfair.

I will briefly move to another area where I have serious concerns. This legislation will disadvantage many international graduates already in training who have spent thousands of pounds in good faith and were encouraged to come to this country to train. I have received representation from the British Association of Physicians of Indian Origin, which is seriously concerned about this. These international medical graduates have been disadvantaged since the start of the NHS; they have been subject to racism, bullying, disproportionate complaints and punishment, and failure to progress in their career. They now risk losing employment, their visa status and everything they have worked for. This seems unfair, especially given the assurance by the UK Foundation Programme that the same preference informed allocation method used in 2024 and 2025 would be used for 2026. Should there not be transitional arrangements for these doctors, who have relied on public assurances?

As is often said, if one intervenes in a complex system, there is no guarantee that outcomes will be achieved but there is a guarantee of unintended consequences. I look forward to engaging with the Minister further and hope we can redress some of these issues.