Medical Training (Prioritisation) Bill

Debate between Baroness Gerada and Lord Clement-Jones

Report stage
Monday 23rd February 2026 Lords Chamber

[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.