Medical Training (Prioritisation) Bill

Baroness McIntosh of Hudnall Excerpts

Report stage
Monday 23rd February 2026 Lords Chamber

[Lord Mohammed of Tinsley (LD)]

My Lords, Amendment 14 would ensure that all regulations under the Bill are subject to the affirmative resolution procedure—or, in simple terms, that both Houses of Parliament get to have a say in and have a vote on any changes that a future Minister or Government make. This is not a narrow technical point; it goes to the heart of parliamentary accountability and to the fair and transparent governance of medical training policy.

The Bill confers broad powers to Ministers to determine key aspects of how prioritisation will operate. These include potentially definitions for eligibility, scoring frameworks, exemptions, transitional arrangements and other detailed rules that will shape the careers of tens of thousands of doctors. In Committee, noble Lords expressed concerns about the breadth of delegated powers in the Bill and the limited parliamentary oversight of these powers. In Committee, it was evident from the debate that Members of your Lordships’ House share the view that regulatory decision-making powers are vast and open-ended, yet the Bill envisages only the negative procedure for most regulations, meaning that the regulations can come into force unless actively annulled.

This falls short of the level of scrutiny appropriate for measures of such significance. It is precisely because of the impact of this legislation on individuals’ careers and NHS workforce planning that the affirmative resolution procedure is the right standard. Ministers should be required to lay each statutory instrument before both Houses and obtain explicit parliamentary approval before they can take effect. This would give the House the opportunity not merely to debate but to approve or reject the detailed rules that give effect to the policy, ensuring that changes are made not by default or through omissions but by the conscious decisions of Parliament.

Medical training policy is not static. It will evolve in response to workforce needs, technical standards and educational practices. There is nothing wrong with working with flexibility. There is something wrong with flexibility exercised without open scrutiny. Doctors plan years ahead; they make life choices on the basis of published criteria. To allow Ministers to adjust those criteria by regulation without positive endorsement by this Parliament risks unpredictability and unfairness.

The use of the affirmative resolution procedure does not prevent Governments acting. It simply ensures that Parliament is properly informed and engaged, strengthening trust in the process and respecting this House’s role in scrutinising public policy. Given the far-reaching nature of these measures that could be set in regulation, the affirmative resolution procedure is not just desirable but necessary. For these reasons, I hope that noble Lords will back my amendment.

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

My Lords, I should advise the House that if this amendment is agreed to, I cannot call Amendment 15 by reason of pre-emption.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord, Lord Mohammed of Tinsley, for opening the debate on this group—and the numerous noble Lords who spoke to it.

I redeclare my interests. I am a professor of politics and international relations at St Mary’s University, Twickenham, where I teach a module on healthcare policy and strategy, and I have been helping with its new medical school. I also work with the Vinson Centre for the Public Understanding of Economics and Entrepreneurship at the University of Buckingham, which has a medical school, although I have no direct connection with the medical school there. I hope I have touched on all potential conflicts.

Amendment 14, from the noble Lord, and Amendment 16, in my name, were debated in Committee, so I do not intend to repeat the arguments that were made then. However, I think it would be helpful if we reminded ourselves that we are dealing with emergency legislation. This is key. The Constitution Committee has warned against the Government’s overuse of emergency legislation, not least because when we legislate in this way we risk creating unintended consequences. We should be very careful and selective in using emergency legislation. In that context, it does not seem unreasonable that your Lordships’ House should be given an opportunity to scrutinise secondary legislation in more detail through the affirmative procedure. I hope the Minister will take on board the concerns about using the affirmative procedure rather than other procedure.

Turning to Amendment 16, I have retabled this amendment for debate today because I am afraid that I was not completely satisfied with the Minister’s response in Committee. I am sorry to say that but, at Second Reading, the Minister explained that the Government’s view is that commencement may not happen with Royal Assent because the changes introduced by the Bill are “a major undertaking” and

“there is a material consideration about whether it is even possible to proceed if the strikes are ongoing”.

However, in the same speech she explained that this is “emergency legislation” which is being brought forward

“as quickly as possible, rather than wait … another year to do so”.

On the one hand, this is a major undertaking that, in the words of the Minister,

“cannot be switched on overnight”.—[Official Report, 4/2/26; col. 1681.]

yet at the same time it is emergency legislation that cannot wait.

Perinatal Mental Health

Baroness McIntosh of Hudnall Excerpts

Wednesday 25th June 2025 Lords Chamber

[Baroness Merron (Lab)]

As the noble Baroness is aware, the long-awaited 10-year plan will be with us shortly. That will set out the parameters for change and the services that we need. Following that, there will a long-term workforce plan, which will deal with the kind of matters the noble Baroness referred to.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I had not intended to ask a question but, following on from the contribution from the noble Lord, Lord Patel, impacts other than the most undesirable one of suicide come from postnatal depression. Among those are an inability of new mothers to cope well with the demands on them and therefore provide the care that very young children need. Is the Minister confident that the way that the NHS now—I am struggling not to say “gets rid of”—moves mothers out of hospital very soon after birth provides the right start to the sort of care that particularly vulnerable women need immediately after giving birth?

[Baroness Merron (Lab)]

My noble friend raises a very useful consideration. Decisions about how long a new mother stays in hospital are a local matter and specific to that woman. The other point I want to raise is that the services we are talking about have actually been expanded to provide care to women for up to two years after birth. That is incredibly important, as is providing a mental health assessment and signposting support for partners, who we should also remember in all of this. The services we are talking about cross the entire span and go on for two years beyond it. That certainly underpins the kind of services we want to see, but I certainly agree with my noble friend that individual cases must be seen as individual cases.

Self-harm: Young People

Baroness McIntosh of Hudnall Excerpts

Monday 28th April 2025 Lords Chamber

[Baroness Merron (Lab)]

The role of civil society is crucial. I have had a number of very helpful meetings and visits, including most recently with the Samaritans. We very much believe that that sector supports the delivery of not just the national suicide prevention strategy, of which tackling self-harm is part, but tackling self-harm where it is not linked directly with suicide.

I refer the noble Lord to the work being undertaken by the multi-centre study of self-harm, which I know will be of interest. It has a long-standing research programme to keep an eye on—more than keep an eye on—and examine self-harm trends, and the findings also inform NICE clinical guidance. Recent research has looked at different ethnic minority groups, the characteristics and outcomes for children under 13 who self-harm, and patterns and risk factors for self-harm among university students—and that is just a snapshot.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, those of us who are not experts but have some direct experience of this problem know that self-harm is not just one thing; it can come in a number of forms. One of the problems for families is that it is not always easy to spot, at least not initially. Can my noble friend say in what way families are being supported to identify and then help young people who are beginning to exhibit signs of self-harm?

[Baroness Merron (Lab)]

My noble friend is right: it is crucial that, where they are able to, friends, family and communities assist those at risk and those who are actually self-harming. The recommendation is that people should not hesitate to speak to a GP or access the free listening services that are available through not just the NHS but the Samaritans, for example.

Funerals: Death Certificate Delays

Baroness McIntosh of Hudnall Excerpts

Thursday 3rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree that those changes—the move from analogue to digital, which will be outlined in the 10-year plan—will indeed help in this area, as well as many others.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, clearly, this is a complex and difficult issue, and there does not seem to be any one reason why these delays have started to extend. Can the Minister tell the House whether there are any financial implications for people who have to wait much longer for a funeral to be arranged, given that they are not cheap to begin with?

[Baroness Merron (Lab)]

I am not aware of the specifics around that point, but we will be very pleased to look into that because we do not want people to be inconvenienced and distressed even further.

Cancer: Older People

Baroness McIntosh of Hudnall Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

I give my sincere condolences to the noble Baroness and her family. Yes, I will raise that. It is a good point to look at, and I thank her.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, what plans do the Government have, if any, to include older people in routine screening programmes, particularly given all the statistics that we have heard in the course of this Question and others? I have asked this question before. I have never heard an answer that I found entirely convincing. I am confident my noble friend will be able to help on this occasion.

[Baroness Merron (Lab)]

I thank my noble friend for her confidence, and I will do my best. Decisions on screening, including the age ranges at which they operate, are made by the UK National Screening Committee. They have an upper and a lower age limit, which are based on evidence and kept under review. Current evidence does not support making changes to these ages. For breast screening, for example, self-referral is available for those over the age of 71 and for bowel screening it is available for those over 75. I confirm to her that this is all evidence-based, and we always keep an eye on the continuing evidence.

Inflammatory Bowel Disease

Baroness McIntosh of Hudnall Excerpts

Monday 20th May 2024 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has twice mentioned the bowel cancer screening programme, which I think is universally accepted to be very successful, and is also very reassuring to those people who are part of it, whatever the outcome of the tests. He will also know that that screening programme and others drop people once they reach a certain age, which coincidentally is the age at which they become more likely to develop the cancers that the screening programme is intended to detect. Do the Government have any plans to increase the age up to which people can be routinely included in bowel cancer screening and other screening programmes?

[Lord Markham (Con)]

The noble Baroness makes an important point. In this and other areas, we are guided by the science; we have been guided by the science on the advice to date. I will go back and ask for the latest thinking on that, and get back in detail in writing to the noble Baroness, but, generally, being guided by the science will be the approach.

Immunisation: Children

Baroness McIntosh of Hudnall Excerpts

Wednesday 8th May 2024 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

My Lords, on the Wakefield effect, as the Minister called it, he will remember that the impact it had on a lot of people was very profound. In particular, some of that was associated with incidence of autism, which again was completely unjustified. Can he tell the House whether any work has been done, in the interests of public information, on what happened to the children who were not vaccinated at that time, and what the outcomes were for them? As a deterrent, it might be useful for people to know what the worst that can happen is if you do not get your children vaccinated.

[Lord Markham (Con)]

The noble Baroness is quite right. I had two young sons at around that time, and it was a concern. Of course, we did go ahead, but it was a consideration. It is an excellent question. I have not seen the study of those various cohort groups but I will go back, because it is something we need to bring out.

NHS App: Medical Records

Baroness McIntosh of Hudnall Excerpts

Tuesday 19th December 2023 Lords Chamber

[Lord Markham (Con)]

Patient records is what the federated data platform is very good at, in terms of drawing data and information from all sorts of sources into one place, so it is always in the ownership of the person, the GP or the individual place. You can make your data available to the private care providers, if you are having an operation with them, for instance, but the data always remains within the NHS and in the ownership of the person.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, following the question from the noble Baroness, Lady Bull, is the Minister confident, in all the talk about advances in technology, that data-sharing within the NHS is fit for purpose? We frequently encounter an apparent disconnect between different departments in the NHS, or different levels of care, where information which should be available to everybody is palpably not or, if it is, it is not being taken any notice of.

[Lord Markham (Con)]

The noble Baroness is absolutely correct. While I think everybody would say that 90% digitisation is pretty good—it is not 100%, but it is pretty good—always making sure people are talking to each other is often the issue. I am sure we have all had examples of that. That is what the federated data platform helps to do, in terms of drawing it all in. For example, Chelsea and Westminster has put what was on 10 different spreadsheets and records into one place. We are getting a lot better at that, but is it perfect and seamless? No, there is still some work to be done.

Sexually Transmitted Infections

Baroness McIntosh of Hudnall Excerpts

Tuesday 5th December 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is absolutely right: young people—15 to 24 year-olds—represent one of the highest levels of this. In 2020 we made relationships, sex and health education classes available compulsorily in schools. We are currently reviewing that to see the effectiveness of it, with a view to expanding it further.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can the Minister tell the House what the current rate of take- up is for vaccination against HPV—human papillomavirus —and what efforts are being made to make sure that all those who should be vaccinated are?

[Lord Markham (Con)]

I will need to come back with the exact figure for the vaccination rate. I know that it is proving quite effective, which is important. On the measures we are taking, we are investing £25 million in women’s health hubs precisely to enable these sorts of vaccination programmes. I will happily follow up in writing with the detail.

Paediatric Care: Wating Times

Baroness McIntosh of Hudnall Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Markham (Con)]

Unfortunately, industrial action is impacting on waiting times; we estimate that about a million appointments have been lost to date. Clearly, that is a matter of regret and not good news for anyone.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I take the Minister back to the question from the noble Lord, Lord Allan, who referred to the necessity for parents to do a lot of running around and following up for themselves. Does he agree that this is a particular problem with the management of long-term conditions in young people—for example, ADHD and other things relating to autism—where the challenge is not just to get the diagnosis but to then get a consistent level of treatment over the long term? Can he comment on what steps have been taken to improve that? Can he also comment on the reported limited availability of appropriate drugs for treating young people with ADHD?

[Lord Markham (Con)]

I am aware from personal experience that, when you have a child with neurodiversity or developmental needs, it is a long journey. We are seeing this manifest itself much more in recent years; I was talking to Minister Caulfield about this just this morning. One-to-one is always preferable but, where capacity is constrained, group education and help can sometimes lend themselves to this space. It is a long-term condition, and clearly it will not be solved by treatment over a few months but needs many years.