Medical Training (Prioritisation) Bill

Debate between Earl Howe and Lord Clement-Jones

Report stage
Monday 23rd February 2026 Lords Chamber

[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.

[Earl Howe (Con)]

My Lords, I too am grateful to the noble Lord, Lord Patel, for leading the debate on his amendments, which seek to establish a new prioritisation hierarchy that puts UK medical graduates first, ahead of those in the priority group who are not UK medical graduates. I should have prefaced my speech by reminding the House of my interest as an honorary fellow of the Royal College of Physicians.

We debated this proposal in Committee, when other noble Lords, including my noble friend Lady Coffey, tabled amendments that sought to introduce a different prioritisation hierarchy. I understand fully the case that the noble Lord is making and I agree that UK medical graduates should have a much fairer crack of the whip in access to medical specialty training places. Fairness has been our primary concern throughout our scrutiny of this Bill. However, I agree also with the noble Lord, Lord Hunt of Kings Heath. The Government have had some hard choices to make.

In an ideal world, where the House had been given more time to consider these matters in the round, we might have been able to improve on the approach that Ministers are taking. For example, there is surely a place for guidance to make clear that the prioritisation process should incorporate considerations of medical and academic excellence, a point that the noble Baroness, Lady Finlay, has consistently made.

I am grateful to the noble Lord, Lord Stevens of Birmingham, for putting the decisions made by the last Government into their proper context. However, given where we are, we accept that Ministers have introduced this as urgent legislation with a specific purpose. In that context, having accepted that the Government’s approach will have the effect that they are seeking to achieve, we are satisfied that the Minister’s proposed method of prioritisation is acceptable.