Health Bill

Debate between Lord Hunt of Kings Heath and Lord Patel

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I have put my name to Amendments 26, 78 and 242, tabled by the noble Baroness, Lady Finlay, and support everything that has been said by the noble Baronesses, Lady Finlay and Lady Hollins, and others. They have highlighted the serious problem of the underfunding of palliative care, whether that is specialist, community or hospice palliative care.

To make my points, I need to personalise them, which I hope I can do successfully. What impressed me most when I had to experience the provision of palliative care was the personalised care plan that was written by the team who were going to look after my wife when she died last year. That was so fundamental for the family and for the patient. The other important bit was the compassion that was shown. I do not know of any other branch of medicine in which I personally feel that compassion is so paramount. It is a person who is dying. There can be nothing more final than death. If we cannot show compassion at that time, then we fail.

The next bit was communication: with the patient, with the team who were going to look after her, and with the family—and the inclusion of family in that communication was extremely important. The team was identified: it was the GP, the district nurses, and the specialist palliative consultant, who, in the end, did not need to provide her services but who none the less was available.

The other important bit was the co-ordination. There was total co-ordination of Macmillan nurses, district nurses and the GP, importantly to assess the medication that was required on a daily basis, 24 hours a day, seven days a week. What I learned, although I am a doctor of long standing, was that for patients who are dying, medication tends to change hour by hour, because their symptoms change. There are not just the symptoms of pain; there are other symptoms that make them uncomfortable, and they need to be relieved of those. In the middle of the night, that service was available. At 2 am, by phone call, somebody appeared five minutes later to provide that medication and care by the team.

The next factor was continuity of care. It was the same GP who visited every day, and the same district nurses, including at the weekends, day and night. That continuity of care was provided all the time.

The next bit was comfort. It is difficult to understand how much comfort is important to these patients when they are dying. They are uncomfortable because of pain, because of the disease that is killing them, and because they have developed symptoms that are difficult, such as retching, vomiting and other symptoms. That requires treatment at the time. If that is not available, the patient who is dying suffers.

Choice—patient autonomy—was another factor: that patients have a say, even though they are dying, as to what would help them. That was important. Furthermore, it was about control, that the patient was helped to achieve their goals. They do have goals, even though they are dying. They know what they want, in terms of comfort and other issues.

Any palliative care proposals and frameworks developed must address this issue, paramount in which should be compassion. If we fail to do this, then we fail. We should not rely on funding from charities organising fêtes and coffee mornings; we should fund the service appropriately and demonstrate that we are a compassionate society.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I take a rather different view from that of the noble Lord, Lord Patel. We need to look back at the foundation of the hospice movement—it was founded within the charitable sector. It has always been valuable that a lot of the funds to run them have been raised by hospices themselves. That has given them a certain degree of independence, which they clearly would not have if they were funded entirely by the state. It also meant that they brought innovation into palliative care in a way that directly funded services would have found difficult.

There is, however, a need now for more support from government. I acknowledge and welcome the resources the Government have put in in the last two years. I hope my noble friend can say when the framework is coming. As I understand it: one of the issues about hospice funding is that it is so hand to mouth. For some reason ICBs, and their predecessors, have seemed to be incapable of giving longer-term contracts and certainty—they always give short-term contracts and operate hand to mouth.

In a sense, this takes us to the heart of the Bill. So many of these amendments are really because we do not trust ICBs to do the job properly. Their main focus is on waiting times and financial performance. With the huge variation in the funding of palliative care, can we have any confidence that, even with the modern framework, we are actually going to get a more comprehensive package of long-term services for hospices?

Of course, there is a wider challenge of palliative care in the NHS itself, which the noble Baroness, Lady Finlay, referred to. Some reassurance on the hospice issue—that the framework, when published, will mean that ICBs have to sort this out, that they have to give long-term certainty and deal with some of the variation in funding that we see at the moment—would be welcome.

Medical Training (Prioritisation) Bill

Debate between Lord Hunt of Kings Heath and Lord Patel

Report stage
Monday 23rd February 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I will speak to my amendments listed in group one. My amendments should be underpinned by the status of UK medical graduates. The competition to get into medical schools in the United Kingdom is one of the toughest of any country. The ratio of success is about 4:1, with the highest A-level grades obtained, including many at A*, but requirements are higher than that.

At completion, on average, a UK medical graduate has a loan of about £72,000, and it is important that we debate this Bill in that context. I have retabled my amendments from Committee for two reasons. The first is that the debate that we had in Committee concentrated—rightly, maybe—more on international medical graduates or graduates from UK university campuses and not so much on the UK medical school graduates, who seem to be losing out on getting training posts. We have all received many emails from UK graduates and international medical graduates. I, presumably because I had amendments in my name, seemed to receive many more from UK medical graduates. Some noble Lords may have seen a petition on the internet addressed to us, Members of the House of Lords, to pass this Bill unamended, from UK medical graduates. I gather that there are over 4,500 names attached to that petition now.

So why am I putting forward these amendments again? Most other countries—the USA, Canada, New Zealand, Australia, Singapore and the EU—prioritise their graduates for further training and even employment. Data from the GMC, NHS England, the royal colleges, the BMA and professional journals shows—I accept there is variation, including in how the data could be interpreted—that graduates from the UK find it difficult to get into core and specialist training programmes, for a variety of reasons. They include: increased output from medical schools, which will increase even more in future years; an increase in post-2019 visas for international medical graduates; and training slots have not increased, with the workforce plan increased to accommodate more doctors.

In the UK doctors’ pay negotiations, one of the primary reasons that they gave was that training was an issue. A second issue was working conditions and a third was pay. I have said publicly in this Chamber before, and I repeat now, that I do not subscribe to any doctor at any time withdrawing their services from patients, for no matter what reason. I therefore do not agree with junior doctors going on strike. Despite the fact that they may have a legitimate reason to complain about their training issues, it is still no reason, as far as I am concerned, to withdraw services from patients.

UK training of doctors has three stages: foundation years 1 and 2; core training; and specialty training, including GP training. The GMC informs me that foundation year one training is available to all graduates who graduate from UK universities, although sometimes they find it difficult as the slots are not available until the last minute. Usually, that ought not to be a problem. In my case, it was two weeks before I had to start the job that I secured a position to do surgery in Penzance, having qualified in St Andrews. It was not a place that I had visited before, but I got through it.

In a 2024 report, the GMC says that, in 2023, 77% of doctors completing foundation year 2 did not or could not enter core training. A lot of them, around 13%, had decided not to, I gather, and may have gone overseas. In 2017, international medical graduates whose primary medical qualification was overseas were 47% of those registered with the GMC; in 2023, this was 68%. The 2023 GMC report said that 40% of doctors entering specialty training were international medical graduates.

It is important that we have opportunities for international medical graduates to come to train in the United Kingdom and have employment status in the NHS. But UK doctors should have a fair shot at being able to compete fairly. UK doctors comment that, after foundation year 2, entering specialty training is like falling off a cliff; it is difficult for them to get into specialist training.

NHS England, in annex 3 of its briefing on the Medical Training (Prioritisation) Bill, says that the potential impact will be an application total of 21,000 for about 10,000 posts, a ratio of 2:1. In 2025 round 1, 28,000 of the 80,000 applications were deemed appointable, according to that document. On competition, annex 4 says that, despite lower competition ratios, over 2,000 appointable UK graduates did not receive an offer in round 1 of 2025.

The expectation, therefore, is that there will be 16,000 UK graduates, a slight increase from last year, applying for core and specialty training, and 26,000 international medical graduates, also a slight increase from last year. That is 42,000, although the NHS England number is 47,000. There is always a variation in the numbers, for reasons I cannot explain. Nonetheless, the ratio is 4:1 for 10,000 slots. The estimate is that 8,000 UK graduates may be forced out of the coming rotation year as they may not have appointments.

The passage of the Bill will mean that priority groups of doctors will also apply for these training slots. I could not find a number for what effect that will have, but maybe the Minister has numbers on how many more doctors will be able to enter specialist training if the priority groups in the Bill are included. So UK graduates, with the expansion of priority groups, will have further competition.

An NHS England publication, with a foreword from Dr Powis and the Chief Medical Officer, says that

“the current bottlenecks in training do not benefit anyone; while some competition has always been a necessary part of medical training and career progression … the current ratios are making sensible career planning and assessment”

for, in my words, UK doctors

“very difficult”.

That is why I put my amendment where I have. I know the later amendments will discuss graduates from other UK campuses being eligible for the priority group, but I will refer to that later. I beg to move.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord, Lord Patel, made some very interesting points, and I am interested in hearing my noble friend the Minister’s response to his amendments. I doubt I have had as many emails as the noble Lord, in view of his expertise in the whole area of medical training and development, particularly at postgraduate level, but it is hard not to feel sympathetic to both sides of the argument. I feel for those doctors trained overseas who thought they were on a pathway to being accepted for specialty training in this country and have had the rules of the game changed half way through.

Equally, though, as the noble Lord, Lord Patel, pointed out, we have the ridiculous situation of growing competition from overseas doctors while UK-trained doctors are finding it very hard to get specialist training. This goes to the wider question about this country’s overreliance on doctors from overseas, and the current recruitment from Africa gives me particular concern about the ethics of this process.

--- Later in debate ---

[Lord Patel (CB)]

My Lords, I might end up sounding like a broken record, but I hope it is still playing well. I will declare my interests, although they are probably irrelevant. I am an emeritus professor at the University of Dundee and have previously been its chancellor. I am a fellow of the several royal medical colleges, and I am associated with several universities in the United Kingdom that have medical schools.

I congratulate the noble Baroness, Lady Gerada, on her most eloquent and powerful argument for Queen Mary, Malta to be considered a special case—and she just about succeeded in doing so. Besides that, the broken record bit about me goes back to UK medical graduates. Some 7.6% of graduates of United Kingdom universities are overseas citizens, but they are all trained in the same curriculum and with the same degree as from UK universities. There are several universities that take these students; there are too many to list them all. The overseas campuses of UK universities of course have the same curriculum because the GMC has recognised the institution and therefore its curriculum. The GMC does not give recognition to any training programmes that do not have the same curriculum for graduates. Whether it is a campus or it is associated with the university, the curriculum is what the GMC approves and, in doing so, it therefore approves the institutio;n.

There are other UK university campuses overseas. Newcastle has 107 trainee doctors in Malaysia. I am told by the GMC that Barts London has a university association in Malta that has 69 graduates—and, as we have heard, Queen Mary in London has had a total of 147 graduates from there. Southampton medical school is approved for a medical course in Germany with 23 candidates. St George’s London, as we have heard, had quite a small number; I was told it was nine, but the noble Baroness, Lady Gerada, said it was seven. There are two more schools that are seeking GMC approval: Swansea in Mauritius and Exeter in Athens. I have no doubt that other medical schools will also jump on the same bandwagon and that, after today’s debate, they will make sure that their curriculum is similar to those followed in the UK so that the degrees from their overseas campuses are also recognised.

I have no objections to any of those—as I said, the noble Baroness, Lady Gerada, made a very strong case for Queen Mary in Malta—but I do point out that, if we add these all up, we will increase the priority groups that will challenge UK medical graduates further. That is the only case I am making.

[Lord Hunt of Kings Heath (Lab)]

My Lords, like the noble Lord, Lord Patel, I apologise for coming back to the substance of the debate on the first group.

We should pay tribute to the noble Baroness, Lady Gerada, for how she has approached these issues. Her amendments, which I agree with, are very tightly drawn to Malta and Newcastle. She has been engaged with my noble friend the Minister and has asked for certain assurances from her; I hope my noble friend will be able to respond to them.

This identifies the madness of the situation that we have. UK universities with campuses abroad often have students coming from the UK; they go over there to study in the hope that they can then come back to the NHS and apply for specialty training places. If ever one wanted a reason for why we need a fundamental, wholesale review and reform of the gamut of medical training, this is it.

I chided the noble Baroness, Lady Gerada, about the royal colleges’ leadership in this area, because the colleges should take leadership. Through her leadership of her college, and that of the noble Lord, Lord Patel, we have examples of the kind of leadership that we desperately need now from the medical royal colleges.

Internet Activity: Energy Use

Debate between Lord Hunt of Kings Heath and Lord Patel

Monday 27th January 2025 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I certainly accept the challenge from the noble Lord: as we wish to see the encouragement of data centres and the use and development of AI in the UK, clearly we want it to be sustainable. I make the point that, in the first place, newer cryptocurrencies use less energy than the original ones, and, secondly, that data centres are increasingly looking to energy efficiency methods. AI can be used as one way in which to improve our management of energy efficiency.

[Lord Patel (CB)]

My Lords, the Minister said that current data centres use about 2% of total electricity generation. Can he quantify that in respect of how many terawatt hours are currently being used by data centres? With the Government’s ambition for AI and the development of more data centres, what will be the requirement in terawatt hours by 2030?

[Lord Hunt of Kings Heath (Lab)]

My Lords, my understanding is that NESO has estimated that 7 terawatt hours will be used by data centres in 2025, rising to 22 terawatt hours in 2030 and to 62 terawatt hours in 2050. As a comparison, it expects annual electricity demand in 2050 to be between 533 and 700 terawatt hours.