Medical Training (Prioritisation) Bill

Lord Jackson of Peterborough Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I have tabled Amendment 2. The clerks suggested changing the wording to what is now there. It is a probing amendment, and like those of the noble Lord, Lord Patel, it could be applied to other clauses as well. It is about the principle. My strong view is that we have opened up medical schools and made more placements because we want to make sure that we have an ongoing workforce. I am delighted to see the noble Lord, Lord Darzi, in his place. He will have done work not only for Health Secretary Wes Streeting recently but previously in making sure that we have a strong workforce pipeline.

I am conscious that many medical schools, by way of survival, by way of diversity, have opened up a number of places. Admittedly, this is still quite small compared with the number of UK citizens going to medical school. However, as the noble Lord, Lord Patel, said, we have a curious definition in this legislation—that a UK medical graduate is simply somebody who went to a UK medical school. I do not think that is what the public would think that this is about. From a lot of the emails, I do not think that it is what a lot of doctors appreciate either—although I appreciate that it is the position of the BMA, which does not want to differentiate in that regard.

We have young people taking on debt by investing in their own education and several billion pounds being put in by the UK Government, by the UK taxpayer, to have this pipeline. Therefore, it is vital to have what my amendment seeks—a set prioritisation in this legislation and not, as the Minister said the other day, a “just one group and then no more” kind of prioritisation. It is vital that UK citizens are given priority.

It is important to look at some of the analysis. It is not the case that all training posts could be filled by UK citizens who have trained to be doctors—far from it. We would not have GPs coming through. According to the 2024 analysis, only about half of the GPs going on the ST1 or CT1 were from UK medical schools. There is a whole series of issues, and we are seeing this in different elements including psychiatry and paediatrics—very few UK medical students, it seems, want to do paediatrics. I could go on with the series, but the point is clear: this is not about excluding people from the rest of the world coming to work in this country or to fill key roles in the NHS; it is about ensuring that our investment is prioritised on UK citizens.

There is a certain peculiarity, which will come up in other groups, about what then happens with the Republic of Ireland and similar. I am not seeking to get into that debate; perhaps we will a bit later.

I want to get a sense of this from the Minister. One thing that is clear in the statistics, and which the Minister and the Department of Health should be seeking to understand more, is that for quite a wide range of the training courses UK students are turning down the opportunity, once they have been offered placements. Why is that? For general practice, I think that only 57% are accepting. I am conscious that people might get posted around the country, but that needs careful scrutiny as well.

I do not wish to suggest in any way that we are not welcoming people from different parts of the world, but it should go back to trying to make sure that we are addressing particular gaps in our NHS workforce, now and in the future, not squeezing people out, and recognising the work that has been done to increase the potential numbers in home-grown talent.

Those of us who spoke at Second Reading have, in the last week, had a lot of emails coming in. I completely understand that there are different stories. For a brief time, when I was Health Secretary, a by-line suggested that I thought everybody should disappear to Australia—far from it. We cannot stop people leaving this country to go to Australia or elsewhere in the world, but we should be making sure that the reason they are choosing to go elsewhere is not because they cannot get a training place here when they have been deemed appointable. Ideally, they would be offered a role. That is something we can fix with this legislation. I hope the Government will rethink their approach to this during the passage of the Bill.

I apologise to the Committee that I will not be here to deal with my amendment later on, but I know that the Front Bench will do so. The time is pressing to get this right. I had not realised quite how soon a variety of decisions need to be made: I believe they need to be made before, or certainly within a few days of, Easter. It is critical that the Government think again. I am sure that, with encouragement from the Committee and from very distinguished medical practitioners, current and past, they will do so. That is why I commend my amendment to the Committee.

[Lord Jackson of Peterborough (Con)]

My Lords, I am delighted to have the opportunity to support my noble friend in her excellent amendment. Broadly speaking, this is a very welcome Bill. I congratulate the Government on bringing it forward to address what is becoming an acute issue, but it could be better. My remarks fall into two separate parts: there is the philosophical issue and there are the practical, evidence-based matters, which I will elucidate in the course of my remarks.

First, it has to be said that British taxpayers fund medical education through universities and the NHS, and we should be thinking much more about the value for money that those taxpayers receive. Prioritising British citizens would ensure that the investment benefits the domestic healthcare system and would, I think, reduce the risk of brain drain, where trained doctors emigrate after completing training. Training costs are substantial—estimated at £200,000 to £500,000 per doctor—and British citizens would be more likely to remain and practise in the UK long term. There is a case that they perhaps provide better value for public investment in medical education.

The wider philosophical issue, as alluded to by the Nuffield Trust, is around the fact that, in recruiting international medical graduates, the NHS has a negative impact on the domestic healthcare sector and staffing shortages in many countries abroad, particularly in Africa and Asia and poorer countries generally. That point has been made over many years. There were issues too about cultural familiarity, language proficiency, better understanding of local healthcare practices and patient expectations, and easier integration into multidisciplinary medical teams.

Specialty training, competition ratios and bottlenecks have reached breaking point. Preliminary information for the 2025 specialty training application cycle is concerning. This year, there are over 33,000 applicants for just under 13,000 training posts. This means that up to 20,000 doctors will be left out of specialty training this August. Even if you are not directly affected, that is a public health and public policy issue.

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[Baroness Merron (Lab)]

We do not anticipate that that is going to cause a problem. The noble Lord did not specifically refer to the EFTA countries, but I should like to. Some of them will not produce any suitable people who are likely to be included, so in our modelling we do not anticipate that there will be a problem. What matters is patient care and getting people with the right training who understand what the NHS is about, understand the culture of the NHS and provide as best as they can. That is what the whole Bill is directed at doing and prioritising.

[Lord Jackson of Peterborough (Con)]

I accept that the Minister is not predisposed to accept the amendment from my noble friend Lady Coffey, and she has made a clear case for that, but is she in a position to reassure the House that the issues raised by my noble friend and others about the relative take-up of specialty training places in less popular disciplines, such as anaesthetics or paediatrics, will be looked at by the department? I did not get the opportunity to make this point, but one point was that prioritising British medical students—not excluding others—would have a positive impact on those particularly hard-to-fill disciplines. Is the department taking that into account generally in its workforce planning?

[Baroness Merron (Lab)]

Yes, we are.

Terminally Ill Adults (End of Life) Bill

Lord Jackson of Peterborough Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Falkner of Margravine (CB)]

My Lords, perhaps reference to the Companion will help reduce the noble Baroness’s confusion about my speech. The Companion says that, once the Chair has put the Question,

“a general debate on the clause may take place”.

I am highlighting problems with the clause. Clause 1 is the substance of the Bill and an equality impact assessment is fundamental to our understanding of whether it should stand part.

To come back to the letter, it refers to the possibility of generating comparative evidence on the wider matters, but that would not have produced sufficiently robust conclusions. The matter raised was that the EIA did not deal with any detail of all those certain protected characteristics because it focused on access to assisted dying. Access to assisted dying is not relevant to the safeguarding risks that we have all spent some eight days in Committee debating. The letter says:

“We intend to update both the Impact Assessment and the Equality Impact Assessment should the Bill receive Royal Assent, once detailed implementation work has been completed”.


That will be too little too late. It is of no assistance to Parliament in considering the Bill and its potential consequences. Indeed, the whole point of an EIA is that it is done before or at the time a decision is taken. I refer again to the Cabinet Office guide to making legislation. A failure to undertake a comprehensive EIA means a failure to comply with a public sector equality duty, as post hoc analysis cannot generally cure a failure to have due regard to equality implications at the time a decision is being made.

That is what the courts consistently emphasise. R (Blundell) v Secretary of State for Work and Pensions 2021 noted that post-decision equality analysis is not sufficient to fulfil the duty, as it is supposed to be a real, open-minded consideration of the equality implications, conducted with substance and rigour, not a rearguard box-ticking exercise.

In concluding, I say to the Government that an accurate assessment of how the Bill impacts people who share each of the nine protected characteristics does not betray that position of neutrality. In fact, it is the converse: withholding information is not an act of neutrality but the opposite of that.

The Constitution Committee published a report on the Bill on 11 September, lamenting that supporting documents, including the EIA, “were issued late” or were not available. In the other place, Ministers gave the excuse that the Bill was “highly dynamic” and likely to undergo significant changes during scrutiny, so it was important to wait until the committee concluded its work so that

“we know what it is that we are assessing the impact of”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 30/1/25; col. 282.]

Now we are told that there is insufficient evidence to produce conclusions that are sufficiently robust. I suggest that the Minister review what both the EHRC and the letter submitted by 59 Members of this House have asked her to do and come back with some more positive news at an earlier date.

[Lord Jackson of Peterborough (Con)]

My Lords, I beg the indulgence of the Committee to raise what I think is an important point; I hope the Committee does not think it pedantic. I had not intended to speak but was prompted to by the excellent speech of the noble Baroness, Lady Falkner, and by my noble friend Lady Coffey’s reference to the lack of insight provided by the Government—I will not criticise the sponsor, the noble and learned Lord, Lord Falconer of Thoroton. This—our deliberations, scrutiny and oversight of the Bill—is a moveable feast, so we need information in real time.

My specific point is not just about freedom of information but about Written Questions that the Government have received and not answered. On 1 December 2025 my noble friend Lord Kempsell asked His Majesty’s Government a very reasonable Question. He asked, with regard to the Bill and its impact assessment,

“what assessment they have made of the effectiveness of judicial approval as a safeguard in countries with assisted suicide regimes, including the proportion of applications refused in those countries and the reasons for refusal”.

Two months on, that Question has not been answered. That is unacceptable, because scrutiny and oversight require us to have all the information in our hands, including comparative legal, regulatory and medical regimes.

By comparison, the very sensible Question from the noble Viscount, Lord Stansgate—I do not want to embarrass him because he is in the Chair—about the use of the Parliament Act was asked on 26 January and answered promptly on 29 January. The point is that there should be equality and a level playing field on Questions asked, irrespective of the position on the Bill of the noble Lord asking it.

[Lord Blencathra (Con)]

I am another Member who had not intended to say a single word on whether the clause should stand part; I am rather relaxed about it. The Government Whips must blame their noble friend Lord Rooker, who provoked me into commenting because I agree, once again, with every single wise word he said.

The noble Lord referenced the Delegated Powers Committee, of which he was a distinguished member at one point. I was the chair of the committee when we produced the Democracy Denied? report. It highlighted the fact that every Government over the past 30 years—Tory, Labour, Conservative-Lib Dem and Conservative again—took more and more powers away from Parliament via delegated powers. The delegated powers in the Bill are excessive and have rightly been criticised.

The noble Baroness is also right that no Government in any democracy in the world can function unless there are delegated powers; not everything can be in Bills. The questions here are: how many delegated powers are appropriate; and what will they contain? The trouble is that we have more than 40—48, I think—possible delegated powers, including Henry VIII powers. That seems excessive.

I pay tribute to the noble and learned Lord, Lord Falconer, for producing some amendments that would implement the delegated powers recommendations, but I think he knows that if he did not produce them, this House, on Report, would implement every single one of the delegated powers recommendations; we would gut those bits of the Bill that did not implement them. So, although he has generously provided some amendments regarding the delegated powers recommendations, he knows full well that this House will implement all of them in any case.

That is all I want to say on the Bill. Delegated powers under all Governments have been increasing and ought to be diminished. Although I have some concerns about the contents of the Bill, I have many more concerns about the 48 powers that will be written by civil servants in the Department of Health. At the moment, they are unable to tell the difference between a man and a woman; I do not want them writing up how I will die in future.

Tobacco and Vapes Bill

Lord Jackson of Peterborough Excerpts

Committee stage
Tuesday 11th November 2025 Grand Committee

Moved by

[Lord Jackson of Peterborough]

114A: After Clause 48, insert the following new Clause—
“Consultation and review of the generational sales ban for tobacco products(1) Before making regulations under this Part the Secretary of State must consult—(a) the retailers of a relevant product or representatives of the manufacturers of a relevant product;(b) the manufacturers of a relevant product or representatives of the manufacturers of a relevant product;(c) consumers of a relevant product or representatives of consumers of a relevant product;(d) any other persons that the Secretary of State considers appropriate to consult.(2) Consultation under this section must include a call for evidence.(3) The Secretary of State must have due regard to all views received as part of any consultation under this section.”Member’s explanatory statement
This amendment requires the Secretary of State to consult retailers, manufacturers and consumers on the practicality, enforceability and efficacy of the products in scope of the generational sales ban on tobacco products before implementing these regulations.

[Lord Jackson of Peterborough (Con)]

My Lords, this amendment is essentially about the product scope of the consultation. I will say at the outset that I am not a smoker, and I have no fiduciary or pecuniary interest in the sector, but I am sure the noble Baroness, Lady Walmsley, will be delighted to know that I am speaking on the basis of empirical evidence which informs my remarks. The focus is specifically on heated tobacco products. I hope noble Lords will not groan about that because, given that the noble Lord, Lord Vaizey, was not here to move his amendment, we have not really had a debate about the efficacy of the ban as it affects heated tobacco products.

The broad thrust of this amendment is about consultation. It would require the Secretary of State to undertake the most basic task of any Government, which is to consult those impacted—retailers, manufacturers and consumers—on the practicality, enforceability and efficacy of the products in scope of the generational sales ban on tobacco products. I will take those points in turn, with the caveat that I will be focusing on heated tobacco products.

Heated tobacco is not smoking. In fact, it is an effective aid, as my noble friend Lord Howe said, in stopping smoking. The generational ban is a misguided step, but if the Government insist on proceeding with it, they should follow the evidence and remove heated tobacco from the scope. I shall speak to that more later. I want to talk about the practicality of the generational ban. Leaving aside the philosophical debate, there are practical public health considerations that may have been reflected in the Bill if a proper consultation had taken place. The first is that, for those who already smoke, heated tobacco products are an effective smoking cessation tool. They have helped Members of this House and the other place to quit smoking. It is illogical to include them in the ban and the Government should commit today to consulting with consumers of heated tobacco products so that they may understand their utility more clearly.

The second public health point is that simply the number of people, especially young people, starting to smoke is now very low. It was 1% of 11 to 15 year-olds in 2021 according to Action on Smoking and Health. An even lower number, just 0.3% according to the same survey, are using heated tobacco products. All of this suggests there is no need for heated tobacco products to be included in the scope of banned products. There will always be outliers and the Government’s own impact assessment

“assumes some people continue to smoke despite it being illegal for effectively all ages to be sold tobacco by 2100”.

For these adults, it makes sense for all cessation products to be available so that the road that has worked for decades can be taken—smoking reduction policies that inform, nudge and dissuade rather than remove the rights of adults to make their own choices.

I want to talk about enforceability and the illicit trade and retailers, and all within the context of proper consultation or otherwise. We do not have to look into a crystal ball to imagine the consequences of this legislation, particularly the generational ban. The policy has already backfired in Australia where there is now a booming illicit trade fuelled by criminal gangs. We would be naive to assume the same situation could not happen here in the United Kingdom. A consultation with retailers would reveal the issues they already face with rising crime and illicit trade. This would undoubtedly worsen with confusing arbitrary rules for different legal products.

We should make these measures as simple as possible for retailers by categorising all smoking cessation products in the same way. That would be a useful start. We know that young people will still be able to get their hands on illegal cigarettes, just as we know that they are able to procure all manner of products that they should not be able to. Teenagers have always been resourceful; that is why it is important that we continue to make all possible smoking cessation tools available to all adults because, whatever the law says, there will be adult smokers born after 1 January 2009.

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[Baroness Merron (Lab)]

I assure the noble Baroness that there is nothing paper about the exercise that we are undertaking, but I accept her point and I have on previous groups. This is not one size fits all; the issue manifests itself in different ways. I wanted to present an overall national position, but I of course understand. That is why we are looking at regulations and why we have a call for evidence, consultations and an impact assessment, so that we do not uniformly treat all areas the same. It is important that we remind ourselves, as I have done repeatedly, that tobacco is a deadly addiction. Stopping children from starting to smoke is the easiest way to reduce smoking rates, and that is at the core of the Bill.

[Lord Jackson of Peterborough (Con)]

Will the Minister give way? I am trying to be helpful. As the Minister has made some quite fair and emphatic comments about the toxicity of heated tobacco and its lack of efficacy in smoking cessation, would she be so kind as to put that in writing to me in order for members of the Committee to consider that as we go forward in the Bill?

[Baroness Merron (Lab)]

I will be happy to.

On Amendments 135A and 136A, tabled by the noble Lord, Lord Johnson, health is a devolved matter, as noble Lords are aware, so the implementation of retail licensing in Northern Ireland is ultimately a matter for the Department of Health in Northern Ireland. However, it is a shared view that it is important that details of our respective retail licensing schemes are informed by adequate consultation with all relevant stakeholders. That is why, in collaboration with the devolved Governments, we have launched a call for evidence that asks detailed questions about a number of matters that noble Lords have rightly raised. It is open until 3 December and asks detailed questions about the implementation of retail licensing, among other topics. I can say to the noble Earl, Lord Howe, and the noble Lord, Lord Johnson, that it asks how a retail licensing scheme can be implemented effectively. We encourage feedback on how existing businesses should be treated specifically, and I hope that responses will come forward.

I remind noble Lords that following the call for evidence there will be a consultation, so there is plenty of opportunity to consider all the important points that have been raised today. For example, we will ask whether there should be any exemptions from needing a licence and whether factors such as restrictions on the location and density of retailers should be features of the scheme. We believe it is important that such decisions are informed by expert views, and it would not be right to prejudge the evidence that we receive by putting in place different rules for one particular type of business, as the amendment suggests.

The absence of a retail licensing scheme, as I have spoken to on previous groups, represents a major gap in the enforcement of tobacco and vape legislation. All tobacco products are harmful, and it is right that we ensure that those selling the products are following the rules and acting responsibly. A retail licensing scheme will help to deter those who fail to do so, and I know all noble Lords are concerned to do that. With that, I hope noble Lords will be good enough not to press their amendments.

[Lord Jackson of Peterborough (Con)]

I thank all noble Lords who took part in this debate on my amendment. I particularly thank the noble Baroness, Lady Fox of Buckley—it goes without saying that of course I support her Amendment 114C—and my noble friend Lord Sharpe of Epsom. This debate and the previous group have shown that it is quite difficult to properly launch a generational ban in a monolithic way without disaggregating the different products, which are discrete products.

I fear that the noble Baroness, Lady Northover, did not actually read the amendment, because it specifically says it is not just for the benefit of retailers and manufacturers. Subsection (1)(d) specifically mentions

“any other persons that the Secretary of State considers appropriate to consult”,

which would include health bodies and charities. Subsection (2) says:

“Consultation under this section must include a call for evidence”,


which, presumably, the latter would also avail themselves of. These are wide ranging and permissive powers of consultation, and I hope she might reconsider when we come back on Report.

We have had a good debate on this issue, given that we did not have a specific heated tobacco product amendment per se. With the proviso that the Minister has given me an undertaking to provide the data on the efficacy of heated tobacco products, and a very straightforward undertaking to do more consultation on these key areas, I am happy to withdraw this amendment.

Amendment 114A withdrawn.

Puberty-suppressing Hormones

Lord Jackson of Peterborough Excerpts

Monday 16th December 2024 Lords Chamber

[Baroness Merron (Lab)]

In view of what the noble Baroness said, it is quite important to consider that the children and young people’s gender services waiting list currently has 6,237 people on it. I certainly agree that waiting lists for these services are too long. We are committed to changing that, which is why I outlined the timetable for the new gender services and the opening of the new centres. They will increase clinical capacity and reduce waiting times for sure. On the point the noble Baroness raised, there is a commitment to the clinical trial, and I am glad there is. As we have brought forward this legislation in an absence of evidence, it is incumbent on us, as a Government, to follow through on what the previous Government started in train, which is to use a clinical trial to provide the evidence. Otherwise, the debate would remain uninformed and not evidence-based, and that cannot be helpful.

[Lord Jackson of Peterborough (Con)]

My Lords, I welcome the Statement and congratulate the Secretary of State on the moral clarity and leadership that he has shown in balancing the evidence base with compassion. Perhaps I may press the Minister on a few points. An indefinite ban is not the same as a permanent ban. Is there a chance that the indefinite ban, which goes to 2027, may segue into a permanent ban as more information and evidence arise over the next few years?

Given that it is pretty well understood that puberty blockers have given rise to fertility problems, bone health issues and psychological health issues, I cannot understand the inconsistent policy of keeping children currently on puberty blockers in the system, when we know that there is no positive evidence base and only a negative one. I think that will affect many children.

My final point is about the eight new regional centres that will be set up. Will we be certain that the ideologically-driven zealots—clinicians who misuse their position and have prescribed unsafe puberty blockers for children and young people—will not find themselves in these new facilities? That is an important issue as we wait for the clinical trial and ruminate on the issues that the noble Baroness, Lady Cass, mentioned. We need to start again on this and to understand that there are more treatments available for the most vulnerable children, who we need to protect, than merely puberty blockers.

[Baroness Merron (Lab)]

I certainly agree with the noble Lord about the vulnerability of children and young people in this regard, which is why we are taking this action. His last point gives me the opportunity to say that we are committed to implementing the recommendations of the Cass review in full. That is a very useful guideline and tool for us to use.

I have no expectation that the situation that the noble Lord described in his third point will happen. Recruitment is subject to all the usual provisions, and I know that the gender services will seek to recruit very positively. If the noble Lord finds out anything else, I am sure he will raise it with me.

On whether the ban could become permanent, the review—at the risk of repeating myself—will report in 2027, as the noble Lord said. I believe that we should wait for that.

Bread and Flour Regulations 1998

Lord Jackson of Peterborough Excerpts

Wednesday 11th December 2024 Lords Chamber

[Lord Dodds of Duncairn (DUP)]

My Lords—

[Lord Jackson of Peterborough (Con)]

My Lords—

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, we will hear from the noble Lord, Lord Dodds, next.

Bread and Flour Regulations 1998

Lord Jackson of Peterborough Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

I know that the noble Lord takes a great personal interest in these matters and has also campaigned very strongly. The area he refers to is being pursued because we want collective agreement on this across the whole of the UK, so that we can confirm that it is government policy with absolutely no qualifications, and that everyone is moving on the same timescale. I can confirm that we have notified the EU Commission and the WTO in order to fulfil international obligations and have thus far received no responses; that is why we are able to proceed with the next legislative steps.

[Lord Jackson of Peterborough (Con)]

My Lords, the Minister is a great asset to the Front Bench. This is a bipartisan issue, and I pay tribute to the noble Lord, Lord Rooker, for his excellent work over the years. When I was a Member of Parliament in the other place, Shine—formerly known as ASBAH—the charity for hydrocephalus and spina bifida, was located in my constituency. I say gently to the Minister that we have been campaigning on this issue for almost 20 years, and to my own Front Bench that there is no demonstrable, empirical scientific evidence of any substantial side-effects of putting folic acid into basic foodstuffs, and that it should happen. Finally, more than 30 countries have pursued this policy; they have tackled the enduring tragedy of spina bifida and hydrocephalus, and the impact they have on families. Therefore, can we please do this as soon as possible?

[Baroness Merron (Lab)]

I certainly hear the very welcome points that the noble Lord makes. As we progress, this will make us the first European country to mandate folic acid fortification of non-wholemeal flour. While some European countries, including Ireland, have voluntary fortification, mandatory fortification is not the case. I and my ministerial colleagues are keen to be in this position.