Specialty Medical Training

Lord Kamall Excerpts

Thursday 17th July 2025 Grand Committee

[Lord Kamall (Con)]

My Lords, first, I should declare my interests. We are not allowed any more just to say, “I refer my interests as in the register”. Very quickly, I am a professor of politics at St Mary’s University, Twickenham, and I am helping that university set up its medical school at the moment. It wants to tackle some of the issues, becoming an innovative medical school looking at technology and AI, but also at doctors becoming entrepreneurs in their own right. I also teach at the Vinson Centre at the University of Buckingham and, in those seminars, I invite people to come and speak on the future of healthcare. I have worked in the past with the Institute for Economic Affairs, have written on healthcare, and Buckingham itself has a medical school. I hope I have covered all that now.

Having taken that one long minute to declare my interests, I thank my noble friend Lord Lansley for securing this debate and for sharing his experience and concern about the complex environment faced by foundation medical schools seeking to provide specialist training posts in the UK. Indeed, on entering the Chamber today, the noble Baroness, Lady Finlay, said to my noble friend and I, “It’s complicated”, and I think this debate shows that it is.

In the UK, we are proud to boast some of the world’s leading universities in medicine and science. During the Covid-19 pandemic, the nation watched with admiration as our brilliant scientists and medical experts led the UK in becoming, if not the first, one of the first countries to roll out an approved Covid-19 vaccine. This reflects not only the dedication of our scientific community and excellent research facilities but the effectiveness of well-designed systems and our huge medical experience, some of which has been on display in this Room today.

The noble Lord, Lord Kakkar, spoke of the continuum in medical training. After graduating from medical school in the UK, graduates enter the NHS’s two-year foundation programme, where they are exposed to a variety of medical specialties. Following this, they are supposed to embark on specialty training.

However, as many noble Lords have pointed out, in recent years, UK-trained medical graduates have struggled to secure a speciality training post. Recent Answers to Written Parliamentary Questions asked by my noble friend Lord Howe and I reveal the scale of the problem. In 2024, there was only one medical oncology specialist training post in the north-east training region. For paediatric training, at stages 3 and 4, in 2024 there was again only one space available in the north-east and two in the West Midlands. Furthermore, in 2024 there were 14,104 foundation programme training places in England, but only 7,929 level 1 speciality medical training posts, meaning that there were almost half the number of speciality posts available for those in foundation training.

If we look at the competition for postgraduate places, as other noble Lords have said, there has been an increase in the ratio from 1.9 applications per place in 2019 to nearly five applications per place in 2024. As my noble friend Lord Lansley said, it has been suggested that this is partly due to international medical graduates being able to apply under the same conditions as doctors in the UK.

As someone who teaches in UK universities, I believe our education system benefits from foreign students. They are good for the UK’s soft power, the health systems in the countries these trainees come from and return to, or even places our British trainees go to. I believe we should continue to train world-leading doctors. If the problem identified by my noble friend Lord Lansley is left unaddressed, it could lead to a transformation in the make-up of our doctors and a decline in opportunities for British graduates. As the noble Baroness, Lady Finlay, said, it is welcome that priority is being given by this government to UK students. In light of this, may I ask the Minister what action the Government are taking to increase the number of speciality posts available and to fill some of the vacancies referred to by the noble Baroness, Lady Finlay?

I have to admit that I have heard from some doctors I met during my time as a Minister, and now as a shadow Minister, that we should focus less on specialism and that we want more people to go into general practice. But the noble Lord, Lord Rennard, just pointed out that there is a bottleneck in GP training. The noble Lord was also absolutely right that social care has to be taken care of.

At this point, I should like to divert slightly, because the late Lord Lipsey and I were working on a cross-party solution to fund social care, but he sadly passed away recently. On behalf of everyone, I pay tribute to Lord Lipsey. I did tell him when he was ill that I would work with another Labour Peer to make sure that we work on a cross-party solution.

As the noble Lord, Lord Kakkar, said, under the previous Conservative Government, former Prime Minister Rishi Sunak unveiled the NHS Long Term Workforce Plan. At the time it was called the most ambitious transformation of NHS staffing in its history. As with any plan, there were critics, but the plan aimed to double medical school places to 15,000 by 2031 and to train 24,000 more nurses and midwives, reducing the reliance on international recruitment by cutting agency spending.

Now that the Government have launched their 10-year plan for healthcare, there are obviously many questions on how this will be delivered and the implications for the workforce. We have heard how the new Government will put aside the previous plan and will produce their own 10-year workforce plan later this year. My noble friend Lord Lansley referred to some of the commitments in the recently published 10-year plan and the noble Lord, Lord Kakkar, rightly raised some fundamental questions that need to be answered. Can the Minister enlighten the Grand Committee on some of the aspects that will be included in that 10-year workforce plan? I know the noble Baroness may have to say that she cannot jump ahead or reveal details, or that it is still being worked on, but could she say whether there are some broad issues that will be tackled at the high level, without necessarily giving numbers? I understand that it is always a challenge to ask a Minister about specific issues in advance of a plan.

Although foreign students are good for our education system, can the Minister clarify what more specific actions will be taken to ensure that there are more opportunities for new UK medical graduates. We should be clear that this is not an anti-foreigner sentiment at all. It is good that we can train people from all around the world—good for our universities, our economy and the countries they will go to. As a country, we will benefit from this in the future, but there are some fundamental questions that all noble Lords have asked. I know the noble Baroness may not be able to answer all of them at the moment, but it is critical that we address these crucial bottlenecks and understand how we can ensure that, while we want to see more students trained and new medical schools may be opening, including the one I am helping with at St Mary’s University in Twickenham, we make sure there are opportunities—to tackle not only the bottleneck but the other side of that bottleneck. Then we can make sure that those trainees, whether British or otherwise, can go on to deliver world-class care in our National Health Service and beyond.