Medical Training (Prioritisation) Bill

Lord Patel Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

Moved by

[Lord Patel]

1: Clause 1, page 1, line 4, after “must” insert “first”
Member’s explanatory statement
This amendment, and others in the name of Lord Patel, seeks to ensure that UK medical graduates are prioritised above other categories of eligible applicants.

[Lord Patel (CB)]

My Lords, my name is also attached to Amendments 3, 6, 7, 8, 12, 13 and 14, which are consequential, so I will not speak to them. This may be the briefest of introductions to any amendment.

My amendment tries to prioritise—which is the main theme of the Bill—UK medical graduates for training in UK programmes. The Bill’s Long Title says it is to:

“Make provision about the prioritisation of graduates from medical schools in the United Kingdom and certain other persons for places on medical training programmes”.


In Clause 1, this therefore also includes

“persons in the priority group”.

In Clause 2, it includes person not only in the priority group but also, in subsection (2), persons who are

“a British citizen … a Commonwealth citizen who has the right of abode in the United Kingdom … an Irish citizen who does not require leave to enter or remain in the United Kingdom … a person with indefinite leave to enter or remain … a person who has leave to enter or remain in the United Kingdom”

and so on. Similarly, Clauses 3 and 4 describe the priority group as including not only UK medical school graduates but many others, including those from countries with which the UK has made a trade deal.

All those priority groups will be able to apply for the same jobs as UK medical graduates. Add to that—several amendments on this are coming later—that the graduates of UK universities that have overseas campuses will also be included in the priority group. They are not all in the amendments today, but if these amendments are accepted, there are other universities not listed which have overseas campuses, such as the two I know—Dundee, for instance—although I did not table an amendment on that.

My amendment is because of the enormous number of emails that we have had, both from UK graduates and overseas graduates who cannot find jobs. I know there are subsequent amendments coming later about those international graduates who are now stuck in a bottleneck for this year, but that is a separate issue. My amendment does not refer to that; it refers to UK medical graduates.

We heard a story on the BBC about Emma, who was one of the 1,000 graduates who cannot get a two-year foundation slot so she cannot progress at all. She cannot find a locum job because they are all full. We heard of people who cannot enter the specialty training programme at years 1 and 2 because the competition for the specialty training programme is four applications for one job. We have 50,000 international medical graduates applying for a job for 2025, for 10,000 slots. If we cannot get UK graduates to find jobs in training programmes, that is scandalous. We could cut the number of medical students—but on the other hand, we are going to increase the number of medical students, and that will compound the issue for future applications for training.

By the way, I am not saying that others in the priority group in these clauses are not to be considered for a job. All I am saying is that UK medical graduates should be prioritised. The definition says “UK medical graduates”, but there are international students who go to our medical schools and therefore they are UK medical school graduates, so we include them. They are about 7% of the total medical graduates of UK universities. My amendment only seeks to prioritise UK medical graduates, who should be considered first—not that the others will not be considered or get jobs in whatever they come to do. This includes the subsequent amendments about overseas campuses and other universities.

I hope that the Opposition Benches will agree that UK medical graduates ought to be the first priority. I doubt that the noble Baroness the Minister will accept my amendment—the Government want this Bill to go through as an emergency Bill and not to be held up because, otherwise, it will run out of time—but I hope that, at the Dispatch Box, while not accepting the amendment, she will recognise that UK medical graduates must have priority above others for training slots. I beg to move.

[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.

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[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am most grateful to all noble Lords for their helpful contributions to this debate. Amendments 1, 3, 6 to 8 and 12 to 14, tabled by the noble Lord, Lord Patel, seek to create tiered categories of prioritisation for the UK foundation programme and specialty programmes. Taken together, they would require places to be allocated to UK medical graduates in the first instance, and then to applicants in the other prioritised categories specified in the Bill. As noble Lords have observed, the Bill sets clear priority groups, but it does not make rankings within these groups, and that is what we are looking at.

I welcome my noble friend Lord Darzi, not least because the review that he undertook for the Government in 2024 recommended that we should prioritise medical training, for all the reasons given by the noble Lords who support it. I will return to this whole area when we debate a later group, but on the point made by the noble Lord, Lord Darzi—this will perhaps also be helpful to the noble Earl, Lord Howe—alongside UK graduates, we are prioritising in the Bill graduates from Ireland and the EFTA countries. This reflects the special nature of our relationship with Ireland—specifically, our reciprocal rights of movement and employment—and our obligations under international trade agreements with the EFTA countries, which the noble Earl, Lord Howe, referred to, that require consistent treatment of these graduates in access to medical training. The amendments that we are looking at would mean that we could not honour these agreements. That, by its nature and definition, would create huge difficulties.

On specialty training, these amendments would also mean that we could not effectively deliver on our policy intention to prioritise applicants with significant NHS experience who understand how the health service works and how to meet the needs of the UK population. It might be helpful if I summarise this by saying that the Bill sets out what I would regard as a binary system where applicants are either prioritised or not. Clearly, once that prioritisation has happened, the normal processes will apply to establish who the appointable applicants are, to fill the posts, and so on.

Amendment 2, tabled by the noble Baroness, Lady Coffey, seeks to create tiered categories of prioritisation for the UK foundation programme and to prioritise UK medical graduates who are British citizens above all other applicants. The Bill as drafted prioritises all UK medical graduates who meet the criteria, regardless of their citizenship status. It might be helpful to the noble Lords, Lord Mohammed and Lord Clement-Jones, to restate that what matters is where a doctor is trained, not where they are born. UK-trained medical graduates have undertaken curricula, clinical placements and assessment standards aligned to the NHS, and are therefore best prepared to move directly into NHS practice.

The Government are committed to prioritising those doctors who have already spent a significant part of their education within the NHS and understand how the health service works and how to meet the needs of the UK population, not least because—this is an issue that we have discussed many times—these doctors are more likely to remain in the NHS for longer, supporting the sustainable medical workforce for the future that we are all looking at.

As I set out in relation to the previous set of amendments tabled by the noble Lord, Lord Patel, this amendment would also mean that we would not be honouring the special nature of our relationship with Ireland and obligations under trade agreements with EFTA countries. I emphasise again in the Chamber today that prioritisation does not mean exclusion. All eligible applicants will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers, which we expect to be the case particularly in certain areas.

My noble friend Lord Winston raised a question about the Bill in respect of highly skilled overseas doctors and particularly referenced clinical academics. As I have said, it is not exclusion from applying—it is prioritisation. It may be helpful more broadly for me to emphasise that there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, because historically they attract fewer applicants from the groups that we are prioritising for 2026. I understand the point that my noble friend is making, but we have to focus on the core purpose of the Bill. With that, I hope that noble Lords will feel able not to press their amendments.

[Lord Patel (CB)]

Obviously, the Minister is not accepting my amendment, but she makes the point that all the priority groups will be treated in the same way—whatever the definition is of people in the priority group, they will all be grouped together as a priority, and that would include UK medical graduates. What assessment have the Government made of the effect that it will have on UK medical school graduates to include all the others in the priority group? What disadvantage will that put UK medical graduates to? Will it be minimal, medium or a lot?

[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.

--- Later in debate ---

[Baroness Merron (Lab)]

I shall be very pleased to do that.

[Lord Patel (CB)]

My Lords, I thank all noble Lords who have spoken today, no matter which amendment they spoke to, and I am grateful to the noble Earl, Lord Howe, for his strong support for my amendment. More importantly, he said that UK medical graduates need to be prioritised and should not have to enter into competition with others whose graduation is not from this country. I know that the Minister was not able to say that UK graduates would be seen to be prioritised; I understand that. Of course, these debates help, because the outside world is interested in what is said here. I hope that particularly those who make decisions about interviewing or selecting for interview for training programmes will get the message, take note of this debate and bear in mind what it was all about. I beg leave to withdraw my amendment.

Amendment 1 withdrawn.

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the past year, and that more than a third of radiology departments were subjected to a ban on hiring clinical radiologists. Given what needs to happen to improve cancer outcomes in line with the new cancer plan, we clearly want an end to the restrictions placed on hiring for these crucial specialists.

[Lord Patel (CB)]

My Lords, I support the amendments in the name of the noble Lord, Lord Stevens of Birmingham, to which I have added my name. I am not going to repeat much of what he said, but I support it because when, in 2026, both the UK and overseas graduates are further down the process of applying—and some have even been asked to come for interview—they will now not be able to continue. That seems morally and ethically wrong, so I support the amendments. I also support the amendment in the name of the noble Earl, Lord Howe. He made his points very strongly.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my role as a pro-chancellor of Cardiff University, and that I have until recently been an observer on the Medical Schools Council; I am still in touch with it.

This group of amendments seems incredibly important for our international reputation for fairness and consistency in what we commit to, but also in wanting excellence in our NHS. Therefore, there needs to be a sophisticated way of prioritising. One of those important areas is the contribution to the NHS, especially during Covid and major events, when some have gone way above what is normally expected and come back from holiday or maternity leave, or whatever, to deal with a major incident, while others have perhaps not always been quite so flexible.

We certainly have a crisis and must deal with it, so this is not in any way to say that we should not be doing this, but the timing is the worry. I will come on to the other degrees in the next group. Can the Minister explain whether the Oriel system itself is a block to incorporating the flexibility that these amendments ask for? There is a real worry among some that the Oriel system is a rate-limiting step, rather than being flexible enough to be rapidly reprogrammed appropriately to allow the intention of these amendments to be incorporated at great speed, and therefore redress the accusation of unfairness.

National Cancer Plan

Lord Patel Excerpts

Monday 9th February 2026 Lords Chamber

[Baroness Merron (Lab)]

I am grateful for the noble Lord’s support for the cancer plan. I should have mentioned this. I will be honest: even as a Minister, I do not always pay full attention to the foreword, and I am sure that other former Ministers might share that, within a plan, but I commend this one to noble Lords, not least because the Secretary of State himself talked about his own experience of being told he had kidney cancer. He described his world being turned upside down. He talked about fear and foreboding, as does our Minister, Ashley Dalton MP. They both talked about fear and foreboding and the need to turn that round with action. That kind of drive, as well as the facts before us, drive this plan.

On the point about a cancer prevention plan and the question of where the strategy is for the reduction of obesity and so on, I say that this is a plan to be read alongside our other commitments. It builds on the 10-year health plan, which laid out the way we would be going forward with our shifts. This is about turning round the whole cancer pathway.

To the point specifically about prevention, I heard what the noble Lord said. We do not take the view that it is “just bad luck”. Where there is prevention, we should absolutely tackle that.

The plan tackles the causes head-on, not just by talking but with government action to cut smoking with the Tobacco and Vapes Bill, reduce obesity, act on alcohol harm and protect people from dangerous UV exposure, including through sunbeds. No one should lose someone to cancer that should have been prevented. We will not ignore the communities that are hit hardest. By having those preventions, we are supporting the communities that are hit hardest. Rolling out lung cancer screening more extensively will be one of the areas of importance.

I referred earlier to cancer alliances. They will promote, for example, new catch-up schemes to enable young people who have missed out on the HPV vaccination at school. They can have it administered at their local pharmacy. We are not leaving matters to chance. We are rolling out home testing kits for cervical cancer for those who do not go to appointments for a range of reasons, rather than offering only one opportunity.

In all these ways, the national cancer plan tackles the causes of cancer. We will continue to see that through. As the noble Lord knows, moving from sickness to prevention is a key factor in our 10-year plan.

[Lord Patel (CB)]

My Lords, I too support the national cancer plan, but I am not here to blow the Government’s trumpet. I will pick up on some of the points.

This is an ambitious plan, and that is good, because it might act as a catalyst for some progress. However, if that progress is to be achieved, the Government need to commit much more than what the cancer plan suggests. The plan suggests:

“Every patient will get a personalised assessment of their needs and a personal cancer plan—a complete support plan complementing their diagnosis and treatment”


and focusing on their wider needs. It goes on to say:

“Every patient will have a named neighbourhood care lead to coordinate their care and support after treatment”.


If that can be achieved, it will be fantastic. Apart from all the technological advances that we will have to fund in research terms, it is ambitious to suggest that liquid blood tests and cancer vaccines could be developed, be tested and be available tomorrow. It could be a long-term shot. Without investment, that will not happen. One of the key areas of deficiency is that there is nothing on what the manpower requirements would be and how this will fit into the manpower plan that the Government already have.

I heard what the Minister said about prevention. I heard nothing about developing cancer centres; we know from experience that outcomes are best when patients are treated in cancer centres, rather than in every hospital in the country. We have no targets to eliminate cancer. For example, it is possible to eliminate cervical cancer by a proper immunisation programme of HPV vaccines.

I am allowed only to ask questions, but it would be nice to have a longer debate. We never had one on the national health plan either. I hope that could be managed somehow.

[Baroness Merron (Lab)]

That last point will, of course, be drawn to the attention of the usual channels. I too would welcome a debate on this. Noble Lords might wish to note that when they have an opportunity to suggest or apply for debates.

The noble Lord’s last point was about elimination of cancer. That is possible in some cases. I am glad that he mentioned cervical cancer. I mentioned in my answer to the noble Lord, Lord Bethell, that we have committed to catch-up HPV vaccination campaigns from this year, to eliminate cervical cancer by 2040. That is absolutely the right thing to do, and to introduce the Tobacco and Vapes Bill, which I hope will become an Act, to phase out smoking and reduce youth vaping, which can be a gateway to smoking. That will also reduce risk factors.

The noble Lord, Lord Patel, is always right to press us to go further. I understand that. This is a plan for the long term but with staging posts along the way. We have already made progress. For example, I was very pleased when we announced a trial called EDITH for breast cancer screening, to harness the benefits of AI, working with operatives for sped up and more accurate diagnoses. This is one example and is to the point that the noble Baroness, Lady Walmsley, raised about AI.

I hear what the noble Lord says about cancer centres. We are seeking to move treatment and diagnosis from hospitals to community. That is one model, but there are others, as the noble Lord would acknowledge. It is right to push us to go further, but what sets this plan apart is not just its level of ambition and its recognition that all is not right in the world but that it is setting out how we will get there. However, I welcome the transparency and leadership which is attached to this—which noble Lords have called for. This plan merits a lot of attention and support. I shall be pleased to discuss it in this Chamber further.

Medical Training (Prioritisation) Bill

Lord Patel Excerpts

2nd reading & Committee stage
Wednesday 4th February 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, when there is such a short Bill, there is a temptation to repeat what has already been said in great detail, because it has not been said by me. I will not succumb to that temptation but will briefly point out the areas where I agree with what has been said, particularly by the noble Earl, Lord Howe, the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Finlay.

In the many letters and emails—hundreds of them—that I have received, two things stood out. One was the grievance felt by people who were already in the process of applying for the jobs; they now feel as if they have been thrown to the wolves. The other lot were the people who are British citizens who trained overseas and cannot now access training in our programmes. There is one other minority group: those who felt that they have had some experience in the NHS, but it is not as yet defined how much of their experience, starting in 2027, will be counted. The noble Lord, Lord Clement-Jones, referred to the immigration requirements which may or may not be counted, but that produces another. These are the groups that feel disadvantaged. What I felt on receiving these letters was that we are making people who have serviced our NHS for decades feel they are no longer required and are to be abandoned. I hope we do not give that impression.

Having said that, I recognise that, in principle, the idea that UK medical graduates should be prioritised for jobs in our NHS is correct, because it is not right that they cannot get the jobs they apply for, particularly in foundation and specialist training. On the foundation programme in Clause 1, I am concerned that British citizens who may have trained in GMC-approved institutions with the same kind of curriculum described by the noble Lord, Lord Clement-Jones, cannot be considered for that. I have already made the point about specialist training programmes and those who have gone through the process of applying in good faith. We do not as yet know what experience will be counted from 2027 onwards, so I hope the Minister can comment on that.

Clause 4 refers to a “UK medical graduate”, and says:

“‘UK medical graduate’ means a person who holds a primary United Kingdom qualification”.


It does not say a “UK citizen” who is qualified. Does that mean that an overseas student attending medical courses in our universities, who is therefore a graduate of our universities, qualifies or not? I might be wrong in my interpretation. The clause continues:

“but does not include a person”

with

“a majority of their … training for that qualification outside the British Islands”.

Some of our universities run joint courses. I am a professor emeritus of the University of Dundee, which, for instance, runs one course for Malaysian students. They do part of their training in Malaysia and finish their clinical training in the UK, at Dundee. The Bill refers to a majority of their training but, in a five-year course, if the overseas student does three years in a UK university, does that count as a majority of their training in the United Kingdom?

I am glad that the Minister alluded to refugee status and was pleased to hear what she said. That was to be one of my points, because I have had representation from Ukrainian refugees who are already working in the NHS, and whose status would otherwise have been removed.

Clause 4(5) says:

“‘primary medical qualification’ means a qualification that is treated by the General Medical Council as equivalent to a primary United Kingdom qualification within the meaning of the Medical Act”.

There are lots of institutions which the GMC recognises as equivalent, but we do not regard their graduates as UK graduates, although they do the same curriculum. Universities such as Newcastle have already been mentioned several times. They have been encouraged by the education department to open campuses, as other universities have been, and to provide the same curriculum. There are then graduates of Queen Mary University, Newcastle University or Dundee University. Their status is not quite clear.

I am concerned about these issues and hope that we will be able to have greater clarification. But I accept that, in principle, prioritising postgraduate medical training for UK graduates is correct.

Baby Milk Powder: Cereulide

Lord Patel Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Merron (Lab)]

Obviously, we are very concerned about toxins and ensuring that there is no damage done to people: that is the reason for the product recall. The effect of this is that it creates bacteria, so it is like food poisoning in that respect.

With regard to what the noble Baroness has said about ARA oil, the concern of the FSA is very much about safety. What has happened here, as I understand, is that ARA oil is a very common ingredient, but this one appears to have had some contamination, which has affected certain batches, and it is those that are being recalled.

[Lord Patel (CB)]

My Lords, what the Minister said is correct, but only partially. Arachidonic acid is the key component that may contain bacillus cereus, which is the product that produces the toxin cereulide, which causes problems for babies including vomiting and diarrhoea. It is the same as any bacteria or virus that causes the gut rot that we often experience. It is a supply chain problem and the current regulatory mechanism relies on self-regulation. That is what needs to be addressed. We had a similar problem in 2008 with another chemical called melamine, which was in milk products and caused kidney damage to babies. Does the Minister agree that it is the regulation of the supply chain and production that needs to be addressed?

[Baroness Merron (Lab)]

As ever, the noble Lord has put things better than I did. I understand the point he is making. The FSA’s role, certainly in the incident response, includes chasing supply chains to identify any additional potential products and businesses. I certainly agree that it is very important to stem any difficulty. But, as it is a live incident, the only point I would make, as I said to the noble Baroness, is that the focus is very much on managing the situation. Therefore, there has not been the opportunity to look into the detail that I agree it needs. That will happen, as it always does, in an incident such as this.

Maternal Mortality

Lord Patel Excerpts

Tuesday 20th January 2026 Lords Chamber

[Baroness Merron (Lab)]

I am glad to say that my noble friend Lady Amos will be very much focusing on this area. I referred earlier to the maternal care bundle, which focuses on the five main causes of maternal death and harm, as well as on setting up best practice. A number of the risk factors are particularly associated with groups who live in areas of greater disadvantage, those who have pre-existing conditions and, as the noble Lord rightly says, sadly, black women, who are three times more likely to die—something that is totally unacceptable in any day and age, but certainly now. We cannot allow this to go on. That is why we have picked up a key recommendation from the Black Maternal Health inquiry for mechanisms for surveillance of severe maternal morbidity. The first data are expected in the summer.

[Lord Patel (CB)]

My Lords, a confidential inquiry into maternal deaths is a good indicator of the quality of maternity services. The fact that the rate has gone up from 9 per 100,000 in my time to 12.8 now suggests that there is a failure of maternity services. To use an example, 155 women who had a history of psychiatric problems—mental health problems—died within a year of delivering a baby. That compares to the total number of 611 maternal deaths. It is a significant number, and yet the specialist perinatal maternity health services that are supposed to look after women with a mental health history have failed. It should be a duty on ICBs to produce a plan, so that women with a mental health history are looked after and have a care plan during pregnancy.

[Baroness Merron (Lab)]

This is absolutely crucial. I welcome that, as of June last year, maternal mental health services are available in all parts of England. We also now have 153 operational mother and baby unit beds providing in-patient care to women experiencing severe mental health difficulties during and before pregnancy. In addition, mental health services are available for women who have pre-existing mental health needs, as well as for those who experience challenges because of their pregnancy or labour. The GP check-up six to eight weeks after birth is absolutely crucial.

Rare Cancers Bill

Lord Patel Excerpts

2nd reading
Friday 16th January 2026 Lords Chamber

[Lord Patel (CB)]

I thank the sponsors of this Bill, Dr Scott Arthur and the noble Baroness, Lady Elliott of Whitburn Bay, for bringing it to this House. Noble Lords must excuse me if I am a bit emotional after listening to the stories, because I too have experienced grief recently due to rare cancer.

I support this Bill strongly, and I hope we will give it swift passage through this House, unamended, so that it can be on the statute book. However, I have one or two concerns. First, I understand the need for the review relating to marketing authorisation, because we need drugs to be developed urgently and we therefore require regulation to change to allow for this. I look forward to listening to the noble Lord, Lord O’Shaughnessy, about the novel ways in which clinical trials can be conducted to speed up this process. I have concerns about the timelines. The Bill gives hope to people with rare cancers, from diagnosis of terminal illness to, we hope, treatment. That is what we hope the Bill will do, but a timeline of three years to carry out a review, with no plan for implementation of that review, seems rather long. Timelines for processes and progress are measured in years, while timelines for tumours to advance are measured in weeks. Patients with rare cancers cannot wait long, so I hope we will address the issue of timelines.

That applies also to the reports that are to be produced every three years, as indicated in the Bill. The idea that there will be a lead clinician for specialist rare cancers, with a duty to guide, co-ordinate and promote research for those cancers, is a good one. As we have heard, funding for rare cancers is abysmally low—about 1/10th of total government funding for research related to cancer goes to rare cancers. That must change, because 50% of deaths related to cancer are the result of rare cancers. Unless we change that, we will not make a bit of difference.

Research is important, but the bedrock of research is the requirement that all these rare tumours are genetically sequenced, so that drugs that already exist can be repurposed to treat other diseases. I will give the House an example: BRAF V600E, the gene associated with certain forms of melanoma, was found to be important in effectively treating certain kinds of brain cancer, and in successfully treating people with rare breast cancers. Charities such as Salivary Gland Cancer UK, which has given me a good brief, and Brain Cancer Justice have pleaded for genomic sequencing of tumours. We must do this for each and every case, to build up a registry—not just of patients who have suffered from rare cancers but patients who are on the register with a tumour.

As Brain Cancer Justice has asked for, we should make sure that tumours are frozen at the point that they are obtained. Without frozen tissues, we will not be able to carry out molecular studies in the future to determine whether there are genes that are affected, and therefore drugs that could be developed related to those genes. It is important that we create a registry, not just a database of patients. I hope this Bill gives much hope to patients, and I hope it will get on to the statute book.

Emergency Adrenaline

Lord Patel Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Merron (Lab)]

This is an important part of the availability, as the noble Lord has highlighted. The kind of issues under consideration when we look at the availability of these welcome products include, in addition to their ease of use without specialist training in community settings and their use through proper training, suitability for different age groups and the temperature sensitivity of the products. Training will be part of how we look at developing the workforce plan, but I take the point about assessing what training is needed when we think about where they will be available. That is very much part of our consideration.

[Lord Patel (CB)]

My Lords, based on the statistics the Minister just cited about the number of lives that would be saved if emergency adrenaline was easily available in the community, can she say what training would be required? If the drug is given inadvertently to a person who is not in anaphylactic shock, what will happen?

[Baroness Merron (Lab)]

The noble Lord raises a point on the practical and safety concerns that we would need to consider in widening access to adrenaline in the community. I should add that that would be regardless of the administration method. On his point, and following on from the question from the noble Lord, Lord Scriven, it is essential that training ensures safe administration, whatever the formulation, because we do not want to create an unsafe environment. The training will be appropriate to what is needed. However, I must emphasise that we are in the process of considering this, but with a positive outlook and an intent to provide.

Resident Doctors: Industrial Action

Lord Patel Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend rightly refers, as I did earlier, to the training bottleneck. The Secretary of State was glad to acknowledge the need to tackle training. While he felt that there was no point on pay to be accepted, he certainly felt that the BMA resident doctors committee had a good point on jobs. To be honest, that is why it is so disappointing to be where we are today.

I will pass on my noble friend’s generous comments to the Secretary of State. He offered to introduce emergency legislation in the new year to prioritise UK medical graduates and other doctors with significant experience of working in the NHS in speciality training posts. That would have made a huge difference, but it has been rejected. He also offered to increase the number of training posts over the next three years, from the 1,000 that was originally announced to 4,000, bringing forward 1,000 of those training posts to start next year—that would have made a huge difference. I could go on, but I have made my point.

I agree with my noble friend’s point about acknowledging the role of nurses. In fact, if my noble friend will allow me, I will go further: we are talking about the whole healthcare team. That is another point to the issue on pay: while the BMA doctors committee continues to press for a pay deal far in excess of anything that anyone else is getting, the impact across the NHS, both on staff and on services, continues to be under threat—and we cannot allow that.

[Lord Patel (CB)]

My Lords, as a doctor, I feel that a doctor withdrawing or withholding services from a patient is dishonourable and unethical—full stop. I find no reason that I can support for a doctor to withdraw their services, because their patients are trusting them with their lives. As far as I am concerned, junior and senior doctors should never go on strike, whether or not the issue with pay is justified—that is a separate issue; there are other ways to discuss and handle that. In response to the question from the noble Lord, Lord Kamall, about what should happen now, junior doctors or resident doctors, or whatever they call themselves, should go back to work and not go on strike—not now and not ever.

There is a separate and long-standing issue with training, which has been referred to. Some years ago I reviewed medical training and was chairman of the Specialist Training Authority. There is a need now to review doctors’ training completely, particularly postgraduate training. It is not sufficient to allow for more training posts—that does not solve the issue. What is required is a complete review of the training of speciality doctors. I hope that the Secretary of State, in his discussions, can make that offer and set up a review. I have no reason whatever to support the junior doctors’ strike.

[Baroness Merron (Lab)]

The noble Lord is an honourable man, as we all know in your Lordships’ House. I heard his comments on how he sees withdrawing labour in this regard, and I hope they are heard more widely. He makes a good point about reviewing training. Unfortunately, we are currently in the position of having made an offer that was rejected. The offer we made is not going ahead, so I cannot give the commitments that the noble Lord might like. We will deal with the strikes in the first instance, as I know noble Lords would expect. I am sure that if we ever get back to a constructive discussion, the issue of a review could be put forward, as the noble Lord suggested.

Brain Tumours: Causes and Treatment

Lord Patel Excerpts

Monday 24th November 2025 Lords Chamber

[Lord Patel (CB)]

My Lords, I thank the Minister for promising us a cancer plan by the beginning of next year. I hope it will be forthcoming, because it will be good to look at how cancer care will change. Regarding brain tumours, the problem is that the symptoms are often vague and mild, so early diagnosis is much more difficult. We need more research into the early diagnosis of tumours. Furthermore, we need much more research than the numbers mentioned by the Minister. One of the success stories, one hopes, in 2026 will be drug gene therapy and viral immunotherapy, which will be put through clinical trials early next year to treat glioblastoma, the major brain tumour killer. I hope we will have more funding, because £30 million, £40 million or even £50 million will not do.

[Baroness Merron (Lab)]

I want to convey to the noble Lord our ambition in this area. I completely accept the point he makes—although not all of them—about the challenge of diagnosing rarer cancers, including brain tumours. Research is absolutely vital. Last September, we announced new research funding opportunities, bringing the brain cancer research community together, because we want to drive step change for patients in the way the noble Lord seeks. Funding decisions will arise from this call, and announcements are expected imminently.

Medical Nuclear Radioisotopes

Lord Patel Excerpts

Thursday 20th November 2025 Grand Committee

[Lord Patel (CB)]

My Lords, I am pleased to take part in this short debate. All the important issues were covered by the noble Baroness, Lady Bloomfield, in her brilliant, comprehensive speech—but not by me, as they say, so I will repeat them.

The noble Baroness is right that it is time urgently to address this issue. The point has already been made that we increasingly need these radioisotopes as medical advances occur, particularly in molecular radiotherapy, which the noble Baroness did not mention. Molecular radiotherapy is used as internal therapy for diseased organs, as opposed to external radiation, which is what we are all familiar with.

We all know that one in two people are going to get cancer. The monitoring of cancers—for example, prostate cancers—requires a particular kind of radioisotope tracer to identify whether there are any metastases. This is now in short supply because we rely on a supply chain that comes from overseas.

Basically, there are two nuclear imaging modalities: SPECT, single-photon emission computed tomography, and PET, positron emission tomography. SPECT imaging relies primarily on reactor-produced isotopes, and we have to completely import them because we do not have a reactor. PET relies on cyclotron-produced images. While we have that facility, we do not have it extensively, so we often have to rely on overseas supply chains.

I will put it in the context of a patient. The overall problem is that they are waiting for a diagnosis, but cannot have it made because the supply chain for radioisotopes is in short supply or has been held up, and their appointment is cancelled. They wait another few weeks before that appointment is made again, during which time the patient’s cancer grows. Alternatively, they are relying on finding out how the cancer is progressing following diagnosis, particularly to see whether the cancer is responding if treatment is being given, and imaging facilities are needed, but the tracer or isotope is not available.

There is a further issue: if we have our own reactor that can be used for research, we will innovate for newer radioisotopes for both diagnosis and treatment. Our scientists are good enough; in fact, they are world leading. Furthermore, most tissues in the body are specific to certain chemical agents. For instance, iodine is used for the thyroid. If we want to diagnose or treat thyroid cancer using internal therapy, we would have a tracer with iodine to target thyroid tumours. Glucose is similarly used for brain tumours, and for identifying cancers that an MRI sometimes will not see. With a particular kind of tracer, PET-CT scans will see them, and therefore diagnosis and treatment happen earlier.

I could say this in one sentence or half an hour of speech, but the message would be the same. We urgently need UK-based radioisotope reactor facilities that produce tracers using radioisotopes, and also a cyclotron facility, so that the whole UK can then rely on our own supply. It also enables our researchers to further innovate for new tracers, and therefore end up leading the world. I say to the Minister that the time is now. Can we have the plan, please? Whether it is in Wales or not—I might have been tempted to say Scotland—the ARTHUR project has already made a good business case and worked this out. The cost is not enormous, particularly in the context of the NHS budget and the benefits that the NHS will derive. I plead for the same as the noble Baroness, Lady Bloomfield.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I congratulate the noble Baroness, Lady Bloomfield, on securing this valuable debate. I think we should judge its value not by the number of people here but rather by the quality of the contributions. This is an important issue and, as the noble Lord, Lord Patel, said, the noble Baroness introduced this in a very comprehensive way, which was extremely welcome.

The Government are committed to delivering critical services that depend on the reliable supply of medical radioisotopes, to which both noble Lords referred. I agree with the noble Baroness and her reflections on the positive health outcomes, also supported by the noble Lord, Lord Patel. These isotopes support positive health outcomes, both for diagnostics and for therapeutics. I was looking at the figures: in England alone, some 700,000 procedures are carried out using radioisotopes every single year. This figure is expected to increase, not least because of their value in the process.

There are three main uses for medical radioisotopes; each relies on different manufacture to get the desired result. PET-CT scans, primarily used for cancer and cardiovascular diagnostics, use isotopes from a comprehensive network of UK-based cyclotrons. SPECT scanners are mainly used to confirm the cancer stage, to identify blood clots and to assess organ functions. These scanners use isotopes manufactured abroad in reactors; the noble Lord, Lord Patel, drew our attention to this. This is also the case for radioisotopes that are used for therapeutics.

As the noble Lord pointed out when he expressed concerns about delays to treatment and the impact on patients—the point was well made—the UK does not currently manufacture medical radioisotopes in reactors. Instead, we have in place a supply chain with isotope sources from multiple countries to aid resilience. I will come on to the point that the noble Baroness made about when that supply chain is disrupted. This gives us access to a global network of expertise and high-quality medical radioisotopes.

The noble Baroness made a strong case in advocating for the Welsh project ARTHUR, a reactor specifically designed for the purpose of medical radioisotope manufacture. The Minister for Medical Technology and Innovation, Zubir Ahmed MP, recently met Liz Saville Roberts MP to discuss this matter, and I can assure the Committee that the Government are in active discussions about this project. I note the points made about the suitability of the area and the potential benefits of this project. The UK Government have not made a formal assessment of the project at this time but are supportive of any manufacturing capacity that can improve reliable access to medical radioisotopes, as has been called for. A domestic reactor would certainly be a welcome addition to the overall supply.

The noble Baroness understandably highlighted the severe shortage of a specific medical radioisotope in 2024. I agree that this was caused by a global disruption to its manufacture. The underlying issue was that several nuclear reactors used for its manufacture were undergoing critical repair work. As noble Lords can imagine, these repairs are normally planned ahead and co-ordinated to ensure that there is always enough capacity to deliver critical isotopes. However, the safe running of reactors will always determine whether they will be taken offline for repairs. In this instance, critical repair work was identified and meant that multiple reactors were closed down at the same time.

Due to a diligent response from the Department of Health and Social Care, NHS England, industry and the NHS services impacted, I am glad to say that the patient impact from this severe shortage was limited. I am grateful to all those who worked to ensure this. However, it underscores the need for multiple available sources of medical radioisotopes. A Welsh reactor—or perhaps a Scottish one, although I would rather not dwell on the argument around the devolved Governments and locations—could be an important addition to this supplier base.

Also raised were the issues with the supplies for PET-CT scanners earlier this year. I can give an assurance that, when there are specific supply issues, such as the one the noble Baroness referred to that impacted north England and the Midlands, the department works with suppliers to recover supplies and services. We are aware of the difficulties and issues that both noble Lords have raised. I hope that response is of some assistance.

We are working to support services and improve outcomes for patients. The noble Baroness said that the Government should explore long-term solutions, so let me outline some of these actions. First, we are committed to a thriving life sciences sector and the development of high-skilled jobs in that sector. The Government have made up to £520 million available through the life sciences innovative manufacturing fund; that is available for any private manufacturing proposal, including for medical radioisotopes in the UK.

Medical radioisotopes support life-saving services, including for diagnostic tests; this Government are committed to supporting the improvement of these services. Therefore, we have announced £6 billion of additional capital investment over five years across new diagnostic, elective and urgent care capacity. This includes funding to increase capacity for both testing and reporting across community diagnostic centres and hospitals.

In early 2026, which is nearly upon us, the Government will publish their national cancer plan. This will set out how we will improve diagnosis, treatment and waiting times in order to improve outcomes for cancer patients and increase survival rates. UKRI, the UK’s national funding agency for science and research, also supports the overall service delivery and has recently invested £32 million for novel total-body PET-CT scanners. All these interventions will, as I say, improve the situation for patients and improve services.

In conclusion, as the noble Lord and the noble Baroness have called for, this Government are committed to ensuring robust and reliable supplies of medical radioisotopes to deliver critical services. We are supporting the development of manufacturing and delivery capabilities in the UK, where this is appropriate, alongside working closely with international partners and suppliers. We are also committed to the economic and industrial development of the UK science sector. That is why we have made available investment funds that are open for applicants who are looking to expand or improve UK manufacture of medicine and medical technology products. This includes UK-based manufacture of medical radioisotopes or their adaption for diagnostic or therapeutic applications.

[Lord Patel (CB)]

I know that intervening on the Minister is unusual in a short debate, but we are not exactly short of time. I think the Minister said that if we had a reactor, it would be a useful addition. It would not be a useful addition; it is a necessity. She did not define any solid plans—unless I missed them—where the Government have a clear intention to establish a nuclear reactor for producing radioisotopes. There is a promise that we will have good contractual agreements with the supply chain lines that the Minister mentioned—I cannot make the Minister’s speech, but I am asking the question—but those cannot be guaranteed because there are only six reactors in the world and they are more than 50 years old. Maybe the Minister could comment on that.