Medical Training (Prioritisation) Bill

Debate between Lord Patel and Lord Clement-Jones

Report stage
Monday 23rd February 2026 Lords Chamber

[Lord Clement-Jones (LD)]

My Lords, it is always a pleasure to follow the thoughtful contributions of the noble Lord, Lord Hunt of Kings Heath.

I give our strong support for Amendments 12, 13 and 15, which have been so convincingly spoken to by the noble Baroness, Lady Gerada, and indeed by the noble Baronesses, Lady Finlay of Llandaff and Lady Wolf of Dulwich. Like the noble Baroness, Lady Gerada, I thank the Minister for her engagement with us on this particular issue, despite the swift passage of the Bill and the rather disappointing response during those meetings.

As I have declared at previous stages, I am the former chair of the council of Queen Mary University of London. My concern is for many of the medical students at the Queen Mary Malta Campus and Newcastle’s Malaysia campus who are affected by the Bill. That is the most pressing issue at hand: the human cost of this legislation in its current form. Over the last few weeks, we have received deeply distressed correspondence from these medical students. Many of them are British citizens who went overseas to study, precisely because of the lack of medical school places here. These students enrolled in GMC-approved courses on the explicit, documented understanding that their degrees were completely identical to those delivered in London or Newcastle, and that they would enter the UK foundation programme on equal terms. To pull the rug from under them now—changing their status to international, mid-cycle, just as they prepare to graduate—is procedurally unfair and totally unacceptable. They made irreversible life and financial decisions based on over a decade of consistent UK Government practice. We cannot treat the futures of our UK-registered university students with such disregard.

In Committee and in her subsequent letter to Peers dated 20 February, the Minister set out her reasons for resisting the inclusion of these students. On these Benches, we have listened carefully. The amendments before the House have been entirely redrafted to address and dismantle every single one of those technical concerns.

First, the Minister argued that the Government cannot control the numbers from overseas campuses, fearing a loophole that would place financial pressure on the NHS and undermine workforce planning. We can fix this. Amendment 12 would explicitly restrict eligibility to

“an overseas campus of a … UK-registered institution that is extant on the day on which this Act is passed”.

The door is firmly shut to future creep. No university can open a new campus tomorrow and exploit this route in the way that the noble Lord, Lord Patel, described.

Further, to address the Minister’s specific fear of uncontrolled numbers, Amendments 13 and 15 would grant the Secretary of State a new statutory power to explicitly cap the maximum number of eligible persons from these campuses. With roughly 50 to 70 graduates a year from Malta and around 120 from Malaysia, we are talking about fewer than 200 students in a system of over 11,000 places. They represent zero threat to workforce planning and, with this amendment, the Government would hold the lever to control the volume. From our conversations, I know that the Minister believes that this would mean opening the door to Irish university campuses and a total of 300 students because of the Windsor agreement. I hope the Minister will explain why they need to be linked when she speaks directly to Amendment 12A, in the name of the noble Lord, Lord Darzi.

Secondly, the Minister argued in her letter that these students should be excluded because they lack familiarity with local epidemiology in UK clinical placements. With the greatest respect, that argument simply does not hold water either. As the noble Baroness, Lady Gerada, with her immense medical experience, has explained, the primary conditions driving NHS demand are fundamentally the same across these nations. Crucially, these students study exactly the same curriculum, take the same UK medical licensing assessment and graduate with the identical GMC-approved primary medical qualification as their peers in the UK. We have the evidence of four graduated cohorts from Malta and those of over 10 years in Malaysia, who have transitioned seamlessly and safely into NHS practice.

As we have discussed before, if the Government truly believe that these students lack clinical familiarity, how can they justify Clause 4 of their own Bill? The Bill prioritises graduates from Switzerland, Iceland, Norway and Liechtenstein. A graduate from Liechtenstein has no UK medical degree, has not sat the UK assessments and has no training in UK epidemiology. We are told that this is due to free trade agreements requiring us to recognise comparable qualifications. It is legally and diplomatically absurd to voluntarily prioritise comparable qualifications from the EEA while rejecting identical qualifications from our own UK public universities.

Thirdly, the Minister cites the need to protect British taxpayers’ investment. The students at Queen Mary in Malta and Newcastle University in Malaysia are self-funded. They provide the NHS with fully trained, UK-aligned doctors at zero educational cost to the public purse. Turning away a pipeline of debt-free, UK-trained doctors is economically illiterate and contradicts the Government’s own value-for-money logic.

Finally, as I said at Second Reading, we risk breaking a solemn international commitment. Since 2009, the UK and Malta have operated under a unique mutual recognition agreement regarding the foundation programme, which was explicitly renewed by the Department of Health as recently as 2024. To sever this now, even in spirit, damages our bilateral relations and actively sabotages the Department for Education’s own strategy to export British higher education globally.

These amendments are safe, narrow and pragmatic, as has been described. They offer the Government exactly what they ask for—control, caps and the closure of loopholes—they protect a tiny cohort of students from unacceptable mid-term uncertainty and they honour our international agreements. I strongly urge the Minister to accept this solution.

[Lord Patel (CB)]

My Lords, I apologise. I should have said that the noble Lord, Lord Darzi, emailed me at noon today to apologise that he could not be here because he had a patient to look after. However, I think the noble Baroness, Lady Finlay, covered his amendment adequately.