Medical Training (Prioritisation) Bill

Debate between Lord Patel and Baroness Coffey

Committee stage
Thursday 12th February 2026 Lords Chamber

[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.

Crime and Policing Bill

Debate between Lord Patel and Baroness Coffey

Committee stage
Monday 2nd February 2026 Lords Chamber

[Lord Patel (CB)]

Can the noble Baroness help me by clarifying what her amendment would mean? Currently, a provider, or anybody who counsels a woman seeking abortion, will take in good faith what the woman might say to them about her gestation. But the noble Baroness’s amendment would move that to “beyond reasonable doubt”, which is at the level of a criminal court and not a social justice or civil court. That would mean that, in every case, the health professional who counsels the woman would have to provide evidence that they believed her beyond reasonable doubt. That would mean that there would have to be evidence beyond reasonable doubt.

[Baroness Coffey (Con)]

My Lords, one reason why I have chosen that phrase particularly at this stage—I might reconsider it for Report—is we are talking about a crime. If this happens beyond the terms which the law sets, it is a crime. This is about the change that happened, moving from taking the second pill at home to then just having both pills wherever. The case to which the noble Baroness, Lady Falkner, referred earlier was one in which another lady got the pills and gave them to the chap. They were then applied unlawfully, obviously, and the other lady was also convicted—admittedly, it was a suspended sentence. But there was accountability.