Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

2nd reading
Wednesday 4th February 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, I also congratulate the noble Lords, Lord Roe and Lord Duvall, on entering this House. As a newbie myself—I have been here only about six weeks—I know that it is an enormous privilege, as well as incredibly hard work.

The principle at the heart of this Bill is the right one: UK-trained medical graduates should be properly prioritised for the foundation programme and subsequent specialist training. No one can dispute that it is wrong that UK graduates, educated at a cost of billions to the taxpayer, are forced to compete with overseas students, pushing many doctors abroad and depleting the talent pool that should be powering the NHS. I am grateful to the Minister for engaging with me over the last few days both personally and in meetings.

However, I have some serious concerns. The first, as has been alluded to, relates to Malta. As the only Member of this House to have Maltese heritage— I thank the noble Lord, Lord Stevens, for reminding me that I have two George Crosses, one from having Maltese nationality and the other from working in the NHS—this is especially important to me. Like many noble Lords, I have received letters and concerns, but I have also received representation from all quarters in the UK and in Malta about the impact of the Bill on Malta, including from its Minister for Health and Active Ageing. He wrote a letter to our government health team where he said:

“Whilst acknowledging the supreme interest of ‘home-grown’ graduates, this development raises serious concerns for this Ministry and the people of Malta. Aside from risking to undermine two centuries of proud tradition and the dissolution of a strong bilateral relationship in healthcare, this strategy puts the training and specialisation of Maltese graduates in jeopardy”.


This matters because Malta has a long, deep and historic relationship with the United Kingdom, and not just in medicine, although I will stick to that. For nearly 200 years, since the first Maltese doctor received their licence to practise from the Royal College of Surgeons, British and Maltese medicine have grown side by side: the same language, the same exams and, for many years, the same training programme. This is why it has been possible for doctors such as my father, who came to this country in 1963, to dedicate their professional lives to the service of the NHS. This is a small group of doctors but they have had an enormous impact—tonight I should have been at a conference celebrating the power and impact that Maltese doctors have had—from revolutionary surgery treatment for Parkinson’s to revolutionary, innovative treatments for cancer.

Nowadays, each year around 50 doctors complete their specialty training in the NHS, under a special arrangement in which the Maltese Government cover 70% of their salary, with a contractual agreement that these doctors return to Malta. It is a so-called finishing school; they come here to do parts of the training that they cannot get in Malta, such as for sickle cell in haematology. It is a win-win. The NHS gets talented, skilled doctors, often working in hard-to-fill non-training grade posts, at very little cost to it.

This Maltese-UK relationship has been strengthened in recent years, as we have heard, with the establishment in Malta of a UK-based medical school, Queen Mary University of London. This is a multi-million pound initiative of QMUL and the Maltese Government. Since 2009, QMUL has delivered an integrated training programme, awarding an MBBS degree that is academically and regulatorily identical to the UK London programme. These are not rich kids buying a medical degree; they are hard-working students, among the top performers across the MBBS exam. The diversity of the campus in Malta mirrors that of the UK: 80% are from Black and minority-ethnic groups, 20% are disabled and 65% are women. Their training is aligned to NHS principles and practice. Nearly 80% of them do part of their training in a UK NHS hospital. Of course they understand the NHS—nearly 70% of these students are British nationals or have indefinite leave to remain in the UK. Deprioritising these doctors risks abandoning a small, committed cohort without a fallback, simply because they choose to fund their own training. This seems unfair.

I will briefly move to another area where I have serious concerns. This legislation will disadvantage many international graduates already in training who have spent thousands of pounds in good faith and were encouraged to come to this country to train. I have received representation from the British Association of Physicians of Indian Origin, which is seriously concerned about this. These international medical graduates have been disadvantaged since the start of the NHS; they have been subject to racism, bullying, disproportionate complaints and punishment, and failure to progress in their career. They now risk losing employment, their visa status and everything they have worked for. This seems unfair, especially given the assurance by the UK Foundation Programme that the same preference informed allocation method used in 2024 and 2025 would be used for 2026. Should there not be transitional arrangements for these doctors, who have relied on public assurances?

As is often said, if one intervenes in a complex system, there is no guarantee that outcomes will be achieved but there is a guarantee of unintended consequences. I look forward to engaging with the Minister further and hope we can redress some of these issues.

Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

Moved by

[Baroness Gerada]

15: Clause 4, page 3, line 2, at end insert “, unless they hold a primary UK medical qualification issued by a UK registered institution, operating on the date of 1 January 2026, which is identical in character to a qualification undertaken in the British Islands and recognised as such by the UK General Medical Council.”

[Baroness Gerada (CB)]

My Lords, I shall speak to Amendments 15, 16 and 19. I want to disclose an interest that I did not have at Second Reading: I am now co-chair of the Malta APPG—and I remain of Maltese heritage.

Amendment 19, in my name and that of the noble Lords, Lord Clement-Jones and Lord Mendelsohn, seeks to add Malta to the list of countries in Clause 4(4). It is precise and proportionate, and it would correct a narrow but serious unintended consequence in the Bill, as I will explain. Of course I acknowledge the need to prioritise UK graduates for training but, as the Minister of Health and Active Ageing of Malta put it in a letter to the Secretary of State for Health and Social Care, the Bill risks

“undermining two centuries of proud tradition and the dissolution of a strong bilateral relationship in healthcare, care, and the training and specialisation of Maltese graduates”.

At Second Reading, I spoke about the unique medical training partnership between the UK and Malta, which dates back two centuries. For example, Maltese surgeons have held licences from our own royal colleges since the 1830s. This is therefore not a recent convenience but a deep historic alignment. It is a relationship that has shaped both systems for generations, creating an instinctive alliance in training, practice, standards and expectations.

The Maltese education system is modelled on the UK system and aligned to British clinical and ethical standards. Training is delivered in English, and the Maltese healthcare system closely mirrors the NHS. That is why my father was able to come to this country in 1963 and devote his working life to serving patients in the east of England, and why others from Malta have done the same, performing well above their weight in serving patients in this country.

Furthermore, postgraduate membership and fellowship remain aligned with the British royal colleges, reflecting a deep and enduring professional loyalty. Indeed, many of these doctors have become trainers, educators and examiners, helping to uphold the quality of UK postgraduate education—some have had daughters who became presidents of royal colleges. Malta and the UK are therefore historically, culturally and educationally linked.

I turn to the comparison of the Malta foundation programme, an affiliated programme to the UK foundation programme, and I shall reflect on the free trade agreements that the UK holds with the countries in Clause 4. Government documentation for the UK’s free trade agreement with these countries requires regulators to

“recognise qualifications or relevant experience of a professional who applies for recognition and possesses comparable professional qualifications”.

The language in that documentation, which recognises reciprocal arrangement, strongly aligns to the UK-Malta affiliate programme and, on that basis, it should be treated no less favourably than these other nations.

Since 2009, our foundation programmes have been formally aligned, sharing the same curriculum and e-portfolio. This alignment was renewed in 2024, confirming that the Malta programme met the same standards and outcomes as the UK foundation programme. To the best of my knowledge, no other country anywhere in the world has that level of mutual recognition.

At the centre of this is Queen Mary University of London’s campus in Malta, a UK public university delivering an identical UK GMC-approved MBBS degree to that which it delivers in its east London campus in Tower Hamlets. The students follow the same curriculum, complete the same statutory mandatory training, take the same UK national qualification exams and graduate with the same UK primary medical qualification. They are registered by the GMC as graduates of Queen Mary University of London.

During Second Reading, the Minister, the noble Baroness, Lady Merron, addressed Malta as a distinct case, and indeed it is. The QMUL training programme is a UK programme delivered overseas under a framework recognised by and supported by the UK Government. More than half the students are UK citizens. The equivalence of training between the UK and Malta is complete, not approximate. It is not close; it is identical. Even the patient profile is the same. Malta’s population, diversity, healthcare system and disease patterns share extraordinary similarities with the UK, particularly compared with any other international training environments. Moreover, most students undertake NHS attachments during their training. These graduates enter the UK workforce fully prepared for UK foundation training, trained at no cost to the UK taxpayer.

The impact of a medical school goes beyond the students. QMUL has made a not insubstantial professional and financial investment in the campus and the Government of Malta have invested in the school’s construction. This aligns with the UK Government’s wider objective of developing international UK university campuses, as outlined in the recent strategy document from the Department for Education. This Bill, if not amended, puts this at risk.

The numbers are small, as the foundation years are capped at between 50 to 70 graduates. This is less than 0.6% of the UK foundation programme places. This is simply no workforce threat, no substitution effect or planning distortion. There is, however, a real risk of unfairness in the Bill as it stands. These students have a legitimate expectation, grounded on 15 years of consistent government practice, and the experience of all preceding QMUL medical graduates, that they should be treated comparably with other holders of UK primary medical qualifications. The Bill as drafted removes that status and places these graduates behind Norway, Iceland, Liechtenstein and Switzerland—jurisdictions whose graduates do not hold a UK primary medical qualification, do not sit the medical licensing or prescribing exams and are not trained on an NHS-aligned curriculum. This is difficult to explain, let alone to justify. This amendment simply corrects this anomaly. It protects a uniquely successful partnership, anchored in history, quality and equivalence.

Going beyond foundation years, a few Maltese doctors come to the NHS every year to fill gaps in their own medical training—so-called finishing school. These are in non-numbered posts. Malta provides 70% of their pay and these doctors are contractually required to return to Malta. This is not a pipeline of overseas doctors displacing domestic graduates. It is a small group, maybe 30 or 40, who meet our standards, all of whom have been examined and trained specifically in UK practice.

Finally and briefly, I turn to Amendments 15 and 16 again in my name and the names of the noble Lords, Lord Clement-Jones and Lord Mendelsohn. These suggests a carefully defined exception in Clause 4 for UK universities operating overseas campuses that deliver an identical UK-approved medical degree as in the British islands. These are exceptionally narrow amendments confined, to the best of my knowledge, to only two programmes in the world—Queen Mary University of London’s campus in Malta and Newcastle University Medicine Malaysia.

At Second Reading, the Minister referred to

“almost 300 applicants from … overseas campuses”,—[Official Report, 4/2/26; col. 1679.]

and noted that the Government need to control this number to “avoid opening the floodgates”. I stress, as I have already said, that the number of QMUL graduates applying for UK jobs is capped by the University of Malta at between 50 and 70, with around 120 from Newcastle University Medicine Malaysia bringing the total to 190. These caps would enable the Government to control the number of overseas applicants.

I also want to make clear my support of the amendment in the name of noble Lord, Lord Forbes, which provides a similar solution. Only institutions operating overseas campuses that meet the criteria set out in the amendments and that are in operation at the time the Act is passed should be included. I beg to move.

--- Later in debate ---

[Baroness Merron (Lab)]

I am happy to set it out in a letter, but I can say immediately that graduates of the Royal College of Surgeons in Ireland’s Bahrain campus are not necessarily prioritised just because part of their programme takes place in Ireland. The Bill is clear that prioritisation applies to graduates of Irish medical schools who complete the majority of their medical education in Ireland, but I am happy to add to that in my letter.

[Baroness Gerada (CB)]

I am grateful to the Minister for the care with which she has addressed my amendments. I will be very brief. I must say I am disappointed, and I have a few points.

I will address Malta first. These are not international medical graduates; these are UK-trained doctors training in a UK university, albeit overseas. As I said, they are trained for the NHS. The Minister mentioned several times that it is not exclusion, it is prioritisation. I have already had emails from two doctors, one of whom is being excluded from applying for a postgraduate examination until the UK cohort has applied. I will not say their specialty, because it might identify them, but it means that the tiny island of Malta will not have this particular specialty because this doctor cannot finish his training until he does that. They are already being excluded from fellowship posts that have been long standing over decades—that is of last week.

Given the fact that the Bill is being taken through the House at such pace, as well as writing a letter—which I understand we will get in our post next week—would the Minister be willing to meet me and several Peers who have already raised some amendments so that we can explore this in more detail and work constructively towards a solution? I am sure these issues will be considered further on Report but, in the light of the Minister’s reply today, I beg leave to withdraw the amendment.

Amendment 15 withdrawn.

Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

Committee stage & Report stage
Monday 23rd February 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, as probably the only person in this Chamber who has headed up a royal college not once but twice—the Royal College of General Practitioners—I feel the urge just to defend them and correct what is been said three times in this Chamber. The royal colleges set the standards and the curriculum; they do not oversee workforce planning, funding, or what the actual training looks like once you get into an organisation. I have to correct those speakers by saying that that is not the job of the Royal College of GPs. I do not disagree that there needs to be reform; absolutely, it is a complete mess—

[Lord Hunt of Kings Heath (Lab)]

My Lords, does the noble Baroness accept that the royal colleges certainly can give moral leadership? I also refer her back to the last junior doctors dispute, about 10 or 11 years ago. As she will remember, the Academy of Medical Royal Colleges, I think it was, set up a group to look at all these issues, and the outcome of that was very disappointing in terms of tangible results in improving the situation.

[Baroness Gerada (CB)]

I thank the noble Lord very much. I have to also tell your Lordships that for the last 20 years I have led what is called the practitioner health programme, which has looked after the mental health of the medical workforce—I no longer lead it. To date, about 40,000, mainly doctors, have passed through that service, most with mental health issues relating to burnout, depression and anxiety, and some with a new diagnosis which I call NHS-itis.

I know about the endless reviews that were done. It is not just the Academy of Medical Royal Colleges, Health Education England, the General Medical Council and the CQC; many of the individual royal colleges looked at the issues of the decline in mental health. Some of these have been raised here, around firms, loss of control, training and the intensity of the workload. Fundamentally, we do not make it easy for any of these doctors—and, by the way, we do not make it easy for the international medical graduates either, who have always fared worse. I agree with the noble Lord that there are solutions, so we do not need another review. The answer is blowing in the wind—we have the solutions—and I am very happy to discuss that at a further time.

[Lord Clement-Jones (LD)]

My Lords, we ought to thank the noble Lord, Lord Patel, for having stimulated such an interesting and important conversation about how terrible our workforce planning in the NHS has been to date, and we have had some very wise words around the House on that subject. It is clearly not fit for purpose, and that is why we are where we are.

On these Benches, we have consistently accepted the Government’s central premise for the Bill: that where the British taxpayer invests heavily in training a doctor at a UK medical school, there is a logic in prioritising that graduate for employment to ensure a return on that public investment. However, although we sympathise with the desire of the noble Lord, Lord Patel, to ensure that UK graduates are prioritised—indeed, a lot of that derives from the fact that our workforce planning system is not fit for purpose—we must be careful not to make the legislation so rigid that it removes any flexibility for the system to function effectively, as we will argue in later groups.

By creating strict statutory tiering that places UK graduates above all other priority categories in every instance, we risk creating a system that cannot respond to realities on the ground. We have received correspondence from many doctors, as I am sure almost every other noble Lord in this House today has done, warning that absolute exclusion or rigid tiering could leave rotas empty in hard-to-fill specialties such as psychiatry and general practice, which rely heavily on international talent.

Prioritisation is a necessary tool for workforce planning but we must ensure that it does not become a blockade that damages the wider delivery of NHS services. As the noble Lord, Lord Stevens of Birmingham, said, we need answers about the future of workforce planning. What will the numbers be for training places? The Government need to answer that as we go through this Bill.

--- Later in debate ---

[Baroness Lister of Burtersett (Lab)]

My Lords, Amendment 11 would add to the list of priority groups people who have been recognised as in need of international protection, who have arrived as a Hong Kong British national or who have arrived on a safe and legal humanitarian route. I will speak simply to this amendment, but I have some sympathy for the amendments in the name of the noble Baroness, Lady Gerada.

I apologise for popping up at this late stage of the Bill’s passage. This issue was brought to my attention by the Refugee Council, which recently spotted that, as it stands, the Bill will exclude those recognised as refugees from prioritisation for medical training posts. This will potentially make it harder for people with medical backgrounds who have been displaced and given protection in the UK to contribute fully to the NHS. This resonates with me because my father, as a young man with a medical qualification, came to the UK in the 1930s as an early refugee from Nazi Germany. He was able to requalify at Glasgow University and, after the war, eventually went on to have a long career as a medical officer in Manchester in what was then the DHSS. As such, he contributed to British society in a way that would now be difficult for medically qualified refugees.

Programmes such as the Refugee Council’s Building Bridges programme support qualified refugee doctors and other health professionals to utilise their skills and experience in the UK. These programmes are based on close collaboration between charities and the NHS. This is beneficial for the refugees themselves, as well as for the UK. That support can include helping refugees to pass the necessary language requirements and get professional registration in the UK. Some refugees will also progress to accessing medical training posts. This has included foundation programmes specifically designed to support refugee doctors into the NHS workforce.

During Second Reading in the other place, the Secretary of State said that the UK

“must break our over-reliance on international recruitment”.—[Official Report, Commons, 27/1/26; col. 803.]

This amendment does not run counter to that aim. Refugees have not come to the UK because they have been recruited. First and foremost, they have sought protection and have been given it. My amendment would simply ensure that those refugees who are also doctors would be able to put their medical backgrounds to good use and continue to develop their expertise for the benefit of the wider community, as well as for themselves.

At the same time as the Bill is progressing through Parliament, the Government are proposing significant changes to settlement for refugees as part of the earned settlement plans. Ministers have said that these changes are supposed to incentivise integration and ensure that settlement is earned. Ensuring that refugee doctors are not placed at a disadvantage because of this Bill would help the Government meet those aims.

At Second Reading, my noble friend the Minister explained:

“Internationally trained doctors with significant NHS experience will continue to be prioritised for specialty training, recognising the service that they have given. This year, immigration status will be used as a practical proxy for NHS experience in order to allow prioritisation to begin swiftly. For following years, we have taken powers in regulations to enable us to refine this approach in consultation with key partners. I have been asked by noble Lords what this means for those with refugee status. This status is not a stand-alone priority group, although refugees will be prioritised for specialty training in 2026 if they fall within another priority category, such as holding indefinite leave to remain or having completed the foundation programme. Refugees who do not fall within a prioritised group may still apply for specialty training posts and the Bill will not change their eligibility to apply for locally employed doctors’ roles”.—[Official Report, 4/2/26; col. 1648.]


The noble Lord, Lord Patel, responded positively with particular reference to Ukrainian refugees. I am not sure that my noble friend’s response was quite as reassuring as he perhaps thought, especially as Ukrainians who have arrived on the Ukrainian scheme will not be in any of the priority groups. If I understand the proposals correctly—this relates to the previous amendment—indefinite leave to remain is being used for places on specialty programmes in 2026 as a quick proxy for recognising doctors who have been trained abroad but who have been employed within the NHS for some time. It is not such a useful proxy for anyone who, like those on the Ukrainian schemes, have no route to settlement or who, under the proposed earned settlement changes, could have to wait 10 years, or even longer, to qualify for indefinite leave to remain.

My amendment also addresses the impact of the Bill on doctors who have come to the UK as part of the Hong Kong BNO visa scheme. As with other refugee doctors, they have sought safety in the UK. Indeed, the scheme is frequently described by the Government as a safe and legal route. The case for their inclusion has been put to me eloquently in an email from an anaesthetic registrar who is a BNO visa holder and is currently working in the NHS. Like many colleagues in a similar position, he migrated to the UK for political reasons before completing his training and now regards the UK as his permanent home, where he wishes to dedicate his career to the NHS. They argue that

“deprioritisation to the point of exclusion would leave us without any pathway to complete training, despite our qualifications and NHS contributions, effectively ending specialist careers for a group formally invited to settle here”.

They also point out that BNO doctors in the NHS form a small, finite cohort. Their main argument is that,

“unlike many other International Medical Graduates who can return home to complete training, those of us on the BNO scheme face unique barriers. Due to the political situation in Hong Kong, returning is not realistic nor possible for many of us. The UK is now our only place to practise medicine and pursue specialist training”.

Although their situation is not quite the same, the argument also applies to other displaced persons covered by this amendment.

At a time when the Government are making it much more difficult to achieve refugee status, should they not at the very least ensure that those who are so recognised and who are medically qualified are able to requalify and use their medical expertise to the benefit of our society? I hope my noble friend will be able to accept this amendment, but I suspect she will not. At the very least, I ask her to give a commitment to further consultation with a view to giving serious consideration to including the groups specified in the amendment, even if only in modified form, in the regulations to which she referred at Second Reading and which were mentioned earlier today. I beg to move.

[Baroness Gerada (CB)]

My Lords, I speak to Amendments 12, 13 and 15 in my name and that of the noble Lord, Lord Mendelsohn. I repeat my conflicts of interest: I am of Maltese heritage, I am a doctor and I am co-chair of the APPG. My amendments are narrow, they are practical and they respond directly to the concerns raised by the Minister in Committee. I respect the Minister and am grateful for the time that she has given me, for her letter and for engaging seriously with this issue.

I fully accept that we must find a solution to the difficulties faced by UK medical graduates, as so eloquently pointed out by the noble Lord, Lord Patel. In doing so, however, we must ensure that we do not unfairly disadvantage a small, specific group of students, do not strain valued relationships with an EU member state and Commonwealth partner or inadvertently undermine a long-standing transnational higher education commitment. That is the purpose of my amendments.

This is not about opening floodgates, nor is it about creating a new route for offshore medical schools. I am speaking here about just two long-established UK universities with overseas campuses: Queen Mary University of London in Malta and Newcastle University in Malaysia. They are the only two that, upon Royal Assent, will meet the criteria for delivering UK primary medical qualifications overseas—the same curriculum, the same examinations, the same degree and, until now, the same eligibility for the UK foundation programme. Historically, there was a third, City St George’s, which is now teaching its final cohort of seven students in Cyprus; that arrangement is closing. In reality, therefore, we are speaking about two mature, well-governed partnerships with capped, predictable numbers of no more than 190 students per year.

Let me address Malta, which I obviously know best. Since 2009, Queen Mary has operated a British medical school in Malta on the understanding that its graduates would be treated in the same way as its London cohort for entry into the UK foundation programme. That reassurance was reaffirmed as recently as 2024. Each year, about 90 students enrol at the university. Many of them are UK nationals, often with a clear intention of serving in the NHS. They are students such as Michael, who comes from Essex; he is a final-year medical student who worked as a nurse during the pandemic before deciding to train as a doctor at QMUL Malta. He is not a rich kid but someone who has dedicated his life to working in the NHS, and has worked, saved and borrowed money to achieve his passion of becoming a doctor. What can he hope for now? If we imply that a UK degree somehow becomes less UK because a lecture theatre is in Malta rather than Whitechapel, we send an unfortunate signal not only to those students but to a close education and historic partner.

The Minister has quite properly raised concerns about NHS exposure and it is true that most clinical placements take place in Malta, but almost all the students undertake NHS attachments. The health challenges they face are strikingly similar to ours—much more so, I would attest, than the health challenges in Iceland, Liechtenstein or Norway. Non-communicable diseases dominate: diabetes, cardiovascular disease and obesity. There is a growing burden of mental illness, especially among children and young people. Its population is ageing and its society is increasingly diverse. The weather may be warmer, but the medicine is not fundamentally different.

This is not merely an assertion. QMUL now has four completed cohorts—147 graduates who have transitioned safely into the NHS and are performing exceptionally well. Why would they not? More than half of them are UK nationals. All are fluent in English, and all have been trained to practise in the NHS. These doctors or students seek no advantage. They only ask not to be disadvantaged because the campus of the UK university is overseas. The numerical impact on domestic graduates would be negligible. The Government’s target competition ratio of two applicants per foundation place would still be met.

Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

3rd reading
Wednesday 25th February 2026 Lords Chamber

[Lord Kamall (Con)]

My Lords, although this was emergency legislation, we have had detailed and constructive debates on prioritisation. We have also had the opportunity to debate some of the deeper issues around the supply of medical specialty training places, and I am grateful to the Minister for her letter. We will continue to hold the Government to account on the delivery of these places over the coming years. As we have said previously, the Bill is not a complete solution to the problem, as the Minister graciously acknowledged. We accept that it is a step forward.

During our debates, we touched on a number of issues, including whether UK citizens who are graduates of UK medical schools should be given first priority. We discussed the issue of international medical graduates who chose to contribute to the UK system of healthcare rather than go to another country, but who may now find themselves at the back of the queue. We discussed graduates of overseas branches of UK medical schools, some of which follow the same curriculum as UK medical schools, and whether some could be granted so-called grandfather rights. We also pressed for secondary legislation to be subject to the affirmative procedure. We understand why the Government have come to their position and why Ministers have not been able to take action on these points in this emergency legislation. However, given more time, I hope Ministers will continue their work to resolve these concerns, which were eloquently set out by a number of noble Lords from all Benches.

There was some debate about whether this was really emergency legislation or whether, in reality, it was simply giving the Secretary of State a bargaining chip in negotiations with the BMA. That may be no bad thing in itself, but the question remains of whether emergency legislation should be used to give Ministers bargaining chips.

Before I sit down, I thank the Minister and her officials for all their engagement throughout the Bill. As His Majesty’s loyal Opposition, we look forward to working closely with the Minister as the Government press ahead with its implementation.

[Baroness Gerada (CB)]

My Lords, I know it is not normal to speak at this stage, so I will be brief. I thank the Minister and everyone who has worked on this Bill, but I want to raise one or two anxieties which have already been touched on.

I believe that the Bill fundamentally challenges one of the principles that I have always held dear, which is fairness. It is unfair to international medical graduates, who we have entreated to come to this country for the last two decades—we have even paid for them to come —to work in hard jobs, in places where UK graduates did not want to do them. Now that we have more people than places, we are basically pulling the rug from under them. We are jeopardising their careers, their futures, their families and their visas.

It is also unfair to those UK nationals who chose, again in good faith, to study overseas and now have been treated like international medical graduates, when they are not. Finally, it is unfair to the commitment that the Department for Education has made around transnational undergraduate and postgraduate education. This Bill, I am afraid, takes away that commitment and says that we do not really mean what we say.

However, I look forward to working with Ministers and officials to see whether we can address some of what I fear will be the unintended and, I suspect, intended consequences of this Bill.