Medical Training (Prioritisation) Bill

Earl Howe Excerpts

2nd reading
Wednesday 4th February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, I begin by declaring my interest as an honorary fellow of the Royal College of Physicians. It is a pleasure to open the first of our discussions on the Bill, and I should like to express my thanks to the Minister for her clear explanation of its provisions and its policy background.

I also thank her for the informative letter that she circulated earlier this week, and for the helpful private discussions she has facilitated. Like the noble Baroness, I look forward to the two maiden speeches we are to hear later from the noble Lords, Lord Roe and Lord Duvall, whom I welcome very warmly to the House.

This Bill may be small in length, but it is far from insignificant, not least because it is being introduced to Parliament on an emergency timetable. More pertinently perhaps, its significance can be measured in its potential effect on the lives and careers of many thousands of doctors. That fact alone makes this a measure deserving of the closest scrutiny, and I am therefore appreciative of the fact that the Government and the usual channels have enabled a greater interval between each stage of the Bill’s passage through the House than was the case last week in the other place.

I should say to the noble Baroness at the outset that His Majesty’s Opposition have no quarrel with the principle underpinning the Bill. However, as she would expect, we have identified and been made aware of very considerable concerns over a number of its key provisions, and I know she will understand that we need to explore these thoroughly during the course of our proceedings.

Doctors trained in this country and funded by the taxpayer should have a fair, clear and consistent pathway to progression within our NHS. Britain trains some of the finest doctors in the world, yet too many are being lost because they cannot access the training places they require. That represents a waste of talent, it undermines morale and it ultimately has consequences for patient care. It also represents a loss of taxpayer investment made through the public support of medical education and training when doctors are forced to take their skills abroad because they cannot progress within the system at home. It is, therefore, a problem that we on these Benches agree must be addressed.

However, the manner in which these challenges are addressed matters greatly. There has to be a test of reasonableness and fairness if the Government’s response can be judged acceptable not only in the eyes of UK-based doctors but to doctors who have studied overseas. The solution to the problem must also offer sustainable, long-term change and not just a short-term sticking plaster. I say that because, as we all know, the danger inherent in emergency legislation of any kind is that it can result in unintended and unwanted effects.

To my eyes, one of the first ways in which the Bill falls short, along with the Government’s narrative, is its failure to address the wider question of how its provisions dovetail with any changes in the availability of training places. To solve the problem of recruitment bottlenecks, the Government are using the Bill to refashion the order in which eligible applicants are considered. However, the other way of approaching the issue is to expand the number of training places. Elsewhere, the Government have promised to deliver 4,000 new specialist training places, including 1,000 places that are needed in reasonably short order.

Where do these plans now sit and how are they likely to affect the career prospects of the doctors of the future and those already in the system, particularly those doctors trained overseas? How quickly can capacity be expanded? These were questions that the previous Government tried to address head-on in the NHS Long Term Workforce Plan, published in 2023, which was well received across the medical community.

I mentioned just now the risks and dangers inherent in introducing emergency legislation on a curtailed timetable and, in that vein, another area of concern is the seeming contradiction in the Government’s characterisation of this legislation as an emergency measure. As we understand it, the Government are proposing that the Bill should come into force not on Royal Assent but at a time of the Secretary of State’s choosing. Why is that? If the Bill before us were genuinely urgent, addressing, as it purports to, the 2026 recruitment round, it is difficult to understand why it would not be commenced immediately following its approval by Parliament and the sovereign.

The disconnect between the Government’s rhetoric and reality is troubling, not least because it serves to highlight a number of provisions in the Bill that pose real worries. One such worry concerns the Bill’s impact on doctors who are trained overseas through established UK higher education institutions. These are doctors who are undertaking identical GMC-approved MBBS courses, sitting the same assessments and receiving the same GMC-approved degrees as their counterparts trained in the United Kingdom.

Under the Bill, these doctors will find themselves suddenly classified in the non-priority category of applicants, both for foundation programmes and for specialty training. We are aware that at least one of these programmes operates under a long-standing international arrangement, with wider diplomatic and institutional implications. The noble Baroness, Lady Gerada, will be addressing the issue in greater detail. At this stage, however, I wish to highlight one programme run by Queen Mary University of London in Malta, which is sustained by a long-standing UK-Malta agreement, first established in 2009 and reviewed as recently as 2024. That agreement sits within a broader context of deep and enduring ties between the two countries’ health systems and approaches to medical education.

Undermining it risks significant and long-lasting repercussions for the UK-Malta relationship. I understand that the Government of Malta have written to the Secretary of State to raise these concerns—so far, I understand, without a response. The Minister very helpfully referred to the Maltese concern in her recent round robin letter, as she did today. But I believe it is an issue we shall want to pursue in Committee in greater depth. The concern is multifaceted because, in the scheme of things, what the Bill does to Maltese doctors looks completely unnecessary. The numbers involved are tiny. The Maltese example demonstrates that the Bill as drafted risks causing disproportionate harm to well-established international partnerships, seemingly not as a matter of policy intent but as a consequence of legislation being rushed through Parliament.

There is a further issue that has been brought repeatedly to our attention by doctors and medical academics in this country and abroad: the position of applicants who are already part way through the current foundation programme recruitment round. The noble Baroness mentioned this in her speech. We have heard compelling evidence of a real risk of creating what has been described as a “stranded cohort”: that is, the cohort of doctors who entered a live national recruitment process in good faith, under published rules and fixed deadlines, only to face the risk of materially different outcomes because prioritisation is applied mid-cycle in a radically different way from before.

We need to be clear on the point that applicants at this stage have already committed significant time and cost to the process and are making concrete plans around registration, visas, relocation and employment. For foundation programme applicants in particular, there is often no straightforward alternative NHS route if an outcome is delayed or left indeterminate, given the constraints around provisional registration.

From a system perspective, uncertainty of this kind also risks avoidable disruption to workforce planning, late withdrawals and rota instability. None of these comments are intended to challenge the core principles of the Bill, but they surely call into question the justification for the process and whether it is fair and reasonable for Parliament to permit what amounts to retrospective disruption to an already defined recruitment cohort. Are the Government willing to make use of the commencement and transitional powers in the Bill to ensure that the changes introduced operate only prospectively, so as to give clarity and fairness for those already in the pipeline?

Beyond the issues I have already referred to, there are a number of further concerns about the way the Bill is framed and how it will operate in practice. As drafted, the prioritisation process that the Bill envisages rests chiefly on one decisive qualifying factor—where a doctor was trained. While that may work as an idea in general terms, we are concerned that it risks excluding from the priority group individuals who are British citizens but who have undertaken part of their training overseas, which can arise for entirely normal and legitimate reasons. Again, I listened to what the noble Baroness had to say on this subject, but one clear example is doctors who have completed elements of their medical training while serving with the UK’s Armed Forces abroad. Those individuals have trained within UK systems, often in demanding circumstances and in the service of this country. It would be perverse if their contribution were overlooked simply because aspects of their training took place outside the British Isles. Any credible definition of a UK medical graduate ought to be capable of recognising that reality.

We must also consider the wider implications of this legislation for medical schools. Changes to prioritisation will inevitably influence the number of international students choosing to study medicine in the UK, with potential adverse financial consequences for institutions that are already under significant pressure. Parliament should not be asked to legislate in the dark on such effects, which is why we believe that there is a strong case for the Government reporting regularly on the impact of these provisions on student numbers and on the financial sustainability of medical schools—centres of excellence that sustain a world-class teaching environment that is a genuine credit to this country.

The Bill was prompted by a problem that we all recognise—too many talented British doctors are finding their progression blocked, and the NHS and, ultimately, patients are paying the price. We support the principle that UK training, public investment and commitment to the NHS should be properly recognised, but principle alone is never enough. If this legislation is to succeed, and succeed fairly, it must be both precise and proportionate. Of course, it must address the core of the problem in a sufficiently far-reaching way. However, it must also recognise the realities of life for aspiring doctors who have submitted applications to enter UK training programmes, relied in good faith on explicit written assurances from the relevant authorities and committed what are often large sums of their own money on the back of those assurances, and who now find the rug pulled from under them.

Legislation designed to remedy the current problem must also take full account of those elements of UK and foreign-based training systems that are in practical terms identical. It must be robust enough to protect UK training pathways stemming from long-standing international partnerships that are already established firmly in our medical education system. Our relations with allies and Commonwealth members such as Malta really matter.

We approach the next stages of the Bill in a constructive spirit. Our aim is not to frustrate its passage but to improve its drafting to ensure that it does what it is intended to do without unintended consequences. We want it to command confidence across the House as well as outside it so that the future of medical training, and indeed the future of the NHS, is genuinely safeguarded and strengthened.

Medical Training (Prioritisation) Bill

Earl Howe Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, the noble Lord, Lord Patel, deserves our thanks for opening our Committee debate in a cogent and powerful way. He is absolutely right: in this country, we train some of the very best doctors in the world—at great expense to them and to the taxpayer—but too many are choosing to leave the training process because in the now expanded competitive scrum they cannot access the training places they require. Each year many remain unemployed. That is a serious policy challenge, and Ministers are right to seek to address it. We need a long-term and fair solution.

The noble Lord, Lord Patel, is seeking to ensure that UK medical graduates are prioritised for training places first before those in the priority group are offered places. There would then be a third tier of prioritisation for any other eligible applicants. This would put UK medical graduates, as defined by Clause 4, ahead in the queue for training places. I do not think we can fault the noble Lord for his logic. If we believe there is currently a massive and disproportionate injustice being meted out to UK medical graduates, we owe them the best chance we can give them to enter further training pathways in this country.

However, I have two questions for the Minister. First, the Explanatory Notes confirm that those who have trained in Ireland, Iceland, Liechtenstein and Norway have been included in the priority group because

“existing agreements require us to recognise their qualifications and offer parity in access to the profession”.

Can the Minister please confirm whether the reordering of prioritisation, as proposed by the noble Lord, Lord Patel, would cut across the existing agreements that the UK Government are bound by?

Secondly, I think many of us agree that emergency legislation should be avoided as far as possible, but where it is necessary, it should be simple and straightforward. On the face of it, the amendments from the noble Lord, Lord Patel, would make the Bill a bit more complicated by adding a further tier of prioritisation. If that is so, I am sure he would argue that the extra complexity is well worth it. It would be helpful if the Minister could tell us whether such an additional tier of prioritisation would make the process more complex to manage.

Amendment 2 in the name of my noble friend Lady Coffey would prioritise UK medical graduates who are British citizens first, then those persons in the priority group and then UK medical graduates who are not British citizens. The category of other eligible applicants is not included. Perhaps it is an inadvertent omission; I do not know. Again, this would create a three-tier prioritisation process, where the Government are currently proposing two tiers, with the added dimension of drawing a distinction between different categories of UK medical graduates. Like the noble Lord, Lord Clement-Jones, I am uncomfortable with that as a matter of policy. On the face of it, the amendment presents a more complex set of arrangements than those proposed by the noble Lord, Lord Patel, so it would be helpful to hear from the Minister how the Government view my noble friend’s suggestions, including their ready workability.

[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.

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Moved by

[Earl Howe]

4: Clause 1, page 1, line 7, at end insert—
“(2) Nothing in this section shall be taken to negate or override a confirmed offer of a place on a UK Foundation Programme where the offer was made prior to the date on which this Act was first laid as a Bill before Parliament.(3) In this section “confirmed offer” means an offer in writing made by a person who has a function of deciding offers of places on a UK Foundation Programme.”

[Earl Howe (Con)]

My Lords, I begin by making it clear that this is very much a probing amendment, for reasons which I shall explain. Across all the many representations I have received on the provisions of this Bill—from UK medical graduates; UK citizens studying medicine abroad; non-UK citizens studying abroad; some in the middle of their degree course; some who have finished their degrees, and some who have commenced but not completed a UK foundation programme—there is one issue that rises to the surface. It is an issue that is most easily encapsulated in the phrase “legitimate expectations”.

Quite justifiably, in my view, individuals who have embarked on the long and costly journey that is required of them in order to gain a GMC-approved medical qualification and who have found themselves suddenly deprioritised by one or other provision within this Bill have questioned the fairness of the dividing lines that the Government have chosen to draw in such summary fashion. Medical graduates—many of them British citizens—who have demonstrated both commitment and excellence and who have adhered in good faith to every step of the process laid down under existing rules are now being told that their trust in the system counts for nothing and that, all of a sudden, their legitimate expectations have been overridden.

Noble Lords will note that my amendment relates specifically to the 2026 UK foundation programme. It suggests that a graduate who has already received a written offer of a place on a foundation programme should be able to rely on the validity of that offer. In reality, I understand that, with very few exceptions if any, applicants to the 2026 UK foundation programme have not yet received formal written offers of employment. However, the formal process began last summer. Eligibility applications were completed last July and foundation programme applications in September. Since then, there have been mandatory UKFP-related deadlines, including the national clinical assessment—NCA—in November and PLAB 1 in December. In other words, the process is active, sequential and consequential, notwithstanding as yet the absence of formal written offers.

To take the case of a medical graduate in February 2026 who finds themselves prospectively deprioritised in the way that I have described, in the Government’s view, at what point on that graduate’s journey does the principle of legitimate expectations kick in? How fair is it to say to a talented and high-achieving graduate that, despite their passing through all the existing procedural hoops, they now need to lower their expectations quite dramatically and accept that they are no longer in that part of the queue for a medical qualification which, in good faith, they previously worked to join?

In summary, my amendment is intended to pose a somewhat broader question than its literal wording would suggest. What do the Government have to say to that cohort of soon-to-be deprioritised graduates who have committed time, effort and money to pursuing their goal? Is there any room for movement? I beg to move.

[Lord Mohammed of Tinsley (LD)]

My Lords, I speak to the amendments in this group in my name—Amendments 5 and 10—and to Amendments 9, 11, 24 and 25 in the name of the noble Lord, Lord Stevens of Birmingham, which I have also signed.

I follow up the point that the noble Earl, Lord Howe, talked about in terms of the fairness for those people who went into the application process last summer. They started this process with the expectation of getting a confirmation any time now and being able to prepare. That is why my Amendment 5 proposes to postpone the implementation of this speciality training prioritisation for this year’s intake, so that those people who are applying for 2027 know that we are changing the rules, rather than telling those people who applied last summer that we have changed the rules. Let me be clear from the outset: this amendment does not seek to undermine the principle of the objectives of this Bill on medical training; rather, it seeks to ensure that these objectives are implemented fairly, coherently and without unintended harm to the very trainees upon whom our healthcare system depends.

The central issue for us here has always been timing. As the Bill currently stands, these changes would be introduced during an active application cycle. This raises serious concerns about procedural fairness and legitimate expectations. Applicants have made life-altering decisions—academic, financial and personal—based on a set of rules that existed last summer when they applied. To change these rules mid-cycle, in my opinion, is not merely inconvenient but fundamentally unjust. Like many others, I have been contacted by affected medical students who have articulated their concerns around the criteria. They noted that they had complied fully with all the requirements enforced at the time of application, only to find themselves potentially excluded by the change that has now been imposed. Without transitional protections, the Bill would disadvantage applicants who acted in good faith, followed the guidance provided and had every reasonable expectation that the rules would not be rewritten half way through the process. This is not about isolated grievance; it reflects a systematic risk inherent in rushed implementation.

Medicine is a profession that demands long-term planning, with years of study, examination, placement and significant personal sacrifice. When Parliament alters the conditions of progression without adequate notice or transition, it destabilises that planning and erodes trust in the system. My amendment therefore offers a modest but proportionate and sensible solution: a one-year delay that would allow for clarity in communications and proper preparation. It would give institutions time to adjust their process, regulators time to issue clear guidance and applicants time to make informed decisions so that people who will be applying this summer know what the criteria are. Crucially it would also align with the principles of this House, which has long upheld fairness, legal certainty and an avoidance of disadvantage. We should be especially mindful of these principles when legislating in areas that directly affect access to professional training and career progression.

There is also the practical consideration. Disruption of the current application cycle risks creating gaps, appeals and bottlenecks that could ultimately harm workforce planning in the NHS. At a time when staffing pressures are already acute, we should really be wary of reforms that may have unintended consequences and might deter capable candidates. My amendment would not delay the reforms indefinitely, but simply ensure that reforms are done properly. By supporting this amendment, we would send a clear message that, while we are committed to improving medical training pathways, we are equally committed to treating applicants fairly and honouring the rules under which they apply.

We have heard about the immigration status mentioned earlier and the criteria on which that is based. With my Amendment 10, I would like to raise with the Minister the alternative option, given that the Government are also seeking to change the rules around indefinite leave to remain. My understanding is that there is a better option. The NHS has its own recruitment platform, the Oriel system, which is able to demonstrate professional commitment to the NHS. In doing so, it shifts the focus from legal residence status to actual service, contributions and engagement with our health system.

The NHS does not run, as we heard earlier, on immigration categories. It runs on people who turn up to shifts, who trained within its system, who understand its pressures and who have committed themselves to caring for patients day in, day out. The Oriel registration is not just a symbolic tactic; it is a gateway through which NHS recruitment, training and workforce planning operates. It is a clear, objective indicator that an individual is already participating in or seeking to participate in the NHS.

Similarly, the concept of professional commitment to the NHS allows for a broader and fairer assessment of contributions. It recognises work undertaken in the NHS trust, clinical placements, foundation training, research, teaching and other forms of service that directly benefit patients and institutions. This approach reflects reality far more accurately than a single immigration milestone, which may have little bearing on an individual’s clinical engagement or future commitments or intentions.

There is also a serious risk of equality issues at stake. Many doctors who have trained in the UK, worked in NHS hospitals, paid taxes and served our communities for years do not yet hold indefinite leave to remain, due to the structures and lengths of immigration pathways. To divert these such individuals despite their proven service risks sending a deeply damaging message that contribution is secondary to paperwork. At a time when the NHS remains heavily reliant on international medical students, we should be careful not to erect barriers that discourage retention or undermine morale. These clinicians are not temporary stopgaps; they are integral members of our workforce. Many intend to build long-term careers here and many already have.

From a practical standpoint, this amendment also improves administrative clarity. Assessing our registration and documenting NHS experience is straightforward, verifiable and directly relevant to workforce needs. By contrast, tying prioritisation to immigration status risks complexity, inconsistencies and unintended exclusion. If the aim of the Bill is to strengthen medical training and to support the NHS workforce, our criteria must align with that goal. This amendment ensures that prioritisation is based on what truly matters: demonstrated commitment to the NHS and the work that it exists to do. Therefore, I urge noble Lords to support both my amendments.

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[Earl Howe (Con)]

My Lords, I am grateful to all noble Lords who have taken part in this debate, especially those from around the Committee who felt able to support my Amendment 4. I think there will be very many people in the medical community who will read the Minister’s reply to my amendment with acute disappointment. I say that not only because of the arguments I tried to articulate about legitimate expectations but also because of the point, well made by the noble Baroness, Lady Finlay, about the damage that the Bill will cause to the UK’s reputation for fairness around the world.

I would also pray in aid the amendment spoken to so ably by the noble Lord, Lord Mohammed of Tinsley, who argued in favour of delaying the implementation of the medical specialty training prioritisation requirements by one year. In doing so, he has very much echoed my thinking in this whole area. My initial reaction to this amendment is that it would have a positive impact on applicant confidence, as well as trust in the system, to pick up again the point by the noble Baroness, Lady Finlay, by allowing an extra year to transition to the new prioritisation process.

I also note that my noble friend Lord Strathclyde, in his role as chairman of the Constitution Committee, has written to the Minister, raising the committee’s concerns about the impact of the new prioritisation regime on applicants for the 2026 cohort who would fall outside the prioritised groups. It seems to me that Ministers really should consider this proposal carefully.

Amendment 10 by the noble Lord, Lord Mohammed, would remove the requirement that those who are prioritised for specialty training programmes must have indefinite leave to remain or leave to enter or remain in the UK, replacing those subsections with the requirement that persons merely need to have been

“registered on the NHS Oriel recruitment platform, or … demonstrated a professional commitment to the National Health Service”.

I thought the noble Lord argued his case very well. Of course, material in this context is the number of applicants who do not currently have leave to enter or remain in the UK who would, under the noble Lord’s amendment, be able to come here. I am, however, quite surprised to hear from the Minister that it would require a manual search of tens of thousands of records to find the answer to that, and that there are not ways of conducting a search automatically or electronically that could reveal the information that is needed. Again, I was disappointed by the Minister’s reply, for the reasons largely cited by the noble Lord, Lord Clement-Jones.

Finally, I comment briefly on the amendments tabled by the noble Lord, Lord Stevens of Birmingham, to which I added my name. These do not seem to me to be onerous on the Government in any way; they merely grant the Secretary of State the power to permit the appropriate authority to make regulations specifying further groups of people who are included. I feel that the Bill is particularly unfair to doctors with significant NHS experience seeking a specialty training post in 2026, and the mechanism proposed in the noble Lord’s amendments could be used to address that unfairness.

It is a pity that the Minister felt compelled to sound a negative note on the proposals by the noble Lord, Lord Stevens. However, having listened to the Minister’s reply and to all the amendments in this group, I think a period of reflection is warranted, hopefully by the Government as well as noble Lords around the Committee. With that, I beg to withdraw Amendment 4.

Amendment 4 withdrawn.

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[Lord Mohammed of Tinsley (LD)]

The noble Lord, Lord Stevens, has given people ideas. Possibly, this could happen, yes.

Thirdly, both courses and study for the convocation are approved by the GMC as being equivalent to the UK medical qualification. This is not about lowering standards or creating a new route through the back door. On the contrary, this is about recognising the standards that already exist and are regulated by the GMC. The GMC is determined that these courses are equivalent in content assessment and outcome. It is difficult to justify why we should exclude them, given the numbers that we heard about earlier.

Universities such as Newcastle—and there may be others as well—rely heavily on this partnership. These programmes have not just happened overnight. They have existed for some time. They are run by UK institutions, aligned with UK curricula and assessed identically to UK standards and subjects. Graduates receive UK-awarded degrees, not foreign substitutes. Such programmes contribute to the NHS. Only yesterday, we heard from Newcastle University that they have had up to 150 students on their Malaysian campus. As we heard earlier, some of those students have come back to the United Kingdom and, in particular, have served for many years as GPs when we have had an acute shortage. We need to take heed of that contribution and also the long-standing relationships that exist both with Newcastle and Queen Mary.

We are only asking for a very small change. We are not asking for tens of thousands of students to come here. We are asking for a small number through long-established partnerships that have existed and stood the test of time. We are asking the Minister for some flexibility. This is being heard from all sides of your Lordships’ House. We are about to go on a holiday. I hope that the Minister will take this time to reflect on our debate and come back on Report with government amendments that we can all support. I look forward to the debate that we are going to have in less than a fortnight’s time.

[Earl Howe (Con)]

My Lords, I shall speak to my Amendments 20 and 21 and in support of the other amendments in this group.

My amendments are intended to work together and to return us to one of the salient themes of our debates at Second Reading, a theme which has been persuasively developed today by the noble Baroness, Lady Gerada, the noble Lord, Lord Forbes, and other speakers. At the heart of their concerns is why the Government have chosen to adopt a definition that threatens to undermine high-quality workforce capacity in the NHS, that jeopardises the sustainability of medical education delivered overseas by UK institutions, and that runs completely counter to the Government’s stated ambitions on promoting British standards of education internationally.

The Bill prioritises graduates based on strict geographic criteria, rather than on the provenance of their qualifications. UK academic institutions such as Queen Mary University of London and Newcastle University have campuses respectively on Malta and in Malaysia which train doctors to GMC-approved standards, using the same curriculum and the same assessments as those employed on their campuses in the UK.

The noble Baroness, Lady Gerada, has eloquently made the case for Maltese-trained students. I can add little to that. The noble Lords, Lord Clement-Jones, Lord Mendelsohn, and Lord Forbes have also spoken very powerfully on the same theme. The amendments of the noble Baroness, Lady Gerada, speak of the two qualifications—in other words that gained in Malta and that gained in London—as being identical in character. The amendment from the noble Lord, Lord Forbes, uses the word “equivalent”. I would go further by saying that the degree issued by the Queen Mary University of London Malta campus is not merely equivalent to a UK degree: it is a UK degree.

Not only that, but Queen Mary University is able to state that cohorts of its students trained in Malta frequently outperform their contemporaries who have studied and trained on the London campus. The intervention from the noble Lord, Lord Winston, has confirmed that that is not an isolated claim. The same claim could be made of many graduates of Newcastle University’s campus in Malaysia. These are excellent doctors, so there is not an issue of quality here.

Nor should there be an issue around numbers. In total, as we have heard, the number of these overseas-trained graduates is modest in comparison to the overall NHS training intake in a given year. The numbers really ought to be treated as de minimis. We have heard from Ministers that, if they were to flex the rules in the way that I and others are proposing, there would be no way for them in the future to control the total numbers of eligible applicants from these sources. My question is: why? It would seem perfectly possible to grant Ministers a power to cap total numbers at a figure corresponding to recent experience. It would then be up to the relevant universities concerned to collaborate year by year to ensure that the cap was not exceeded. That is what my Amendment 21 is intended to do.

Finally, we return to the issue of legitimate expectations. For all the reasons that I have given, students trained on overseas campuses of UK institutions have never dreamed of questioning whether the status of their qualification would differ in the slightest from the status of the qualification gained by their student colleagues in London. They are, in consequence, not to put too fine a point in it, appalled that, through this Bill, they are suddenly to be regarded as less deserving of a medical career in the NHS. I ask the Minister to think again.

[Baroness Merron (Lab)]

My Lords, I am grateful for this debate, as I have been grateful for the time that noble Lords have given to discussing their concerns about various aspects of the Bill in advance of today. I can say to both the noble Earl, Lord Howe, and the noble Lord, Lord Mohammed, that I always reflect on what they and other noble Lords say. Indeed, I reflect on what every noble Lord says—it is true that I may listen to some more than others, but that would be telling. I am genuinely grateful. In my view, it really does assist the passage of legislation and I take it very seriously. I will of course reflect, as I have before, not just on what is said in the Chamber but on what we have discussed outside.

The noble Earl, Lord Howe, said previously that people will be watching and reading this debate, and I absolutely agree and am glad that they do. So I must emphasise the point that this is not about excluding people from their applications; it is about prioritising. The reason we are in this position is the removal of the resident labour market test in 2020, which changed the whole landscape. In 2019, there were 12,000 applicants; now, there are nearly 40,000 applicants, which means four resident doctors for every specialist training post. I believe that noble Lords understand the scale. Internationally trained doctors make a huge contribution and will continue to do so. We are aiming to bring forward those internationally trained doctors who have significant NHS experience for training posts in the future, which I think is absolutely right.

Let me turn to the amendments in this group: Amendments 15 and 16, tabled by the noble Baroness, Lady Gerada; Amendment 17, tabled by my noble friend Lord Forbes; and Amendments 20 and 21, tabled by the noble Earl, Lord Howe. Each of these amendments seeks to ensure that graduates of overseas campuses of UK medical schools are prioritised for foundation and specialty training. I understand why this is being raised, and it is quite right to probe this whole area, in my view. While I appreciate the intention behind these amendments, and the manner in which they have come through, the Government are unable to accept them.

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[Lord Mohammed of Tinsley (LD)]

My Lords, I know that it is late, but it is important that I move this amendment, which seeks for all regulations that are made under the Bill are subject to affirmative resolution procedures. In simple terms, after the Bill is passed, we would have a vote in both Houses on any changes made to allocation of spaces. This amendment goes to the heart of parliamentary accountability.

The Bill as currently drafted grants Ministers broad regulation-making powers, including the ability to amend key operational aspects of medical training with limited parliamentary oversight. My concerns are not with the intentions of the current Minister or the present Government but with the precedent that this sets. Delegated powers once granted outlive individual Ministers or Governments.

Medical training is an area where stability and predictability are essential. Doctors and medical students plan years in advance—sometimes decades. They make decisions about education, location, finances and family life based on the rules that Parliament sets. If those rules can be altered by secondary legislation without a positive vote in both Houses, we risk creating uncertainty and undermining confidence in the system.

The affirmative resolution procedure would provide a necessary safeguard. It ensures transparency, debate and accountability. It allows Parliament to examine whether proposed changes are proportionate, evidence-based and aligned with the original intent of an Act. Importantly, in this case, it would give affected shareholders—medical students, trainees, regulators and the NHS workforce—the assurance that changes will not be made without democratic consent and accountability.

This House has repeatedly expressed concerns about the expansion of executive powers through delegated legislation, particularly in areas with significant policy impacts. The Delegated Powers and Regulatory Reform Committee has, on numerous occasions, warned against the inappropriate use of negative or minimal scrutiny procedures where primary legislation confers wider discretion. My amendment responds directly to those concerns.

There is also a practical benefit. Requiring affirmative approvals encourages better policy-making. Ministers can explain, justify and defend their proposals in open debate. That process often improves the quality of regulations, identifies unintended consequences and builds broader support for necessary reforms.

This amendment would not prevent future Governments adapting the medical training system. It would simply ensure that, when they do so, they do so with Parliament, not without it and not by going around it. It would preserve flexibility while embedding accountability. At a time when trust in politics and political institutions is fragile, Parliament must demonstrate that significant changes to professional regulations are made openly and responsibly. Requiring a positive resolution in both Houses is a modest but important step in that direction. I therefore commend this amendment to your Lordships’ House.

[Earl Howe (Con)]

My Lords, I am grateful to the noble Lord, Lord Mohammed, for his amendment and his very helpful introduction. From these Benches, we have consistently raised our concerns about the downsides of emergency legislation. The Constitution Committee chairman, my noble friend Lord Strathclyde, wrote in his letter to the Minister that the Constitution Committee has

“repeatedly raised concerns about the fast-tracking of legislation, highlighting in particular the need to ensure that effective parliamentary scrutiny is maintained”.

We are all of us, I hope, doing our utmost in the short time available to scrutinise the Bill fully, but, with such a short period of time available, we cannot discount the possibility that this legislation will have unintended consequences. The noble Lord, Lord Clement-Jones, posited one particular example in his speech during the last debate.

It is true that the Delegated Powers and Regulatory Reform Committee has not brought anything in the Bill to the attention of the House. However, in the light of the fact that the Bill has been fast-tracked through Parliament, there is, I believe, a case for making all regulations under this Act subject to the affirmative procedure, allowing for additional future scrutiny. Like the noble Lord, Lord Mohammed, I look forward to hearing the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am grateful not just for this brief debate but for the efforts of noble Lords to expedite this legislation. I acknowledge the short timeframe—it is not as short as in the other place but, nevertheless, noble Lords have been most co-operative, and I value that.

Amendment 23, tabled by the noble Lord, Lord Mohammed, seeks to require that all regulations made under the Act are subject to the affirmative procedure. This is an amendment we are not able to accept. To reiterate our intention, the Bill sets out the groups of people who are to be prioritised for specialty training from 2027 onwards. I reassure the noble Lord that the delegated power is limited to adding to this list by reference to significant experience working as a doctor in the health service or immigration status.

Similarly, we have set out in the Bill specialty training programmes excluded from the prioritisation scheme. The delegated power is limited to amend this list, and it gives necessary operational flexibility to respond to future changes in recruitment, training and workforce needs—something that I know noble Lords are very attuned to the need for.

I am sympathetic to the desire for parliamentary scrutiny and I always try to ensure that it is provided but, because of the limited scope of these powers, we believe that the negative procedure is appropriate. As the noble Earl, Lord Howe, just referred to, the Bill has been assessed by the Delegated Powers and Regulatory Reform Committee, and no suggestion has been made that the negative procedure was inappropriate for this regulation.

I have spoken in a previous group to why we are dealing with emergency legislation. I hear what is said about the downsides, but we have to balance that with the scale of the problem and the urgency that it demands. That is why we decided to introduce emergency legislation.

The noble Earl spoke about the Constitutional Committee letter. We will be responding formally to the committee to address its concern. With that, I hope the noble Lord feels able to withdraw his amendment.

Medical Training (Prioritisation) Bill

Earl Howe Excerpts

Report stage
Monday 23rd February 2026 Lords Chamber

[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.

[Earl Howe (Con)]

My Lords, I too am grateful to the noble Lord, Lord Patel, for leading the debate on his amendments, which seek to establish a new prioritisation hierarchy that puts UK medical graduates first, ahead of those in the priority group who are not UK medical graduates. I should have prefaced my speech by reminding the House of my interest as an honorary fellow of the Royal College of Physicians.

We debated this proposal in Committee, when other noble Lords, including my noble friend Lady Coffey, tabled amendments that sought to introduce a different prioritisation hierarchy. I understand fully the case that the noble Lord is making and I agree that UK medical graduates should have a much fairer crack of the whip in access to medical specialty training places. Fairness has been our primary concern throughout our scrutiny of this Bill. However, I agree also with the noble Lord, Lord Hunt of Kings Heath. The Government have had some hard choices to make.

In an ideal world, where the House had been given more time to consider these matters in the round, we might have been able to improve on the approach that Ministers are taking. For example, there is surely a place for guidance to make clear that the prioritisation process should incorporate considerations of medical and academic excellence, a point that the noble Baroness, Lady Finlay, has consistently made.

I am grateful to the noble Lord, Lord Stevens of Birmingham, for putting the decisions made by the last Government into their proper context. However, given where we are, we accept that Ministers have introduced this as urgent legislation with a specific purpose. In that context, having accepted that the Government’s approach will have the effect that they are seeking to achieve, we are satisfied that the Minister’s proposed method of prioritisation is acceptable.

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

My Lords, I am most grateful to noble Lords across the House for their considered contributions to this group of amendments and to the noble Lord, Lord Patel, for his introduction to this group. I have a third reason to be grateful—namely, for the understanding of the challenge that this Government are facing and the need to take action. I do not take that for granted. We are not able to support the amendments tabled by the noble Lord, Lord Patel, and I will go through the reasons.

In answer to the noble Baroness, Lady McIntosh, the Bill already sets clear priority groups without any further ranking within them. This is a binary system: applicants are either prioritised or they are not. It might be helpful to your Lordships House to say that the priority groups set out in the Bill have been agreed across the four Governments of the nation. They are best placed to support moving to what we all want—a sustainable workforce to meet the health needs of this population.

As I emphasised in Committee and at Second Reading, prioritisation does not mean exclusion. Non-prioritised graduates will still be able to apply, and they will be offered places if vacancies remain after prioritised applicants have received offers. For specialty training, there are likely to be opportunities in general practice, core psychiatry and internal medicine, which, historically, attract fewer applicants from the groups that we are prioritising for 2026.

Alongside UK graduates, the Bill prioritises graduates from Ireland—this reflects, as I have spoken of before in this Chamber, the special nature of our relationship with Ireland—along with graduates from Iceland, Liechtenstein, Norway and Switzerland, which reflects our obligations under international trade agreements with the European Free Trade Association countries to treat their graduates no less favourably. The amendments would mean that we would not be honouring these arrangements as we would be prioritising UK medical graduates over applicants from these countries.

The agreements with EFTA countries precede this Government. The agreement for Iceland, Norway and Liechtenstein was made in July 2021, and for Switzerland in 2019. The bottleneck issues that this Bill is designed to address were primarily driven by the removal of the resident labour market test in 2020. I know noble Lords will understand the need to uphold these international obligations, albeit we receive very low numbers of applicants from EFTA countries. As I noted in my recent letter to the noble Lord, Lord Mohammed, and to give noble Lords some idea of scale, there are a total of two applicants from EFTA countries for foundation and specialty training in 2026.

For specialty training, the amendments would mean we would be prioritising UK medical graduates over applicants with significant NHS experience. That would undermine the effective delivery of our policy intention, for which there is much sympathy in this Chamber, to prioritise applicants with significant experience working in the NHS. The Government have rightly committed to prioritising those who have made a considerable contribution to our health service because they better understand how the health service works and how to meet the needs of the UK population.

The noble Lord, Lord Patel, asked how many more students in the priority group would be able to enter specialty training. I will be pleased to write to the noble Lord on that matter.

My noble friend Lord Hunt and the noble Baroness, Lady Finlay, called for improvement of the broader approach to medical training, and that is something with which I would definitely concur. We have published phase 1 of the medical training review, which identifies the key challenges and the areas for improvement across postgraduate medical training, as noble Lords are inquiring about, and asks what is working well. Phase 2 of this work is already under way, and will focus on exploring those issues and developing options for change.

The noble Baroness, Lady Finlay, asked that I give an assurance that Oriel would, as an appointment process tool, have what she described as a more subtle way of looking at NHS experience. I can confirm that we will be engaging with stakeholders on what the best definition is and what is most appropriate for NHS experience. That will then allow us to update the system.

The noble Baroness, Lady Finlay, asked about merit-based selection and made a valid point about the quality of applicants. I assure your Lordships’ House that the Bill does not replace in any way a merit-based selection. Existing recruitment processes for foundation and specialty training already assess applicants against rigorous, merit-based criteria, including competence, performance and suitability for training, all of which I know are of concern, and rightly so, to the noble Baroness. The Bill sits alongside that process, not instead of that process.

The noble Lords, Lord Stevens and Lord Clement-Jones, asked about specialty training places. In the 10-year health plan, which the noble Lord, Lord Stevens, referred to, our commitment is to create 1,000 new specialty training posts over the next three years, focusing—importantly, in my view—on specialties where there is the greatest need. The Bill will not delay this process. There are some programmes and regions already at capacity for delivering properly supervised training posts. Expanding that training capacity will therefore need to be done gradually to ensure that placements remain of the high quality that we need and that appropriate supervision is in place to support it.

I hope that I have dealt with the main questions raised. For these reasons, I hope the noble Lord will withdraw his amendment.

--- Later in debate ---

My noble friend’s Amendment 7 offers a pragmatic solution, replacing the ILR requirement with a benchmark of at least two years of training or employment in the NHS. This would create parity with the UK foundation programme and tell doctors who have kept our hospitals running that their service actually counts. I urge the Government to have another look at whether they can utilise the Oriel system and accept this fairer metric. Otherwise, I believe the Government should accept Amendment 3, which would delay the Bill’s impact until 2027.

[Earl Howe (Con)]

My Lords, with these amendments, the noble Lord, Lord Mohammed, has reprised proposals he made, and which we debated, in Committee. In Committee, the Minister emphasised a point that I must say resonated particularly strongly with me. She pointed out that the delay proposed in Amendment 3 sets the Government back in their timetable to address the bottlenecks in medical training. Although I acknowledge all that the noble Lord said about fairness, I must accept that a delay of a year would set the Government back significantly in their plans. Given our support for the main principle underpinning the Bill, we cannot, I am afraid, support that amendment.

However, I reiterate that prioritisation is only part of the solution to the problem we have been talking about. It is a logical and sensible step, but the bottlenecks in medical training, which are having such a pernicious effect on the future opportunities of young doctors, will not be ameliorated until the number of training places is increased significantly. The Minister’s answer in the previous group to the question about training places posed by the noble Lord, Lord Stevens of Birmingham, was helpful. However, can she go any further and indicate whether the Government consider that the additional training places which have already been announced are likely to be sufficient, or is there a possibility that more may be announced in the coming months?

The noble Lord, Lord Mohammed, made a strong case for Amendment 7, and I endorse the powerful comments made not only by him but by the noble Lord, Lord Clement-Jones. Can the Minister provide us with further information on the Oriel system? There is a sort of fog surrounding this subject.

When we last debated this issue, I was surprised that the Minister was unable to give clarity on the number of individuals who have demonstrated an established commitment to the NHS but do not have leave to remain. It seems to me essential that we have clarity on the number of doctors that this amendment would affect. Has she had the opportunity to look into this in more detail between Committee and Report? If we are not able to get greater clarity on the issue today, will the Minister at least give a commitment to look at any cases where a doctor has demonstrated that commitment but does not have indefinite leave to remain, so that we can ensure that any injustices that may arise as a result of this emergency legislation are resolved swiftly at ministerial level?

[Baroness Merron (Lab)]

I am grateful to noble Lords on all sides of the House for their contributions today. I turn first to Amendment 3, tabled by the noble Lord, Lord Mohammed. As I explained in Committee, this is not an amendment that we are able to support. As has been emphasised, including today, a key aim of this Bill is to address the severe bottlenecks in medical training that have built up over recent years. These pressures are having real consequences, evidenced most starkly, I believe, through the most recent industrial action, where concerns about stalled career progression and training opportunities have featured and continue to feature heavily.

The noble Lord, Lord Mohammed, rightly spoke about the concerns of applicants mid-cycle, and I do recognise the concerns about this group and the impact on them, particularly where applicants did not know how prioritisation might affect them. But, although I absolutely understand the concerns, which we have discussed, these have been carefully considered and, at the end of it all, we have to make decisions about what it is we are trying to do. There will be people who are affected in ways that none of us would have chosen, but it has not been possible to make a change in legislation, particularly at this pace, without some effect on some groups. So, yes, it is a choice, and it is one that we have made. But I acknowledge of course the impact on those who are in the middle of a cycle of application.

With regard to the proposal in the amendment, I can only endorse the comments by the noble Lord Earl, Lord Howe, that another year of inaction would only deepen the frustration felt by UK-trained doctors and further destabilise the workforce. I do not think that is something that any of us want to see. So, we do believe that applying prioritisation to the 2026 intake is both necessary and justified. If we wait, as this amendment suggests, until 2027, it is projected that competition ratios will have risen even further. That would mean more UK graduates unable to progress their careers on time, with greater risk to the long-term sustainability of the NHS workforce, and protecting the long-term sustainability of the NHS workforce, protecting patients and protecting patient care and services is what this Bill is all about. That is why we are not able to accept another year’s delay, although I understand why the noble Lord put his amendment forward.

In addition, there is a difficulty in terms of the drafting in respect of this amendment, because it would create two clauses related to the prioritisation of applicants to specialty training programmes for 2027, and each would have a different approach to prioritisation. I am sure that the noble Lord would not want to create operational confusion or undermine legal certainty, but I thought it important to point that out.

I turn to Amendment 7, also tabled by the noble Lord, Lord Mohammed. First, following our conversation earlier—I am grateful for the noble Lord’s flexibility in that regard—I want to reassure him and your Lordships’ House that we are absolutely committed to recognising those who have worked in the NHS for a significant period. There is a very good reason for this: as well as it being the right thing to do, those individuals are much more likely to stay in the National Health Service for the long term, and they are much better equipped to understand how the health service works and how to meet the needs of the UK population. Again, that is a core driver in this Bill. It is our intention to prioritise those with significant NHS experience for specialty training. However, we are unable to support Amendment 7, for a number of reasons. I appreciate that the amendment was changed, but I want to refer at this stage to the points made by the noble Lord, Lord Clement-Jones; I discussed these matters with him earlier today.

While the NHS Oriel recruitment system holds some information about an applicant’s NHS experience, it cannot be used consistently or fairly for the 2026 round. The data has been collected on the basis that it would be checked by employers before appointment, not for retrospective automated assessment. It is indeed the case that applicants enter their employment history on Oriel as free text, but with no consistent format. Yes, there is a tick-box to indicate NHS experience, but I have to emphasise that it is self-declared—and that is the problem. There is no mechanism for verification to confirm that the employer listed is an NHS organisation, or any other relevant detail. That is why I spoke about this in Committee: it would require a manual review of tens of thousands of applications. That means a high risk of error, potentially delaying offers and start dates: again, nothing that any of us would wish to do. It would of course be destabilising for applicants and trusts, so it is not operationally feasible and nor would it be fair.

The noble Earl, Lord Howe, asked for more information on the Oriel system. I would welcome speaking to him at great length about it as, having looked into it in a practical sense, I can absolutely see the limitations. In my letter to the noble Lord, Lord Clement-Jones, which I have placed in the Library, more detail has been provided on the system, which may be of help to the noble Earl, Lord Howe. But if the noble Earl would like a more in-depth acquaintance with the Oriel system, he and other noble Lords are most welcome to benefit, as I have done.

The noble Baroness, Lady Finlay, spoke of voluntary experience as a possibility for being NHS-significant experience, and I understand why she raises this. On this point and also to the point about the amendment, there is currently no agreed threshold for what constitutes significant NHS experience. The fact is that views on this differ widely, as evidenced today by the noble Baroness. That is why we have committed to full engagement on this issue for future years, rather than rushing through the changes for 2026. Once we have agreed the parameters around experience, the Oriel system will be updated to ensure that data is collected in a consistent, verifiable format—that is the key—to support fair assessment in future recruitment rounds. Our aim is to have this in place in time for the next specialty training round, which will open for applications in autumn 2026.

For the current recruitment round, the Bill uses a set of carefully chosen specified immigration statuses, as this is a practical and proportionate proxy for identifying applicants most likely to have significant NHS experience. After careful consideration, we have concluded that this is the best approach for the 2026 recruitment round.

On the question from the noble Earl, Lord Howe, about the potential for additional training places and the likelihood that the ones I referred to earlier will be sufficient, we are keeping the numbers under review, as we always do. The noble Earl asked me to look at particular cases, and I am always happy to do that. We should bear in mind that it is often difficult to comment on very specific individual cases, but I am pleased to look at the broad point that he makes.

On the basis of the reasons I have outlined, I hope the noble Lord will withdraw his amendment.

--- Later in debate ---

[Lord Mohammed of Tinsley (LD)]

My Lords, briefly, I offer our support from these Benches to Amendment 11, in the name of the noble Baroness, Lady Lister, and to the amendments in the name of the noble Baroness, Lady Gerada.

I want to talk about the amendment in the name of the noble Baroness, Lady Lister. I am sure that other noble Lords will have had an email from a woman from Ukraine, who set out her concerns. We as a nation have proudly welcomed and given safe sanctuary to people from Ukraine, predominantly women and children. However, because of the conflict in her country she has not been able to fulfil her dream of being a doctor; she has tried to navigate the system, through working as a care worker, and would like us to be able to support her.

I plead to the Minister: can we not have some flexibility, at least when it comes to specific circumstances? We have been so generous as a nation in welcoming those people, who, if they had their way, would be in their country. They want to continue building on the education that they had in their nation. I am sure that there will be others as well. Is there some flexibility? I hope that the Minister can comment on that.

On the amendments tabled by the noble Baroness, Lady Gerada, when we had this discussion before the Recess it was clear that we were asking for those two overseas medical schools. They are the only ones that are active now. The amendments are clear that no other schools would be allowed to open up and go through the loophole that some noble Lords have talked about. We are talking about very small numbers. However, those numbers are important because we have also had emails from British nationals who have gone to study abroad with an expectation. As I said on my amendments in the previous group, we are changing the rules for them mid-cycle. There must be some level of flexibility.

We want the Bill to go through, but we would like it to be a bit fairer than it is. I talked previously about the unintended consequences of pushing this though. A lot of the funding for these two campuses comes from overseas. It is not costing the UK taxpayer money, but it is a pipeline, as my noble friend Lord Clement-Jones said. Having listened to the noble Lord, Lord Forbes, and spoken to my noble friend Lord Shipley, I know that they very strongly support the overseas campus that Newcastle University has in Malaysia. I hope that the Minister supports those two universities. There are no others in these circumstances.

[Earl Howe (Con)]

My Lords, the amendments in this group seek to change the definition of the priority group. We debated the principle behind the amendments tabled by the noble Baroness, Lady Gerada, and the noble Lord, Lord Darzi, in Committee. I shall come back to the amendment tabled by the noble Baroness, Lady Gerada, in a moment.

Meanwhile, the amendment tabled by the noble Baroness, Lady Lister, seeks to include a new group of people who should be prioritised for medical specialty training places. We have not, as she said, debated this precise issue before. She argued the case very powerfully. However, we need to come back to the object of the Bill, which is to resolve the specific problem of UK medical graduates having insufficient priority in accessing medical specialty training in UK workforce planning. Our prime focus should be on those young UK doctors who have put so much effort into their studies and who now want to progress further in the NHS.

I appreciate the force of everything that the noble Baroness, Lady Lister, said. I observed earlier that we are not living in an ideal world. However, for the reasons that I have given, I am not convinced that including an additional group—in this case, those who have come to the UK from Afghanistan, Ukraine, Syria or Hong Kong—will necessarily improve the Bill’s effectiveness in resolving the problem that it is designed to address. Those doctors are not, and surely cannot be, part of the NHS’s workforce planning framework.

That said, I think we can all agree that, where an individual comes to the UK through a safe and legal route as a legitimate refugee and has skills to offer our country, we should welcome them offering those skills. It would therefore be helpful to know from the Minister what support her department is giving and will give to medically trained people who have come to the UK legally and who wish to serve in the NHS.

I will say some brief but important things about the amendment from the noble Baroness, Lady Gerada, without, I hope, repeating what has been said. The merits of her case were ones which she powerfully presented in Committee, and she has done so again today.

I want to highlight three key points. First, QMUL’s campus on Malta and Newcastle University’s campus in Malaysia are not “foreign institutions”. Yes, they may be physically located abroad but, constitutionally, both are UK institutions and the qualifications they award are UK qualifications based on a UK-prescribed medical curriculum. Doctors have made career plans based on that long understanding. Therefore, badging graduates from those overseas campuses as international medical graduates, which is the implication behind the Government’s position, does them a grave injustice. In my submission, they are not international medical graduates in the sense that we normally understand the term—a point well made by the noble Baroness, Lady Finlay.