Junior Doctors’ Foundation Programme

Jim Shannon Excerpts

Wednesday 22nd April 2026 Westminster Hall

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab) [R]]

I beg to move,

That this House has considered the Foundation Programme and its role in supporting and retaining resident doctors.

Thank you, Mrs Barker, for chairing today’s debate. First, I must thank everyone for coming and say something about my interests. As many know, I am an ear, nose and throat surgeon and I have a son who is a registrar in accident and emergency medicine. I am a fellow of the Royal College of Surgeons, I have an MD from the University of East Anglia, and my medical school was at Sheffield.

This debate is to consider the foundation programme and its role in retaining resident doctors. It is a privilege to introduce the debate, and I am grateful to all the colleagues who have come along this morning. As we all know, our resident doctors just spent six days on the picket lines; the wards were covered by others, operations were postponed and patients’ appointments were rescheduled. When the strikes ended, as they did just over a week ago, the problems did not go away. That is why I asked for the debate. If we are serious about resetting the relationship between this Government and the medical profession, as I believe we all are, we must begin somewhere, and in my view we should begin where every doctor begins: at the foundations.

[Jim Shannon (Strangford) (DUP)]

From this morning’s papers—perhaps the hon. Member will wish to refer to this—it seems that the Health Secretary had engaged with the British Medical Association and had an agreement with its leader. Does the hon. Member share my disappointment that even with that agreement, it went ahead with the strikes? When it had agreed a wage packet for doctors that could be anything from £50,000 as a starting wage to £100,000, it seemed that we had the recipe for an agreement, yet it was all thrown away by, it seems, the BMA.

[Peter Prinsley]

I heard the same thing; indeed, I met Dr Fletcher from the BMA yesterday myself and heard exactly this story, so the situation is intensely frustrating, but I believe that we can get ourselves back to a position in which an agreement can be reached.

My argument this morning is simple. The foundation programme, the first two years of a doctor’s working life, is, in its present form, not supporting and retaining doctors as it should. The problem is that the doctors are treated like numbers on a spreadsheet rather than the people they are, and some of our brightest young doctors, at precisely the moment when they need the most support, are considering leaving the NHS altogether.

Let me set out what the system does, why it is failing, what we have learned from recent attempts to reform it and what I believe we ought to do instead; but let me first refer to a Royal College of Physicians survey of resident doctors that was done in 2025, which has some interesting findings. Only 44% of the resident doctors stated that they were satisfied with their clinical training. Just 26% of the respondents felt ready to move on to the next step. About 20% of the doctors thought that the recruitment process was fair, which meant that 80% of them thought that it was unfair. About half of them want to work less than full time and, most alarmingly, only 65% of them said that they thought they would be working in the NHS in five years’ time.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

As always, it is a pleasure to serve under your chairship, Mrs Barker. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for setting the scene incredibly well. We all appreciate his in-depth portrayal of the issues. I thank him for his 40 years, as I understand, of service to the NHS. It probably does not seem that long but, on paper and statistically, it clearly is.

The hon. Member has forgotten more than I will ever know about the procedures, as I speak from a layman’s point of view. I can, however, outline what young doctors have told me, which certainly bears repeating. They work through their F1 and F2 years in fight-or-flight response. They work unsociable hours without a support network. They make life and death decisions, then return home from that night or day on duty and wonder whether they made the right decision. They wonder whether they missed something and they worry about their patients.

Doctors are empathic with their patients, they are compassionate and they understand the issues incredibly well. They follow shift patterns that on paper look like a different week but, in reality, they are working 80 hours over seven days. Off days on call keep them on tenterhooks waiting to know if they will be called in to do more work, which they will respond to out of duty and compassion. They are scheduled to finish work at 8 o’clock and on a regular basis they only leave at 9.30 pm. They start work before 8 am and take their first break at 2.45 pm, and that is not a one-off on a busy day—every day is a busy day. It is almost like “Groundhog Day”—that film where the alarm goes off at 6 am, he gets up, he does all the things, he goes back to bed and the next day starts the same—but for doctors, it is life and death.

When I asked how they function on that lack of sleep and sustenance, one 23-year-old doctor told me:

“I keep sweets in my pocket and pray for guidance.”

It needs to be more than that. I carry sweets in my pocket because, as a diabetic, if I feel myself going down, I have a chew on one and it brings me back up again, but for them, it is to ensure their concentration. Christians always pray for guidance in everything they do. They need wisdom in all the work that they do.

When I asked that 23-year-old doctor what was next for her in life, what she wanted to specialise in and what her hopes were for the future, she said:

“I am so exhausted that I don’t think anything is next.”

The exhaustion takes over. The workload is overwhelming. Put simply, she is burnt out and feels unsupported and uncertain—not because she is not a confident person, but because the workload and all that she has done have overtaken her. That is replicated numerous times, in too many doctors for us to attribute it to personality. It is not her personality, because she is a lovely young lady; it is the current procedure.

I am very pleased to see the Minister in his place. He has empathy and understanding of what we need for our doctors. I am confident that his reply will encourage and hearten us. Hopefully, it will also help with the expectations on young doctors from families and with the paperwork—that has never been more onerous, yet there is no time for them to set aside to do it because they are overwhelmed by the workload in wards and A&E and surgical work supporting doctors. If their placement is in a smaller hospital, they do not have the support of house doctors or consultants during evening shifts, and the pressure is immense. I said earlier that it is overwhelming, and it is, to the extent that they sometimes just say to themselves, “My goodness me, how am I going to keep going?”

We all understand that medicine, by its very nature, is highly pressured and that skills are learned not only in books, but in practice. For the junior doctors I met back home, it is a physical practice—they learn by what happens in the ward. Home-grown students are not being retained, however, so changes to the system must take place, and take place soon. In his introduction, the hon. Member for Bury St Edmunds and Stowmarket referred to one doctor who went from Norwich to Belfast and another who went from Belfast to Norwich. It is unreal, and it seems idiotic—I use that word in a very gentle way—that that should take place.

Training a doctor in the UK costs the taxpayer roughly £230,000 to £327,000 per student from medical school through foundation training. That is a big sum of money, but we are training someone on whom we depend to be the best in a critical situation in hospital. Who of us, when we have a chat with our doctor and ask for their opinion, will not accept what the doctor tells us as gospel? We trust that we can depend on that doctor’s diagnosis of the disease, so that money must result in qualified, capable doctors and not just young people who could have made a difference if they had been given the support and reasonable working hours with reasonable pay to make all the on-calls and missed sleeping patterns worth it.

[Alex Easton]

Another problem we have in Northern Ireland is that many doctors are moving over to private care, which is leading to shortfalls of NHS doctors. Is that something we need to tackle to retain doctors in the NHS?

[Jim Shannon]

It certainly is. To be fair, I do not know of any doctors who have made the journey, but I know that they are certainly aware of the bigger wage packets available in, for instance, Australia, Canada and New Zealand, where they can go for two or three years. The problem is that if they go away for two or three years, they may never come back. It is not just a matter of going to earn big money to pay off student fees and move forward—it is more than that. It is a critical issue, so the hon. Member is right to mention it.

I wonder whether the Minister would consider in his response the option of having student doctors sign a retainer that would keep them in the NHS, and consider providing a bursary for their fees. I understand that Wales does that; I know it is a regional matter for us in Northern Ireland, but if Wales can do it, there are certainly points for us to consider.

I have constituents who have gone to Wales from Northern Ireland for the purpose of going away for two or three years—I think of one young lady in particular whose family I know well. She went to Wales and completed her full studies there at university and in the hospitals. Then, of course, what happens? She meets a young Welsh guy and he sweeps her off her feet and the next thing we know, she is engaged, she is married—she is never coming home.

We will not have the advantage of that young lady’s expertise, but Wales will. I am very pleased that Wales will have that expertise, because she is an excellent student and person. I am sure there are many other people for whom the same thing has happened, because love is a funny thing, is it not? When it gets you, you cannot get off it. You are caught forever. From my point of view, my wife has stuck with me for 39 years—my goodness, she needs a medal.

I have spoken at length about intelligent, capable young people who feel overworked and underappreciated but who, most importantly, feel overwhelmed. That can change with support—support that must echo from here not with words, but with appropriate pay and staffing. If we do that, we will retain the best of the best within the NHS. I do not doubt that that is the desire of the Minister and this Government, and of every hon. Member here.

--- Later in debate ---

[Stephen Kinnock]

That gives me an opportunity to highlight the fact that this Government have delivered a 29% pay increase for resident doctors. Although I absolutely accept that, prior to July 2024, over 14 years of dealing with an incompetent Government, they suffered from being underpaid and neglected, and we had to seek to fix that—we have done that in good faith and with good will—there have to be limits to what we can offer. The sky is not the limit; the limit is the deeply damaged and parlous state of the public finances that were left to us when we took over in July 2024, and the significant pressures across every aspect of Government.

We implore the resident doctors and the BMA to come back to the table. The Secretary of State believed that he had a deal with the officers of the BMA, and those officers then took that deal to the broader committee. There is no doubt that that committee has ideological motivations, and it refused to accept the deal. We are now in a very challenging position. The Secretary of State has asked several times for a face-to-face meeting with the entire committee, and that request has been refused. We have to make progress, but I simply remind its members that most of our constituents would see a 29% pay increase as a pretty positive deal.

[Jim Shannon]

I thank the Minister for that comprehensive response to the hon. Member for Birmingham Perry Barr (Ayoub Khan). So near and yet so far—that is the way I see it. I have always supported the Secretary of State in his endeavours to secure a deal, and it is incredibly frustrating to get so close to one and for it then to fall down. I am probably reiterating what the Minister said, but although the deal fell and we did not secure what we all hoped for, does the Department intend to continue engaging with the BMA and the junior doctors to secure a deal? We have got so close that we must be able to get this over the line.

[Stephen Kinnock]

The short answer is yes, absolutely—our door is always open. We have to find a constructive way through this. I accept that it is not always just about pay; it is also about broader terms and conditions—exactly the things we have been debating today. That is why I was so excited by the fast-track legislation we brought forward specifically to address the bottlenecks and the impact of the disgraceful decision under the previous Government to remove the resident labour market test. We are seeking to fix all those problems, and we need a constructive partner on the other side of the table to do that. We are starting to see in opinion polls that public support for the action taken by the BMA and resident doctors is eroding quite seriously, and I hope they take that into account before they make their next decisions.