Medical Training (Prioritisation) Bill

Karin Smyth Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to close on behalf of the Government. I welcome the support of the Opposition spokespeople and the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran). I put on record my thanks to them for meeting me in advance of the Bill and for airing their concerns.

From the many contributions this afternoon, there is clearly a broad base of sympathy and support right across the House for the measures in the Bill to support our NHS staff, who have been at the sharp end of every ill-conceived policy of the past 14 years—not least since the previous Government lifted the visa restrictions in 2020, as outlined by my hon. Friend the Member for Bournemouth West (Jessica Toale). The last Government’s failure to do any proper workforce planning has also led to patients struggling to find a GP appointment while GPs struggle to get a job, bottlenecks for resident doctors and an over-reliance on overseas workers and a refusal to foster our own home-grown talent.

Although I welcome the support, I find it slightly ironic that some of the Opposition speeches were around the need for clear and consistent routes and for clarity. That is exactly what we intend to provide to fix the mess. We will bring forward wider issues in the workforce plan, which, as the boss said earlier, will be in the spring. That is as a result of the concerns around training from the Royal Colleges and other stakeholders and making sure that we do that properly. We will bring that forward in due course.

[Helen Maguire (Epsom and Ewell) (LD)]

rose—

[Karin Smyth]

I am going to make some progress. Time is of the essence, I am afraid, but we can pick up more in Committee.

When I was a manager in the NHS, I worked alongside many overseas doctors, and I want to make it clear from this Dispatch Box this afternoon that they are, of course, welcome here. The NHS is and always will be one of the most diverse employers in the world. This Bill is about bringing future generations into the health service and giving them the secure future that we all know they need. It is about sustainable workforce planning so that patients are no longer at the mercy of the market. Crucially, it is also about fairness. How is it fair that every year the taxpayer picks up a £4 billion bill to train medics who cannot then get jobs? Those taxpayers deserve a return on their investment. How is it fair that medics in this country put themselves forward to train, make sacrifices, get into debt and work long hours only to find themselves trapped in bottlenecks?

I am going to try to address a number of colleagues’ points. I commend my hon. Friend the Member for Sunderland Central (Lewis Atkinson), for his experience and for outlining the capacity and demand issues that people like him have to face as managers, and also for his important point about our workforce needing to reflect our society. He talked about the great work being done in Sunderland, and I was pleased to meet the leaders there, including Dr Wilkes, to see the work they are doing so that we can take that elsewhere. That is exactly what we want to do.

I also commend my hon. Friend the Member for Carlisle (Ms Minns)—the mum of a nurse, as she told us—for putting on the record the work of the Pears Cumbria School of Medicine and the intention of growing doctors who are steeped in Cumbria. She also mentioned health inequalities, and I would be pleased to meet my hon. Friend to discuss those issues further. My hon. Friend the Member for Thurrock (Jen Craft) was right to highlight the soaring numbers of people we are losing and to recognise that it was all going back to front.

Why do we need emergency legislation? We need Royal Assent by 5 March at the latest to ensure that the change happens this year. We do not want medics to face another year of bottlenecks. Specialty training offers will be made from March, and any delay will risk vacancies in August. This emergency legislation gives the NHS the certainty and stability it needs to carry on bringing down waiting lists and to keep us on the road to recovery. The people applying for those posts need enough time to make decisions about their lives, including deciding where they will move, finding accommodation and sorting childcare, and they deserve enough time to get on with that.

A number of colleagues have raised the definition of prioritisation for training posts. Let us be clear that, for specialty training posts starting this year, we will prioritise UK medical graduates and others, using their immigration status as a proxy for having significant experience of working in the health service. Colleagues might wonder whether there has been some pulling of strings to include Irish doctors in that prioritisation, but I can assure them that that is not the case. Ireland is included because of our special and long-standing relationship with Ireland and very similar epidemiology. I thank the hon. Member for South Antrim (Robin Swann) for the important points he raised about Magee College and working with the devolved institutions. I can assure him that officials have worked closely with officials in Northern Ireland on this. If there are any other issues, he should please raise them, but we have worked closely on that point.

From next year, 2027, immigration status will no longer automatically determine priority. I accept some of the points from my hon. Friend the Member for Poole (Neil Duncan-Jordan) . He perhaps suggested that the proposal was crude, but it is a proxy for this year. Next year we will bring forward regulations to prioritise whether someone has significant experience as a doctor in the health service or by reference to their immigration status. This point was raised by the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon, and many others. We will continue to work with all partners and the devolved Governments to agree those criteria in time for the autumn application round.

On international staff, my hon. Friends the Members for Birmingham Edgbaston (Preet Kaur Gill) and for Uxbridge and South Ruislip (Danny Beales), the Chair of the Select Committee and others raised the issue of foreign doctors. Let us be clear that international staff play an important role in our NHS and they always will. The NHS might be the most diverse public body in the world, and we would not have it any other way, but we are recruiting doctors from abroad—sometimes even from countries that are short of medical staff—when there is already a pool of applicants at home.

As my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge) said, we are not about nicking other people’s workforces. Home-grown doctors are more likely to work in the NHS for longer, and be better equipped to deliver healthcare tailored to the UK’s population, because having been trained in the UK’s epidemiology, they better understand it. It is not fair for British taxpayers to spend over £4 billion training medics every year, as my hon. Friends the Members for Worthing West (Dr Cooper) and for Cannock Chase (Josh Newbury) said. Nor is it fair for doctors who struggled to get into specialty training places. As my hon. Friend the Member for Birmingham Edgbaston said, a responsible Government get a grip on this.

I will refer to the amendments when we move into Committee of the whole House. We are seeing the green shoots of recovery as we repair the NHS following the damage done over the past 14 years. We are turning another page on that decline. However, the decision in 2020 to lift visa restrictions has done untold damage to the system and to staff morale, and contributed to a national mood of cynicism and pessimism, especially among the young, so we need to act. Those points were articulated well by the hon. Member for Weald of Kent (Katie Lam), and expertly, as always, by my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley).

Let me end my remarks by talking about the many young people who will be affected by the changes that we are setting out. As my hon. Friend the Member for Ipswich (Jack Abbott) said, these are not abstract statistics but personal costs. When I speak to those in my family, my constituency and even my parliamentary office who have breached the first barrier of getting to a medical school from a state school, I am disheartened to hear how many of them feel that their careers would be better served by moving abroad. In the 1970s, James Callaghan said that if he were a young man, he would emigrate. I do not want young people to take that path; I would rather say to them, “By all means, travel, see the world and enjoy that time, but there are great opportunities for you all in this country, and we want you to rebuild the NHS with us.” My niece is currently in Australia, and we sometimes call this the “bring Talia home Bill”.

The NHS must play its part in training our young people and keeping top talent in the UK. If colleagues agree that that is worth doing, and if they want to keep our people here, they should join us in voting for the Bill.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Committee of the whole House (Order, this day).

Medical Training (Prioritisation) Bill

Karin Smyth Excerpts

Committee of the whole House
Tuesday 27th January 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

In the interests of time, I will address the amendments at the end of proceedings, when I have heard from them—I think we have the gist of most of those issues. I restate our firm commitment to the Bill and all clauses.

Let me turn to clause 4 and clarify how we are defining “UK medical graduate” and “the priority group” for the purposes of the Bill. “UK medical graduate” in this context excludes those who have spent all or the majority of their time training for their medical qualification outside the British isles. This means that if a person has obtained a primary UK qualification but has studied mainly overseas, they will not be eligible for prioritisation as a UK medical graduate unless they fall into another group that is to be prioritised under the Bill. While internationally educated graduates from overseas remain an important part of the workforce and can continue to be recruited under the Bill, we are committed to growing home-grown talent, who are more likely to work in the NHS for longer, and to be better equipped to deliver healthcare tailored to the UK’s population.

Clause 8 sets out the territorial extent of the Bill and deals with commencement. The Bill extends to England, Wales, Scotland and Northern Ireland, and we have worked closely with the devolved Governments to ensure that it meets all needs and provides consistency. We are grateful to them for their support in bringing these measures forward so quickly. The Bill will engage the legislative consent motion process, and the devolved Governments have committed to commence this process in their Parliaments.

To ensure that the systems, planning and operational capacity required for successful implementation are in place, the Bill will be commenced

“on such day or days as the Secretary of State may by regulations appoint.”

As the Secretary of State outlined on Second Reading, this is an important fail-safe to ensure that we are not in a position in which a law is enacted that we cannot implement effectively at the time. I am happy to expand on that after we have discussed the amendments, but the key issue is the ability of the NHS and training providers to deliver the measure. That is why we have a fail-safe; we first need to be very clear that the NHS is in a position to deliver. Members have talked about the strikes. Those would be one consideration, and there are many others. We are asking the NHS and training providers to do something very difficult very quickly, and in order to ensure that they have the capacity and capability to do it safely, we are reserving the right to commence the Bill at a later date, rather than at the end of this Session. I will come back to the amendments when I close the debate.

[The First Deputy Chairman of Ways and Means (Judith Cummins)]

I call the shadow Minister.

--- Later in debate ---

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

As always, Mrs Cummins, it is a pleasure to serve under your chairmanship. I rise to speak to new clause 2, which stands in my name and is supported by many other Conservative Members. I declare again that I am now a non-practising doctor and my wife is a doctor.

I believe that ambition should be encouraged, and success should be dependent on the talent and hard work of the individual. However, in a vocation where we really want to encourage and support the brightest and the best, the signal being beamed out by the NHS and its various arms and quangos is unfortunately quite different. We have already seen this over the years in how the NHS treats competence and excellence among doctors—someone could be the best doctor in the world and be treated exactly the same as someone who is just about competent. No other operation would approach employment, and celebrating and supporting success, in that way.

I do not think, though, that I have ever seen as egregious and extreme an example of completely ignoring talent and merit as the preference informed allocation system. The shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), has laid out some of the details behind that system, but I encourage Members across the Committee to read about how preference informed allocation works—about the soulless, computerised, algorithmic method by which it allocates human beings a random number. That random number is then the sum total of those people’s dreams, hopes and ambitions when it comes to placements as they take their first steps into their medical career. To me, PIA looks better suited to the dystopian sci-fi programmes that I enjoy watching—better suited to “Logan’s Run” or “The Prisoner”, in which people are allocated numbers. It is not the way that we should be treating people in this country, and it is outrageous that such a system has been brought into force. We in this House should stand up for merit, and I really hope the Minister will affirm from the Dispatch Box today that the Government will dismantle this awful scheme.

[Karin Smyth]

I am grateful to Members for their contributions to the wider debate at this hour and for their considered amendments. I will respond briefly to their points and the amendments that have been tabled.

Amendment 6 and 7 would widen the scope of who is prioritised for specialty training starting in 2026 by prioritising applicants who worked as a doctor in the health service on 13 January. Although we welcome the intention to recognise the importance of internationally trained doctors, we cannot accept the amendments at this time. They would mean that the Bill was ineffective in delivering on its intention to tackle bottlenecks and ensure that we have a sustainable medical workforce that can meet the needs of the population.

I remind the Committee again that the Bill does not exclude anyone. In particular, there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, which historically attract fewer applicants from the groups we are prioritising for 2026. International medical graduates also continue to have opportunities in locally employed doctor roles. That could lead to NHS experience that might count towards future prioritisation as we look to make regulations to set criteria for what is considered “significant” NHS experience from 2027.

Amendment 10 would ensure that members of the armed forces are not excluded from prioritisation due to having undertaken medical training while on posting outside the British islands. We cannot accept that amendment as we believe it is not necessary. That is because medical cadets do not spend time outside the British islands as part of their UK medical degree. While cadets undertake their elective with the military, which may be overseas, that is no different from other civilian medical students, many of whom undertake electives overseas. As such, we do not believe that medical cadets are disadvantaged by the Bill.

Amendment 9 would include all British citizens within the priority groups so that British citizens will be prioritised for the purposes of the foundation programme and specialty training from 2027 onwards. It has no effect for 2026 specialty training, as British citizens are already prioritised by virtue of their immigration status. We therefore cannot accept the amendment. To do so would risk a significant increase in the pool of prioritised doctors who would compete with UK-trained doctors. The amendment would incentivise the expansion of the market for overseas medical schools, including medical schools working with foreign Governments to grow the overseas campus sector. That could offset any increase in postgraduate training places and undermine workforce planning. While British citizens will be prioritised for specialty training places in 2026, this is a proxy that is necessary for practical reasons. From 2027 we want to prioritise applications with experience and training based in the NHS.

Again, prioritisation does not mean exclusion. International medical graduates who are not prioritised will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers. However, it is important that we do not incentivise actions that will undermine the Bill. This Bill will reduce competition for places for UK-trained doctors so that home-grown talent can become the next generation of NHS doctors.

Amendment 8 would limit the definition of a UK foundation programme in clause 5 to include programmes only where the majority of training has occurred within the UK. Although I understand the desire to do that, the number of doctors on a foundation programme within the meaning of the Medical Act 1983, but where the majority of training occurs outside the UK, is very small. Indeed, we understand that there is only one such active training programme. There are fewer than 25 doctors on that programme this year, of which fewer than five applied to continue their training in the UK. As such, there is no material impact on the Bill, so we do not think amendment 8 is necessary. However, we will keep the situation under review.

Amendments 2, 3, 4 and 5 would change the procedure for making regulations to set additional priority groups for specialty training from 2027. The regulations would prioritise additional groups based on criteria indicating that a person is likely to have significant experience of working as a doctor in the health service or by reference to their immigration status. To be clear on our intention, the Bill sets out the groups of people who are to be prioritised for specialty training from 2027 onwards. The delegated power is limited to adding to that list by reference to their having

“significant experience of working as a doctor in the National Health Service”,

or immigration status. Although I am sympathetic to the desire for more parliamentary scrutiny, as outlined by the hon. Member for North Shropshire (Helen Morgan), we believe that, due to the limited scope of the power, the negative procedure is justifiable. I therefore encourage her not to press those amendments to a Division.

Amendment 1 would change the commencement of the Bill—from being commenced by regulations to being commenced automatically on Royal Assent. As my right hon. Friend the Secretary of State outlined, the commencement clause is important, and I have addressed that point. It is a failsafe that, given the tight timeline for introducing the Bill, will ensure that we are not in a position where a law is enacted that we cannot implement effectively for whatever unforeseen reason.

As I have said, there is also the question of whether it is even possible to implement prioritisation if, for example, the strikes are ongoing, given the strain that they put on resources and the impact that could have on delivery of the Bill. Because our objective is not just to move quickly but to get this right, these considerations are key to the commencement of the Bill, which is why the Government believe that we need to be able to commence the Bill when it makes sense to do so. For those reasons, we cannot accept the amendment.

We do not think that new clauses 1 and 3 are necessary, because the data is already published, or, as we have said, we would be seeking to monitor the impact. New clause 2 would require the allocation of individual candidates to foundation and specialty training places on merit, once the requirements to prioritise certain applicants had been met. We consider the new clause to be unnecessary at this time because existing systems for recruitment to foundation and specialty training already assess the applicants on many of the merits outlined by in it. The Bill does not alter that; it simply ensures that UK medical graduates and other eligible applicants are prioritised.

[Dr Spencer]

Will the Minister give way?

[Karin Smyth]

I am coming to the hon. Gentleman’s point. We will keep the current system under review—I think the Secretary of State was clear about that—but we think that any change is best made through established guidance rather than through legislation.

Many Members raised the issue of our relationship with Malta and Queen Mary, and the work that is done there. That relationship is clearly important. We have a great deal of work ongoing with Queen Mary, in the medical field as well as others. We are not excluding anyone. We are making sure that the prioritisation works in the best way possible, and we will of course keep all that under review. I thank hon. Members for their constructive debate on this important legislation.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clauses 2 and 3 ordered to stand part of the Bill.

Clause 4

“UK medical graduate” and “the priority group”

Amendment proposed: 9, page 3, line 3, after “are” insert

“a British citizen or are”.—(Stuart Andrew.)

This amendment would require British citizens to be prioritised for places on UK Foundation programmes and for interviews and places on speciality training programmes from 2027 onwards.

Question put, That the amendment be made.

--- Later in debate ---

[Karin Smyth]

I beg to move, That the Bill be now read a Third time.

I will not use this time to rehearse any of the arguments made today. We have had some good discussions. I want to thank the Leader of the House, the Chief Whip, parliamentary counsel and business managers, the public servants in my Department and NHS England, who have worked so hard to bring this together, and the devolved Governments for their support. They really have worked well together to bring this important measure to this place.

I am also grateful to all colleagues for scrutinising the Bill so thoughtfully and thoroughly during today’s proceedings and, as I said previously, for meeting me last week to go through some of the provisions. It shows that Parliament can put its shoulder to the wheel and get stuff done in the public interest. We act in the public interest because we were elected on a mandate to fix our broken NHS and make it fit for the future, and we will not succeed in that goal without our workforce, who are and will always be our greatest asset.

When I worked in the NHS during the Lansley reforms, I had a front-row seat to see their devastating impact on staff morale. I saw that patients bore the brunt of some of that collapsing morale. When our workforce does well, our NHS does well. That is why we are working to restore confidence and renew belief among frontline staff. The Bill is another step on that journey, and I urge colleagues to come with us and see it through.

Question put and agreed to.

Bill accordingly read the Third time and passed.