Medical Student Places

Lord Evans of Rainow Excerpts

Monday 22nd April 2024 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what progress has been made on plans to increase the number of medical student places in England.

[Lord Evans of Rainow (Con)]

My Lords, we are on track to meet the NHS Long Term Workforce Plan and aim to double the number of medical school places in England from 7,500 to 15,000 places a year by 2031-32. We have allocated 205 additional medical school places and provisionally allocated 350 more for the 2024-25 and 2025-26 academic years respectively. In 2020, the Government completed an expansion in the number of medical school places in England from 7,500 per year, a 25% increase.

[Baroness Merron (Lab)]

My Lords, may I start by saying on behalf of these Benches that we wish to express our deep condolences on the sad passing of Baroness Gardner of Parkes and our colleague Baroness Massey? May their memories be for a blessing.

Ministers recently advised the Office for Students that only 350 additional places for trainee doctors would be funded in 2025-26. On the basis that, at this rate, it will take over 21 years to meet the Government’s promise to double the number of medical training places, what assessment has been made of the effect this will have on medical schools, which had in fact been told to plan for considerably greater numbers? Where does this leave the Government’s promise to double medical places by 2031?

[Lord Evans of Rainow (Con)]

My Lords, I would like to follow the noble Baroness’s tribute to Baroness Gardner of Parkes and Baroness Massey. I also pay tribute to the late Doug Hoyle, an outstanding north-west MP and an outstanding public servant.

We remain committed to the long-term workforce plan’s target to double the number of medical school places by 2031 and are in fact ahead of schedule. The planned expansion is not uniform in each year; it increases substantially in later years. The timeline allows for new and existing medical schools to build the physical and teaching capacity needed, and to develop curricula and receive General Medical Council approvals where needed.

[Baroness McIntosh of Pickering (Con)]

My Lords, may I add my condolences to those who have spoken on the loss of Baroness Massey and, in particular, Baroness Gardner, who shared an office with us in this building? She will be greatly missed. Long may their memories live, and may they rest in peace.

I declare my interest with the Dispensing Doctors’ Association. While the increased number of places at medical schools is welcome, does this take account of the large number of people who are expected to retire in the next five to 10 years—especially GPs—and are currently only in their 50s?

[Lord Evans of Rainow (Con)]

I thank my noble friend for that question. She is right to point out that certain GPs in their 50s retire, but the Government are committed to increasing the number of GPs. As I indicated in my Answer, there is a substantial number of younger new GPs in the pipeline.

[Lord Allan of Hallam (LD)]

My Lords, I associate these Benches with the condolences to the families of the noble Baronesses, Lady Gardner and Lady Massey. The Government, in their response to a Guardian article that queried the student numbers, said that numbers will be increasing “exponentially until 2031”. Exponentially is an impressive adverb that is sometimes used to mean something that is fast and getting faster. It also has a more precise meaning, and there is a formula. Will the Minister share the formula being used between now and 2031, so that we can see how many places will be allocated each year?

[Lord Evans of Rainow (Con)]

I thank the noble Lord for that question. I do not have a formula in my briefing pack, but I will ask that question and refer the answer back to the noble Lord. I would also point out not to believe everything that you read in the Guardian.

[Lord Naseby (Con)]

Is my noble friend aware that, out of every three sixth formers who wish to become a doctor, only one will find a medical school place? Is that not a tragic loss, at a time when we are really short of doctors? At the other end of the spectrum, we also know that the number of doctors who work in the NHS once qualified is going down. Against that background, surely, we should have another look at our forecasts and the provision we make for more medical school places.

[Lord Evans of Rainow (Con)]

In my initial Answer, I pointed out that the Government are increasing the number of medical school places, but he raises an important point. If he has any specific cases of students not getting a place and lets me know about them, I will look into them.

[Lord Watts (Lab)]

My Lords, the Minister is not responsible for the crisis we are facing in the health service, but we have had 13 years of cuts in training for doctors. Does he not accept that it was a major mistake not to recruit more doctors and make available more places in universities to train the number of doctors we need?

[Lord Evans of Rainow (Con)]

The noble Lord raises an important point about the number of doctors, but I fear I am repeating myself. The Government have laid out in their long-term NHS workforce plan that we will have a significant increase in the number of doctors—from 7,500 each year, in five new medical schools. So that may have been the case in the past, but it will not be in the future through to 2030-31.

[Lord Patel (CB)]

My Lords, the training of doctors requires expansion of resources in pre-clinical years and particularly clinical years. It also requires expansion of foundation year one and the useless foundation year two, which are clinical years in which they train in hospitals and GP practices. What are the Government doing to finance both the clinical years and the foundations years?

[Lord Evans of Rainow (Con)]

One of the reasons why we cannot accelerate the training of doctors in GP practices, for example, is capacity. That is why the Government have funded five new training hospitals. The noble Lord is absolutely right, but it is about capacity and that is why we are ramping it up, and it will increase in time as outlined in my initial Answer.

[Baroness Kingsmill (Lab)]

We need to keep the doctors we already have, not just the ones we are training for the future. Does the Minister know how many doctors are leaving the country and going to places such as Australia?

[Lord Evans of Rainow (Con)]

Every year, approximately 4% of all doctors registered with the General Medical Council—roughly 300,000 doctors on the register—relinquish their licence to practise. The vast majority go on to work in the NHS after completing their foundation programme training. GMC analysis shows that 93% of doctors enter speciality or GP training and are working as a doctor in the UK within three years of completing the foundation programme. The noble Baroness refers to Australia specifically. It is my understanding that for a newly qualified doctor who has spent several years working hard to qualify, it is quite an attractive place to practise as a doctor, but they do come back to the United Kingdom.

[Lord Sandhurst (Con)]

My Lords, last year it was reported that 25% of doctors drop out after two years’ foundation training. After five years, the drop-out rate in total is 40%. So increasing the number of students is not the answer, or any part of it. Is not the crucial thing to ensure that young doctors are encouraged to remain in training? That may mean more care in selecting them in the first place, but it also means making it better for them while they are training.

--- Later in debate ---

[Lord Evans of Rainow (Con)]

Student drop-out is not unique to the medical sector. My noble friend is absolutely right: it is very important that, before students decide to take on a lengthy medical course, they decide whether it is right for them.

[Baroness Bloomfield of Hinton Waldrist (Con)]

My Lords, despite the myriad problems faced by the Betsi Cadwaladr health department in north-west Wales, perhaps my noble friend would join me in congratulating Bangor University on opening a new medical school. The first cohort of students will start in September this year.

[Lord Evans of Rainow (Con)]

My noble friend is an advocate for everything Wales. Of course, I will do exactly that: congratulations all round.

[Lord Grocott (Lab)]

My Lords, we have heard about trained medical staff going to work overseas. We are also very familiar, of course, with the other end of the discussion. Many trained medical staff come from overseas to work in our country, to the great benefit of the health service. Surely, the answer to both those challenges has to be for us to train and retain medical staff in this country, neither exporting them somewhere else nor being entirely dependent on imports from somewhere else.

[Lord Evans of Rainow (Con)]

I agree with the noble Lord. That is why the long-term workforce plan commits to improving retention by improving the culture and leadership to ensure that up to 130,000 fewer staff will leave the NHS over the next 15 years. But the noble Lord is absolutely right: doctors from overseas, trained in third-world countries and elsewhere, come to our country and, as the noble Baroness said earlier, also go to attractive places such as Australia. As I say, young people like to experiment with other countries but do come back. It is also a testament to the NHS that so many foreign-trained doctors decide to practise here.