Medical Training (Prioritisation) Bill

Lord Jackson of Peterborough Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I have tabled Amendment 2. The clerks suggested changing the wording to what is now there. It is a probing amendment, and like those of the noble Lord, Lord Patel, it could be applied to other clauses as well. It is about the principle. My strong view is that we have opened up medical schools and made more placements because we want to make sure that we have an ongoing workforce. I am delighted to see the noble Lord, Lord Darzi, in his place. He will have done work not only for Health Secretary Wes Streeting recently but previously in making sure that we have a strong workforce pipeline.

I am conscious that many medical schools, by way of survival, by way of diversity, have opened up a number of places. Admittedly, this is still quite small compared with the number of UK citizens going to medical school. However, as the noble Lord, Lord Patel, said, we have a curious definition in this legislation—that a UK medical graduate is simply somebody who went to a UK medical school. I do not think that is what the public would think that this is about. From a lot of the emails, I do not think that it is what a lot of doctors appreciate either—although I appreciate that it is the position of the BMA, which does not want to differentiate in that regard.

We have young people taking on debt by investing in their own education and several billion pounds being put in by the UK Government, by the UK taxpayer, to have this pipeline. Therefore, it is vital to have what my amendment seeks—a set prioritisation in this legislation and not, as the Minister said the other day, a “just one group and then no more” kind of prioritisation. It is vital that UK citizens are given priority.

It is important to look at some of the analysis. It is not the case that all training posts could be filled by UK citizens who have trained to be doctors—far from it. We would not have GPs coming through. According to the 2024 analysis, only about half of the GPs going on the ST1 or CT1 were from UK medical schools. There is a whole series of issues, and we are seeing this in different elements including psychiatry and paediatrics—very few UK medical students, it seems, want to do paediatrics. I could go on with the series, but the point is clear: this is not about excluding people from the rest of the world coming to work in this country or to fill key roles in the NHS; it is about ensuring that our investment is prioritised on UK citizens.

There is a certain peculiarity, which will come up in other groups, about what then happens with the Republic of Ireland and similar. I am not seeking to get into that debate; perhaps we will a bit later.

I want to get a sense of this from the Minister. One thing that is clear in the statistics, and which the Minister and the Department of Health should be seeking to understand more, is that for quite a wide range of the training courses UK students are turning down the opportunity, once they have been offered placements. Why is that? For general practice, I think that only 57% are accepting. I am conscious that people might get posted around the country, but that needs careful scrutiny as well.

I do not wish to suggest in any way that we are not welcoming people from different parts of the world, but it should go back to trying to make sure that we are addressing particular gaps in our NHS workforce, now and in the future, not squeezing people out, and recognising the work that has been done to increase the potential numbers in home-grown talent.

Those of us who spoke at Second Reading have, in the last week, had a lot of emails coming in. I completely understand that there are different stories. For a brief time, when I was Health Secretary, a by-line suggested that I thought everybody should disappear to Australia—far from it. We cannot stop people leaving this country to go to Australia or elsewhere in the world, but we should be making sure that the reason they are choosing to go elsewhere is not because they cannot get a training place here when they have been deemed appointable. Ideally, they would be offered a role. That is something we can fix with this legislation. I hope the Government will rethink their approach to this during the passage of the Bill.

I apologise to the Committee that I will not be here to deal with my amendment later on, but I know that the Front Bench will do so. The time is pressing to get this right. I had not realised quite how soon a variety of decisions need to be made: I believe they need to be made before, or certainly within a few days of, Easter. It is critical that the Government think again. I am sure that, with encouragement from the Committee and from very distinguished medical practitioners, current and past, they will do so. That is why I commend my amendment to the Committee.

[Lord Jackson of Peterborough (Con)]

My Lords, I am delighted to have the opportunity to support my noble friend in her excellent amendment. Broadly speaking, this is a very welcome Bill. I congratulate the Government on bringing it forward to address what is becoming an acute issue, but it could be better. My remarks fall into two separate parts: there is the philosophical issue and there are the practical, evidence-based matters, which I will elucidate in the course of my remarks.

First, it has to be said that British taxpayers fund medical education through universities and the NHS, and we should be thinking much more about the value for money that those taxpayers receive. Prioritising British citizens would ensure that the investment benefits the domestic healthcare system and would, I think, reduce the risk of brain drain, where trained doctors emigrate after completing training. Training costs are substantial—estimated at £200,000 to £500,000 per doctor—and British citizens would be more likely to remain and practise in the UK long term. There is a case that they perhaps provide better value for public investment in medical education.

The wider philosophical issue, as alluded to by the Nuffield Trust, is around the fact that, in recruiting international medical graduates, the NHS has a negative impact on the domestic healthcare sector and staffing shortages in many countries abroad, particularly in Africa and Asia and poorer countries generally. That point has been made over many years. There were issues too about cultural familiarity, language proficiency, better understanding of local healthcare practices and patient expectations, and easier integration into multidisciplinary medical teams.

Specialty training, competition ratios and bottlenecks have reached breaking point. Preliminary information for the 2025 specialty training application cycle is concerning. This year, there are over 33,000 applicants for just under 13,000 training posts. This means that up to 20,000 doctors will be left out of specialty training this August. Even if you are not directly affected, that is a public health and public policy issue.

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[Baroness Merron (Lab)]

We do not anticipate that that is going to cause a problem. The noble Lord did not specifically refer to the EFTA countries, but I should like to. Some of them will not produce any suitable people who are likely to be included, so in our modelling we do not anticipate that there will be a problem. What matters is patient care and getting people with the right training who understand what the NHS is about, understand the culture of the NHS and provide as best as they can. That is what the whole Bill is directed at doing and prioritising.

[Lord Jackson of Peterborough (Con)]

I accept that the Minister is not predisposed to accept the amendment from my noble friend Lady Coffey, and she has made a clear case for that, but is she in a position to reassure the House that the issues raised by my noble friend and others about the relative take-up of specialty training places in less popular disciplines, such as anaesthetics or paediatrics, will be looked at by the department? I did not get the opportunity to make this point, but one point was that prioritising British medical students—not excluding others—would have a positive impact on those particularly hard-to-fill disciplines. Is the department taking that into account generally in its workforce planning?

[Baroness Merron (Lab)]

Yes, we are.