Medical Schools: Training Places

Lord Kamall Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Robathan]

To ask Her Majesty’s Government how many training places for new doctors there were in medical schools and other institutions in (1) 2000–01, and (2) 2021–22; and what plans they have, if any, to increase the number of places for 2022–23.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

In the 2000-01 academic year in England, there were 4,300 government-funded medical school places. Initial data shows that, in 2021-22, 8,460 places have been taken up, including additional places for students who completed A-levels in 2021 and had an offer from a university in England to study medicine subject to their grades. The Government continue to monitor the number of medical school places that they fund to ensure that it is in line with NHS workforce requirements.

[Lord Robathan (Con)]

My Lords, the Answer is quite encouraging, but doctors and other medical staff are working flat out on our behalf, and we are told that there are not enough doctors. That is because we are not training enough. Some 21 years ago, Gordon Brown confected a row over a girl called Laura Spence, who was well qualified but was not able to get into Oxford to read medicine because there were not enough training places. We have had all three major parties in government in those 21 years, and there are still not enough training places. Rather than taking doctors from the poorest countries in the world, where they are needed, and bringing them here, does not my noble friend think that it is time to make sure that we train enough doctors in this country and that there are enough training places for them so we can actually service our own needs?

[Lord Kamall (Con)]

I thank my noble friend for the question, but there are record numbers of medical students in training. There are currently more than 35,000 doctors in undergraduate training and 60,000 doctors in foundation and speciality postgraduate medical training. On the international market, we follow strict ethical guidelines, in line with the World Health Organization guidelines.

[Lord Watts (Lab)]

My Lords, is it not the case that the extra doctors that we were promised by 2016 will not be enough to compensate for the number of doctors who will retire? Can the Minister say something about what he is doing about the number of doctors who are going to retire shortly, which will cause even more of a shortage?

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[Lord Kamall (Con)]

The noble Lord raises an important question, but the fact is that we are training more doctors, and we are recruiting internationally where it is ethical to do so. On retirements, we are looking at a scheme that lasts until 2024 to allow doctors to come back without it affecting their pension.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare that I am a fellow of the Royal College of Physicians. Do the Government accept the report from that body, Double or Quits, which has shown that we need 15,000 medical school places annually? Doubling the number of medical school places to that number would cost £1.85 billion, which is only one-third of what hospitals currently spend on agency and bank staff. Therefore, an increase is an investment to save.

[Lord Kamall (Con)]

I thank the noble Baroness for that question and for the advice and expertise that she has passed on to me in my short time in this place. As part of the expansion, we have opened five new medical schools across England, in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. Sometimes we have the training, but it is difficult to find doctors in certain locations. We have tried to move training as close to those locations as possible.

[Lord Naseby (Con)]

My Lords, as well as increasing the numbers, is it not equally important that we ensure that every newly qualified doctor, on whom we spend well over £200,000, signs up for at least four years in the NHS, as do every male and female who joins our Armed Forces today?

[Lord Kamall (Con)]

I thank my noble friend for that suggestion. I will look into it and get back to him.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, will the Minister indicate what research has been carried out into the training opportunities for specialist doctors post-graduation who wish to pursue careers as consultant orthopaedic surgeons? At the moment, because of Covid investment resources, there are no training opportunities for them in Northern Ireland. Will the Minister raise this issue and indicate what efforts will be made to address it?

[Lord Kamall (Con)]

I thank the noble Baroness for sharing the experience of Northern Ireland. It is really important that we ensure that we have more training places and that we address the types of training that we do. As the noble Baroness will be aware, it is no longer a simple question of nurses and doctors: we are training a number of physicians’ assistants and specialists, and we will continue to do so.

[The Lord Bishop of St Albans]

My Lords, this latest Covid omicron variant has made us realise that we are one human race, and we are now facing a scandal whereby we are relying on bringing in doctors from some of the poorest parts of the world to look after our needs. For centuries, this country was renowned for sending doctors and nurses abroad and founding hospitals in all parts of the world. What consideration have Her Majesty’s Government given to ensuring not only that we are producing enough of our own doctors but that we are expanding our tertiary education and bringing in more people to send them back to help some of these countries as part of our global Britain initiative?

[Lord Kamall (Con)]

When training doctors from abroad, we follow international guidelines and World Health Organization ethical guidelines. For example, when I recently had a meeting with the Kenyan ministry to talk about the UK-Kenya health partnership, the point was made to me that they were training far more people than they had places for in their own country. They thought that their talent was a valuable export, while at the same time, remittances went back to their country.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. Does the Minister accept that long-term workforce planning requires an effective apparatus that is able to understand the changing population demographic, changes in the nature of the delivery of healthcare and how technology and innovation might impact that? Do Her Majesty’s Government have a view about establishing such an apparatus as part of the current Health and Care Bill before your Lordships’ House?

[Lord Kamall (Con)]

There has rightly been much discussion of workforce planning for the NHS and adult social care, and the Bill will build on this. Clause 35 will bring greater clarity and accountability in this area, requiring the Secretary of State and the NHS to produce a workforce plan.

[Baroness Merron (Lab)]

My Lords, with the intensification of the Covid booster programme, more doctors will, of course, be diverted from their usual roles, making it even harder for people to get an appointment at their local surgery, and record waiting lists will continue to increase. What revisions will the Minister make to existing plans for numbers of training places to meet the need for more trained staff, including doctors, nurses, lab technicians and auxiliaries? How will the Minister respond to the report from the Royal College of Surgeons that 13,000 planned operations have been cancelled in the last two months alone?

[Lord Kamall (Con)]

The focus and priority for the next three weeks is on omicron and making sure that people get their boosters as quickly as possible. It is not only doctors who are involved: nurses, pharmacists and, incredibly, a number of civil servants are now taking part in that programme. For the next three weeks, the focus is on getting more jabs into arms.

[Lord Sikka (Lab)]

My Lords, successive Governments have poached doctors from comparatively poor countries to meet the shortages here. As the Minister knows, it costs a vast amount of money to educate and train a doctor, so developing countries have been deprived of their talents. Will the Minister explain that, or give an undertaking that the Government will provide compensation to poorer countries for stealing their assets?

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[Lord Kamall (Con)]

The Government follow strict ethical guidelines on international recruitment, in line with WHO guidance, which says we should not be taking nurses and doctors from countries and depriving their health services. But where countries have a surplus—a number of developing countries around the world actually train more people than they have a use for in the local system—they see it as a valuable source of income.

[Lord Scriven (LD)]

My Lords, it is not just a question of the total number of doctors but the number in certain specialisms where there is already a dearth of professionals. What are the Government doing to ensure that, as more doctors come on, they are particularly geared to specialisms where there is already a dire dearth of doctors?

[Lord Kamall (Con)]

When it comes to workforce plans, particularly in local areas where there is understaffing, we are very much focused on specialisms that are understaffed.

[Lord Turnberg (Lab)]

My Lords, we are losing doctors more rapidly than we can train them, and it has been like that for a while. The average age at which a physician retires is now 58; it used to be 62. What are the Government doing to help doctors stay in post and to bring them back part-time after retirement to help the NHS?

[Lord Kamall (Con)]

As the noble Lord will be aware, there is a temporary measure to bring doctors back, without affecting their pensions, which lasts until 2024. We are looking into whether that should be continued, as well as increasing the number of training places.