Junior Doctors’ Foundation Programme

Peter Prinsley 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.

[Alex Easton (North Down) (Ind)]

I thank the hon. Member for securing this debate. Given that the foundation programme is typically the first full-time frontline post for doctors and often coincides with the period when they are most vulnerable to stress and burnout, does he agree that the Government should be doing more to address their workload?

[Peter Prinsley]

Certainly we must address the workload but, as I will reveal later in my speech, there are many things that we can do to help the situation.

Let me say a bit about my own experience, which admittedly was a long time ago—

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

No!

[Peter Prinsley]

I know—it is hard to believe. I was a medical student in Sheffield, and my first jobs were at the Royal Hallamshire hospital and the Northern General hospital. I have fond memories of the time that we started there. There was, for instance, a doctors’ mess with hot food. There was somewhere for us to live; we had residences. It is ironic that the name “junior doctors” was changed—just last year, I think—to “resident doctors”, because that is the very last thing they are. The residences have all disappeared—they have been sold off—and the doctors work shift systems, sometimes with absolutely nowhere to rest.

We had six-month rather than four-month rotations, which meant that we got to know the teams we worked with. We worked with named consultants. We had a distinct pyramidal team, with senior registrars, registrars and senior house officers, and we knew the people we were working with. They were people we had known as medical students; they were often the people who had taught us. That meant that there was a sort of support network for young doctors as they started in their careers. On the whole, the newly qualified doctors of today do not experience anything quite like that.

[Jamie Stone]

It is great to hear a qualified doctor talking about this matter. Health is devolved in Scotland—I must put that on the record—but in my constituency one finds that an awful lot of social care workers are calling it a day and walking away, with all sorts of unfortunate ramifications such as delayed discharge. Crucially, the support for doctors that the hon. Gentleman is talking about is not there or has been reduced. Does he agree that, if we boosted social care workers’ pay and conditions and retained them, that would help doctors?

[Peter Prinsley]

I absolutely agree that doctors are only part of a much bigger healthcare system. We certainly need to look after all the people involved in health and social care. Of course, that is more of a problem in geographically remote districts such as the hon. Gentleman’s constituency, where I believe it is difficult to recruit professions of all sorts.

I do not want only to sound nostalgic this morning, although of course I am. I am not arguing that absolutely everything was better in my time, because it certainly was not, but in one important respect it was better: it was designed around human beings. It understood that newly qualified doctors are individuals, not one of a herd to be simply moved across a map by a computer. It also recognised that pastoral support and clinical teams matter, and that the transition from medical student to doctor is a particularly vulnerable moment in a medical career. Let us come back to that point soon.

Today, we have a thing called the foundation programme. In 2024, the foundation programme office replaced the application process with something called preference informed allocation. What happens is that medical students list the foundation schools in order of preference, and are each assigned a computer-generated rank. The rank is not informed by academic achievement, personal circumstance, where the student trained or what they did; it simply works through the ranks and places the student accordingly.

The UK foundation programme’s 2026 figures show that of the 10,810 graduates allocated this year, 82% received their first preference. Superficially, that sounds quite reassuring, but I do not really think it is. Every year, a minority of graduates—this year it is roughly 1,900 young doctors—end up somewhere other than their first choice. The minority who do not get their first preference find themselves, aged 22 or 23, packing up their lives for a city where they know nobody. As I put it in the Chamber last month, it is a

“crazy foundation lottery that sends a doctor from Norwich to Belfast and a doctor from Belfast to Norwich.”—[Official Report, 26 March 2026; Vol. 783, c. 452.]

That is what we mean when we talk about a lottery. It is not a figure of speech, but a literal description of how the system works.

There is another reason why this headline figure flatters to deceive: the system incentivises what we call strategic preferencing. The students know the ranking system is random and that a high rank does not protect them tomorrow, so they game it. They preference the foundation schools they think they can realistically get, rather than the ones they actually want. A high first preference rate is, in part, a measure of the student lowering their ambition to protect themselves against a coin toss. That is not a system working; that is a system being worked around.

Let me say a bit about couples. Medical students often form a couple with other medical students or other people who work in hospitals, because that is the nature of a hospital. The foundation programme offers something called linked applications, but the unfairness is particularly acute. Two medical students in a relationship can choose to link their applications so that they are allocated together, but the pair is placed using the lower of the two ranks, so that if one of them is lucky in the ballot and the other is not, both are placed in the worst ranked situation. Should the algorithm be unable to accommodate both in a single school, the link is broken. A student cannot unlink once they have applied, and there is no appeal. The system quite simply cannot see that these are two people trying to begin their careers side by side. It just sees two records on a database.

That has knock-on consequences throughout the rest of the service. When foundation doctors are disorientated, unsupported and demoralised, their work does not disappear; it flows upwards to the more senior doctors, who take more and more of it on themselves. Young doctors should not be deployed by ballot into strange cities, with only limited account taken of their circumstances—their partners, their dependants, their health or their need to be near home. The claim that the current system is somehow fairer than the one it replaced is, I am afraid, one we cannot accept.

Let me talk about how we got here and the recent reform. The old system was not perfect. For many years, medical students competed on a combination of academic decile and a national examination known as the situation judgment test. The SJT was quite unpopular: it was stressful, it had unpredictable validity and there was a documented score gap that consistently disadvantaged candidates from ethnic minority backgrounds. That was a real and serious unfairness, and those who reformed the system were right to try to address it. When the students lobbied against the SJT, they had a good reason to do so, but they did not ask for a random number generator—yet that is essentially what they got.

In 2024 the SJT was abolished and academic achievement stripped out. In their place came PIA, underpinned by a computer ranking. It is hard to think of a clearer case of throwing the baby out with the bathwater. Students asked for fairness, and they were given randomness. Those are not the same thing. Fairness takes account of circumstance; randomness ignores it. Fairness rewards merit and responds to need; randomness does neither. What we have is not a reformed system, but an experiment that has gone wrong.

That is not just my view. The medical training review led by Professor Stephen Powis and Professor Chris Whitty, published last October, drew on more than 8,000 responses, 6,000 of them from resident doctors. Its very first recommendation was that

“a reform of postgraduate medical education and training is undertaken as a matter of urgency.”

It also recommended that recruitment to medical training be reviewed so that it is

“fair and equitable to all candidates”.

It is not sufficient, on any reading of the report, for allocation merely to be random. Random is not fair.

The BMA has taken a big interest in this question, which is not surprising, and I will read out some of its recommendations:

“The BMA is calling for: meaningful improvements to working lives with greater access to support services, supervision, rest and mess facilities; increased flexibility in rotations, including the option to swap placements; a guarantee that all UK graduates will be offered a foundation post, with full details provided at least 12 weeks before the start date; and any review of the allocation system to include proposals for a new recruitment process developed with meaningful consultation with students.”

There is another group of doctors that we should consider: those who will progress to become academic doctors. There is a crisis in this country of clinical academics, the doctors who teach the next generation of doctors. It has become very difficult to recruit into clinical academia. The career pathway for clinical academics has become very uncertain, and we have an emerging crisis—a real and present crisis—that must be addressed. One way to do that is to think about how we recruit foundation doctors into academic programmes.

Here is a straightforward proposal, which I hope colleagues will improve rather than simply accept. Let us return to a firm-based model for the first year of training. The F1 placement should be arranged by the medical schools, not by a centralised national algorithm, with each new doctor placed alongside peers they already know with consultants who have taught them. That is the system we had so many years ago. Medical schools know their students; they know who has the caring responsibilities, who has a linked partner, who has health needs, who has a strong reason to stay close to home. They are in the best possible position to start designing a year that makes sense for each individual.

That does not preclude movement later. F2 can broaden horizons, and specialty training will often mean relocation, but in the critical first year, when doctors are doing their first on-calls up at night by themselves, writing their first prescriptions and being present at their first deaths, they should not be alone in a city where they do not know anybody. They should be doing that with the support of their friends, teachers and colleagues they already trust. I do not think that would be particularly expensive; it might even cost less than the centralised allocation machinery we run today. Whatever we do, I offer one principle: medicine is the most distinctly human of professions and it is futile, and somewhat ironic, to try to reform it with an algorithm. The reform must be human.

Let me close where I began. Resident doctors have just come off picket lines. I do not think that in this debate we can rehearse the pay dispute, which is a matter for another day, but the strikes are not just about pay. At root, they are about a sense that the profession has been treated as though it does not matter. The individual doctor has become invisible behind the workforce spreadsheet. The Government have taken one very important step, with the Medical Training (Prioritisation) Act 2026 giving UK graduates the rightful priority for specialist training places—and that matters. Today’s debate is an opportunity to take the next step to fix the starting point itself.

We have in medicine one of the most extraordinary workforces in the world. Young doctors are among the best trained, most dedicated and most compassionate professionals. We owe them and, more importantly, the patients who depend on them, better than a lottery. We owe them the fair, well-supported, human start they deserve. I believe that would go a long way to resetting the Government’s relationship with the profession, and towards ending these damaging rolling strikes.

--- Later in debate ---

[Peter Prinsley]

Some time ago, when I came here, I had working with me an intern, Dr Harry Dunn, who was a medical student at Cambridge University. He graduated last year. He came top, not only of the University of Cambridge medical student cohort, but of the whole of the University of Cambridge, so he was the top student of his year. He was offered a foundation post in Northern Ireland. He chose not to take it, and has now gone into consulting, having given up medicine. That is an extremely sad example of an unintended consequence of this crazy lottery.

[Dr Johnson]

I congratulate that person on his prowess in university. He is clearly an incredible person, and it is a shame that he has been lost to medicine. I am sure Northern Ireland is a great place to work, and it is disappointing that he did not want to go there, but he should have been able to apply for the jobs that he wanted in places where he wanted to work, and to compete fairly for them. That is a bit stressful and competitive—but getting into medical school is competitive.

You may not know this, Mrs Barker, but the hon. Member for Bury St Edmunds and Stowmarket and I grew up on the same street, in the same town, and went into similar-ish careers. We competed for medical school places and for our jobs. We are all here today having competed against others for election—that is the reality of life. To remove the competition, which is based on meritocracy, and replace it with a random allocation is more unfair and stressful than the alternative.

One of the issues raised about the old scheme was that it was difficult to recruit in some areas. The competition for the best jobs, or at least those perceived to be the best or most wanted jobs, means that some areas of the country and some specialties could find themselves with the people who did not succeed in getting the jobs they wanted. How do we manage that? It used to be managed with rotations. When people went to the interview for specialist jobs, they would be called in one at a time and told, “These are the rotations available. Which one do you want?” The best jobs—the most popular ones—would be mixed with the least popular, so that would mitigate the problem.

There is one issue that I want to raise briefly. Some medical schools in the UK, including Newcastle, have overseas campuses in Malta, Cyprus and Malaysia. Some British people have gone to those branches of UK medical schools and have found themselves completely excluded from places in the United Kingdom under the medical training changes that the Government have made in the past couple of months, which seems wrong. We talked about that when the Bill went through, and the Minister was keen to reassure us that all would be well, but we have found that British students have not been able to get jobs in the British training programme. Will the Minister look at prioritising at least those who went to medical school before the changes for British jobs?

The current system gives junior doctors—resident doctors, as they are called now—no agency, no control, no appeal and no alternative. It is clearly unfair. Could the Minister update the House on how he intends to fix the system?

--- Later in debate ---

[Peter Prinsley]

I thank all hon. Members who came to speak in the debate. I particularly thank the hon. Members for Strangford (Jim Shannon) and for Birmingham Perry Barr (Ayoub Khan), who gave very interesting Back-Bench contributions. I also thank the Minister and the Opposition spokespeople—the hon. Members for Sleaford and North Hykeham (Dr Johnson) and for Winchester (Dr Chambers)—for their contributions. It is quite true that the shadow Minister and I grew up on the same street—probably about 10 houses apart, but many more than 10 years apart.

This has been an interesting debate, whose purpose was to highlight the plight of foundation doctors. As we have said, if we can fix the foundations, we will be able to fix the problems we have with our young doctors. I definitely think that this industrial dispute, which has been rolling and rumbling on for several years, is solvable. It sounds as though we were close to solving it and particularly to attending to the conditions of young doctors.

[Paula Barker (in the Chair)]

Order. I remind the hon. Member that this is not a chance for a second speech; it is just a winding-up speech.

[Peter Prinsley]

I will wind up, then. I thank everyone very much, and I look forward to seeing success in the future.

Question put and agreed to.

Resolved,

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

Oral Answers to Questions

Peter Prinsley Excerpts

Tuesday 14th April 2026 Commons Chamber

[Stephen Kinnock]

We will publish those data and statistics in August, in the usual way, but I can tell the hon. Lady that we have created a safety net for urgent dental care. Following the reforms that kicked in on 1 April this year, there is now a requirement for all NHS dentists to deliver 8.2% of their contract in urgent care. We absolutely recognise that more needs to be done in cases such as that of her constituent, and that is what we are focused on with fundamental dentistry contract reform.

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

May I congratulate the ministerial team, the University of East Anglia and the Office for Students on finally getting the new dental school at the university over the line? It will admit 25 students from September next year and will go some way to dealing with the dental deserts that we inherited in Norfolk and Suffolk. In the meantime, what progress has been made with the General Dental Council to increase exam capacity for dentists coming from overseas to help with the present crisis?

Ehlers-Danlos Syndrome and Craniocervical Instability

Peter Prinsley Excerpts

Thursday 26th March 2026 Westminster Hall

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

It is a pleasure to serve under your chairship, Ms Furniss. I was not going to talk in this debate until last week, when a lady came to my surgery at Bury St Edmunds. I used to hold surgeries all the time for patients with ear, nose and throat disorders; now I hold surgeries for constituents who come with political difficulties. This young lady was in a wheelchair, and told me she had Ehlers-Danlos syndrome and that she had been to Germany to get a diagnosis, after many years of failing to get one in this country.

Ehlers-Danlos syndrome is a disorder of the protein that is involved in the making of the connective tissue—which is the tissue that joins us all together—particularly the elastic bits. When I was a medical student there were four types of Ehlers-Danlos syndrome, and it was quite a favourite topic for examine questions. But now I see from the Ehlers-Danlos Society that there are 13 recognised types of the syndrome. We always thought of it as the double-jointed disease, and one would loosely test it by seeing whether someone could take their thumb and put it against the side of their arm—I increasingly cannot even get mine to a right-angle now.

It is a rare disorder. To give hon. Members a flavour of the different sorts of Ehlers-Danlos syndrome, there is a hypermobile Ehlers-Danlos, which is the double-jointed person. That is about one in 5,000 people. The classical Ehlers-Danlos, which is where people get this very stretchy skin that kind of falls away, is about one in 20,000 people. The really frightening Ehlers-Danlos syndrome is the one that affects the lining of the blood vessels. The blood vessels have an elastic lining, and if the elastic lining fails, they begin to expand, causing aneurysms. The most frightening aneurysms are those of the main aorta, which in some patients can rupture, leading to sudden death. They can occur all over the body, however, and therefore cause all sorts of curious neurological or gastrointestinal symptoms depending on where the aneurysms are happening. That is about one in 100,000 people. There is even a dental Ehlers-Danlos syndrome, which causes the teeth to loosen and fall out. That is about one in a million people.

Given that there are many different types of Ehlers-Danlos syndrome, it is not surprising that it can be difficult to diagnose. To diagnose something, one has first to think of it. In my long career as an ENT surgeon, I saw very few cases, but I am certain that I missed many cases. I did some brief research into ear, nose and throat surgery and Ehlers-Danlos, and there is a particularly frightening situation that occurs in patients who need to have their tonsils out. Ehlers-Danlos syndrome is associated with this instability of the neck vertebrae—the cervical vertebrae; the axis and the atlas bones. When one does a tonsillectomy, one anaesthetises a patient and tips their head right back to open the mouth as wide as one possibly can. I saw a report from 2013 by Agarwal of a child who developed quadriplegia after a tonsillectomy. The tonsils were taken out, and when the child woke up, the arms and legs would not move, because the spinal cord had been compressed by the subluxation of the vertebrae.

Diagnosis is difficult, and we must first think of it. We should do what we can to educate people, particularly clinicians in medical schools and nursing schools, and even the general population. A debate such as this is certainly helpful in that respect. Research is essential. Specific genetic mutations are associated with many of the varieties of Ehlers-Danlos syndrome—sadly not the most common sort, but certainly many of the other sorts. The Minister may know that there is a proposal for universal genome sequencing of newborns and young people in this country. I do not think that future generations will have this problem of odd clinical symptoms accumulating over decades before somebody works out what has happened, because in future, people will be able to access their genomes. We will be able to predict what will happen.

However, just because we can predict it and identify the genes that are causing it, that does not mean that we will come up with magic treatments. We will certainly need to provide services for all the people with this condition into the future. Diagnostic pathways and well-organised arrangements for the clinical care of people with this presently completely incurable condition are essential.

Resident Doctors: Industrial Action

Peter Prinsley Excerpts

Thursday 26th March 2026 Commons Chamber

[Wes Streeting]

I thank the shadow Secretary of State for his response and questions. Beneath some of the criticism of the Government was a consistent message about the unreasonable and unnecessary position of the BMA, but let me address his criticism none the less.

The shadow Secretary of State accused me of “boasting” yesterday about the progress this Government are making on the NHS. For once, I cannot say we are following the pattern of our predecessors, because of course, they did not make any progress. From the moment they entered government, we saw the NHS begin to slide in the worst direction, to the extent that we went into a modern health emergency—the pandemic—woefully underprepared, leaving our country more damaged as a result. I am proud of the progress we are making. We know that what we have seen in terms of results and patient satisfaction are grounds for optimism, not cause for complacency. What we are trying to do as a Government is absolutely essential for the country, to give it back an NHS that is there for people where they need it, when they need it. That is why the BMA’s position is both disappointing and self-defeating for all of us.

The shadow Secretary of State talked about the approach I took in opposition. There is a difference between the approach that this Government have taken and the approach of our Conservative predecessors. We have always been prepared to get around the table; we never close the door. As I said from the other side of the House, the power to end strikes does sit with the Government when they are willing to compromise, willing to negotiate and willing to treat the workforce with respect. That is what this Government have done, in contrast to our Conservative predecessors, which is why it is so disappointing that with a deal available—a good deal—the BMA is turning away.

The BMA should reflect not just on the contrast with the past, but on the contrast with the future. There is no more pro-NHS, pro-doctor Health Secretary or Government waiting in the wings. I am not even sure that the alternative is a Conservative Health Secretary; that person may well come from Reform UK—the party whose Members occasionally turn up and sit in the corner, when they can be bothered and when they are not flouncing out in a hissy fit. Catch them on a good day and Reform Members may even say the quiet bit out loud: they do not believe in the NHS. They do not believe in it as a public service free at the point of use, and they are certainly not going to treat the BMA or resident doctors with more respect or generosity than a Labour Government. I think the BMA needs to reflect on that.

The shadow Secretary of State asked about affordability. One of the great things about the deal that we agreed is that it is affordable because it involves productivity gains—not just the productivity gains that we have already achieved in the NHS, the target being 2% and the reality that we have achieved 2.7%, but the productivity gains built into the pay structure reform.

The shadow Secretary of State asked about the jobs. I will be honest, and I am sure NHS chief executives will want to say more about this. The fact is that I and Jim Mackey have had to do a considerable degree of persuading and arm-twisting to persuade NHS trusts to create additional specialty training places, because they have not been convinced of their necessity or utility. Part of their reservation has been about the conduct of resident doctors and the BMA. I have had a hard job to do to sell that. Those jobs will not materialise if the BMA rejects this deal, I am afraid. There is a not a “something for nothing” culture here.

I say to the crab people who still believe that they are pursuing a really effective “bank and build” strategy that they should look at what they are confronting now, and look their members and their colleagues in their eye. This is not bank and build any longer; this is a high-and-dry strategy, and it is not going to work. That is why it is important that we end this dispute and that we do it together, in the spirit of partnership. There is still time to do that—there is still a week. The door is not closed; the offer is still there, and I urge them to take it before it goes.

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

I share the frustrations of Ministers and of the Government. I know that they have worked really hard on this. Dr Fletcher of the BMA has also worked hard, and I am sure that there is a deal to be done somewhere. The Medical Training (Prioritisation) Act 2026, to prioritise UK graduates, was very welcome, but I wonder whether we can also do something to fix the foundations of medical careers, by devising a much better system than the crazy foundation lottery that sends a doctor from Norwich to Belfast and a doctor from Belfast to Norwich. That would be a great expression of good will. Meanwhile, I am sure that my colleagues in the NHS will work around this strike—our patients will be safe—and I am sure that our NHS will continue to improve under this brilliant Labour Government.

[Wes Streeting]

I thank my hon. Friend for his support in trying to influence a more constructive approach, for the advice that he has given me and members of the resident doctors committee, and for the experience that he brings to these exchanges. He is right to praise Jack Fletcher for the constructive approach that he and his officers have taken. It has not been easy, but I know that officials have enjoyed the constructive engagement, and I thank enormously the officials who have worked tirelessly on this. I think all those involved in the discussions, on both sides of the table, are disappointed by the outcome, and that is why I urge the BMA to seize the offer before it is too late.

My hon. Friend talks about other changes, such as to placements and rotations. I think that BMA officers recognise my desire to not only do this deal, but to create a new business as usual with the BMA, where we have people around the table on a regular basis looking at what we can do to improve the health service for patients and staff and to make real progress on those issues. We cannot do that if we are in conflict. That is the tragedy of the position we find ourselves in. I think we have built trust through engagement and dialogue with the BMA committee officers. It is only disappointing that members of the committee are not prepared to get around the same table as me, because if they did, they might realise the sincerity and the opportunity.

Palliative Care

Peter Prinsley Excerpts

Thursday 5th March 2026 Commons Chamber

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

I thank my hon. Friend the Member for York Central (Rachael Maskell) for this important debate. I pay tribute to her political expertise in this area and for everything she has done.

Dame Cicely Saunders—much quoted in this debate—was the founder of the hospice movement in this country. She understood that medicine is not only about curing illnesses; it is about dignity and ensuring that people are supported compassionately at the most vulnerable moment of their lives. It was her work that transformed how we think about care at the end of life, and today hospices all over the country continue that legacy. In my own work as an ear, nose and throat surgeon dealing with patients with advanced cancers in the head and neck, I am well aware of the importance of hospices.

I also pay tribute to Dr Eric Wilkes, who was a brilliant general practitioner and founder of the hospice movement in Sheffield. He was one of my teachers and one of the first people to understand the importance of integrating end-of-life care into community and hospital settings at St Luke’s hospice. The term “palliative care” was invented only in 1990—some 20 years or so after I first met Dr Wilkes—and the Sheffield model has been completely crucial to this development.

I would like to talk about palliative care in my constituency of Bury St Edmunds and Stowmarket, and in particular the remarkable work of St Nicholas hospice, its wonderful chief executive Linda McEnhill and all her staff. The hospice provides essential support for those approaching end of life and for their families and loved ones. What makes that hospice a little unusual is that it sits right on the campus of West Suffolk hospital, an arrangement that facilitates help for the patients in the hospice from all the services within the hospital. If, for example, a patient falls and fractures a leg, or needs an ear surgeon, support is available rapidly and nearby. Most hospices simply do not have access to that level of clinical support, and that is a real advantage for the Bury St Edmunds hospice.

St Nicholas hospice also illustrates a wider challenge facing palliative care across the country. As we know, demand for hospice services is increasing. St Nicholas lately increased its capacity by about 33% to meet the needs of patients and families in the local community. To expand, more staff need to be recruited, so we must do something to increase training capacity across the hospice service, particularly because we must ensure that we have a seven-day service. If we need to increase the service from a five-day service to a seven-day service, we need two sevenths more people.

Palliative care is a crucial part of a healthcare system. The problem, as we have heard on many occasions, is that hospices rely on charity and legacies. That is obviously admirable, but it raises an important question—one that I think was first asked by Baroness Finlay in the other place. We do not expect a maternity service to require charitable funding. If we needed a new maternity service, we would expect the NHS to put it up. Yet for some reason, if we need a hospice, we expect a charity to raise the funds for it and to run it. Being born and coming to the end of life are just inevitable parts of life, so I think we need a paradigm shift—a philosophical change—in the way we think about palliative care, which must be regarded as a core part of our national health service. If we genuinely believe that dignity at the end of life matters, let us make palliative care core.

[Madam Deputy Speaker (Caroline Nokes)]

That brings us to the Front-Bench contributions. I call the Liberal Democrat spokesperson.

Rural GPs: Funding

Peter Prinsley Excerpts

Wednesday 11th February 2026 Westminster Hall

[Esther McVey]

It is always good to have my hon. Friend—and I do call him my hon. Friend—intervene on me. He makes very good points. It is also important that a local GP chooses, and can see what their local constituents require and what is best for their health outcomes.

The move to a new model based on deprivation rather than workload is, at best, an act of ignorance that fails to acknowledge the significant challenges of running GP practices in rural areas; at worst, it represents yet another example of Labour’s assault on rural life. Measuring pressures on GPs solely through the lens of deprivation would ignore the complex, distinct demands faced by rural practices. Rural communities have older populations. In 2019, the House of Lords Rural Economy Select Committee found that the average age in rural areas was almost six years higher than in urban areas, and a quarter of the rural population were over the age of 65.

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

I am grateful to the right hon. Member for securing this important debate. Dr Richard West MBE and Dr Daniel James, general practitioners in Woolpit in my Suffolk constituency, have been awarded the Royal College of General Practitioners East Anglia Faculty GP prize this year in recognition of sustained contribution to rural mental health and community-focused general practice. Does she agree with me that we must do all we can to look after the mental health of the rural population, particularly isolated farm workers?

[Esther McVey]

The hon. Member raises a very good point indeed. I congratulate his constituents. The pressure that I know the farming community is under and the impact that the family farm tax has had on the mental health of the rural community and farmers has been significant.

Life expectancy is longer in rural areas, placing greater demands on GP practices. Statistics published by the Department for Environment, Food and Rural Affairs suggest that people born in mainly rural areas in 2018 to 2020 were expected to live two and a half years longer than people born in urban areas. Older populations place greater demands on GP surgeries, presenting with complex healthcare needs and higher levels of chronic illness and frailty. The Rural Services Network analysis shows that GP-registered patients over the age of 75 account for 11% of rural GP patients, compared with just 7.5% in urban settings.

--- Later in debate ---

[Esther McVey]

I agree with the hon. Member. I will come on to my surgeries that are indeed in Victorian buildings—spread across four—and need to be brought together and modernised. That is in Knutsford in my constituency. I know that there will be many other places like that across the country. The hon. Member raises a valid and pertinent point.

We know that GP services in rural communities are spread across a large geographical area, and many elderly residents in Tatton live alone. Although such independence is cherished, travelling long distances to access healthcare is more difficult. Public transport is often limited or non-existent. Community transport schemes exist in Tatton, but they cannot always accommodate short-notice or urgent medical needs. Often, elderly residents do not drive, so they are left reliant on costly taxis or GP staff taking the time to travel to a patient’s home. That places additional pressures on already stretched services. In Lostock Gralam, despite a population of about 2,800 people, there is no GP practice. That forces patients to make a lengthy journey to Northwich, and without a direct bus service many are left to rely on taxis to make their appointment.

For those communities, recruiting and retaining staff becomes more difficult and more expensive. The Rural Services Network reports that 59% of hard-to-recruit GP speciality training posts are located in rural areas. There is less access to specialists and consultants, which makes their services more expensive. Community services and provision are sparser in rural areas, too. Pharmacies, which help to relieve pressure on GPs in urban areas, are not as common in rural areas. When I secured this debate, I was contacted by the Dispensing Doctors’ Association, which provides an essential role in dispensing medicines to patients who live more than 1.6 kilometres from a pharmacy. It delivers to about 10 million patients across England, but is facing increasing challenges due to its reliance on manual delivery.

In addition, while urban pharmacies move ahead with digital efficiency, rural pharmacies often struggle to keep pace because broadband coverage is often unreliable, rendering remote consultations near impossible and service delivery more difficult. The benefits of digitisation in healthcare are well understood across this House, but they rely entirely on having the right infrastructure in place. Without connectivity, rural practices are simply unable to access or benefit from Government investment in that area. There are lots of people from rural areas here, and we know how unreliable our broadband infrastructure is.

In 2022, the all-party parliamentary group on rural health and care published an inquiry into healthcare in rural areas. It concluded:

“Rurality and its infrastructure must be redefined to allow a better understanding of how it impinges on health outcomes”.

No progress has been made on achieving that. Removing the rurality measure of GPs’ funding entirely would be a step backwards in understanding how settings impact GPs’ ability to provide healthcare.

There is little transparency about who exactly will be consulted in the funding model review. In a written answer to a parliamentary question, the Government confirmed that the review

“will draw on a range of evidence and advice from experts,”

such as the Advisory Committee on Resource Allocation and the British Medical Association general practitioners committee, but there is little information beyond that. There are GPs in Tatton who are keen to contribute but, as of yet, have not been able to.

[Peter Prinsley]

Will the hon. Member give way?

[Esther McVey]

I will indeed, although I am keeping an eye on the time.

[Peter Prinsley]

There is obviously a problem with funding the recruitment of additional GP partners in rural surgeries. Does the hon. Member agree that we should think carefully about how the partnership model itself might be improved?

[Esther McVey]

The hon. Member raises another good question, and we can ask the Minister to look into that.

The logical conclusion of not having GPs from rural areas take part in this review is that the Government do not want to listen to them. They are intent on rewriting the formula without acknowledging the realities of delivering rural healthcare. A broadbrush measure such as deprivation cannot take into consideration the very close link between the ability to deliver healthcare and the rural or urban settings in which GPs exist. It comes as little surprise. Whether selling off our family farms or introducing a devolution agenda that pits rural against urban areas, time and again the Labour Government have shown that they are not willing to listen to rural areas, but are quick to sell out rural Britain at the first chance.

As is typical, Labour’s response to pressure is to level down some areas, which serves only to create additional pressures elsewhere, rather than acting to fix them. The pressure faced by rural healthcare will not disappear soon. The NHS long-term workforce plan, published under the previous Government in 2023, recognised that the increased demand from an ageing population is not uniform in the UK. It estimated that

“In 2037, a third of people aged over 85 will be living in rural communities”

compared with just a quarter now. The Government must act to address that trend.

I have been campaigning for a new medical centre in Knutsford, as was acknowledged before, where doctors desperately need more space and modernised facilities to meet patients’ needs. The current surgeries in Knutsford do not do that; they are all Victorian buildings and are not suitable. I have been pressing for that for a long time. I have met with the Minister—I thank her for that—and I would be grateful for an update on the progress of the practice in Knutsford.

GP practices deliver community care and their ability to deliver is reliant on the environment in which they serve the patients. We must have a funding formula that acknowledges the challenges of delivering healthcare in rural areas. I would be grateful if the Minister could answer the following questions. Who is being consulted in the review, and will it include those with first-hand experience of delivering healthcare in rural settings, like my GPs in Tatton? What assurances can be provided that rurality will remain a factor in a new funding formula? Given the specific challenges they face, will the Department commit to publishing an assessment of the impact on rural communities ahead of any change to the funding formula?

Brain Tumour Survival Rates

Peter Prinsley Excerpts

Monday 9th February 2026 Commons Chamber

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

It is an honour to speak in this debate. I thank my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) and the hon. Member for Witney (Charlie Maynard) for securing it. We have heard many fine and very heartfelt speeches this evening, particularly those recounting personal stories about Members’ families.

Our new cancer strategy was announced last week. Sadly, political events of the past few days have somewhat submerged its importance, but we should be talking about it, as it is much the most important political development as far as I am concerned. We have seen little progress in brain tumour care—that is the truth of the matter. Those tumours are devastating; they rob victims of years of life, and wreck families. I have seen such patients over the years, and I can say that diagnosis may be very difficult, even with the help of hindsight.

An average general practitioner will see a new brain tumour once every seven years, but they will see thousands of patients in that time, so it is not surprising that the tumours are difficult to diagnose. I hear that a patient with a brain tumour will often have visited their general practitioner five or six times before a diagnosis is made. We must do what we can to raise awareness. In ear, nose, and throat care—which, as Members may know, is my specialty—we see a condition called acoustic neuroma. It is a brain tumour on the nerves that lie between the ear and the brain—the balance nerves. Such tumours are rare, even in ear, nose and throat clinics. I would see only a handful of them each year. Sometimes they present with a little hearing loss in one ear, or with just a little ringing. Sometimes they present incidentally.

Some of the other brain tumours we see in the ENT world are very rare. One that sits in the roof of the nose —an olfactory neuroblastoma—is so rare that I probably saw fewer than six or seven cases throughout my career, yet it presents with a loss of sense of smell, which is a very common problem for people who come to see ear, nose and throat surgeons or general practitioners. We must not deceive ourselves that we are dealing with an easy condition, for this is a difficult one.

I believe that we must support research into these mysterious diseases. As I have said before in this Chamber, this country is desperately short of medical researchers and clinical academics. Many of our clinical academics are getting towards the end of their careers, and we are not doing enough to recruit new academics in the early part of theirs. I would like us to think about what policies we might develop to encourage that—this is a political problem. My hon. Friend the Member for Mitcham and Morden said that given we have made so little progress, we must be content with the status quo. I beg to differ; we are not content with the status quo, and that is why we are all here this evening to discuss this matter.

We know that this is a promising time for some areas of medical research. Genetic research, for instance, is now becoming very important. I am not sure that whole genome sequencing, if that were available for everybody, would solve the problem, but it is the way we are going. Before I came to this place, I was involved in research into a rare ear disease called cholesteatoma. We did genetic research on that—genome sequencing—and we were able to identify some of the genes that probably cause the condition, but that does not make it any easier for us to prevent it, for we cannot choose our genetic code.

The problem with brain tumours is that they are deep-seated and inaccessible. We cannot see them or feel them, which is why curative approaches are so elusive. We can debate this in the Chamber until the cows come home, but that debate will not bring the cure, so we must decide what politically we can do to help. I welcome the £32 million boost to brain cancer research, and our new approach to clinical trials. I thank my hon. Friend the Member for Edinburgh South West (Dr Arthur) for his Rare Cancers Bill, and I congratulate him on getting it to advance so far. Like me, he is a new Member of Parliament, and I am in awe that you have managed—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

He has managed—not “you”.

[Peter Prinsley]

Yes, I am in awe that my hon. Friend has managed to achieve so much; you see, Madam Deputy Speaker, I am a new Member of Parliament!

Let us encourage clinical trials, for as Lord Vallance has said:

“Clinical trials are the route by which promising research can be turned into treatments”,

which will save lives.

--- Later in debate ---

[Dr Johnson]

My right hon. Friend invites me to speak outside my area of expertise; I am afraid I do not know the answer to that.

[Peter Prinsley]

Will the shadow Minister take an intervention?

[Dr Johnson]

I will, particularly if the hon. Gentleman has an answer for my right hon. Friend.

[Peter Prinsley]

I cannot understand how there can be a relationship between head injury and brain tumour. Repeated injury causes some neurological conditions, particularly for footballers, whom we see getting early dementia, but I do not see a connection between head injury and brain tumour. Does the shadow Minister?

[Dr Johnson]

It is certainly something that I have read about. I am happy to be corrected by the hon. Gentleman if he feels that my resources are incorrect, but that was certainly one of the suggestions for how to prevent these tumours. I do not think that prevention will necessarily be the major way in which we improve the survival rate. I also do not think that it will be early diagnosis, but I would like to finish talking about that. Regular screening for people with genetic disorders can really help to identify tumours early, and the second thing that can help is access to diagnostic tests. The Conservative Government introduced community diagnostic centres across the country, which increased the number of scanners available to those who needed a scan to identify whether they had a brain tumour. This Government have said that they will double the number of scanners available. Can the Minister comment on whether they are on track with that?

We need the workforce plan, so that we have the people to perform and interpret the scans. I do not know whether the Minister has had any tips on whether the workforce plan is imminent, but can he give us a date for when it is likely to be published? It has been delayed, but it is important. We have the cancer plan, but so much of it is dependent on the workforce plan. Thirdly, opticians have a role to play. Since a South Tees project pioneered in 2015, opticians have been able, during regular eye tests, to identify people who have signs of brain tumours, and to refer them, when necessary. Encouraging people to get regular eye tests may contribute to early diagnosis.

The fourth thing that can help with early diagnosis is symptom awareness—among both the general public and healthcare professionals. I want to talk about HeadSmart, a 2011 programme about the types of symptoms that could help identify a brain tumour. It had quite significant cut-through with both healthcare professionals and the public. It halved the time for a scan, and for diagnosis of children with brain tumours. It also improved the cognition of survivors, but it did not significantly improve the survival rate. While early diagnosis helps a bit, it is very difficult—particularly in children, who are quite neuroplastic, so symptoms appear quite late. The location and type of tumour are more important in the treatment and prognosis, and there are many different types. That makes this area of medicine extremely complicated, so I think the answer is that we need better treatments.

Treatments currently include steroids, chemotherapy, radiotherapy and surgery, but there are many others with promise. Convection-enhanced delivery enables chemotherapy to be delivered across the blood-brain barrier more effectively. Many hon. Members have talked about freezing, and last month there was a debate on the topic of freezing brain tumour samples; does the Minister have an update following that debate? His colleague, the Under-Secretary of State for Health and Social Care, the hon. Member for West Lancashire (Ashley Dalton), said that she would look at the detail and report back, so I hope that he will have an update for us this evening. Gene therapy has also shown a lot of promise, and there has been talk this evening about the trial in which an adeno-associated virus is used as a vector to seek out the glioblastoma cells and use the patient’s immune system to kill the tumour cells. That trial has promise; if it works, it could lead to real improvements in treatment.

Research will be key. BioNTech’s 2023 partnership promised that there would be 10,000 patients in cancer vaccine trials by 2030, but new innovators face barriers. This is a global fight; work is going on right across the globe, and we need to make the UK’s environment one that stimulates and supports research, so that British people can have the earliest possible access to the newest treatments. At the moment, the wider economic picture for research is not great, and we have seen some researchers pull out of investments in the UK. Taxation, national insurance, employment rules and the speed of adoption by the NHS are all factors that I hope the Minister will try to improve.

The hon. Members for Edinburgh South West (Dr Arthur) and for Strangford (Jim Shannon) talked about the devolved Administrations. Could the Minister comment on how he and his team are working with those Administrations to encourage research right across the United Kingdom? I also wanted to talk about rural areas, because it is all very well encouraging trials in the UK or England, but so many of those trials are in the centre of London, or in the other big cities; it is much more difficult for people living in rural areas, such as my constituents in Sleaford and North Hykeham, to access them. Could the Minister please update the House on how he is making it easier for research to occur in rural spots?

The hon. Member for Witney summed it up perfectly when he said that ambition is important, but actions, not words, are the key. We need specific, measurable targets, not just warm words—this Government have been very good at warm words on health, but much poorer on delivery. For the sake of the one in two people who will get cancer, and all their friends and loved ones, I hope that on this occasion, there is more action, not just words.

National Cancer Plan

Peter Prinsley Excerpts

Thursday 5th February 2026 Commons Chamber

[Ashley Dalton]

The trust to which the right hon. Gentleman refers is the trust where I had my primary cancer treatment, so I am acutely aware of the challenges. We have set a really clear and simple ambition: to get cancer patients the timely care they need, and to meet all waiting time standards by the end of this Parliament. That means that by March 2029, 80% of patients will get a diagnosis or the all-clear within 28 days, and 85% of patients will start their treatment within 62 days of referral. Some people have asked me why the figure is not 100%. It is not possible to make it 100%, because not everybody’s cancer is simple or easy to identify, and sometimes it takes longer. We want to ensure that the only reason for delays beyond 62 days is the complexity or specifics of someone’s cancer, not the inability of a trust to meet the targets.

We are going to cut waiting times by giving trusts and cancer alliances detailed practical information and granular data on individual cancer types so that we can highlight real-time pathway insights through a federated data platform, and by streamlining the cancer metrics so that we can shine a light on unwarranted variation in care. We are providing information and best practice, thereby taking the best of the NHS to the rest of the NHS. We are linking up professionals and clinicians across the UK, so that they can share their best practice. Trusts can help and support each other to reach the targets.

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

What a brilliant plan, and I congratulate the Minister on bringing it to the House this afternoon. However, cancer trials need clinical academics, and we have a crisis in clinical academic recruitment, retention and funding. Does she agree that we must find ways to encourage young clinicians into academic and research roles?

[Ashley Dalton]

Yes, I do agree, and we are working on that. We are establishing the cancer trials accelerator programme to increase the speed, scale and reliability of cancer trials, and we will use the new health tech access programme to make it quicker. We will also be supporting the development, through the workforce plan, of all the clinicians required, including academics.

Medical Training (Prioritisation) Bill

Peter Prinsley Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

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

I welcome the Government’s plan to change the law. It was obvious to me and to others that such a change would be needed, and it was one of the matters about which the newly elected doctors spoke to Ministers last year.

Imagine, Madam Deputy Speaker, that you have graduated from a medical school, excited at last to be called a doctor, and looking forward to finally getting to work after years of intense study, uncountable examinations and fierce competition. When this happened to me at Sheffield medical school, our early pre-registration posts were organised by the university. We were simply distributed around the local hospitals. We were in familiar locations, with our classmates and consultants who knew us. We began, rather hesitantly, to work as doctors, but suddenly we had responsibility for life and death.

However, something changed. Now young doctors are simply sent by chance, with little notice, to a region of the country they have never visited. They are far from their friends. Ironically, they are now called resident doctors, but that is the very last thing they are; the residences have long since disappeared. The shift system replaced the on-call rotas, and the doctors’ mess disappeared, so hot food was no longer available. Now, if they are lucky, they have an office chair in which to rest, and a sandwich dispenser in a cold corridor. They have no friends nearby, nowhere to live, and nothing to eat at night. It is not really the best start, and these are the young doctors on whom your life may depend. We really must do something to look after the health workers who look after us—all health workers. That does not just mean paying them properly, although we obviously must do so. Today we are speaking about our doctors, for young doctors face a very uncertain future.

After Brexit, many of our European doctors just left. The deficit was filled, as so often in the past, by doctors from the rest of the world. Especially in hospitals that are remote from medical schools—such as my hospital, the West Suffolk hospital in Bury St Edmunds, and the hospital where I worked for so many years, the James Paget hospital in Great Yarmouth—we have always depended on brilliant doctors from many nations, many of whom have become my long-term colleagues and some of my best friends. Immigration rules were altered after Brexit, effectively enabling applicants from across the world to apply for a very limited number of posts. As we have heard, although competition is healthy, it is certainly not healthy for the ratio of applicants to posts to go from about 2:1 to more than 4:1. As we have also heard, this is absolutely the cause of the bottlenecks. UK graduates simply cannot progress and are obliged to repeat years, often as unstructured and unrecognised clinical fellows. They leave the country or give up medicine altogether. The Government have rightly recognised that this must change.

Medical training is a continuum, and the end result is a general practitioner or a hospital specialist—by the way, I much prefer “specialist” to “consultant”. Doctors have five or six years of undergraduate training, and eight to 10 years of postgraduate training, and it makes no sense to graduate so many students and then fail to accommodate them in postgraduate training. The measure to prioritise the graduates of UK medical schools is simply common sense and I support it, alongside, I understand, almost all Members of the House.

Finally, let me issue a word of warning. The number of new medical schools—I understand that there are many new medical schools, including the one in Cumbria, which I did not know about—means that we have more graduates than ever. That is good, because we have insufficient doctors, but the health system must create additional training posts, more substantive posts for general practitioners and hospital specialists, and incentives to create these posts, especially in general practice, so that our new neighbourhood health centres, which I like to call “Bevan health centres”, can be fully staffed and open late at night, and so that we see an NHS renewed. That is our aim, and we will achieve it.

Less Survivable Cancers

Peter Prinsley Excerpts

Tuesday 6th January 2026 Westminster Hall

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

It is a pleasure to serve under your chairship, Mr Efford. I thank the hon. Member for Wokingham (Clive Jones) for securing this debate. Cancer remains a most feared word. We doctors have learned to use all sorts of other words: “growths”, “tumours” and suchlike. There are relatives who will tell us, “Don’t use that word in front of the patient, for it would simply kill him.” But things have changed. Cancers that were considered incurable are now curable, and cancers for which there was no treatment are now treatable. Such is the power of scientific progress, for it is upon science that we will depend.

What exactly is a less survivable cancer? It is one defined by persistently poor outcomes across all stages. Many have mentioned the six with a survival rate at five years of only 16%. One such example was my lovely neighbour, who presented last Christmas with loss of vision in one eye. He was found to have secondary lung cancer in the retina. It was completely incurable and unamenable to any effective treatment. Sadly, he was dead within a few weeks.

Our country has a proud record of medical research. After all, it was here that we first discovered the link between cigarettes and lung cancer, when epidemiological studies of British doctors were conducted in the 1960s. When that was revealed, my own dad gave up his pipe. The greatest act of our new Government, some 60 years later, was to continue with the legislation introduced by the last Government to ban cigarette sales, eventually, for every citizen.

Clinical academics are doctors who not only teach the next generation of doctors, but translate scientific research into clinical applications and the supervision of clinical trials. I did an MD at the University of East Anglia on the clinical observation on the genetics of a rare ear disorder, so I understand the difficulties of medical research, but also the intrinsic delight that comes with unravelling the mysteries of medicine. That role is particularly critical for less survivable cancers, where progress will depend on sustained academic leadership on converting research into viable treatment.

Unfortunately, there has been a serious collapse in the number of clinical academics in our country. Many are now approaching retirement, and the levels of recruitment of young clinical academics are completely insufficient. We must address this crisis, starting with co-ordination between the Department of Health and Social Care and the Department for Education, so that salary equivalence is restored to retain the existing workforce on which our medical science depends. Let us do something we can actually do to make survivable cancer survivable. This is our political task.