Medical Training (Prioritisation) Bill (Allocation of Time)
Tuesday 27th January 2026
(1 day, 13 hours ago)
Commons ChamberMedical Training (Prioritisation) Bill 2024-26 Read Hansard Text Amendment Paper: Committee of the whole House Amendments as at 27 January 2026 - (27 Jan 2026)
Medical Training (Prioritisation) Bill
Tuesday 27th January 2026
(1 day, 13 hours ago)
Commons ChamberMedical Training (Prioritisation) Bill 2024-26 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Committee of the whole House Amendments as at 27 January 2026 - (27 Jan 2026)
The Secretary of State for Health and Social Care (Wes Streeting)
I beg to move, That the Bill be now read a Second time.
I begin by thanking the Leader of the House, the Chief Whip, their counterparts in the other place, colleagues in my Department and in the NHS, the Bill team and parliamentary counsel, who have moved mountains to prepare this Bill in double-quick time. I once again place on the record my sincere thanks to my counterparts in the Governments of Wales, Scotland and Northern Ireland—as well as the respective Secretaries of State for those nations—for the spirit in which, regardless of party, they have helped us to bring the Bill forward. Last but by no means least, I am enormously grateful to Jackie Baillie, Labour’s deputy leader in Holyrood, for her wise counsel.
The NHS is on the road to recovery, not least because of the herculean efforts and dedication of NHS leaders and frontline staff who, even in the depths of winter, are delivering outstanding episodes of care, hour after hour and day after day. Among the encouraging signs of year-on-year improvement are waiting lists falling at their fastest rate in three years—down more than 300,000 under Labour—and quicker ambulance response times, shorter waits in A&E and speedier cancer diagnoses for more people. December was the busiest month in NHS history for 999 calls, but despite that, and regardless of industrial action and winter pressures, ambulances arrived at heart attack and stroke patients nearly 15 minutes faster compared with last year.
The progress we are seeing is a reminder that nothing positive for the people who use the NHS ever happens without the people who work in our NHS. Our investment and modernisation are starting to restore confidence and renew belief among frontline staff; with that, hope, optimism and ambition are returning too. That is why, outside of the pandemic, staff retention is at its highest in a decade and vacancies are at their lowest since records began in 2017. There is lots done, but, as we know, there is so much more to do.
I will always be honest about the state of our national health service—what is going well and where we need to improve. There is no sugar coating the fact that staff morale is still too low, and the way that some of our NHS workforce is still treated and the conditions in which too many of them still work are nothing short of a national disgrace. Not only is it a stain on our NHS, but it shames us as a country when those who care for us in our hour of need suffer bullying, harassment and racist abuse; have nowhere to rest, go to the toilet or get changed; cannot get a hot meal on a night shift; have limited flexible working options; must book holiday a year in advance; need to log in seven times just to use a PC; spend time form-filling rather than looking after patients; and face basic errors with pay and contracts. Before Christmas, I had a doctor in my constituency advice surgery in tears as she described the way she had been treated by a previous employer. This is no way to treat the people who kept us going when everything else stopped, so we are taking action.
Trusts are now implementing the 10-point plan for resident doctors and my Department, together with NHS England, is developing new staff standards to create better working practices and better conditions.
We have awarded above-inflation pay rises to everyone working in the NHS for this year and last year, which is beginning to recover the pay erosions seen under the last Government. We have begun 2026 with constructive talks with the British Medical Association’s resident doctors committee, as we seek to broker industrial peace. I have also told NHS leaders that they need to step up when it comes to the conditions that their staff face. They cannot expect the Secretary of State to micromanage availability of hot food in their canteen, for example.
However, there are workforce problems that only Government can solve. We have known for years that the treatment of resident doctors is often totally unacceptable and that the very real fears about their futures are wholly justified. Every time I have met a resident doctor, either formally or informally, they have told me without fail how their careers are blocked because there are far too many applicants for training places. Not only do I think that they have a legitimate grievance, but I agree with them.
Dr Kieran Mullan (Bexhill and Battle) (Con)
The Secretary of State is essentially talking about postgraduate training. I wonder what thought he has given to new clause 2 in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). I have spoken to students who worked really hard all the way through medical school to get the best exam results and perform highly but then ended up in an allocation system that pays no attention whatsoever to that. Merit has been entirely removed from the system. I think it was wrong for us to make that change. Does he have any sympathy for returning to a merit-based system?
Wes Streeting
I certainly do have sympathy with that argument. We have begun to move the system in the right direction in terms of giving applicants greater preference in placements, but it is not lost on me that the system of rotations, placements and jobs means doctors are moved around the country and families are uprooted. The frictional cost of relocating from one place to another is a challenge that resident doctors in particular face. I do not think that an amendment to the Bill is the right vehicle in which to address that issue, but I am sympathetic to the arguments that the hon. Member makes, and I am sure he will make them again during this afternoon’s proceedings. We will take his arguments seriously and look to work together with the BMA and others to act to improve the experience of training, rotations and jobs.
UK graduates used to compete among themselves for foundation and specialty roles. Now they are competing against the world, because of the visa and immigration changes made by the Conservative Government post Brexit. The situation is compounded by the previous Administration’s total lack of workforce planning, which saw more students going to medical school without the number of specialty training places being increased. That is why we see the training bottlenecks that resident doctors face today.
Several hon. Members rose—
Wes Streeting
I will give way to the hon. Member for Henley and Thame (Freddie van Mierlo) and then to my hon. Friend the Member for Hitchin (Alistair Strathern).
Freddie van Mierlo (Henley and Thame) (LD)
A constituent of mine is studying medicine at Queen Mary University of London but at a campus in Malta. Students at the Malta campus complete the same General Medical Council-approved curriculum, assessments and licensed exams as London-based students, and graduates hold a UK primary qualification. He was given a formal guarantee that he would be at no disadvantage if he chose to study at the Malta campus. Can the Secretary of State reassure me that graduates like my constituent will be prioritised on the NHS foundation medical training programme?
Wes Streeting
Students studying in Malta will not be prioritised in the Bill, but they will still be able to make applications. Queen Mary University’s Malta website is clear that Queen Mary does not administer the UK foundation programme and cannot control whether or on what basis applicants are accepted into the programme, and no one is guaranteed a post on qualification.
Dr Andrew Murrison (South West Wiltshire) (Con)
Will the Secretary of State give way?
Wes Streeting
I will make some progress because, with respect, I have not yet set out the measures that we are to debate today. Let me take the intervention from my hon. Friend the Member for Hitchin, then I will set out the Government’s rationale and take further interventions.
Alistair Strathern (Hitchin) (Lab)
I wonder if the Secretary of State shares my residents’ utter disbelief that the last Government created a system where thousands of UK medical graduates, educated at the cost of billions to the UK taxpayer, were suddenly forced to compete with overseas students, pushing many abroad for their careers and losing a big talent pool that should be powering our NHS and getting it back on its feet.
Wes Streeting
That is right. I have to say, many of my counterparts around the world cannot fathom how we ended up in this situation in the first place. They certainly do not do as we have been doing, investing so much in their home-grown talent only to then see that talent compete on equal terms with anyone from anywhere else in the world.
Let me set out why we need this Bill. There are workforce problems that only Government can solve. We know that the treatment of resident doctors has been totally unacceptable for years and we see the training bottlenecks that resident doctors face today. In 2019, there were around 12,000 applicants for 9,000 specialty training places. This year, that has soared to nearly 40,000 applicants for 10,000 places, with nearly twice as many overseas-trained applicants as UK-trained ones. As a result, we now have the ridiculous state of affairs where UK medical graduates, whose training British taxpayers fund to the tune of £4 billion a year and who want to carve out a career in their NHS, are either being lost abroad or to the private sector. If we do not deal with that, the scale of the issue and the resentment it causes will just get worse. More taxpayers’ money will be wasted, more British medics will turn their backs on the NHS, and patients and our NHS will ultimately suffer.
Seamus Logan (Aberdeenshire North and Moray East) (SNP)
The Secretary of State knows that the SNP believes that this is a pragmatic Bill that will have a net-positive outcome for the health service in Scotland. We welcome the Bill and are glad to support it. However, there are specialty fields, such as general practice, which have a high number of international graduates. Because of Government policy, there are significant challenges in supporting the retention of some individuals. For example, the new requirement for settled status is 10 years with some exceptions, whereas training programmes are often only three years long. I am sure that the Secretary of State does not want the UK to be a hostile environment for our vital overseas medical staff. Will he therefore make representations to the Home Office so that it is aware of the anomaly?
Wes Streeting
I will say two things to the hon. Gentleman. This Bill does not in any way detract from the fundamental point that the NHS has always been an overseas recruiter and we have always been fortunate to draw on global talent from around the world who come and give through their service, their taxes and their wider contribution to the national health service and our country. We will continue to welcome that and people will continue to be free to apply. In future, they will apply on terms that are fairer to our own, home-grown talent.
There is nothing in what the Home Secretary proposes that will stop people who come through our universities and have the skills that we need to contribute to our health and care system applying for jobs and settling and making the UK their home. The Bill supports the Home Secretary to reduce an over-reliance on overseas talent and labour, which contributes to levels of net migration that even bleeding-heart liberals like me can see are too high. That is the issue that the Home Secretary seeks to deal with.
Kevin Bonavia (Stevenage) (Lab)
My right hon. Friend is right that we need to deal with this pressing problem and I support the aims of the Bill. However, as he can imagine, as the only current Member of this House with Maltese heritage, I have had representations from all quarters, both in the UK and in Malta, about the impact on Malta of this. Our two countries have a special health relationship, including the affiliation of the UK foundation programme with the Maltese equivalent. I understand that now may not be the time to have Malta in the priority group, but I note that there is a power in clause 4(6) that allows the Secretary of State to amend that in future. Is that something that my right hon. Friend will think about reviewing in future?
Wes Streeting
My hon. Friend is right about the measures in the Bill. He is also right about the importance of our relationship with Malta, which is long-standing and deep, and this Government place enormous value on that. We will, of course, keep the workings of the measures in the Bill under review. He is also right to say that the Bill provides flexibility to the Secretary of State to adjust, as our needs may demand.
Dr Murrison
The Bill is basically a good one, and we all share the intent to encourage home-grown talent to remain in our national health service, so could the Health Secretary explain why he appears to have set his face against British students who for various reasons train at, for example, St George’s in Cyprus or St George’s in Grenada and who then want to come back and practise in our national health service? They want to come back and practise at home. Amendment 9 would deal with that conundrum. Why will he not support it?
Wes Streeting
We set UK medical school places based on future health system needs. We cannot control how many places the overseas campus universities create, whether they are UK-based universities or not. Prioritising those graduates in the way that the right hon. Gentleman suggests would undermine sustainable workforce planning. It would also undermine social mobility and fair access. Those campuses are commercial ventures; they receive no public funding and students are generally self-funded. The nature of prioritisation is that we set priorities, and these are the priorities that this Government are setting out. We must break our over-reliance on international recruitment.
As I have said, I am proud of the fact that the NHS is an international employer, and it is no coincidence that the Empire Windrush landed on these shores in 1948, the very year our NHS was founded. We are lucky that we have people from around the world who come and work in our health and care service. Since Brexit, however, under the last Government, we have begun to see something much more corrosive, with the NHS poaching staff from countries on the World Health Organisation’s red list because their own shortages of medical practitioners are so severe. The continued plundering of doctors from countries that desperately need them while we have an army of talented and willing recruits who cannot get jobs is morally unacceptable. If some Opposition Members want to defend that record and dismiss the morality argument, I would point out that that position is naive on economic grounds. Competition for medical staff has never been fiercer. The World Health Organisation estimates a shortfall of 11 million health workers by 2030. Shoring up our own workforce will limit our exposure to such global pressures without depriving other countries of their own home-grown talent.
Ben Coleman (Chelsea and Fulham) (Lab)
I congratulate my right hon. Friend on his excellent speech and the strong points that he is delivering. I associate myself with the remarks of my hon. Friend the Member for Stevenage (Kevin Bonavia) about Malta. As a member of the Health and Social Care Committee, I have also been approached by Queen Mary University. It seems to me that we should be approaching this with a sense of fairness, and if students have entered into a GMC-recognised course with the expectation of having priority access for foundation status, we should accept that those who are currently in training still enjoy that, even if we change the rules for people who enter those courses in the future. Is that something that my right hon. Friend will consider?
Wes Streeting
As I have said, the position we have set out is founded on fairness. The basis on which people have applied to these universities has made it clear that the universities cannot guarantee places and that overseas applicants studying at UK universities’ overseas campuses can still apply. There is nothing to prevent those people from applying, but when it comes to prioritisation, we are prioritising UK-trained medical graduates from UK-based universities who have undertaken their training here in the UK. I think that is the right priority to draw.
Wes Streeting
I will take an intervention from the hon. Gentleman. I will come to my right hon. Friend in a moment.
Gregory Stafford
The Secretary of State mentioned the need for more medical staff across the world and, of course, in this country as well. At the general election, he pledged to double the number of medical school places by 2030. Is that still a commitment, and how far has he got with it?
Wes Streeting
With respect, I think the hon. Gentleman has got his chronology slightly wrong. As shadow Health Secretary, I proposed that we should double the number of undergraduate medical school places. That policy was poached by the then Conservative Government, who made modest progress with it. We then came into government, looked at their long-term workforce plan and concluded that it was not a particularly long-term workforce plan, and we are revising it as we speak. The number of medical school places will be determined by future need. We will publish our long-term workforce plan in the not-too-distant future.
Wes Streeting
I will give way to the hon. Lady and then to my right hon. Friend the Member for Oxford East (Anneliese Dodds).
Alison Bennett
The Secretary of State rightly notes that there is international competition for healthcare talent. On Friday, I met Dr Osoba, a GP who trains future GPs. She told me how disheartening it is to train future GPs whose intention is to leave the UK. What is the Secretary of State doing to ensure that British-trained medics stay working in the NHS?
Wes Streeting
The hon. Member puts her finger right on the issue at the heart of the Bill. That is exactly the challenge we want it to address. The Bill is not a panacea—it does not solve all the problems—but reducing competition for specialty places from around four to one to less than two to one, as the Bill will do, will make it far more likely that people who have undertaken their training here in the UK will stay here and contribute to our national health service. Of course, there is much more to do on career structure, pay and conditions, but we will go as fast as we can and as far as the country can afford. We recognise that we need to keep the great people we have invested in, because doing so is in their interest and in our national interest.
Anneliese Dodds
My question relates to exactly that issue. The Secretary of State will be aware, because I have written to his Department about it a number of times, that many disabled medics face a particular challenge. They may have had to take time out of their training because of a medical condition. They are told that they can obtain a certificate of readiness to enter specialty training and go into a training specialism, but the computer says no and NHS England is not sorting this out. Will he please get a personal grip on this and fix it for my constituents?
Wes Streeting
I am certainly aware of my right hon. Friend’s concerns. I can give her that assurance and will report back to her on progress.
Without action to prioritise UK medics, we will also make it tougher than it already is for those from working-class backgrounds like mine to become doctors—or, for that matter, to even consider a career in medicine. The odds are already stacked against them: they are less likely to know doctors, their teachers may be less familiar with how to help students into medical school, they will have fewer opportunities to do work experience, and fewer people in their lives will tell them that they should aim high and reach for the stars. The result is that only 5% of medical school entrants are from lower-income working-class backgrounds. Someone’s background should not be a barrier to becoming a doctor, so our job—especially as a Labour Government committed to social justice—is not just to ensure that a few kids like me beat the odds, but to change the odds for every child in this country so that they can go as far as their talents will take them.
Aphra Brandreth (Chester South and Eddisbury) (Con)
It is vital that we address this issue to ensure that UK-trained doctors are prioritised for vacancies over international applicants—the Secretary of State is making important points about that. We need those places to be opened up for UK medics immediately, so will he explain why the Bill will not come into force immediately after Royal Assent but instead includes provision for it to come into force
“on such day or days as the Secretary of State may by regulations appoint”?
Wes Streeting
It is important that the Bill is workable. A number of factors may well interrupt our ability to move at the pace at which I want to open up those places. One of those factors is the ongoing risk of industrial action. We know that the BMA is balloting for further industrial action at the moment. We respect the process that it is undertaking, and we are not closing the door to discussions while it does so. However, we are clear that that is a further disruption risk. I hope that we will be in a position to open up a new application round very shortly for current applicants, but that will depend on our ability to expedite the passage of the Bill through both Houses, and to ensure that the system is ready to implement it. That is why bringing forward the Bill on this timescale has been particularly important.
Dr Murrison
I am grateful to the Health Secretary; he is being generous with his time. Is he saying that he intends to use this as some sort of lever or bargaining chip in his discussion with the BMA?
Wes Streeting
I am clear that this is about whether the system will be ready to implement the measures in the Bill. I must say that I view the Conservatives’ amendment on this issue with a degree of cynicism. Not so long ago, they were accusing me of being too kind to resident doctors when it came to making changes to pay or conditions without something in return. They seem to have completely changed their position. I am sure that that is not remotely cynical and is for entirely noble reasons, but I will wait for the shadow Health Secretary, the right hon. Member for Daventry (Stuart Andrew), to make his case. Let’s just say that I am not entirely convinced.
The Bill implements the commitment in our 10-year plan for health to put home-grown talent at the front of the queue for medical training posts. Starting this year, it prioritises graduates from UK medical schools and other priority groups over applicants from overseas during the current application round and in all subsequent years. For the UK foundation programme, the Bill requires that places are allocated to UK medical graduates and those in a priority group before they are allocated to other eligible applicants.
For specialty training, the Bill effectively reduces the competition for places from around four to one, where it is today, to less than two to one. That is a really important point for resident doctors to hear, not least because in the debate we had on the Government’s previous offer to the BMA, that point was lost amid some of the broader and, frankly, more contested arguments between the Government and the BMA around pay. It is not just the provision of additional training posts that reduces the competition ratio; it is also the measures in this Bill. I hope that that message is heard clearly by resident doctors as they think about their own futures immediately or in the coming years. For posts starting this year, there must be prioritisation at the offer stage, and for training posts starting from 2027, prioritisation will apply at both the shortlisting and offer stages.
In the 10-year plan, we committed to prioritising international applicants with significant NHS experience for specialty places in recognition of the contribution they have made to our nation’s health. This year, we will use immigration status as a proxy for determining those who are eligible, so that we can introduce prioritisation as soon as possible. From next year, under the terms of the Bill, we will set out in regulations how we are defining significant NHS experience.
Wes Streeting
I give way to my hon. Friend with significant NHS experience.
Dr Opher
I commend the speed with which my right hon. Friend has brought this legislation to Parliament. I have been a GP trainer for 25 years. Fifty per cent of GP trainees are international medical graduates, and there has been some disquiet from them. Will he reassure our international medical graduates that they are welcome and treasured in the health service?
Wes Streeting
My hon. Friend is absolutely right about the contribution that international medical graduates make, and I have no doubt that that will continue to be the case for many years to come. I hope it is clear to those going through medical school or aspiring to a career in medicine that, in terms of the future of healthcare in this country, general practice is where it’s at. We are looking to shift the centre of gravity in the NHS out of hospital and into the community, with care closer to people’s homes and, indeed, in people’s homes, with GPs as leaders of a neighbourhood health service. I hope that gives encouragement to GPs serving today about the future of their profession, about which they care enormously. I also hope that that message resonates with people who are thinking about a career in medicine, when they think about what kind of career that might be.
Sarah Pochin (Runcorn and Helsby) (Reform)
I recently spoke to a doctor in my constituency who was concerned about resident doctors going abroad to get a training place in their chosen specialty. We in Reform welcome this Bill. Can the Secretary of State make a commitment that we will prioritise our own UK-trained resident doctors ahead of those trained abroad, and will he assure me that the Bill will help UK-trained resident doctors to secure a training post in their chosen specialty?
Wes Streeting
I can give the hon. Member that assurance—that is exactly what the Bill does. Madam Deputy Speaker, I cannot, however, resist the enormous temptation to say that while I welcome the support of the hon. Member and her party, I hope that her party’s position will not change now that it has adopted so many of the formerly Conservative culprits who landed us with this system in the first place. Whether it is the former Home Secretary, the right hon. and learned Member for Fareham and Waterlooville (Suella Braverman), or the former Immigration Minister, the right hon. Member for Newark (Robert Jenrick), I am afraid that Reform looks rather more like the Conservative party that the country rejected at the last election, which I am sure will not be lost on people when they go to the ballot box in May—[Interruption.] As my hon. Friend the Minister for Care says from a sedentary position, Reform UK are increasingly the teal Tories—it is certainly the most successful recycling project currently taking place in the House of Commons. Anyway, that was totally self-indulgent, and very churlish given that the hon. Member for Runcorn and Helsby (Sarah Pochin) is supporting the Bill, so I will slap myself on the wrist and get back to the serious matters at hand.
As we set out these changes, it is important to note that they will have no impact on doctors working in the armed forces, who will continue to be a priority, and neither does the Bill exclude international talent, as people will still be able to apply for roles and continue to bring new and vital skills to our NHS. The principle here is home-grown talent. It is not about where students are born; it is about where they are trained. What the Bill does is return us to the fair terms on which those home-grown medics competed before Brexit.
Robin Swann (South Antrim) (UUP)
I welcome the Secretary of State’s approach to the Bill, and how he has worked across all devolved Administrations. May I seek his assurance that medical students who reside in Northern Ireland, who identify as Irish and who study in an Irish institution in the Republic of Ireland will not be excluded from coming back to work in the national health service in Northern Ireland, where we very much need all the talent we can get?
Wes Streeting
I absolutely give the hon. Member that assurance—the Bill covers medical graduates from the UK and Ireland, for very obvious reasons. I welcome the broad support that the Bill appears to have across the House, because for the changes to benefit applicants in the current round—for posts starting this August—it must achieve Royal Assent by 5 March. Any delay will risk vacancies in August and disrupt planning in NHS trusts, which rely on their new trainees to deliver frontline care. Doctors also need sufficient time to find somewhere to live, sort childcare and arrange other aspects of their lives before their posts start. I am grateful that Parliament has agreed to expedite the Bill’s progress, and confident that we will be able to work at pace with our majority in this House, and with cross-party support in the other place.
Layla Moran (Oxford West and Abingdon) (LD)
I sense that the Secretary of State is about to reach the end of his remarks. We are keen to start the debate, but it would be helpful to get clarity on one thing before we begin. When will we see the workforce plan? It has been delayed a couple of times. We wrote to the Department in November asking for an explanation as to why it has been delayed and when we can expect it. Can the Secretary of State give us some clarity, because that is the context in which the narrow technical measure that we are discussing needs to happen?
Wes Streeting
That is a fair question from the Chair of the Health and Social Care Committee. We are taking longer than I would have liked with the workforce plan. I hope it reassures the hon. Member and the House that we have taken more time because that is what the royal colleges, trade unions, and clinical and NHS leaders asked us to do. Their strong urging was to get it right, rather than rush according to a political timetable, which I thought was a fair challenge. It will be published this spring.
Alex McIntyre (Gloucester) (Lab)
I welcome this legislation. Does the Secretary of State agree with me that the fact that the Government have listened to the concerns of resident doctors about training places, and have acted at pace to bring forward the legislation, shows that we as a Government are committed to fixing the problems left behind by the Conservative Government? Does he agree that the BMA should consider that when thinking about going forward with any potential further action?
Wes Streeting
I agree with my hon. Friend. For context, I say to members of the BMA and resident doctors that to bring forward legislation in this way and at this pace is not easy. We have a packed legislative programme. The clock is ticking on getting everything through that we want to get through in the time that we have available, and I am grateful to the business managers in both Houses for facilitating the Bill. Cross-party support is going to be important, particularly in the other place, where we have lots of expertise to draw on, including from Cross-Bench peers.
We have introduced the legislation because fundamentally we agree with the case that the BMA and resident doctors have been making. In our discussions with BMA representatives, immediately prior to the last round of industrial action and since, it has been very clear that when it comes to jobs, we are not that far apart. We recognise the problems and we are working together to address the solution. On pay, there remains a gap between the expectations of the BMA and what the Government can afford. All I ask of resident doctors and their BMA representatives is some understanding and a bit of give and take about the range of pressures on the Government and the national health service, many of which require funding, which is why there are choices and trade-offs.
I hope that the BMA representatives know and have noticed that, regardless of the fact that we remain in dispute on these issues and have had a number of rounds of industrial action, I have not slammed the door in their faces and stopped talking—we have continued with good-natured and constructive talks—and I have not thrown my toys out of the pram either, and said “Right, we will not proceed with this Bill.” We have continued to work to enact solutions that we think are good for resident doctors, and therefore good for patients and good for the NHS. I hope that this will be the spirit in which we can work together.
The goal is to be in a place, particularly with the BMA and resident doctors although this applies to other groups in the workforce too, where we can work together and make progress outside disputes, so that we can gather around tables as partners, rather than as opponents. That will take some gear shifting from where we have been to where we want to be, but I know that both the Government and the BMA have entered the new year in that spirit, so we will continue to make progress.
Having stressed the urgency of the legislation, I want to address the commencement clause included in the Bill, which has already been raised. First and foremost, it is there as a failsafe. We are running to an extremely tight deadline. I do not want to be in a position where a law is enacted and we are unable to implement it in a timely and orderly fashion. Secondly, there is a material consideration about whether it is even possible to proceed if strikes are ongoing, because of the pressure that they put on resources and the disruption that is caused operationally, particularly among the people I require to help me deliver the measures in the Bill. Of course, I am keeping my options open. We are in a good place with the BMA, and we have entered the latest round of talks in good spirit, but we do not yet have an agreement on their disputes and we are waiting for the outcome of their ballot, so I am not going to do anything now that unnecessarily makes it harder to end the strikes.
The Opposition amendment to remove the commencement clause is designed to make industrial action more likely, not less likely. It tries to bind my hands and make this job even more difficult. It looks like political gameplaying, at a time when we are trying to save the NHS, and it looks like party interest before national interest. I hope that the Conservatives will consider whether their amendment is really necessary.
British taxpayers spend £4 billion training medics every year. We treat them poorly, place obstacles in their way and make them fearful for their futures. We are forcing young people, who should be the future of our NHS, to work abroad, in the private sector or to quit the profession entirely. It is time that we protect our investment and our home-grown talent. This Bill will ensure a sustainable workforce, cut our reliance on foreign labour, halve competition for places and give home-grown talent a path to become the next generation of NHS doctors. I commend this Bill to the House.
Madam Deputy Speaker (Judith Cummins)
I call the shadow Secretary of State.
Stuart Andrew
No, I am most definitely not defecting.
In the spirit of being constructive, I will start by saying that the Opposition support the principle behind the Bill. Doctors trained in Britain and funded by the taxpayer should have a fair, clear and consistent route to progress in our NHS. Britain trains some of the best doctors in the world, yet too many are leaving—not because they want to, but because they cannot access the training places they need. That wastes talent, damages morale, and ultimately affects patient care. However, support in principle is not a blank cheque; the Bill must work in practice, not just look good in a headline. We should also be honest about why we are here. Much of what is in the Bill has been promised by the Government since their election in plans, reviews and ministerial statements, and the fact that it is only being brought forward now suggests that this is catching up, not leading.
The first test is delivery. We cannot solve a shortage by changing the queue. Unless the Government deliver the 4,000 new specialist training places that they have promised, including the 1,000 places that are needed early, the Bill will not fix the bottlenecks; it will simply shift frustration from one group of doctors to another. That is why we are proposing constructive amendments to the Bill that we believe are workable and fair.
The next test is clarity. The real impact of this Bill will be determined by the rules that sit beneath it—who qualifies, how experience is assessed, and how decisions can be challenged. We welcome the focus on foundation training; prioritising UK and Irish graduates for foundation training is sensible, as it strengthens the pipeline and improves workforce planning. However, it will only work if there are enough placements and the system is transparent. That is why amendment 8 would clarify that a UK foundation programme must mean a programme in which the majority of training takes place in the United Kingdom. That is a necessary safeguard against loopholes.
Amendment 9 would ensure that from 2027, British citizens on UK foundation programmes are prioritised in a meaningful way. Prioritisation must apply not only at the final offer stage, but at interview, which is where selection decisions are often made. The amendment addresses many of the points that Labour Members have been raising, so I encourage them to support amendment 9 when we divide on it.
We are also concerned about doctors serving overseas with the armed forces. I was pleased to hear the Secretary of State talk about them, since they certainly should not be penalised because part of their training takes place abroad on service. As such, amendment 10 would expand the definition of a UK medical graduate to include those undertaking placements as part of an armed forces posting outside of the British Isles. I hope the Secretary of State will consider accepting that amendment to give reassurance to our armed forces, which I know is something he cares about. These are practical changes that would improve fairness and operability, and we hope the Government will adopt them.
We also support new clause 2, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), which would make clear that once priority groups are established, training places should be allocated on merit. That allocation should be based on academic achievement and clinical performance, rather than a lottery or a computer-generated ranking divorced from real performance. Again, I hope the Government will seriously consider the new clause. When the Minister for Secondary Care sums up, will she put on record that merit will remain central to selection?
Another issue that cannot be ignored is the impact on medical schools, especially those that rely on international students. New clause 3 would require an annual report to Parliament on the number of international students at UK medical schools and the financial consequences flowing from the Bill’s provisions. International students pay higher fees and help sustain our universities. If those numbers fall, what funding model would replace them? When she sums up, will the Minister for Secondary Care outline what assessment has been made of the impact on medical school finances? How many international places do the Government expect to fund in future, and on what basis?
The Bill cannot stand in isolation. Workforce planning depends on more than allocating training posts; it requires enough trainers and clinical supervisors, viable rotas that support learning and facilities that make training possible. The revised NHS workforce plan must set out how those needs will be met, and how the extra training places will be staffed and supported. With NHS England set to be abolished in April 2027, we need to hear from the Government who will lead workforce planning and accountability thereafter.
Our approach is straightforward. We will support measures that are fair and practical, that strengthen patient care and that respect staff. We will press the Government where we feel that proposals are rushed, underfunded or left vague. Backing doctors means giving them a route to progress and ensuring that the system is properly planned and properly resourced. I repeat that, in principle, we support the Bill. We want doctors trained in Britain to build their careers in the national health service.
That brings me to enactment. As we have heard, the Government propose that the Bill should take effect when the Secretary of State decides, rather than on the date of Royal Assent. When he said that he wanted to introduce this Bill, and that it would be urgent, I said that we encourage that and support it. However, if this Bill is truly urgent, and if Ministers want it to affect this recruitment round, why would they not commence it immediately? The Secretary of State should not be playing politics with people’s jobs. It is not right for doctors, including those not involved in industrial action, to be treated as bargaining chips, and it is not right for Parliament to be treated in this way to give him the tools that he needs because he did the first set of negotiations so badly. Will the Government support amendment 1, so that the Bill takes effect on Royal Assent? Will they commit to enacting the Bill as quickly as possible?
When does the Secretary of State intend to commence the Bill? If the Minister for Secondary Care cannot give the House a date today, what makes the Bill so urgent that it needs to be pushed through Parliament in a single day? Will the Government proceed with this legislation, even if no agreement is reached with the BMA? If industrial action is paused, will the Government still honour their commitment to prioritise UK medical graduates?
Many doctors took industrial action because they felt that their career progression was blocked. This Bill could play a part in rebuilding that trust, but that will only happen if Ministers deliver, publish the detail and follow through. They must be straight with the House. If this Bill is urgent, it should commence on Royal Assent. If implementation takes time, the Government should publish a timetable and the steps required to deliver it. To do anything else, frankly, would be discourteous to Parliament.
Dr Murrison
I think the Secretary of State has perhaps misunderstood how traumatic the process is for the young medical graduates going through this performance. Does the shadow Secretary of State agree that the sooner this legislation comes into force, the better it is for those young people, some of whom are finding the current situation incredibly difficult? They do not know what the successor scheme will look like, and the delay is adding to that unhappiness.
Stuart Andrew
I absolutely agree with my right hon. Friend. I said right at the outset that we would be constructive, but we have heard from many who are anxious about their future and do not know what will happen. The sooner that we can give them that certainty, the better. That was the premise on which we offered to support the Bill. I am grateful to him for making that point.
I am conscious that others want to speak, so I will end by saying this. Prioritisation without capacity will not fix the workforce crisis. Promises without delivery and headlines without planning will not retain the doctors whom our NHS needs. The Government must fund the extra places, set out the operational detail, and begin this reform without delay, because that was the premise that the Secretary of State identified. When he came to Parliament just a few weeks ago, he said that we needed to get on with this urgently, and that he would encourage business managers to provide the time. Well, if that is the case, let us get on with the job.
Preet Kaur Gill (Birmingham Edgbaston) (Lab/Co-op)
I welcome the Bill. I have long argued that a strong state must be rooted in work, contribution and fairness, and that principle stands behind the Bill. For too long, medical training pathways have drifted away from that principle. Taxpayers invest heavily in medical education, clinical placements and postgraduate training, but we have not been honest about who ultimately benefits from the investment. At a time when the NHS is under immense pressure, that is not sustainable.
The Secretary of State set out the scale of what we are dealing with. The taxpayer invests more than £4 billion every year in medical education, with more than £1 billion invested in undergraduate clinical placements, and more than £3.3 billion invested in postgraduate foundation and specialty training. That is public money, spent so that British patients have the doctors they need. However, since the lifting of visa restrictions in 2020, we have seen a fundamental shift in the way that medical training places are allocated. In the 2025 recruitment cycle, more than 25,000 overseas-trained doctors applied for training posts, and more than 15,000 UK graduates were competing for the same—nearly 13,000—round 1 and round 2 positions. As we heard from the Secretary of State, there are more than 47,000 applicants in 2026. That is a dramatic surge.
The Bill does one straightforward thing. It prioritises UK medical graduates for training posts, both foundation and specialty, where the NHS has already invested heavily. In my constituency, we see this clearly. University Hospitals Birmingham NHS foundation trust is one of the largest NHS trusts in the country. Just under 30% of my constituents work in the health sector. That figure is double the national average. We are home to the University of Birmingham medical school, one of the best in the country. The scale of public investment in training, supervision and infrastructure is enormous, and rightly so. However, the Bill recognises the basic truth that when the taxpayer pays, the public should see the return. Prioritising those who are most likely to work and stay in the NHS is not exclusionary; it is common sense. It is how we rebuild a health service that is resilient, staffed and fair.
Dr Murrison
I entirely agree with the Chair of the Select Committee that we need to keep Brits working in our national health service. Does she agree that we need to add to the priority list British nationals who, for one reason or another, are training in medical schools outside the United Kingdom—in Prague, in Malta, in Cyprus and in the Caribbean? The reasons why they are training in those places are many and varied, but they are British, and their intent is to practise in the national health service. However, they are being deprioritised by this measure.
Preet Kaur Gill
I am not the Chair of the Select Committee, and I think that the Secretary of State set out his position. This is really important. This is about UK taxpayers’ money being invested in training doctors, and we must ensure that UK trainees are able to secure training places once they graduate. That is the issue that we are discussing.
Let me be clear: this is not a criticism of international staff. The NHS would not and could not function without the dedication, skill and compassion of people from around the world, and we should say that plainly and with gratitude. Every day, they hold our system together. However, a mature, confident country can value that contribution while also saying that we cannot replace long-term workforce planning with a permanent reliance on overseas recruitment. That is not fair on British trainees, not fair on source countries, and not fair on the NHS. As we heard from the Secretary of State, the World Health Organisation has estimated that by 2030, there will be an 11 million shortfall in health workers, as every country competes for the same limited workforce. This Government understand that putting British workers first is not something for which we will apologise. It is what the public expect.
The Prime Minister has been clear: a serious Labour Government must align migration, skills and training policy with the national interest. We cannot simply be passive; we must shape our domestic workforce to ensure that the NHS can continue to function. The same principle should apply wherever we are overly dependent on skilled migration because domestic training was neglected for 14 years under the Conservatives. Investing in people in the UK, and expecting that investment to strengthen Britain, is not ideological; it is responsible government.
The powers conferred to the Secretary of State in this Bill are important. The Royal College of Radiologists’ 2024 census found that 83% of cancer centre heads of service in the west midlands were concerned about patient safety as a result of workforce shortfalls. In 2024, only 19% of clinical oncology training places in the west midlands were filled. Will the Secretary of State outline how he intends to use the powers in this Bill and work with the integrated care boards to ensure that access to training matches regional workforce needs and health demands?
Above all, this Bill is about respect—respect for the taxpayer, respect for the NHS workforce, and respect for a health service that must be planned for the long term, not patched up year on year. This is exactly the kind of reform that the public expect from a Labour Government who are serious about work, contribution and the future of our NHS.
Madam Deputy Speaker (Judith Cummins)
I call the Liberal Democrat spokesperson.
Helen Morgan (North Shropshire) (LD)
I am pleased to welcome this Bill, broadly. It seeks to prioritise graduates from UK and Irish medical schools for foundation and specialty training places. On this point, the Liberal Democrats support the Government, but we have some concerns about how that will be delivered, and about the real-world consequences for our NHS, patients and the doctors who keep our health service going.
Taxpayers invest around £4 billion every year in training young doctors, yet far too many are left competing for too few posts. In 2025, around 12,000 UK-trained doctors competed with 21,000 international doctors for just 9,500 specialty training positions. Many highly skilled young doctors, who were ready to serve in the NHS, were left without a pathway into specialist practice. That is clearly unfair and unsustainable. It is hardly surprising that so many doctors decide to leave the country altogether and seek opportunities elsewhere, where their training and wellbeing are valued. This is a tragedy for them and a tragedy for patients, so prioritisation is right, fair and long overdue.
However, reorganising a queue does not shorten it or make it move any faster. The reality is clear: the NHS has a deep workforce shortage, with crises in some specialties, and this Bill alone cannot solve it. A detailed long-term workforce plan, which ensures that training provides the skill mix that the NHS needs for the future, is required as soon as possible. I look forward to the Minister confirming when that will be delivered.
Shortly before Christmas, the Government committed to 4,000 additional specialty training places in their negotiations with the British Medical Association, including 1,000 that were brought forward, but following the collapse of those negotiations, it remains unclear whether those places will materialise. Patients cannot wait for certainty, and neither can exhausted staff. Will the Minister confirm those places, and go further by addressing other issues that have prevented doctors from working in the NHS, such as restrictive rotas, workplace violence and inflexible working? Dealing with such issues might prevent doctors who have secured specialty training places from moving abroad once their training is completed, ensuring that taxpayers’ money is not wasted, and that doctors with local, relevant experience remain in the NHS.
I turn to the details of the Bill. We have concerns about clause 7(1), which allows Ministers to change eligibility for prioritisation through the negative procedure. That will enable sweeping changes, without proper parliamentary scrutiny, to who can access training places. Given the scale and sensitivity of the NHS workforce pressures, such decisions must not be made behind closed doors, or at the whim of a future Health Secretary with less desirable motives than the current one. That is why the Liberal Democrats have tabled amendments that would require Parliament to approve any future changes through the positive procedure.
We are also troubled by the Government’s decision to apply the new rules part of the way through the 2026 specialty recruitment cycle. The Bill allows for prioritisation at the offer stage for medical specialty training places in 2026. I would like the Minister to clarify in her closing remarks whether this means that international doctors already working in our NHS—who have paid for exams, secured visas and maybe uprooted their life and their family—will suddenly be pushed to the back of the queue, mid-cycle. These doctors keep our hospitals running today. They entered the system in good faith, and it seems unfair to change the rules midway through the process.
I would also be grateful if, in the Minister’s closing remarks, she outlined the expected impact on NHS service provision if people who are deprioritised during the application process decide to leave en masse. Will she give my constituents in North Shropshire reassurance that patient safety and patient outcomes will not be impacted? The Liberal Democrats would prefer implementation to begin in 2027, at the interview stage; that would protect both fairness and patient safety.
Would the Minister elaborate on the impact of the Bill on universities that offer medical degrees elsewhere in the world? I think we have all been contacted by Queen Mary, University of London; the implications for the university may be serious if graduates, who have always been considered UK graduates, undertaking NHS training, and a UK medical qualification registered by the General Medical Council, suddenly have their expectations changed.
As I have mentioned, retention is just as critical as recruitment, but unfortunately it is outside the scope of this limited Bill. In the year to September 2023, 10.7% of NHS staff—about 154,000 people—left their role. Burnout is rife, morale is low and too many staff are working in buildings that are crumbling around them. We have been contacted by GP trainers who are worried that the doctors they are training plan to leave for Australia or Canada as soon as they qualify. The promised workforce plan must address this problem.
International comparisons lay bare the scale of the problem. England has just 3.2 doctors per 1,000 people, which is well below the OECD and EU average of 3.9. We would need 40,000 more doctors to meet that benchmark. Prioritising UK graduates is sensible, but it will not on its own deliver the workforce that patients urgently need. That is why the Liberal Democrats have tabled an amendment requiring a specialty by specialty workforce assessment. Shortages are acute in general practice, radiology, cancer care, mental health and more, and transparency is essential if training places are to be directed at where the need is greatest.
It is neither right nor remotely sustainable that, at a time when patients struggle to see a GP, qualified GPs are unemployed, yet that is happening now, with vacancy freezes and financial pressure creating an NHS in which shortages sit alongside unemployment. The Government’s decision to raise national insurance has only exacerbated the problem, forcing some practices into lay-offs or closure. In my North Shropshire constituency, several GP practices have told me that they cannot take on additional doctors because they are constrained by the outdated physical space in which they operate. The Liberal Democrats would fund 8,000 more GPs, ensuring that every patient could see a GP within seven days, or 24 hours if the need was urgent, because we cannot fix the NHS without fixing the front door.
NHS staff are the backbone of our health service, and they deserve better working conditions and a fair career path. We will continue fighting for an independent pay review body, for safe and modern buildings, for flexible working from day one, and for practical support, such as reduced parking charges, so that staff are not penalised for simply turning up to care for us. We will always stand up for our NHS and the people who make it work. While we support this Bill, we will push to ensure that its implementation strengthens our health service as much as possible.
Jack Abbott (Ipswich) (Lab/Co-op)
It is a pleasure to speak in support of the Medical Training (Prioritisation) Bill. This Bill goes to the very heart of the future of our national health service—the doctors on whom our health service depends. It is about fairness, protecting taxpayers’ money, and building a home-grown NHS workforce that is sustainable in the long term. It is about making sure that those who have trained here have the opportunity to become the next generation of doctors working in our health service.
Every year, it is becoming harder for graduates of UK medical schools to find a place on a foundation or specialty training programme. Since 2019, competition for postgraduate training places has increased by a staggering amount. In 2019, there were about 12,000 applicants for 9,000 places, but in 2025 the situation became even more stark. There are now more than 30,000 applicants, and over 12,000 UK-trained doctors and nearly 21,000 overseas doctors compete for fewer than 10,000 places. That is an enormous and unsustainable change. For some specialties, the competition is much fiercer. Aspiring neurosurgeons, for example, had to compete against 26 others to secure a place, and there were 737 applicants for just 10 cardiothoracic surgery training places.
Those are not abstract statistics, and behind every number is a person who has spent years training, often at great personal and financial cost, only to find their opportunities for career progression drying up. Some take time out, some seek experience abroad and some leave medicine altogether. Many do not have a choice. They are forced by a system that has become so congested that getting a training post in something that they are passionate about and trained in is completely unattainable. Every time a doctor leaves the NHS, there is no guarantee that they will come back.
The Secretary of State is incredibly committed to increasing medical school places, and we desperately need more doctors, but we have to be honest with ourselves: we cannot expand medical school places without addressing the growing crisis of competition for training places. It is within that context that the Medical Training (Prioritisation) Bill must be understood. There has been a direct correlation between the lifting of visa restrictions in 2020 under the Conservatives and the dramatic rise in competition for foundation and specialty training posts. Maybe that was one of the Conservatives’ Brexit bonuses that they so eloquently talked about. This needs to be addressed, because otherwise we risk training doctors for a system that cannot support them. We are recruiting doctors from abroad at a time when there is already a substantial pool of eligible applicants who have trained in the UK or are already working in the NHS. That cannot be right.
General practice is particularly reliant on international doctors, with half of first-year trainees having qualified outside the UK in 2024. Let me be clear, because this point matters enormously: international medical graduates have always played, and will continue to play, a vital role in our NHS. Many of our hospitals and services simply could not function without them. The Bill does not diminish that contribution, and neither does it seek to close the door to international talent, but it does ask fair and reasonable questions. When we are spending almost £4 billion every year to train doctors in the UK, is it right that those doctors are increasingly unable to access the very training posts that they need to progress? Is it right that huge amounts of taxpayers’ money is spent training doctors, only for that investment to be lost when doctors are forced out of the system or choose to go overseas or into the private sector? If we are honest with ourselves, how progressive is it that we poach doctors from countries that desperately need them, while we have our own brilliant and willing recruits who cannot get jobs here?
If we are serious about building an NHS that is stable, resilient and fit for the future, we must also be serious about retention and recruitment, so we must ensure that those we train can stay, specialise and build careers here at home. What is the alternative? We train thousands of talented, hard-working young people at significant public expense, only for them to hit a wall, feel undervalued and leave either the NHS or medicine altogether. Every doctor we train in the UK who chooses to leave is an enormous loss for our health service and our country. It is such a waste of talent and money. We cannot afford to lose our next generation of doctors—the future of the NHS depends on it—yet that is where we are headed unless we do something now. It is urgent.
Prioritisation is not about exclusion; it is about safeguarding public investment and guaranteeing the long-term sustainability of our NHS workforce. It is about ensuring that the NHS remains an attractive place for young doctors to build a career, and that doctors in this country feel valued, which the previous Conservative Government failed miserably on. The Bill sends an important signal to young people in this country considering a career in medicine that we want them to build a long and fruitful career right here in the UK, in our NHS. It says to those currently picking their A-level options or deciding whether a medical degree is right for them that their hard work will be rewarded and we want them to succeed.
The Bill is not a silver bullet. It will not solve every workforce challenge facing our NHS overnight, but it is a sensible and necessary reform that will go a significant way towards dealing with a deeply concerning and growing problem. If we care about the future of our NHS, we must care about the doctors in it and the doctors who will sustain it in the years to come. For the sake of the future health and viability of our NHS, I therefore urge all Members to support the Bill.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
I will start with what is now a traditional declaration: I am a non-practising doctor and my wife is a doctor. I thank the Secretary of State for his comments, and for thinking through the content and merits of my new clause 2, on allocation based on merit. I hope that, as the Bill proceeds through this place and the other place, he continues to focus on that, because it is a very important point. For my Second Reading speech, I am not going to focus on the details of new clause 2—I will hold that back for Committee. Instead, I want to make some general comments.
In a sense, the Bill treats the symptoms of what has been happening in the medical workforce. I do not think it is a cure for the fundamental disease or the problems we have had over the years, which are in part down to a creeping de-professionalisation of the medical profession. I also think they are down to the way we have approached doctors’ appointments to placements, and how we assess their skills and CVs, and how that then leads to different appointments and places. Doctors are thrown from pillar to post, subject to the whims of a computer or a training programme. It has been shown time and again that one of the most important things in people’s eyes, or at least what gives most work satisfaction, is autonomy.
Unfortunately, we have sleepwalked into a situation, in pursuit of a weird type of fairness in the allocation of jobs, that works towards equality of outcome as opposed to equality of opportunity. Doctors have found themselves unable to compete or have control over their lives. Where they are allocated to their foundation school or their specialty training has a real, material impact. Crucially, within allocations, the geographical regions are huge. That means uprooting: moving your family and your social network. In the training scheme there really is no power that a doctor can exert in terms of choice or preference. My understanding—I am a creature of the Nursing and Midwifery Council and the Medical Training Application Service, when I was coming through and applying for posts—is that we just used to let doctors competitively apply for different posts and put together a sort of portfolio CV. That has all changed.
There is now the allocation to training programme schemes and national contracts, which is something I have been campaigning about for quite some time. Do not get me wrong: I think the way the BMA has behaved is absolutely appalling. I categorically and unreservedly condemn the approach that it has taken, and not just under this Government but under previous Governments over various disputes concerning junior doctors. But the fact that doctors have found themselves in a situation where they need to have a militant trade union is a consequence of the training schemes, programmes and national contracts not treating doctors as professionals when it comes to applying for jobs.
It also means that the training providers, the trusts and the integrated care systems, cannot provide options that doctors might want to compete for. They cannot say, “Well, we’re a really good research unit, so we’re going to have an offering that pursues a certain type of doctor who wants to go down the academic pathway.” We do not have trusts or regions that can say, “Actually, this is an area where there is quite a lot of social and economic deprivation, so we want doctors who are interested in certain specialties.”
For all sorts of different reasons, there are parts of the country that are oversubscribed and parts that are undersubscribed. We cannot use what we use in every other walk of life, which is changing remuneration to encourage people to go to other places. We cannot say, “You know what? Let’s look at flexible working arrangements.” As part of my medical school rotations, I was in Barnstaple. I can only imagine that if the trust for Barnstaple had recruitment challenges—I do not know if it does or does not—then it could look at whether people are into surfing or ensuring they could get involved in other activities outside of medicine. Dare I say, as a former doctor, that medicine is important but there are more important things than people’s careers, in particular their work-life balance. We have a system that does not enable that to happen. The behaviour of the BMA is, in a sense, a consequence of dismantling the normal human experience in the approach to the selection and allocation of jobs.
That has real consequences locally. Ashford and St Peter’s, my local trust, struggles to recruit because of the proximity to London, which has London weighting. Since we are on the border of London, to look at it purely financially—if that is the main priority—it makes more sense to pop into London and work than it does being employed in my area. Runnymede and Weybridge, by the way, has house prices and a cost of living that are equal to a big chunk of London, but there is no approach to regionalisation.
I am really glad that the Secretary of State is in his place to hear my contribution. I will say to him something that I have said to many previous Secretaries of State. When he is in those difficult negotiations with the BMA and hears from doctors about the workforce experience challenges that they have, would it not be better if we trusted doctors—and, for that matter, anyone who is subject to a national contract—to make decisions for their own lives, and that we devolve decision around pay and terms and conditions to some form of regional unit? For medicine, the obvious solution would be the integrated care systems, but there could be different solutions and ways of approaching it.
I think ICS devolution would make the most sense, but there are other opportunities to do it. That way, it moves from the Government essentially getting stuck in the middle of doctors, who are making difficult decisions about their careers and having to balance and judge different T&Cs of work, and the employers, which are different NHS trusts, being unable to use the normal mechanism that any other employer would use to recruit and incentivise people. If we do not do that, unfortunately the consequence is a Bill like the one we are debating: ever-increasing state intervention to try, in the absence of a market system, to impose a command economy.
The Secretary will have seen the issues dealing with local doctor prices. The fact that we have struggled with high locum payments for so long is because we do not allow the doctor employment market to resolve itself for adjustments in contracts. The system would save a huge amount of money overall if, rather than having a huge amount of money going to locums and a national contract system for doctors, we let the market sort it out. I will support the Bill, but I see it more as palliation than the definitive treatment that we need to solve the workforce problems for the NHS going forward.
Lewis Atkinson (Sunderland Central) (Lab)
I welcome the Government bringing forward this legislation, and not just in response to the significant concerns that doctors currently have about access to training places, but as an important part of a reset, with a longer-term approach, to ensure that we have an NHS workforce that is fit for the future.
I am going to go off script and respond to some comments that the shadow Secretary of State, the right hon. Member for Daventry (Stuart Andrew), made. He rightly pointed out that the Bill is about prioritisation, not immediate capacity. However, in week one or two of NHS manager school, one of the core techniques that is taught is about capacity and demand modelling. A fundamental assumption about the capacity of our workforce going forward is retention—how long they will work over the course of their careers. The GMC is absolutely clear that an international medical graduate will, on average, work for a shorter period of time in the UK than a UK medical graduate—they are more likely to leave.
I suggest that it is entirely sensible that the Government are bringing in the legislation now, in advance of their NHS workforce planning, because the Bill fixes a core assumption of that plan. To give an example, I have managed cancer waiting lists and, knowing that I have a list of patients I am responsible for, feared that the lower gastrointestinal oncologist who is getting on will announce their retirement without a clear succession plan, as lower GI oncologists are in short supply. This Bill is not just the right thing to do but provides the absolute clarity around medical capacity that will allow the Government to do the proper demand work that is necessary to build the NHS of the future.
Turning to the immediate situation, I have heard the views clearly expressed by medical graduates in Sunderland and across the country about the bottlenecks they face when trying to secure foundation and specialty training places. Many are left in prolonged periods of uncertainty, unable to progress despite years of study.
When we talk about trainees, we risk giving the impression that the contribution made by these talented young people will all be in the future, but of course, in reality, people in training positions provide a huge contribution of direct service to the NHS today, forming the core of the medical workforce in hospitals up and down the country. When I was an NHS operational manager, I had to get to know the new rotation of core, foundation and specialty training doctors every time as they rotated around. Meeting those inspiring and motivated young people was not just a lovely thing to do but a hugely important one, as the day-to-day care of the patients in the specialties I was responsible for was largely provided by the people on those training courses.
That experience also highlighted to me how, over a decade under the previous Government, there was a total failure to put in place a proper care framework for those foundation and specialty doctors, which left UK-trained doctors competing in increasingly crowded pools. We have heard some of the numbers already from the Secretary of State: in 2025, there were more than 30,000 doctors competing for just 9,500 training posts. That is not a system that shows proper regard for the commitment of medical graduates or for their wellbeing, let alone a system that is designed to meet the future needs of the country or the NHS. We invest hundreds of thousands of pounds training each medical student, but too often we fail to retain them. That represents a loss not only of talent, but of public investment.
However, I think it is important, as others have done, to put on the record our recognition of the enormous benefit brought by medical professionals who have chosen to come to the United Kingdom and dedicate their careers to the NHS. I know that will continue even after this legislation is passed. As I always say, healthcare is a team sport, and in my experience, when a team is working together under significant operational pressure, the commitment of everyone in going the extra mile, no matter which country they trained in and what nationality they are, is always exemplary. That is the case throughout the NHS that I know.
The contribution of international medical and wider clinical staff to our NHS is invaluable, and it must never be diminished or forgotten. I know that will continue. It is important, therefore, that the discussion of the Bill is not interpreted as a slight on their contribution or commitment.
In aggregate, as I have said, the GMC has been clear that while international graduates are essential to the functioning of our health services, they are statistically more likely to leave the UK workforce within six years of joining compared with those who train here. That reality makes clear the risk of overreliance on a system that is unpredictable and, ultimately, unsustainable. This Bill is about balance, not exclusion; it is about ensuring that the significant public investment we are making in training doctors in this country translates into a stable and sustainable workforce for the years ahead.
Jim Shannon (Strangford) (DUP)
As others will know, I have raised this matter a number of times in the Chamber. In Wales, for example, the health service pays students’ fees and trains them, and students then have an obligation to stay with the Welsh health service for a period of time. One of my constituents, whom I know well, did just that. She went there, received training and stayed there. What happened, of course, is that she met someone in Wales who she fell in love with, and now she wants to stay there, so we will lose her in Northern Ireland. The point I want to make is this: if paying the fees retains the staff in Wales, should we not also do that in Northern Ireland, Scotland and England? We could do so in this Bill.
Lewis Atkinson
There is some merit in the hon. Gentleman’s proposal, not just for medical training but across the clinical workforce. As Members have acknowledged, we pay significant sums of public money training clinical staff, but the graduates incur significant student debt. If a UK-trained undergraduate student decides to work abroad, the UK taxpayer will have invested a significant amount in their training, and that is then lost. It strikes me that there is an opportunity for the Government to think about the sort of incentive that the hon. Gentleman describes as part of wider workforce planning.
That is pertinent to my next point about the importance of the medical workforce reflecting our wider society, particularly the working class communities of the north-east of England. I want to ensure that a young person doing well at a state school in Sunderland has as much encouragement and access as anyone else in the country to study medicine and, crucially, progress through the ranks to the highest grades. We have heard some talk of international medical schools, but I can absolutely assure Members that there are not state school-educated kids in Sunderland thinking that they will pay privately to study in Grenada or anywhere else.
As the Secretary of State rightly pointed out, there have been welcome improvements on diversity in the NHS, but we often fail to consider socioeconomic background in that. The first line of the NHS constitution states:
“The NHS belongs to the people.”
But sometimes it can feel like it is staffed by a pretty unrepresentative slice of the people, particularly in medical roles.
In that spirit, I recognise the excellent work of the University of Sunderland medical school, which has placed widening access at the heart of its mission. Building on a 100-year history of wider clinical training, the school opened in 2019, shortly before the covid-19 pandemic—a period that starkly exposed our over-reliance on overseas recruitment and underlined the importance of growing our own workforce. By 2022, 47% of the University of Sunderland’s intake were local students, and it now ranks sixth in the UK for student satisfaction.
However, it is no good universities like Sunderland in my constituency doing excellent work on widening participation at recruitment stage if when we get to foundation training and specialty training those students are disadvantaged in competition. In my view, the Bill will help to ensure that talent nurtured by institutions like the University of Sunderland is retained and prioritised for the benefit of our NHS.
I highlight that medical schools such as Sunderland are increasingly placing a huge emphasis on training their medical students in a multidisciplinary environment alongside the trainee nurses and trainee pharmacists of the day, so that they are prepared to work in the multidisciplinary environment that our NHS rightly demands. I am not sure that all international undergraduate courses are always so advanced, so it is right to prioritise this UK-based training approach for the multidisciplinary ethos of the NHS in the future.
Other Members have mentioned the wide variation in specialist training fill rates, and GP recruitment has been mentioned as part of that. It is also worth saying that the national statistics about specialty training mask significant regional variations. The GP specialty training fill rate has been as low as 62% in the north-east of England, and as we have heard, over 73% of applicants for GP specialty training in 2023 were international. That has a disproportionate effect in regions like mine. My constituents want to have the confidence that there will be a stable GP workforce as part of our community for the long term. I cannot tell them in all candour that the status quo delivers that, so we must make changes of the type that the Bill sets out.
I hope that by introducing effective, regulated training pathways, the Bill will improve retention and strengthen workforce planning in our communities, including in areas such as women’s health, where training provision has not kept pace with rising demand. When I look at the shape of the NHS elective waiting list, it is no coincidence that some of the trickiest waiting time problems are in specialties such as gynae, where we have had recruitment and training challenges in recent years.
To close my remarks, I re-emphasise the link between capacity and demand, which I hope the Minister will touch on in advance of the workforce plan. Will she also say a little about the medical training review and the phase 1 report for NHS England and how the Government will work with that?
Katie Lam (Weald of Kent) (Con)
The NHS has a deeply unusual set-up when it comes to its workforce. The Government set the rules for who can qualify as a medical professional, decide how many medical training places to offer and control the flow of medical graduates into the NHS. They decide how much to charge medical students and under what conditions and since the NHS is by far the country’s primary employer of medical professionals, the Government also have effective control over the pay and conditions of those who qualify, and are responsible for deciding where medical trainees go and when. As a result, the health service workforce is not subject to the same labour market conditions as other organisations. The Government control both the supply of and the demand for its own workforce.
It is welcome to see this legislation before us, which rightly gives priority to British-trained doctors for NHS training posts, particularly at the early stages of their career. Those who decide to practise medicine in this country should have reasonable confidence that, if they wish to do so, they can build a career here. The Bill goes some way towards addressing the current situation in which British-trained doctors are being squeezed out of the system in favour of overseas recruits, despite the Government’s control of both the supply of new British graduates and the number of training places.
In 2025, 15,723 British-trained doctors were set to compete for 12,833 NHS training posts. This is already a competitive environment. However, the NHS’s focus on overseas recruitment meant that those British-trained doctors were also forced to compete with another 25,257 overseas trainees. It is clearly absurd that the British Government should restrict the number of training places offered, while also increasing demand for those places through a policy of overseas recruitment, having spent hundreds of thousands of pounds to train each medical student in this country.
That is particularly true when we know that doctors trained overseas are two-and-a-half times more likely to be referred to the GMC by their employer than doctors trained here. Many overseas recruits are hard-working and well-meaning, and many are excellent at the work that they do. Yet we must be honest about the fact that relying on overseas recruits instead of training more medical professionals in this country is not always a like-for-like swap.
Both medical trainees and patients would benefit from a system that trains more doctors here and ensures that those British-trained doctors are given a reasonable chance at moving quickly into an NHS training post. The system should also reward ability and allocate training posts based on merit. The current system of random allocation not only fails to reward our most talented medical graduates but creates profound uncertainty for those at the start of their careers.
Last summer, one of my constituents qualified as a doctor. He graduated with one of the very highest marks in the year—he was in the top three—from one of the most competitive medical schools in the country. He is clearly an outstanding student and will make an incredible doctor. In any sane system, he would have been placed immediately and been able to choose his location and specialism to keep him incentivised and happy within the NHS and to make the most of his obviously considerable talents. Instead, because of the mismanagement of places and the lottery system, he was not placed at all in the first round of allocations. He was not placed in the second, the third or even the fourth round. With fewer than four weeks to go, he still had no placement and no sense of where he would spend the next few years of his life, including whether he might be able to live close to his partner, who was also a doctor and graduating with him.
That is an insane way to treat our most brilliant graduates. I hope the Government will change their mind and amid their other good changes accept the amendment tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), to which I have added my name, to ensure that training places are, in future, allocated on the basis of merit. If the Bill aims to provide certainty to British-trained doctors that they will be able to build a career in this country, which is a noble aim, it should also recognise that the current system of randomly allocating training places is one of the biggest causes of uncertainty in our system. It would be far better for doctors and patients to have a system that instead prized excellence, providing a clear basis on which medical trainees could be allocated and creating a system that rewarded the most talented graduate doctors. It is right that the health service prioritises British-trained doctors. It is also right that, across every area of the public sector, we reward talent, effort and merit.
Ms Julie Minns (Carlisle) (Lab)
I would like to place on record my interest as the mother of an NHS nurse.
It is a privilege to speak in today’s debate and to do so on behalf of my Carlisle constituency, which I am proud to say has recently taken a transformative step with regard to medical training, with the opening of the Pears Cumbria School of Medicine. This new graduate school of medicine is being jointly pioneered by Imperial College London and the University of Cumbria, and I put on record my thanks to Professor Martin Lupton, Professor Mary Morrell and Professor Brian Webster-Henderson, whose vision the medical school is, and to Sir Trevor Pears and the Pears Foundation, whose generosity has made their vision a reality.
As with the Medical Training (Prioritisation) Bill before us today, the Pears Cumbria School of Medicine purposefully prioritises home-grown talent. The school also seeks applications from students from non-traditional backgrounds, encouraging applications from groups that are less well represented in medicine. As part of the school’s commitment to widening access, the four-year graduate programme has no GCSE or A-level requirements. The reason for this approach is simple: it provides the best chance, year in, year out and generation after generation, for Carlisle and Cumbria to produce our own doctors. These doctors will often come from the surrounding communities and, in part because of where they are trained, will be deeply committed to the local area and its people.
In geographically remote areas such as ours, the ability to train and retain our own doctors is critical. It matters enormously. Cumbria faces some of the most entrenched health inequalities in the country. We have struggled for years with recruitment and retention across both primary and secondary care, and our hospital trust relies heavily on locums. We know all too well that the traditional model of medical education, centred on large metropolitan teaching hospitals, simply does not produce or attract the workforce that rural areas such as mine need.
That brings me back to the Bill before us today. The Government are right to prioritise UK graduates for foundation and specialty training places. The Bill represents a significant and welcome step towards restoring confidence in the training pipeline, addressing the growing mismatch between the number of medical graduates and the number of available posts, and ensuring that those who have invested years of training in our NHS are not left without a route on which to progress. It is a sensible, fair-minded reform that will bring much-needed stability to a system that has been under real strain.
For Carlisle and Cumbria, however, the issue is not only who gets priority but where the training posts are located. At present, although foundation training can be delivered locally, it can be delivered only where accredited F1 and F2 posts exist. In Cumbria, the number of those posts is limited. The North Cumbria integrated care trust is able to provide places for some foundation trainees, and others will find F1 and F2 posts in primary and community care settings, but further accredited places will be required at foundation level. I ask the Minister to explain, in her response, not just how the new powers will prioritise UK medical graduates and members of the priority group, but how the powers might be used to widen the availability of accredited F1 and F2 posts in areas such as Cumbria, where there is a shortage of doctors.
Even if we successfully retain Pears medical school doctors in Cumbria for their foundation programme training, the risk of losing them when they come to their specialty training programme is even greater, because doctors will overwhelmingly choose to settle near to where they complete their training, particularly their specialist training, and Cumbria will never be able to provide every specialty training pathway within the county to retain our home-grown talent. We simply do not have the population size or the case mix to deliver all specialisms in our trusts. However, that does not mean that we cannot design a system that keeps trainees connected to Cumbria throughout their training. I therefore urge the Minister to consider how the regulation-making powers granted by the Bill can address that issue.
Pears medical school believes that a new approach to specialist training is the way forward. I recently wrote to the Secretary of State seeking a meeting between him and representatives of the medical school to explore that approach, and I very much hope that he will soon accept that meeting. I also ask Ministers to consider seriously how specialty training can be structured so that trainees who complete F2 in Cumbria are supported to remain based in the region, even if their specialist rotations take them elsewhere for short periods. That could mean funded return-to-base arrangements, rotational models anchored in Cumbria, or formal partnerships between specialist centres in UK cities and community providers in Cumbria. In other words, we need a training pathway that allows people to specialise with Cumbria, not away from it, because if we allow the system to pull trainees out of Carlisle at the very moment they are beginning to put down roots, we will simply recreate and repeat the cycle that has left rural areas like mine short of doctors for too long.
The Pears Cumbria School of Medicine is a once-in-a-generation opportunity to reshape the medical workforce in Cumbria, but it will fully succeed only if training programmes are aligned with its purpose. In welcoming the Bill, I urge Ministers to ensure that its implementation meets the requirements and needs of remote communities. Prioritisation is important, but place matters too.
Madam Deputy Speaker (Judith Cummins)
I call the Chair of the Health and Social Care Committee.
Layla Moran (Oxford West and Abingdon) (LD)
I broadly welcome this common-sense Bill. I am left rather flummoxed that we got to this point, but here we are. It is self-evident that if we pay to train doctors, they should be prioritised and encouraged in all manner of ways to stay in the UK. I understand why we must expedite the measures: talks with the BMA are ongoing and we want to avert strike action. I sincerely hope that the BMA and all resident doctors hear this debate and see that Parliament is listening to them, and that, together, we can avert industrial action, which does nothing to help the recovery of the NHS—fingers crossed that this works.
I will talk about the fears that I have heard about in my postbag. We are here in part because of the lack of a big joined-up workforce plan. We have been talking about such a plan for many years, but the previous one was clearly flawed, no matter which way one looked at it. It is in that context that we are bringing forward this very specific and quite technical point.
However, for resident doctors—formerly known as junior doctors—and for medical students, this is not technical at all; it affects their lives. Marco, an Oxford medical student, wrote to me last year to say that he was
“particularly concerned about the prospect of unemployment from being unable to secure a training position.”
He pointed out that countries such as Canada, the US and Australia already have structured approaches, while England has fallen behind.
Yasmin, another constituent, said:
“I studied for six years and graduated with over £70,000 of debt. I completed my foundation programme in a crumbling district general hospital, where I was routinely overworked and trying to care for patients in corridors under conditions that felt increasingly unsafe. I worked extremely hard to provide the best possible care despite these circumstances. Yet now, after two exhausting years, I find myself unemployed.”
Yasmin told me that many of her colleagues had been forced to take non-medical jobs—in administration, hospitality and other sectors—simply to survive. Some will never return to medical practice at all.
If our brightest and most committed young doctors are worried about unemployment, or are leaving the profession altogether, the system is clearly fundamentally broken and needs reform, so the Bill is a necessary step. Notwithstanding the good reasons to support the Bill, we must be mindful that it may well have unintended consequences if it is not implemented fairly. I am particularly concerned about the impact on overseas doctors who have already made significant life decisions based on the current rules.
Lamia, one of the many medical graduates in my postbag this week, said:
“Over the past two years, I have organised my professional life around the UK’s published requirements, completing examinations, securing GMC registration, and investing significant personal and family savings, even incurring debt. I also declined a stable job opportunity abroad to focus on the MSRA based on the rules at that time.”
She feels that to suddenly change things retrospectively is an injustice. The Government must clarify what “significant experience” means, because this will have an effect on people’s life choices. Perhaps the Minister could indicate that today—are the Government looking at one year, two, five or 10?
There is also the issue of British universities’ overseas campuses, which we have heard about from a number of Members. Graduates of institutions such as Newcastle University Medicine Malaysia, Queen Mary University of London in Malta and St George’s in Cyprus are excluded from the Bill. The vice-chancellor of Newcastle University, Professor Chris Day, wrote to me to say:
“these graduates complete the same medical degree, receive the same accreditation, and the majority then go on to train and work in the UK.”
As these students studied in English to UK standards, they transition into the NHS as quickly and effectively as home-based counterparts. He makes the point that they are incredibly effective very quickly within the NHS.
The Secretary of State explained why these students are being excluded: the Government cannot determine how many overseas campus places these universities will provide. However, to flatter my friend on the Health and Social Care Committee, the hon. Member for Chelsea and Fulham (Ben Coleman)—he is not here, but I know he will appreciate the flattery—he is absolutely right that the Minister could include a tightly drafted exemption for those who have already started those courses. I heard what the Secretary of State said about the fact that the terms and conditions on the website never guarantee a post, but we all know how this works. If we buy a product, understanding that for years and years it has worked a certain way, it cannot suddenly change halfway through. It would only take a year or two for this to wash through the system, so that we do not exclude those who have made the commitment and spent huge amounts of money in good faith, thinking that it would help. There could be some movement here, for a relatively small number of people. I hope the Government are listening to those voices. I am not sure it is a necessary battle, and it could be sorted in future regulations.
The other concern I have, which I have raised with the Minister and with the Secretary of State when he made a statement on the strikes before Christmas, is the signal that the Bill is sending to our overseas doctors. The more that we can all say this, the better: they are absolutely critical to our NHS. The chief executive of the GMC, Charlie Massey, gave evidence to the Health and Social Care Committee last week, and he was clear: doctors who qualified overseas make up around 42% of the medical workforce. Of course, we are not talking about that number, but if even a small proportion now might not want to work in our system, it will leave gaps that we simply cannot fill. Any conversation about prioritising UK graduates should explicitly recognise the immense contribution they make.
I want some concrete answers on this issue. We can keep talking about it, but will any measures be put in place? How will we show our appreciation? We must bear it in mind that these are highly mobile individuals to have come here in the first place. I understand the mantra that this is prioritisation, not exclusion, but if they find themselves excluded from some of the more popular specialisms, they may decide that they would rather leave the country and pursue that specialism elsewhere than stay in this country. We need them. There are potential unintended consequences in the short term. Has any modelling been done of how this might feed through the system? If the impact is negligible, what does that mean in concrete terms? Our Committee’s concern is that losing even a small number could have adverse consequences down the line.
My final point is on the workforce plan. I am confident that the Committee’s letter to the Minister is on her desk, and I hope it will be expedited soon. It would be better to flesh out some of the detail. The Secretary of State set out what the delay is and said the plan will be published in spring. I know that these things change, but we need to know exactly what is happening behind the scenes, so that we can get an understanding of the issues that are now being incorporated that were not there before. I agree we have to get this right. It was not right first time, and we have already had so many workforce plans that I understand why there is scepticism among the Royal Colleges and elsewhere that this one will work. Let us get it right—absolutely—but in the interim, by making such changes without the bigger picture, I fear we will end up doing more damage. England has 3.2 doctors per 1,000 people, but the OECD average is 3.9, and it is 4.5 in countries like Germany. The BMA estimates that we need another 40,000 additional doctors, so the 4,000 places announced by the Secretary of State do not even begin to get there.
The other issue, of course, is the leaky bucket: retention. Every time I meet anyone in the sector they say, “How do you solve the workforce issue?” I understand why the Government focus on training—it is an issue they can dial up when they can—but the thing that really matters is retention. Having a conversation about training places and inputs is essentially turning on the drip of a tap when we have a big hole at the bottom of the bucket. For GPs, we had a session on the shift to community, and if we are going to deliver that, boy do we need home-grown doctors as part of it—I totally get that. According to a survey by the Royal College of General Practitioners, one-third of GPs might leave in the next five years, with stress being the leading factor, and with 44% citing unmanageable stress, and 73% saying that patient safety as a result of the high work load was causing them moral injury. That is mimicked across all the different specialisms, and it is something we need to address. I appreciate that it is not an issue for this Bill, but it has a material effect on whether these measures will solve the problems that the Government say they will.
In conclusion, I welcome the Bill and urge the Government to think again about overseas campuses, even in a short, time-limited, tight way. Let us also say again how much we value our international doctors, and how much we want them to stay. I am looking forward to hearing more from the Minister than just the warm words that I am sure she will provide. What else could we do to ensure that doctors believe that the NHS is a place where their career can thrive, not just make it slightly more bearable than it was before? We all want the NHS to succeed; I am sure they do too and that they want to stay and be part of it.
Jen Craft (Thurrock) (Lab)
People are the backbone of our NHS, and I am incredibly grateful to the healthcare staff who work in it, particularly in Thurrock, and who care tirelessly every day, often in difficult conditions, for my constituents. As a lifelong Thurrock resident, I have experienced their excellent care as a patient, and now as an MP I see at first hand when visiting services in our area that they perform all the time to a high level despite the immense pressure they are under.
This Bill is about supporting our excellent NHS workforce, prioritising home-grown talent to ensure there is a pipeline for the next generation of fantastic doctors and nurses. It is right that it is introduced as emergency legislation, because the former Government left the NHS in a critical condition. The Tories’ botched policies on immigration saw students and junior doctors who study in the UK competing against the world for foundation and specialty roles. Visa and immigration changes meant that thousands more international workers applied for coveted training positions in the NHS. In 2019, there were 12,000 applicants for 9,000 specialty training places. That figure has now soared to nearly 40,000 applicants for 10,000 places, with twice as many overseas-trained applicants as UK-trained ones.
Those bottlenecks mean that we are losing home-grown talent. We are losing people who grew up in our communities, studied at our schools and universities, and know our NHS back to front from personal experience, because they move to jobs abroad or in the private sector. The Bill begins to correct those mistakes. It implements the commitment in our 10-year plan for health to put home-grown talent at the front of the queue for medical training posts, ensuring that UK graduates are prioritised for foundation and specialty training places. It is a signal of this Government’s intent to improve terms, conditions, and opportunities for doctors. It is a downpayment on the tangible progress offered in the deal that the BMA unfortunately rejected in December, and it marks a critical step in supporting long-term sustainable workforce planning for the NHS, ending our—let’s face it—unethical addiction to hiring from abroad. There is also an economic case. Each year, we spend £4 billion on training medical students and doctors, only to not offer those graduates a training place to continue their careers in NHS. By ensuring that we retain that talent, we will ensure that patients in the UK benefit from the investment, which is better for local doctors and the taxpayer.
Retention of staff is particularly vital in Thurrock, where we have a critical shortage of GPs and an acute hospital trust ranked among the bottom in the country. It has always been difficult to recruit doctors to our area, not least because if staff get a job 10 miles down the road—even one mile down the road, in some cases—they can earn significantly more because they will benefit from London weighting. Last year, I held a roundtable with local GPs to ask them why they chose to work in our area and how I could encourage more young doctors to make it their base.
Many young people growing up in Thurrock say that they would like to return home after medical training. They are ambitious to improve our NHS and they want to serve their community. They want to live and work in the area where they grew up. Ensuring that those graduates are prioritised to local places and have local career training, advancing their ongoing professional development, is key to unlocking a sustainable long-term workforce for our area. I urge the Secretary of State to use the opportunity afforded by both this Bill and the upcoming workforce plan to ensure that the right professionals are in the right places geographically, in order to fill historical gaps in provision.
I also urge the Secretary of State to use the workforce plan to ensure that training, recruitment and retention in all professional areas is considered and planned for, particularly in those vital professions that are often overlooked. Allied health professionals, such as speech and language therapists, physiotherapists and occupational therapists, spring to mind and must feature in the plan, particularly those working in paediatric care, where waits for diagnosis are often felt acutely. I add a personal plea for the unique and important role played by learning disability nurses, who are already under strain. The charity Mencap, among others, warns that the role could collapse in three years’ time without urgent Government action. Those nurses are crucial in ensuring that some of the most vulnerable people in our society receive safe, effective healthcare, and in avoiding preventable deaths.
I welcome that the Secretary of State has brought this Bill forward, and the efficiency and speed shown in turning the legislation around at pace. I urge him to use the same efficiency and speed to bring forward the workforce plan, in order to set the right direction of travel to recruit, train and retain home-grown talent. I encourage him to bring forward the workforce plan as soon as possible, to ensure that those gaps in vital provision are addressed and to support our communities through our fantastic NHS well into the future.
Gregory Stafford (Farnham and Bordon) (Con)
At the heart of the Bill is a simple test: does the Bill improve care for patients? Every delay in training, every cancelled clinic and every rota gap caused by workforce instability ultimately lands on the patient. It means longer waits, greater travel distances and, in too many cases, care that comes too late.
I was recently contacted by my Farnham and Bordon constituent, Dr R, as I will call her, who is a UK-trained medical graduate. Like thousands of others, she completed her studies in good faith, expecting a clear and credible pathway into the NHS. Instead, she now finds herself in a system where non-training posts are disappearing, competition ratios for training places are rising sharply and the holding pattern roles that once allowed junior doctors to remain clinically active while reapplying have all but vanished.
This is not a niche concern affecting a handful of individuals; it is a systemic failure that directly impacts patients. When trained doctors are unable to progress, fewer reach consultant and GP level in the years ahead. Services become overstretched, continuity of care is lost and waiting lists grow even longer. That is why I support the intention behind the Bill. Prioritising UK medical graduates, ensuring that the UK foundation programme is genuinely delivered in the United Kingdom and restoring confidence in the medical training pipeline are all necessary steps if we are serious about rebuilding NHS capacity for the benefit of patients.
I have supported amendments to this Bill because they strengthen those aims. They ensure that UK medical graduates are properly recognised as such, that training programmes are UK-based in substance rather than just name, and that allocation of training places is grounded firmly in merit, clinical knowledge, aptitude and performance. Patients, quite rightly, expect their doctors to be selected on ability and doctors expect fairness, and those principles should command support across this House. I also welcome new clause 2, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), which addresses growing concern among doctors and patients about the erosion of merit-based progression. When merit is undermined, morale suffers; when morale suffers, retention suffers, performance suffers, and ultimately patient safety suffers.
As such, the context of this Bill matters. Resident doctors have received cumulative pay rises approaching 30% over recent years—among the highest in the public sector. Despite this, industrial action has continued. It is increasingly clear that the BMA is determined to extract every possible concession from the Government, using sustained disruption as leverage. While I do not align myself with some of the Secretary of State’s more inflammatory language, I do share the realisation he has belatedly reached: that repeated above-inflation pay settlements have not brought this dispute to an end, and that further concessions risk rewarding brinkmanship rather than restoring stability for patients.
However, in pressing its case so aggressively, the BMA has inadvertently shone a spotlight on a genuine and serious problem in the system: a broken training and progression pathway that leaves UK doctors without secure routes into the NHS. That problem is real, it affects patients, and it must be addressed regardless of the outcome of pay negotiations. That is precisely why this Bill matters and why it must not be treated as a bargaining chip, yet that is exactly the risk created by the way in which the Bill is drafted. It will come into force only when the Secretary of State gives permission. In theory, that may appear sensible; in practice, it allows a patient-benefiting reform to be delayed, diluted, or deployed as leverage in negotiations.
Before Christmas, Ministers openly discussed this legislation in the context of talks with the BMA. The implication was clear: progress on training reform was conditional. Now, months later, with industrial action ongoing, it appears that the same dynamic may be emerging again. That approach undermines confidence among doctors and, far more importantly, undermines care for patients. If a measure will improve the NHS for patients and doctors alike, it should be implemented because it is right, not because it is tactically useful. That leads me to a number of questions for the Minister to answer when she responds, which are all grounded in patient outcomes.
Patients need capacity and certainty. They need more doctors progressing through training, not further delays and ambiguity. If the Government genuinely believe that prioritising UK graduates will strengthen the workforce, why is the commencement of this Bill discretionary at all? What assurance can the Minister give patients that these reforms will not be delayed indefinitely while negotiations continue? Patients have already endured significant disruption from industrial action—hundreds of thousands of appointments and operations have been cancelled or rescheduled. Without further pay concessions, can the Minister explain how this Bill will reduce the risk of future disruption, or is she effectively accepting that patients may face continued instability?
There is also the question of scale. The BMA itself has said that the Bill does not go far enough to close the gap between applicants and available training posts. What assessment has been made of how many UK graduates will still be unable to access foundation or specialty training even after this legislation is passed, and what will that mean for patient access to care in the coming years? Patients in many parts of the country already struggle to access GPs, psychiatrists and emergency medicine specialists. How will the Secretary of State and the Minister ensure that these reforms do not inadvertently worsen shortages in hard-to-recruit specialties or underserved areas?
Finally, there is the question of credibility. If this Bill is genuinely good for patients, good for workforce stability and good for the NHS, why should its implementation depend on a ministerial decision at some undefined point in time? Why not give doctors and patients certainty by bringing it into force immediately on Royal Assent? This House has a responsibility to put patients first, not leave patient care hostage to industrial negotiations. That is why I strongly support amendment 1, which would ensure that the Bill comes into force at the moment of Royal Assent. It removes unnecessary delays, ambiguity, and the risk that these reforms will be postponed indefinitely while workforce and pay disputes continue. UK medical graduates, hospitals and training bodies need certainty that the rules will apply from day one, so that allocations, protections for those trained on military postings, and fairness measures can begin to operate without delay. The amendment would ensure that reforms designed to strengthen transparency, meritocracy and the workforce will take effect when they are needed most. That clarity is particularly important given the absence of a published NHS workforce plan.
We need certainty for doctors that delivers stability for services, which in turn delivers better patient care and better outcomes. That is the standard by which this Bill should be judged, and it is the standard it must meet.
Lizzi Collinge (Morecambe and Lunesdale) (Lab)
It is a pleasure to speak in support of the Medical Training (Prioritisation) Bill. We all know that our NHS faces workforce shortages in many specialties. In my constituency of Morecambe and Lunesdale, the workforce problem, combined with other factors, means that my constituents are not seeing the improvement in waiting times that other parts of the country have seen. The progress that has been made nationally is astounding, and we Government Members should be proud of that, but there are pockets where that progress has not been made, and that is unacceptable. I would welcome more conversations with Ministers about how we can tackle that, and I will continue to raise the matter with the local NHS.
Alongside the workforce shortages, we have the bizarre situation that doctors who need training places are struggling to get them, particularly those who are UK graduates. Competition for foundation and specialty training places has grown, partly because of a 2020 change to visas that lifted restrictions on overseas applicants applying for those training places. I would like to believe that that was done in good faith to try to increase the NHS workforce and to plug specialty gaps, but because of how it was done, UK graduates ended up competing, not with perhaps one other person, but with six other people for a training place. That is clearly unhelpful, particularly when we have already invested so much in their education.
Doctors have taken on a lot of debt to go through their initial training. Faced with this level of competition, and unable to continue their training in the UK, many medical graduates are being pushed to seek employment abroad or, even worse, to leave medicine altogether. Pressure is uneven across the system; some specialties are heavily oversubscribed, while some are left with unfilled posts. For example, there is a 15% staffing shortfall in oncology. For many years, I was the deputy chair of the Lancashire health scrutiny committee, so I saw Tory incompetence in the health service in real time. That particular example adds to the litany of their failures in health. Over 14 years, they made us poorer, sicker and less able to get early help.
This Bill addresses the failure to provide training places for doctors, in order to ensure that UK graduates can continue to train in the UK. It introduces a system of prioritisation for UK medical graduates, and will deliver this Labour Government’s commitment to a more sustainable medical workforce. It protects public investment, reduces excessive competition and ensures that our home-grown talent can become the next generation of NHS doctors. No disrespect to the fantastic medics who come from abroad to work here—they do such a fantastic job, and our NHS would not have survived without that immigrant workforce—but prioritising UK-trained graduates would bring us into line with international norms. Favouring domestically trained clinicians helps countries to ensure that they have a stable workforce. To be honest, we should not be nicking other countries’ doctors, particularly doctors from countries with underdeveloped health systems. I do not believe that is in line with our values.
UK taxpayers invest around £4 billion every year in training doctors, so the aim of any sustainable workforce policy should be to see all UK graduates in training posts. A fifth-year medical student who wrote to me aptly described this Bill as essential to safeguarding what he calls
“fair access to training opportunities amongst UK graduates”,
and to ensure that the NHS workforce pipeline survives in the long term.
I am glad to see the Government addressing this issue with the urgency it deserves. Doctors, of course, are only one part of the health service. Many professions work together to care for patients, but doctors are a vital part of the NHS, and we need to ensure that UK medical graduates can progress their careers. This goes alongside all the other work that the Labour Government are doing to make us healthier as a nation, whether on controlling tobacco and vapes, helping people to afford healthy food, or enabling earlier access to primary care. I urge colleagues across the House to support this Bill.
Robin Swann (South Antrim) (UUP)
As I said earlier, I will be supporting the Bill. I thank the Secretary of State and the Minister for their engagement with the devolved institutions on the Bill’s intentions, and on expediting its progress. Its implications for Northern Ireland, and for the medical workforce spanning the islands, are crucial.
As has been discussed, the Bill introduces a UK-wide duty on providers of medical training to prioritise applicants who have graduated from medical schools in the UK or the Republic of Ireland. While health is a devolved matter in Northern Ireland, I entirely recognise that this legislation is essential to preserving a joined-up and UK-wide approach to medical training and recruitment. For too long, we have seen increasing pressures on training pathways, with locally trained graduates facing uncertainties and bottlenecks when moving from undergraduate education into foundation and specialty training. I hope very much that the Bill will ensure that those who trained in UK and Republic of Ireland systems have a clear and reliable route into employment in those same systems.
I welcome clause 4, which refers to the terms “UK medical graduate” and “the priority group”, but am concerned about the drafting of amendment 9, which was tabled by members of His Majesty’s official Opposition. If Northern Ireland were excluded from these arrangements in any way, by default, it would face an invidious choice between accepting increased competition for limited training places and withdrawing from national recruitment altogether. The latter would place a significant administrative and financial burden on local bodies, particularly the Northern Ireland Medical and Dental Training Agency, and could risk undermining long-established recruitment structures.
I welcome the fact that the Bill does not impose additional costs on health services in Northern Ireland, given that the system is under unprecedented financial strain. Instead, it simply changes the order in which applications are considered for existing programmes, and by doing so, it helps to protect the investment made in medical education. However, I seek an assurance from the Minister in connection with a graduate-entry medical school that was created at Magee College back in 2021. The first cohort of graduates came through in June 2025—69 second-degree doctors and surgeons. I hope that nothing in the Bill will hinder their progression into the workforce. I am sure that the Minister has engaged with the Northern Ireland Health Minister on ensuring that there are no impediments to that progression.
Ultimately, the Bill supports locally trained doctors and maintains the integrity of national recruitment systems. I therefore fully support it, along with its extension to Northern Ireland through the legislative consent motion process. I genuinely wish the Minister well, and commend her on the constructive approach taken to recognising Northern Ireland’s devolved competences while ensuring alignment across the entirety of the United Kingdom. However, I will support the Opposition amendment regarding the timing. In my view, this legislation is not just the right thing to do. It is the timely thing to do in order to tackle the issue of workforce recruitment, and it should not be used in any negotiations with the British Medical Association to resolve another issue out there. I seek an assurance from the Secretary of State, as other speakers have done, that the Bill will be introduced in the right manner, because it is the right thing to do.
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.
Dr Beccy Cooper (Worthing West) (Lab)
As always, it is an honour and a privilege to follow my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley), who is a retired ear, nose and throat surgeon. It has been a pleasure to listen to my colleagues in the House debating this Bill. In common with Members from across the House, I absolutely welcome the Bill, and I am glad to see it come forward. I have heard from many of my junior medic colleagues about the issues that my hon. Friend set out so eloquently, and we need to care for our UK graduate workforce.
In recent years, NHS workforce planning has not been done well. There has been an increase in the number of medical students training, which we welcome, but there has not been a commensurate increase in the number of jobs available at the end of that training, which makes no sense. Training is expensive, and UK graduates should be able to access employment at the end of their training. As many Members from across the House have said, there must be recognition that healthcare professionals are part of a global workforce. There will continue to be a natural flow of my medical colleagues heading to other parts of the world to deploy their skills, and there will continue to be a global workforce in our national health service. We should not underestimate the mutual learning that results from this arrangement.
I am chair of the all-party parliamentary group on global health and security. We are undertaking an inquiry with our Global Health Partnerships colleagues on the net benefits to the UK from international recruitment, and at the future reciprocal benefits for both the UK and countries of heritage. The benefits will go both ways; we should not underestimate that. A balance needs to be found, and I think this legislation more than achieves that. We are prioritising UK graduates, increasing the number of placements available, and continuing to recognise international skilled personnel who already have experience of the UK health service, whom we value and do not want to lose. This will of course need close monitoring, alongside implementation of the NHS workforce plan. All that has been said, but I just wanted to reinforce it.
What has not been mentioned in the Chamber this afternoon, and I would like to bring it to the Minister’s attention, is the public health workforce. As a declaration of interest, I am still a public health consultant or specialist on the General Medical Council register. The public health workforce is exempt from the prioritisation in this Bill, because we are very fortunate that public health benefits not only from medical graduates such as myself, but from a non-medical workforce. There are benefits from this mix, and the global nature of public health is reflected in having an international mix, but public health training is hugely oversubscribed in the United Kingdom. So will the Minister give further consideration to this exemption to ensure that UK graduates do not continue to face the issues, which have been so eloquently outlined, currently faced by their medical colleagues?
Dr Simon Opher (Stroud) (Lab)
I will keep this short, because many of my points have already been made. I think that there are two main problems. The first is about priority for our medical graduates. To be honest, I was a little bit surprised when, about a year ago, I found out that they are not prioritised. That clearly is not reciprocated around the world, and we need to change it. The other problem is our training numbers. If we are training medical students up to graduation, we must ensure that the number training fit into our postgraduate training, because otherwise it is crazy, which is the situation we find ourselves in.
I have been a GP trainer for about 25 years, and many of the doctors I have trained as GPS have gone off to Australia. My favourite went to New Zealand and is staying there, although I keep trying to entice her back by saying how great it is that the NHS is improving. GP training is unique. It involves 18 months in general practice in a one-on-one apprenticeship-type system, and I think the system in the UK is one of the best in the world. It teaches continuity of care for patients, and it also teaches the skills that are bringing back the family doctor. This is about the doctor being the gatekeeper to the NHS, and also protecting the patient against the NHS and from over-investigation.
In fact, I always think an MP is bit like a GP, because a GP has to know a little about absolutely everything, which is the same for an MP. I would like to give a shout-out to my Stroud GP trainers group, who visited Parliament last year, and also to the 8,000 GP trainers in this country, who do a fantastic job, often going above and beyond their responsibilities.
I would like to mention international medical graduates—I have had a number of them. At the moment, 50% of those training in the UK are international medical graduates—I understand that in Teesside the figure is 100%—and we are depending on these people to provide some of our general practice. I have had fantastic trainees from India, Spain, Germany and Algeria, who have all become fantastic NHS GPs. As I have said, we must ensure that they are welcome and treasured in the NHS, because they constitute a large body of GPs in our system. Although we need to prioritise UK graduates, we must not put off international graduates from coming and helping us to deliver a new NHS.
I would like to make another point about medical training. Postgraduate medical training goes through a process, and it is important that we recalibrate this so that the number of training spots exactly matches the number of our medical graduates. That is particularly true for anaesthetists. There are bottlenecks in anaesthetics training, and if we could relieve those bottlenecks, we would get more anaesthetists training and could start to bring down our waiting list. However, that will involve a decent workforce plan, which I understand we are developing, and proper planning for the future, so we can get our waiting lists down and deliver a better NHS for everyone.
To conclude, after years of failure and the neglect of our home-grown talent, this Government are taking action so that our doctors can train, stay and serve the communities that need them most. I urge Members to support the Bill.
Jessica Toale (Bournemouth West) (Lab)
This Bill matters enormously in my constituency. The NHS is one of the largest local employers. Our hospitals, community services and care settings are the backbone of our local economy. We also have outstanding institutions—Bournemouth University, Bournemouth and Poole College and the Health Sciences University—ready and willing to provide a strong local pipeline of medical and health professionals. I have met professors at the school of midwifery at BU worried about whether its graduates will get a first placement, specialist nurses unable to progress their careers, and early-career psychiatrists forced to look for work far from home. That is not through a lack of demand for these services in the local area. If we train doctors here, fund their education through British taxpayers and ask them to commit their lives and careers to the NHS, we owe them a fair chance to build those careers within it.
The shadow Health Secretary, the right hon. Member for Daventry (Stuart Andrew), has said that we should not play politics with people’s jobs. I agree, but we must recognise that the situation we are in now is a direct result of the Conservatives’ ill thought-through visa changes in the wake of the mess left by their post-Brexit settlement for the UK. The fact that we now have more than double the number of overseas-trained applicants than UK-trained applicants for a limited position is a consequence of that. Under the Conservatives, we became too reliant on pulling the immigration lever to solve our workforce shortages. Their policies meant that UK graduates are being squeezed out, with too many lost to the private sector or overseas not because of a lack of talent or commitment, but because the system did not work for them. I was proud to campaign on a commitment to train more local young people and to encourage companies to hire locally before looking overseas, and the same should be true for the NHS, so I am pleased that the Bill is doing that.
This is not about blaming or disrespecting migrant workers. International doctors and those from our immigrant communities who work in all elements of our NHS are valued and respected. Immigration has enriched my town. The people who have come to the UK to care for our elderly, nurse our sick and heal our injured are important parts of the vibrant and diverse community that we have in Bournemouth, and I thank them for their service.
We should also be proud that the NHS is a world-renowned employer and a real part of our soft power influence. Countries around the world aspire to the type of universal healthcare offering that we have in the UK, and our specialists train health professionals around the world. For many doctors around the globe, time spent working in the NHS is a badge of honour, but poaching doctors from countries that desperately need them while UK-trained doctors cannot progress is morally wrong. It undermines global health equity and erodes trust here at home. It is right that we prioritise skilling our own people; other countries recognise that reality. The United States, Canada and Australia prioritise domestic graduates for training opportunities.
The Bill is consequential for me, as a Labour MP for a constituency that has never voted Labour before. Bournemouth and Poole are often seen as affluent areas, but they contain real inequalities and serious barriers to social mobility. In places such as West Howe and Alderney, parents tell me that they feel forgotten. They worry that their children do the right things, work hard and get the right grades, but are constantly told that they cannot compete or are locked out. If we want young people from council estates to believe that they belong in medicine, we must back that belief with opportunity. We cannot claim to be the party of social mobility and dignity in work if we do not put the ladders in place.
The Conservative record is clear: expanding medical places without expanding training posts, liberalising visas without the workforce planning and leaving UK graduates to carry the cost. The Bill is a necessary correction. It is fair, responsible and morally right for our NHS, communities and the next generation. To any students or recent graduates considering Australia, I say this: if we get this right, we have beaches that are just as impressive in Bournemouth, even if I cannot always guarantee the weather.
Josh Newbury (Cannock Chase) (Lab)
At its heart, this Bill is about fairness—fairness for the doctors who train in this country, and fairness for the patients who rely on the care provided by our fantastic NHS workforce. Before Brexit, graduates from our British medical schools predominantly competed among themselves for foundation and specialty training posts, but since Boris Johnson’s disastrous visa and immigration changes made under the previous Conservative Government, that picture has changed completely. Doctors trained here are facing huge barriers to progressing their career and caring for patients up and down the country, and many are turning to jobs abroad or within the private sector. That is not because they lack the ability or the commitment, but because of how the system was left to drift by the previous Government until it has got to this point of being set up against our graduates.
We hear a lot about the doctors who train here but then end up going abroad, but we hear a lot less about the concerns of the doctors who remain here in the UK. They are passionate about our NHS and want to dedicate their careers to it. They want to build their lives here, but all too often they find that they simply cannot secure a training post. This is not a new problem; it is a reality that has been behind the flight of doctors overseas for many years. But only now do we have a Government who are committed to tackling it. I commend the Health Secretary not only for bringing forward the Bill, but for committing to bring in changes as swiftly as possible.
Our NHS and our constituents are missing out on our home-grown talent because of the previous Government’s changes to immigration, which led to the so-called Boriswave. As we have heard, international medical graduates contribute hugely and are welcome, but visa changes have had a destabilising effect on British-trained doctors who now face double the competition for every single post. We are training more doctors now than ever before, but we have failed until now to match that ambition with a system that supports them. As we have heard, we spend around £4 billion a year training doctors in the UK, a huge investment of public money, and it is only right that taxpayers see that investment translating into doctors building their careers in our NHS.
The prioritisation to which the Secretary of State referred is about sustainability and keeping things fair for our UK-trained graduates, not about shutting out international talent. The NHS is rightly proud to be a major international employer and people from around the world will continue to bring vital skills to our health service. Of course, anyone who can apply now will still be able to apply. But many countries from which we are recruiting also desperately need their own doctors. We should be proud that people want to come and work here, but it is morally unacceptable to pinch doctors from other countries that need them, meanwhile leaving our brilliant and willing resident doctors unable to get training places.
The Bill builds on action that the Government have already taken to boost the NHS workforce. When the Government came into office, we heard concerns from GPs and patients alike about a dire need for more GP surgery capacity, while many qualified GPs were out of work. Labour removed the red tape around the additional roles reimbursement scheme and more than 1,000 additional GPs have since joined our primary care workforce. When the Government heard from nurses who were just about to qualify and struggling to find work, despite a clear and chronic need for more nurses, they brought in the graduate guarantee. Now the Government are acting again.
Following the Secretary of State’s constructive approach to negotiations with the BMA, he offered a package of support, including quadrupling the number of specialist training posts being created in the coming three years and funding resident doctors’ Royal College exam and membership fees. Despite a rejection of that deal, he is making good on his commitment to put British graduates back on a level playing field, giving them a fair shot at taking the next step in their careers, with competition ratios that are reasonable and workable.
The Bill will ensure that the NHS retains the talent it has developed through excellent medical schools such as Keele University in Staffordshire, rather than losing that talent to overseas recruitment or forcing doctors out of the profession altogether. The BMA has welcomed extending prioritisation to the foundation programme, which the Government expect will significantly reduce the number of placeholder offers faced by final-year medical students. I hope that as their members vote on whether to take further strike action, they will see that the Government do not make pie-crust promises. We are taking the steps we said we would take to fix the issues that they have raised.
I know that the Bill will not fix every workforce challenge overnight, but it is certainly a big step in the right direction. It will reduce competition for training places and, most importantly, send a clear message to resident doctors who trained in this country: if you want to progress your career here, the Government will back you. For those reasons, I am proud to support the Bill.
Danny Beales (Uxbridge and South Ruislip) (Lab)
I thank the Secretary of State and the Minister for the Bill, which delivers on the promises made previously in this place in response to the proposed industrial action a couple of months ago. It is welcome to see the pace with which the Government have moved in progressing these important changes. It shows their commitment to backing doctors and medical professionals in this country.
There is a lot to welcome in the Bill’s provisions. Members have talked at length and with a lot of personal and professional expertise about the challenges of the medical training system. As a member of the Health Committee—alongside the Chair, the hon. Member for Oxford West and Abingdon (Layla Moran), and others who have spoken—we often hear about the need for a proper workforce plan to address the NHS’s long-term issues with training and development, which frankly have failed staff and patients.
It is important to reflect on, as others have, the important and vital contribution that doctors and nurses from around the world have made. That is the case in my constituency at Hillingdon hospital, and in GP and community-based health services. My mum recently had a stroke and, fortunately, recovered from it at University College London hospital in central London. As ever, it was doctors, nurses, speech therapists and allied healthcare professionals from almost every country around the world who helped and supported her to recover. I am sure that they will continue to serve our national health service with dedication and commitment, and I am sure that the whole of this House is thankful for their service.
As we have heard, however, it is absurd that thousands of British doctors trained by our NHS at great expense, funded by the British taxpayer, are currently unable to find jobs in the NHS after graduation. In a time of crisis for the NHS, we do not have a penny to spare, and every pound needs to go even further. It is a great waste of talent and capacity, and it is not fair to young doctors in the system, who are being beaten to entry-level NHS positions by doctors from overseas with decades of experience.
Vikki Slade (Mid Dorset and North Poole) (LD)
I wonder if the hon. Member has given any thought to residents such as George and Dennis in my constituency, who are both British citizens, brought up here, but went to work abroad either because they are dual citizens and wanted to be able to learn in two languages, or because of the covid delays. They will not be included in these measures. Does the hon. Member think they should be included within the second tier of graduates from places like Iceland and Liechtenstein? Does he have any views on whether we should be excluding British citizens?
Danny Beales
I am about to turn to a specific issue about British citizens, so I hope I will pick up on the hon. Member’s points. More generally, there is nothing progressive about a system that promotes a brain drain from some of the most deprived and underdeveloped communities in the world, with significant health needs. To have doctors and nurses come from those systems on an industrial scale, and to take away the resources spent in those systems on education and training for our benefit in a western, developed country, is not progressive. It is important to welcome the provisions in the Bill that address those challenges.
As the hon. Member for Mid Dorset and North Poole (Vikki Slade) raised, I will press the Secretary of State—and the Minister for Secondary Care, who is now in place—on the specific language of the Bill, which seeks to prioritise graduates from medical schools in the United Kingdom, rather than UK citizens who are medical graduates.
Like other Members, I have been contacted by a number of my constituents who will be affected by these provisions. That includes Alisha, a British citizen who was schooled and grew up here; her family live in Ickenham in my constituency, and she is a first-year medical student at Queen Mary University of London’s campus in Malta, which my hon. Friend the Member for Stevenage (Kevin Bonavia) mentioned earlier. When she enrolled last year, she was given a guarantee by the university that she would face no disadvantage compared with students on the London campus.
We have heard that there can never be any guarantees; that there is not a legal contract that this Government make with individuals; and that this House is sovereign, and can make different decisions. But I think there are issues of fairness around the retrospective applications of decisions that we make that can affect people’s lives, particularly at crucial points, such as when studying or getting a job—decisions that have major impacts on someone’s future life chances.
Alisha studies a British curriculum and she will be awarded the same degree qualification as her peers on the London campus. However, if the Bill’s current wording is interpreted strictly geographically instead of institutionally, it would mean that she is categorised as an international medical graduate, despite being a British citizen, studying a British medical degree at a British university.
I ask the Secretary of State to take away this point and, with officials, to look at this specific issue in greater detail and at modelling and sharing the number of UK citizens projected to be affected this academic year by those changes. If, as has been suggested by Queen Mary University, this is a matter of 40 or 50 individuals, I ask the Secretary of State to look at whether further changes could be made to ameliorate the impact on UK citizens, at least in a transitional way, that would not bind us in future academic years. I also ask that officials have discussions with Maltese counterparts about our important and ongoing strategic relationship in health and other key areas.
To conclude, there is much to welcome in this Bill. I know that medical colleges and societies strongly support many of the provisions. I hope that they will be the start of a broader process of a comprehensive workforce plan that will address the many challenges in workforce planning, training and development and the numbers of bottlenecks that exist throughout the workforce system so that we have a training and development system for medical professionals in this country that delivers both positive results for patients and better and fairer outcomes for those applying to study, learn and train.
Neil Duncan-Jordan (Poole) (Lab)
As the final contributor from the Back Benches, I shall try to strike a slightly different tone from the rest of the debate.
Over the past few days, I have been contacted by a number of constituents who are likely to be affected by today’s emergency Bill. One of those is Dr Khan, a resident doctor at Poole general hospital’s emergency department. He trained overseas and has been working in the NHS for almost three years. He also has a young family living in my constituency. As an international medical graduate working in the NHS, he is concerned that the proposed emergency legislation on UK medical graduate prioritisation will have a negative impact on people like him. Although I support a sustainable domestic medical workforce, implementing these changes mid-cycle in 2026, after applications have closed and commitments have been made, is, I believe, a breach of procedural fairness.
My constituent has raised further concerns that I would also like to share. The technical proposal to use immigration status such as indefinite leave to remain or citizenship as a proxy for NHS experience is both blunt and unnecessary. The Oriel application system already specifically collects data on whether an applicant has more than six months of NHS experience, and this existing evidence-based metric should be used to prioritise those already contributing to our health service rather than relying on immigration status.
Many of Dr Khan’s colleagues have relocated to this country and planned their lives based on the rules in force when the applications opened in late 2025. To change the rules now, while we are in the middle of the interview window, will cause immense personal distress and undermine our long-standing commitment to fairness.
There is also a genuine risk to the workforce. Our NHS relies heavily on our international staff, and today’s Bill risks damaging the UK’s reputation as a fair employer. It could lead to an exodus of skilled professionals that the NHS, in my view, cannot afford to lose.
When the Minister responds, will she consider providing clear transitional protections for the 2026 cohort who are already here? Will she further consider that any new criteria should be implemented prospectively for 2027 and that any measure of NHS experience should utilise the data already collected, rather than blunt immigration-based proxies?
A few days ago, I submitted a written question on the impact that the proposed changes to rules around indefinite leave to remain for health workers would have on the viability of the NHS 10-year workforce plan. The response from the Department was that no such assessment had been made. I fear that we are now making the same mistake again. Those who are already here and making a contribution need to be acknowledged for their service. I would welcome any assurances that the Minister could give to Dr Khan and all those like him who are already a valued part of our NHS.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I am pleased to respond on behalf of the Opposition, but first I should declare my interest as a consultant paediatrician and member of the British Medical Association.
Medicine is a vocation, but it is also an art and a science, and training takes a long time. After, in general, five years as a medical student, new resident doctors need to train further in a specialism such as orthopaedics, ophthalmology or, in my case, paediatrics. Postgraduate training varies in length and structure among the specialties, but in broad principle it is divided into a foundation programme and more specialist training. The foundation programme is two years long and teaches a variety of skills. Specialist training is more specific, and there are well over 60 different specialties that people can choose from. It is those two phrases—the foundation programme and specialist training—that the Bill refers to.
We are in a situation where there has been a huge surge in the number of applications per training post. One reason for that is the substantial increase in the number of medical school places. That was caused by action by the previous Conservative Government to improve the number of doctors in the long term. The previous Government opened five medical schools—at Sunderland, Anglia Ruskin, Kent and Medway, Edge Hill and, very close to my constituency, Lincoln. The first students at those universities graduated in 2023, 2024 and 2025, which increased the number of students looking for posts.
At the time there was also a widespread expansion of existing medical school places—and, of course, there was the pandemic. During the pandemic, students who had applied for medical school and accepted offers found themselves unable to take their exams, and teacher-assessed grades meant that there was a huge increase in the number of successful applicants who got the grades they needed. There were more compared with the number that was statistically expected. The Government lifted the cap, and there was a huge number of medical students in that period. Many of them qualified last summer. That is why there is a huge increase in the number of local graduates.
In response to my hon. Friend the Member for Farnham and Bordon (Gregory Stafford), the Secretary of State talked about his pledge to double medical school places, but there does not appear to have been an increase in the number of medical school places this year, and a statement from the Department for Health and Social Care at the weekend suggests that it is not a Government commitment. When the Secretary of State was asked whether he stands by his pledge, he seemed to say no, so I would appreciate it if the Minister clarified that issue.
In 2024 at a visit to the Royal Derby hospital, the Secretary of State said that that site would be part of delivering the doubling of the number of medical school places that Labour is committed to in order to ensure that the NHS has the staff it needs to treat patients on time. He then encouraged people to vote for that in the 4 July general election. Will he clarify whether he stands by his pledge, and if so, when does he expect to start delivering on it?
UK factors are not the main cause for the rise in numbers. The BMA has published figures from freedom of information requests that show that the number of UK graduates applying for training programmes went up from 9,273 in 2023 to 12,305 in 2025, which is an increase of about a third. Over the same period, the number of international medical graduates applying for specialist training went from 10,402 in 2023 to 20,803 in 2025, which is a doubling of applications.
The surge in numbers has left British graduates facing unemployment. Some may pursue careers overseas and not return. The valuable contributions from international medical graduates are appreciated, but many complete training and return to their home nation, which could leave us with a potential shortage in the long term of consultants and GPs.
The Government are right to step in to prioritise local talent. As such, we support the principles behind the Bill. However, there are some issues that we have questions about. First, the foundation programme applications are in progress. An application window closed on 8 October, and pre-allocation outcomes were due in mid-December. Foundation school applications due on 26 February are also to be delayed. The foundation programme website states that allocations can only occur once the Bill receives Royal Assent. That delay in itself, and the uncertainty associated with it, is difficult enough for young doctors and their families. Yet the Secretary of State creates an extra layer of uncertainty by adding clause 8 and the right to withhold activation of the Bill to a day of his choosing. Why is he doing that?
What are the foundation programme and the people who run it to do? Should they wait, based on, “Will he, won’t he?” and, “When will he allocate it, when will he not?” Should they allocate places anyway, on the basis, as has been said already, that people need to know where they will live and sort out their arrangements? Or will they have to reallocate if the Secretary of State activates it, after it was allocated on the basis that he had not done that yet? That is not the way to treat professional, hard-working people.
As my hon. Friend the Member for Farnham and Bordon said in his speech, this is not just about doctors; it is about patient safety now and in the future. The Conservatives have submitted an amendment that would activate the Bill on Royal Assent. I urge the Secretary of State to do what is right for the country and for patient safety and support it.
Secondly, Labour has forgotten the British people—those we represent and should prioritise. I will say more as we consider the specific amendment, but under Labour’s Bill, foreign nationals completing a primary medical degree in Iceland, Norway, Liechtenstein, Switzerland and the UK are in a priority group. Yet a British citizen who trained in the USA, Canada, France or even the Malta campus of a UK medical school are not.
The hon. Member for Sunderland Central (Lewis Atkinson) talked about the likelihood of international medical graduates leaving the UK after training, but surely that is an argument to ensure that British trainees are prioritised wherever they have trained—if the degree is suitable. The Conservative amendment ensures that British people are always front and centre, and we urge the other Opposition parties to back it. The issue of British citizens was raised earlier too. I want to clarify for the avoidance of all doubt that when we say “British citizens” we mean those from England, Wales, Scotland and Northern Ireland.
There are other clarifications, which I will be grateful if the Minister can address when winding up. On military doctors, what position is in place to ensure that military resident doctors are able to access the posts that they need? What impact will the Bill have on them, particularly if, as the world is more dangerous now, they spend more time overseas in future than at present?
As Conservatives, we believe in meritocracy and, as such, I support new clause 2 tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). We all want excellent doctors and—I will say more about this in Committee—a random allocation does not encourage excellence. It produces stress and uncertainty, it does not encourage excellence, so I support the amendment.
We agree with the principle of the Bill, but we encourage the Government to accept amendments that encourage excellence, to think through the detail, to put politics aside and do what is right for the country, to prioritise British citizens and to activate the Bill immediately on Royal Assent.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to close on behalf of the Government. I welcome the support of the Opposition spokespeople and the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran). I put on record my thanks to them for meeting me in advance of the Bill and for airing their concerns.
From the many contributions this afternoon, there is clearly a broad base of sympathy and support right across the House for the measures in the Bill to support our NHS staff, who have been at the sharp end of every ill-conceived policy of the past 14 years—not least since the previous Government lifted the visa restrictions in 2020, as outlined by my hon. Friend the Member for Bournemouth West (Jessica Toale). The last Government’s failure to do any proper workforce planning has also led to patients struggling to find a GP appointment while GPs struggle to get a job, bottlenecks for resident doctors and an over-reliance on overseas workers and a refusal to foster our own home-grown talent.
Although I welcome the support, I find it slightly ironic that some of the Opposition speeches were around the need for clear and consistent routes and for clarity. That is exactly what we intend to provide to fix the mess. We will bring forward wider issues in the workforce plan, which, as the boss said earlier, will be in the spring. That is as a result of the concerns around training from the Royal Colleges and other stakeholders and making sure that we do that properly. We will bring that forward in due course.
Karin Smyth
I am going to make some progress. Time is of the essence, I am afraid, but we can pick up more in Committee.
When I was a manager in the NHS, I worked alongside many overseas doctors, and I want to make it clear from this Dispatch Box this afternoon that they are, of course, welcome here. The NHS is and always will be one of the most diverse employers in the world. This Bill is about bringing future generations into the health service and giving them the secure future that we all know they need. It is about sustainable workforce planning so that patients are no longer at the mercy of the market. Crucially, it is also about fairness. How is it fair that every year the taxpayer picks up a £4 billion bill to train medics who cannot then get jobs? Those taxpayers deserve a return on their investment. How is it fair that medics in this country put themselves forward to train, make sacrifices, get into debt and work long hours only to find themselves trapped in bottlenecks?
I am going to try to address a number of colleagues’ points. I commend my hon. Friend the Member for Sunderland Central (Lewis Atkinson), for his experience and for outlining the capacity and demand issues that people like him have to face as managers, and also for his important point about our workforce needing to reflect our society. He talked about the great work being done in Sunderland, and I was pleased to meet the leaders there, including Dr Wilkes, to see the work they are doing so that we can take that elsewhere. That is exactly what we want to do.
I also commend my hon. Friend the Member for Carlisle (Ms Minns)—the mum of a nurse, as she told us—for putting on the record the work of the Pears Cumbria School of Medicine and the intention of growing doctors who are steeped in Cumbria. She also mentioned health inequalities, and I would be pleased to meet my hon. Friend to discuss those issues further. My hon. Friend the Member for Thurrock (Jen Craft) was right to highlight the soaring numbers of people we are losing and to recognise that it was all going back to front.
Why do we need emergency legislation? We need Royal Assent by 5 March at the latest to ensure that the change happens this year. We do not want medics to face another year of bottlenecks. Specialty training offers will be made from March, and any delay will risk vacancies in August. This emergency legislation gives the NHS the certainty and stability it needs to carry on bringing down waiting lists and to keep us on the road to recovery. The people applying for those posts need enough time to make decisions about their lives, including deciding where they will move, finding accommodation and sorting childcare, and they deserve enough time to get on with that.
A number of colleagues have raised the definition of prioritisation for training posts. Let us be clear that, for specialty training posts starting this year, we will prioritise UK medical graduates and others, using their immigration status as a proxy for having significant experience of working in the health service. Colleagues might wonder whether there has been some pulling of strings to include Irish doctors in that prioritisation, but I can assure them that that is not the case. Ireland is included because of our special and long-standing relationship with Ireland and very similar epidemiology. I thank the hon. Member for South Antrim (Robin Swann) for the important points he raised about Magee College and working with the devolved institutions. I can assure him that officials have worked closely with officials in Northern Ireland on this. If there are any other issues, he should please raise them, but we have worked closely on that point.
From next year, 2027, immigration status will no longer automatically determine priority. I accept some of the points from my hon. Friend the Member for Poole (Neil Duncan-Jordan) . He perhaps suggested that the proposal was crude, but it is a proxy for this year. Next year we will bring forward regulations to prioritise whether someone has significant experience as a doctor in the health service or by reference to their immigration status. This point was raised by the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon, and many others. We will continue to work with all partners and the devolved Governments to agree those criteria in time for the autumn application round.
On international staff, my hon. Friends the Members for Birmingham Edgbaston (Preet Kaur Gill) and for Uxbridge and South Ruislip (Danny Beales), the Chair of the Select Committee and others raised the issue of foreign doctors. Let us be clear that international staff play an important role in our NHS and they always will. The NHS might be the most diverse public body in the world, and we would not have it any other way, but we are recruiting doctors from abroad—sometimes even from countries that are short of medical staff—when there is already a pool of applicants at home.
As my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge) said, we are not about nicking other people’s workforces. Home-grown doctors are more likely to work in the NHS for longer, and be better equipped to deliver healthcare tailored to the UK’s population, because having been trained in the UK’s epidemiology, they better understand it. It is not fair for British taxpayers to spend over £4 billion training medics every year, as my hon. Friends the Members for Worthing West (Dr Cooper) and for Cannock Chase (Josh Newbury) said. Nor is it fair for doctors who struggled to get into specialty training places. As my hon. Friend the Member for Birmingham Edgbaston said, a responsible Government get a grip on this.
I will refer to the amendments when we move into Committee of the whole House. We are seeing the green shoots of recovery as we repair the NHS following the damage done over the past 14 years. We are turning another page on that decline. However, the decision in 2020 to lift visa restrictions has done untold damage to the system and to staff morale, and contributed to a national mood of cynicism and pessimism, especially among the young, so we need to act. Those points were articulated well by the hon. Member for Weald of Kent (Katie Lam), and expertly, as always, by my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley).
Let me end my remarks by talking about the many young people who will be affected by the changes that we are setting out. As my hon. Friend the Member for Ipswich (Jack Abbott) said, these are not abstract statistics but personal costs. When I speak to those in my family, my constituency and even my parliamentary office who have breached the first barrier of getting to a medical school from a state school, I am disheartened to hear how many of them feel that their careers would be better served by moving abroad. In the 1970s, James Callaghan said that if he were a young man, he would emigrate. I do not want young people to take that path; I would rather say to them, “By all means, travel, see the world and enjoy that time, but there are great opportunities for you all in this country, and we want you to rebuild the NHS with us.” My niece is currently in Australia, and we sometimes call this the “bring Talia home Bill”.
The NHS must play its part in training our young people and keeping top talent in the UK. If colleagues agree that that is worth doing, and if they want to keep our people here, they should join us in voting for the Bill.
Question put and agreed to.
Bill accordingly read a Second time; to stand committed to a Committee of the whole House (Order, this day).
Medical Training (Prioritisation) Bill
Tuesday 27th January 2026
(1 day, 13 hours ago)
Commons ChamberMedical Training (Prioritisation) Bill 2024-26 Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Committee of the whole House Amendments as at 27 January 2026 - (27 Jan 2026)
19:12 - The Committee divided: - Ayes: 91 / Noes: 378 - Question accordingly negatived.
19:26 - The Committee divided: - Ayes: 61 / Noes: 311 - Question accordingly negatived.
19:39 - divided: - Ayes: 88 / Noes: 310 - Question accordingly negatived.
The First Deputy Chairman of Ways and Means (Judith Cummins)
I remind Members that in Committee they should not address the Chair as “Deputy Speaker”. Please use our names. Madam Chair, Chair or Madam Chairman are also acceptable.
Clause 1
UK Foundation Programme
Question proposed, That the clause stand part of the Bill.
The First Deputy Chairman
With this it will be convenient to consider:
Amendment 6, in clause 2, page 1, line 16, at end insert—
“(e) persons within subsection (3),”.
This is a paving amendment for amendment 7.
Amendment 7, page 2, line 6, at end insert—
“(3) A person is within this subsection if they—
(a) were actively employed as a doctor in the NHS or Health and Social Care Northern Ireland on 13 January 2026; and
(b) had submitted a valid application for a UK specialty training programme for a start date in 2026 before the day on which this section comes into force.
(4) For the purposes of subsection (3), “actively employed” includes, but is not limited to, persons on fixed-term Trust Grade, Clinical Fellow or Staff, Associate Specialist and Specialty Doctor contracts.”
This amendment would require applications to specialty medical training in 2026 from those already employed in the NHS to be prioritised.
Clause 2 stand part.
Clause 3 stand part.
Amendment 10, in clause 4, page 3, line 2, at end insert—
“unless that time was spent outside the British Islands as part of a posting with the UK armed forces.”
This amendment would include within the definition of a UK medical graduate anyone who spent all or part of their training on a military posting outside the British Islands.
Amendment 9, page 3, line 3, after “are” insert
“a British citizen or are”.
This amendment would require British citizens to be prioritised for places on UK Foundation programmes and for interviews and places on speciality training programmes from 2027 onwards.
Clause 4 stand part.
Amendment 8, in clause 5, page 3, line 30, at end insert
“,provided that the majority of training for the programme takes place in the United Kingdom.”
This amendment would require a UK Foundation Programme to be a programme for which the majority of training takes place inside the United Kingdom.
Clause 5 stand part.
Clause 6 stand part.
Amendment 2, in clause 7, page 5, line 1, leave out paragraph (a).
This amendment, taken together with amendment 4, would provide that regulations made under Clause 3 are subject to the affirmative procedure.
Amendment 3, page 5, line 24, leave out “section 3 or”.
This amendment is consequential on amendments 2 and 4, which provide that regulations made under Clause 3 are subject to the affirmative procedure.
Amendment 4, page 5, line 40, after “under” insert—
“section 3 (regulations describing persons who may be prioritised for specialty training programmes from 2027 onwards)”.
This amendment, taken together with amendment 2, would provide that regulations made under Clause 3 are subject to the affirmative procedure.
Amendment 5, page 6, line 19, at end insert—
“(6) Before laying before Parliament a draft statutory instrument containing regulations under section 3 the Secretary of State must obtain the consent of—
(a) the Welsh Ministers, if the draft regulations contain provision which would be within the legislative competence of Senedd Cymru if it were contained in an Act of the Senedd;
(b) the Scottish Ministers, if the draft regulations contain provision which would be within the legislative competence of the Scottish Parliament if it were contained in an Act of the Scottish Parliament;
(c) the Department of Health in Northern Ireland, if the draft regulations contain provision which—
(i) would be within the legislative competence of the Northern Ireland Assembly if it were contained in an Act of that Assembly, and
(ii) would not, if it were contained in a Bill for an Act of the Northern Ireland Assembly, result in the Bill requiring the consent of the Secretary of State.”
This amendment would require the Secretary of State to obtain the consent of the relevant devolved government before laying draft regulations under section 3. It is consequential on amendments 2 and 4.
Clause 7 stand part.
Amendment 1, in clause 8, page 6, line 23, leave out from “on” to the end of line 24 and insert
“the day on which it is passed”.
This amendment would bring the Act into force on the day on which it receives Royal Assent.
Clause 8 stand part.
New clause 1—Report on impact—
“(1) The Secretary of State must lay before Parliament an annual report on the impact of the provisions of this Act.
(2) A report under this section must include—
(a) an assessment of the impact of the provisions of this Act on the number of applications for places on—
(i) UK Foundation Programmes, and
(ii) UK speciality training programmes, and
(b) if the assessment under paragraph (a) concludes that there has been a decrease in the total number of applications attributable to the provisions of this Act, an analysis of the potential impact of that decrease on the number of fully qualified doctors working in the NHS and Health and Social Care Northern Ireland, including specific analysis of the impact on the number of general practitioners and on each medical specialism.
(3) The first report under this section must be laid before 31 December 2029.”
New clause 2—Allocation of individual places on merit—
“(1) This section applies to the allocation of individual candidates to specific places on a UK Foundation Programme or a UK specialty training programme, whether that allocation takes place in the course of deciding offers of places or otherwise.
(2) A person who has a function of allocating places on a UK Foundation Programme or a UK specialty training programme must ensure that, once the prioritisation requirements set out in sections 1 to 3 of this Act have been applied, those allocations are based on an assessment of the applicants’ merits.
(3) For the purposes of the assessment of the applicants’ merits, a person may take into account—
(a) the candidates’ educational achievements,
(b) the candidates’ clinical performance,
(c) structured assessments of relevant skills and knowledge,
(d) the candidates’ research, leadership, management, quality improvement, and teaching skills, and
(e) the candidates’ knowledge relating to the place being allocated.”
This new clause would require the allocation of candidates to specific training places to be decided on an assessment of the candidates’ merits, after the prioritisation requirements in clauses 1 to 3 of the Bill have been met.
New clause 3—International students—
“(1) The Secretary of State must report annually to Parliament on the impact of the provisions of this Act on the numbers of international students at UK medical schools.
(2) This report must include an assessment of the financial impact on medical schools.”
This new clause would require the Secretary of State to report to Parliament annually on the impact of the measures in this Act on the numbers of international students studying at UK medical schools.
The Minister for Secondary Care (Karin Smyth)
In the interests of time, I will address the amendments at the end of proceedings, when I have heard from them—I think we have the gist of most of those issues. I restate our firm commitment to the Bill and all clauses.
Let me turn to clause 4 and clarify how we are defining “UK medical graduate” and “the priority group” for the purposes of the Bill. “UK medical graduate” in this context excludes those who have spent all or the majority of their time training for their medical qualification outside the British isles. This means that if a person has obtained a primary UK qualification but has studied mainly overseas, they will not be eligible for prioritisation as a UK medical graduate unless they fall into another group that is to be prioritised under the Bill. While internationally educated graduates from overseas remain an important part of the workforce and can continue to be recruited under the Bill, we are committed to growing home-grown talent, who are more likely to work in the NHS for longer, and to be better equipped to deliver healthcare tailored to the UK’s population.
Clause 8 sets out the territorial extent of the Bill and deals with commencement. The Bill extends to England, Wales, Scotland and Northern Ireland, and we have worked closely with the devolved Governments to ensure that it meets all needs and provides consistency. We are grateful to them for their support in bringing these measures forward so quickly. The Bill will engage the legislative consent motion process, and the devolved Governments have committed to commence this process in their Parliaments.
To ensure that the systems, planning and operational capacity required for successful implementation are in place, the Bill will be commenced
“on such day or days as the Secretary of State may by regulations appoint.”
As the Secretary of State outlined on Second Reading, this is an important fail-safe to ensure that we are not in a position in which a law is enacted that we cannot implement effectively at the time. I am happy to expand on that after we have discussed the amendments, but the key issue is the ability of the NHS and training providers to deliver the measure. That is why we have a fail-safe; we first need to be very clear that the NHS is in a position to deliver. Members have talked about the strikes. Those would be one consideration, and there are many others. We are asking the NHS and training providers to do something very difficult very quickly, and in order to ensure that they have the capacity and capability to do it safely, we are reserving the right to commence the Bill at a later date, rather than at the end of this Session. I will come back to the amendments when I close the debate.
The First Deputy Chairman of Ways and Means (Judith Cummins)
I call the shadow Minister.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I will speak to the amendments tabled by the Opposition. First, amendment 9 would require that from 2027, priority is given to British citizens on UK foundation programmes, and that they are prioritised for interviews and places on specialty training programmes. Clause 4 defines a UK medical graduate as a
“a person who holds a primary United Kingdom qualification within the meaning of the Medical Act 1983 (see section 4(3) of that Act)”.
However, it does not include
“a person who spent all or a majority of their time training for that qualification outside the British Islands.”
The Secretary of State has stated his intention to prioritise UK medical graduates, but he has failed to protect all British citizens in doing so. Our amendment would ensure that British citizens who study on an eligible medical course overseas were still prioritised in the Bill. There are many scenarios in which we may need to ensure that we protect British citizens. Consider, for example, a spouse, partner or child of a serving member of the UK armed forces who completes relevant training overseas while their relative is posted in Cyprus; a student at Queen Mary University of London who has completed the bachelor of medicine and bachelor of surgery course at its Malta campus but received a UK medical degree; a young British citizen who has studied in the US or France, owing to a family relocation; or, given that the largest bottleneck is not in training places but in getting a place in medical school at all in some cases, a British student who has gone to study overseas because of their fervent desire to become a doctor.
Those are all entirely possible and plausible scenarios in which British citizens have completed their relevant training, and wish to bring their skills back and to relocate in their homeland for the rest of their career, but may not be covered by the Government’s prioritisation model. The Government’s prioritisation model is based on where the degree was taken, rather than also considering who did it. The Secretary of State must ensure that we do not overlook our own citizens if we are to fairly address the competitive landscape for training posts. The Opposition therefore urge the Government to accept amendment 9.
Amendment 10 is a probing amendment to explore the effects of the Bill on military personnel. As a Member of Parliament representing an area with a large armed forces community, I know that medical trainees are an integral part of our serving community. The world is becoming an increasingly dangerous place, and junior trainees may be sent abroad earlier in their career than is currently the case. It is clearly wrong to penalise people who are doing brave work caring for our armed forces. They ought to be provided with optimal opportunities, and the Secretary of State has a duty to ensure that they are not overlooked. I would be grateful if the Minister covered that in her response.
New clause 3 would require the Government to make an annual report to Parliament about the Bill’s impact on the number of international students at UK medical schools, and the financial impact on UK medical schools. We talked about the bottleneck, and the balance between UK and international students training at UK medical schools; clearly, becoming a UK graduate will now come with a significant premium. What impact will that have on British children getting to make their choices and become doctors if they want to? What incentives does it provide to universities to increase the number of international students, and what effect will that have overall on UK medical schools?
New clause 2, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), is about places for UK foundation and speciality training programmes, and the importance of allocation on merit, because we all want the very best doctors. When I became a doctor—believe it or not, it was 25 years ago this year, Madam Deputy Speaker—I applied for a job as a junior house officer, as it was called then. I applied for the jobs I wanted, I was interviewed by the consultants who would have been supervising my training, and then I was offered the jobs.
The experience of students today is very different. They are allowed to put in a preference and say which deanery or foundation area they would like to work in, but that is all. After that, the application goes into a computer system, which gives them a single rank that is not based not on anything they have done at university, or on whether they got good results or worked hard, or anything like that. The computer system will do a first pass, and if the first choice is available, it will give the student their first choice. If it is not available because by the time its gets to that student those places have gone, the computer system will miss the student and go on to the next one. When it has completed its full pass of the list, it will start again, and when it comes to that student next time, it will give them the highest preference that is still available.
Once the student has been allocated a foundation deanery, the process starts again within the locality, and I mean “locality” in the loosest possible sense. Take those applying for the Trent rotation; they could be posted in Lincoln, Boston, Nottingham, Derby or Burton. The doctor has no control over where they will go, and very little ability to express a preference. My hon. Friend the Member for Weald of Kent (Katie Lam) spoke about a student in her locality who had not been able to get a place, despite being at the top—third, I think—of their university class. It is clearly not fair to give people no opportunity to control their future. By the way, there is no right of appeal, so having been given their place, the choice for the student is: that place or no place.
The hon. Member for Sunderland Central (Lewis Atkinson) spoke about ordinary children from the north-east. Having once been an ordinary child from the north-east, I agree that it is important that people have opportunity, but it is equality of opportunity, not equality of outcome, that matters. I worry that the system creates equality of outcome. We therefore support new clause 2, tabled by my hon. Friend the Member for Runnymede and Weybridge.
Amendment 1 would require the Bill to take effect on the date of Royal Assent, as opposed to a date at the discretion of the Secretary of State for Health and Social Care. The Bill is deemed necessary emergency Government legislation to prioritise medical graduates in the United Kingdom for places on medical training programmes. When he announced the Bill in an attempt to avert industrial action by resident doctors in December, the Secretary of State told the House that he had been working intensively with his team to
“to see how quickly we could introduce legislation”—[Official Report, 10 December 2025; Vol. 777, c. 430.]
However, the Bill does not commit to a date when these measures will be enacted. Instead, the power lies in the hands of the Secretary of State, giving him a clear bargaining chip for future negotiations. It is clear that the Government intend to pass this legislation urgently, as they have said. However, without a commencement date, there are clear concerns that the Bill is just a negotiating tactic to prevent industrial action by resident doctors, and can be scrapped at a later date. There remains the prospect of further industrial action, despite the legislation being introduced. The Secretary of State should not be asking Parliament to pass a Bill that he has no intention of enacting if the British Medical Association plays ball and holds off on strikes. Either the Secretary of State thinks that this is emergency legislation that we need to get on with and enact, or he does not.
It is vital that the legislation is enacted straight away, because students are due to be given their training programme places now, and they need to decide where they are going to live. They cannot put their life on hold, and measures to prioritise UK doctors cannot be held off, until the Secretary of State has finished dangling a carrot in front of the British Medical Association. The Opposition are clear: while we are supportive of the principles of the Bill, it must be used for offers made this year.
Amendment 8 would clarify that under clause 5, a UK foundation programme is a programme where the majority of training takes place inside the United Kingdom. A foundation programme is defined as
“an acceptable programme for provisionally registered doctors”
in section 10A of the Medical Act 1983. It is vital to clarify that a UK foundation programme is a programme where a majority of training takes place inside the United Kingdom. That is because the General Medical Council can approve foundation programmes overseas. If it is not explicit that a foundation programme needs to be in the United Kingdom, a loophole is created whereby a foundation programme could be approved overseas, creating a back way into the system and circumventing the measures that the Government have tried to put in place. I encourage the Minister to look at that carefully as the Bill progresses.
In summary, we support the Bill, but we have concerns about some of the clauses, so we have tabled amendments that we hope the Government will look at carefully.
Helen Morgan (North Shropshire) (LD)
The amendments in my name raise concerns about the Bill’s impact on fairness, transparency and the smooth functioning of the NHS, notwithstanding the Liberal Democrats’ overall support for the Bill.
Clause 7(1) would allow Ministers to change who is eligible for prioritisation through the negative procedure, meaning that such changes could be made unilaterally, without meaningful scrutiny. In practice, that hands the Secretary of State the power to redraw the boundaries of opportunity, and to decide who gets prioritised for medical training places, without Parliament ever having a say. That is unacceptable for a decision that affects people’s lives and careers, as well as the future capability of our health service. While I do not doubt the intentions of the Secretary of State and the Front Bench team, it opens the door to the risk of political whim or prejudice influencing who gets access to career-defining opportunities in the future. That is why the Liberal Democrats have tabled amendments 2 to 5 to reverse this, and to ensure that any changes must be subject to full parliamentary consent.
On the timing of the Bill’s implementation, the Government intend to apply the new prioritisation rules midway through the 2026 specialty recruitment cycle. Let us reflect on what that means in practice. Doctors already working in the NHS have entered this cycle under one set of rules. They have paid for exams, secured visas, arranged travel, uprooted their families and committed themselves to the NHS. To change the rules halfway through the process would not only be potentially destabilising for services, but very unfair to those individuals, many of whom are plugging urgent staffing gaps right now.
We already face real workforce pressures, so the last thing our NHS needs is a wave of dedicated doctors forced out by uncertainty, or pushed to leave the country because the Government moved the goalposts after applications had already begun. For this reason, we believe that the Bill should come into force from 2027. We must protect frontline services and protect the integrity of the applications process. To address the problem directly, we have tabled amendments 6 and 7 to safeguard those already in the 2026 application cycle, ensuring that they are not deprioritised, because that is a simple matter of fairness.
We have also tabled amendments to improve the transparency and long-term impact of the Bill. Across the NHS, we face severe shortages, not just in general practice but in radiology, oncology, mental health services and many other specialities.
Helen Maguire (Epsom and Ewell) (LD)
Last year, research by the Royal College of Radiologists found that 76% of English cancer centres had patient safety concerns due to workforce shortages. While we welcome the Government’s recent commitment to ending the postcode lottery of cancer care, does my hon. Friend agree that the Government need to publish an assessment of the Bill’s impact on doctor numbers, broken down by speciality, to ensure that cancer treatment is not delayed because of staff shortages?
Helen Morgan
I thank my hon. Friend for her point, which I agree with fully. That is why we have tabled new clause 1. It will require the Government to publish a report on the Bill’s impact on the number of applicants to foundation and speciality training programmes and, crucially, to break that down by speciality. If applications fall as a result of these changes, the Government would be required to assess the impact on the total number of fully qualified doctors entering the NHS. This report would be produced annually after three years, allowing time for a full training cycle to complete. It is a sensible safeguard, one that ensures that we do not inadvertently exacerbate the very workforce shortages that we are trying to address. To return to the core principle that is at stake, we are not opposed to the Bill’s objective. We support the principle of prioritising those who have trained in the UK, but that principle must be implemented fairly, transparently and with proper oversight.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
As always, Mrs Cummins, it is a pleasure to serve under your chairmanship. I rise to speak to new clause 2, which stands in my name and is supported by many other Conservative Members. I declare again that I am now a non-practising doctor and my wife is a doctor.
I believe that ambition should be encouraged, and success should be dependent on the talent and hard work of the individual. However, in a vocation where we really want to encourage and support the brightest and the best, the signal being beamed out by the NHS and its various arms and quangos is unfortunately quite different. We have already seen this over the years in how the NHS treats competence and excellence among doctors—someone could be the best doctor in the world and be treated exactly the same as someone who is just about competent. No other operation would approach employment, and celebrating and supporting success, in that way.
I do not think, though, that I have ever seen as egregious and extreme an example of completely ignoring talent and merit as the preference informed allocation system. The shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), has laid out some of the details behind that system, but I encourage Members across the Committee to read about how preference informed allocation works—about the soulless, computerised, algorithmic method by which it allocates human beings a random number. That random number is then the sum total of those people’s dreams, hopes and ambitions when it comes to placements as they take their first steps into their medical career. To me, PIA looks better suited to the dystopian sci-fi programmes that I enjoy watching—better suited to “Logan’s Run” or “The Prisoner”, in which people are allocated numbers. It is not the way that we should be treating people in this country, and it is outrageous that such a system has been brought into force. We in this House should stand up for merit, and I really hope the Minister will affirm from the Dispatch Box today that the Government will dismantle this awful scheme.
Karin Smyth
I am grateful to Members for their contributions to the wider debate at this hour and for their considered amendments. I will respond briefly to their points and the amendments that have been tabled.
Amendment 6 and 7 would widen the scope of who is prioritised for specialty training starting in 2026 by prioritising applicants who worked as a doctor in the health service on 13 January. Although we welcome the intention to recognise the importance of internationally trained doctors, we cannot accept the amendments at this time. They would mean that the Bill was ineffective in delivering on its intention to tackle bottlenecks and ensure that we have a sustainable medical workforce that can meet the needs of the population.
I remind the Committee again that the Bill does not exclude anyone. In particular, there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, which historically attract fewer applicants from the groups we are prioritising for 2026. International medical graduates also continue to have opportunities in locally employed doctor roles. That could lead to NHS experience that might count towards future prioritisation as we look to make regulations to set criteria for what is considered “significant” NHS experience from 2027.
Amendment 10 would ensure that members of the armed forces are not excluded from prioritisation due to having undertaken medical training while on posting outside the British islands. We cannot accept that amendment as we believe it is not necessary. That is because medical cadets do not spend time outside the British islands as part of their UK medical degree. While cadets undertake their elective with the military, which may be overseas, that is no different from other civilian medical students, many of whom undertake electives overseas. As such, we do not believe that medical cadets are disadvantaged by the Bill.
Amendment 9 would include all British citizens within the priority groups so that British citizens will be prioritised for the purposes of the foundation programme and specialty training from 2027 onwards. It has no effect for 2026 specialty training, as British citizens are already prioritised by virtue of their immigration status. We therefore cannot accept the amendment. To do so would risk a significant increase in the pool of prioritised doctors who would compete with UK-trained doctors. The amendment would incentivise the expansion of the market for overseas medical schools, including medical schools working with foreign Governments to grow the overseas campus sector. That could offset any increase in postgraduate training places and undermine workforce planning. While British citizens will be prioritised for specialty training places in 2026, this is a proxy that is necessary for practical reasons. From 2027 we want to prioritise applications with experience and training based in the NHS.
Again, prioritisation does not mean exclusion. International medical graduates who are not prioritised will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers. However, it is important that we do not incentivise actions that will undermine the Bill. This Bill will reduce competition for places for UK-trained doctors so that home-grown talent can become the next generation of NHS doctors.
Amendment 8 would limit the definition of a UK foundation programme in clause 5 to include programmes only where the majority of training has occurred within the UK. Although I understand the desire to do that, the number of doctors on a foundation programme within the meaning of the Medical Act 1983, but where the majority of training occurs outside the UK, is very small. Indeed, we understand that there is only one such active training programme. There are fewer than 25 doctors on that programme this year, of which fewer than five applied to continue their training in the UK. As such, there is no material impact on the Bill, so we do not think amendment 8 is necessary. However, we will keep the situation under review.
Amendments 2, 3, 4 and 5 would change the procedure for making regulations to set additional priority groups for specialty training from 2027. The regulations would prioritise additional groups based on criteria indicating that a person is likely to have significant experience of working as a doctor in the health service or by reference to their immigration status. To be clear on our intention, the Bill sets out the groups of people who are to be prioritised for specialty training from 2027 onwards. The delegated power is limited to adding to that list by reference to their having
“significant experience of working as a doctor in the National Health Service”,
or immigration status. Although I am sympathetic to the desire for more parliamentary scrutiny, as outlined by the hon. Member for North Shropshire (Helen Morgan), we believe that, due to the limited scope of the power, the negative procedure is justifiable. I therefore encourage her not to press those amendments to a Division.
Amendment 1 would change the commencement of the Bill—from being commenced by regulations to being commenced automatically on Royal Assent. As my right hon. Friend the Secretary of State outlined, the commencement clause is important, and I have addressed that point. It is a failsafe that, given the tight timeline for introducing the Bill, will ensure that we are not in a position where a law is enacted that we cannot implement effectively for whatever unforeseen reason.
As I have said, there is also the question of whether it is even possible to implement prioritisation if, for example, the strikes are ongoing, given the strain that they put on resources and the impact that could have on delivery of the Bill. Because our objective is not just to move quickly but to get this right, these considerations are key to the commencement of the Bill, which is why the Government believe that we need to be able to commence the Bill when it makes sense to do so. For those reasons, we cannot accept the amendment.
We do not think that new clauses 1 and 3 are necessary, because the data is already published, or, as we have said, we would be seeking to monitor the impact. New clause 2 would require the allocation of individual candidates to foundation and specialty training places on merit, once the requirements to prioritise certain applicants had been met. We consider the new clause to be unnecessary at this time because existing systems for recruitment to foundation and specialty training already assess the applicants on many of the merits outlined by in it. The Bill does not alter that; it simply ensures that UK medical graduates and other eligible applicants are prioritised.
Karin Smyth
I am coming to the hon. Gentleman’s point. We will keep the current system under review—I think the Secretary of State was clear about that—but we think that any change is best made through established guidance rather than through legislation.
Many Members raised the issue of our relationship with Malta and Queen Mary, and the work that is done there. That relationship is clearly important. We have a great deal of work ongoing with Queen Mary, in the medical field as well as others. We are not excluding anyone. We are making sure that the prioritisation works in the best way possible, and we will of course keep all that under review. I thank hon. Members for their constructive debate on this important legislation.
Question put and agreed to.
Clause 1 accordingly ordered to stand part of the Bill.
Clauses 2 and 3 ordered to stand part of the Bill.
Clause 4
“UK medical graduate” and “the priority group”
Amendment proposed: 9, page 3, line 3, after “are” insert
“a British citizen or are”.—(Stuart Andrew.)
This amendment would require British citizens to be prioritised for places on UK Foundation programmes and for interviews and places on speciality training programmes from 2027 onwards.
Question put, That the amendment be made.
Karin Smyth
I beg to move, That the Bill be now read a Third time.
I will not use this time to rehearse any of the arguments made today. We have had some good discussions. I want to thank the Leader of the House, the Chief Whip, parliamentary counsel and business managers, the public servants in my Department and NHS England, who have worked so hard to bring this together, and the devolved Governments for their support. They really have worked well together to bring this important measure to this place.
I am also grateful to all colleagues for scrutinising the Bill so thoughtfully and thoroughly during today’s proceedings and, as I said previously, for meeting me last week to go through some of the provisions. It shows that Parliament can put its shoulder to the wheel and get stuff done in the public interest. We act in the public interest because we were elected on a mandate to fix our broken NHS and make it fit for the future, and we will not succeed in that goal without our workforce, who are and will always be our greatest asset.
When I worked in the NHS during the Lansley reforms, I had a front-row seat to see their devastating impact on staff morale. I saw that patients bore the brunt of some of that collapsing morale. When our workforce does well, our NHS does well. That is why we are working to restore confidence and renew belief among frontline staff. The Bill is another step on that journey, and I urge colleagues to come with us and see it through.
Question put and agreed to.
Bill accordingly read the Third time and passed.