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Lord Patel
Member’s explanatory statement
This amendment, and others in the name of Lord Patel, seeks to ensure that UK medical graduates are prioritised above other categories of eligible applicants.
Lord Patel (CB)
My Lords, I will speak to my amendments listed in group one. My amendments should be underpinned by the status of UK medical graduates. The competition to get into medical schools in the United Kingdom is one of the toughest of any country. The ratio of success is about 4:1, with the highest A-level grades obtained, including many at A*, but requirements are higher than that.
At completion, on average, a UK medical graduate has a loan of about £72,000, and it is important that we debate this Bill in that context. I have retabled my amendments from Committee for two reasons. The first is that the debate that we had in Committee concentrated—rightly, maybe—more on international medical graduates or graduates from UK university campuses and not so much on the UK medical school graduates, who seem to be losing out on getting training posts. We have all received many emails from UK graduates and international medical graduates. I, presumably because I had amendments in my name, seemed to receive many more from UK medical graduates. Some noble Lords may have seen a petition on the internet addressed to us, Members of the House of Lords, to pass this Bill unamended, from UK medical graduates. I gather that there are over 4,500 names attached to that petition now.
So why am I putting forward these amendments again? Most other countries—the USA, Canada, New Zealand, Australia, Singapore and the EU—prioritise their graduates for further training and even employment. Data from the GMC, NHS England, the royal colleges, the BMA and professional journals shows—I accept there is variation, including in how the data could be interpreted—that graduates from the UK find it difficult to get into core and specialist training programmes, for a variety of reasons. They include: increased output from medical schools, which will increase even more in future years; an increase in post-2019 visas for international medical graduates; and training slots have not increased, with the workforce plan increased to accommodate more doctors.
In the UK doctors’ pay negotiations, one of the primary reasons that they gave was that training was an issue. A second issue was working conditions and a third was pay. I have said publicly in this Chamber before, and I repeat now, that I do not subscribe to any doctor at any time withdrawing their services from patients, for no matter what reason. I therefore do not agree with junior doctors going on strike. Despite the fact that they may have a legitimate reason to complain about their training issues, it is still no reason, as far as I am concerned, to withdraw services from patients.
UK training of doctors has three stages: foundation years 1 and 2; core training; and specialty training, including GP training. The GMC informs me that foundation year one training is available to all graduates who graduate from UK universities, although sometimes they find it difficult as the slots are not available until the last minute. Usually, that ought not to be a problem. In my case, it was two weeks before I had to start the job that I secured a position to do surgery in Penzance, having qualified in St Andrews. It was not a place that I had visited before, but I got through it.
In a 2024 report, the GMC says that, in 2023, 77% of doctors completing foundation year 2 did not or could not enter core training. A lot of them, around 13%, had decided not to, I gather, and may have gone overseas. In 2017, international medical graduates whose primary medical qualification was overseas were 47% of those registered with the GMC; in 2023, this was 68%. The 2023 GMC report said that 40% of doctors entering specialty training were international medical graduates.
It is important that we have opportunities for international medical graduates to come to train in the United Kingdom and have employment status in the NHS. But UK doctors should have a fair shot at being able to compete fairly. UK doctors comment that, after foundation year 2, entering specialty training is like falling off a cliff; it is difficult for them to get into specialist training.
NHS England, in annex 3 of its briefing on the Medical Training (Prioritisation) Bill, says that the potential impact will be an application total of 21,000 for about 10,000 posts, a ratio of 2:1. In 2025 round 1, 28,000 of the 80,000 applications were deemed appointable, according to that document. On competition, annex 4 says that, despite lower competition ratios, over 2,000 appointable UK graduates did not receive an offer in round 1 of 2025.
The expectation, therefore, is that there will be 16,000 UK graduates, a slight increase from last year, applying for core and specialty training, and 26,000 international medical graduates, also a slight increase from last year. That is 42,000, although the NHS England number is 47,000. There is always a variation in the numbers, for reasons I cannot explain. Nonetheless, the ratio is 4:1 for 10,000 slots. The estimate is that 8,000 UK graduates may be forced out of the coming rotation year as they may not have appointments.
The passage of the Bill will mean that priority groups of doctors will also apply for these training slots. I could not find a number for what effect that will have, but maybe the Minister has numbers on how many more doctors will be able to enter specialist training if the priority groups in the Bill are included. So UK graduates, with the expansion of priority groups, will have further competition.
An NHS England publication, with a foreword from Dr Powis and the Chief Medical Officer, says that
“the current bottlenecks in training do not benefit anyone; while some competition has always been a necessary part of medical training and career progression … the current ratios are making sensible career planning and assessment”
for, in my words, UK doctors
“very difficult”.
That is why I put my amendment where I have. I know the later amendments will discuss graduates from other UK campuses being eligible for the priority group, but I will refer to that later. I beg to move.
Lord Hunt of Kings Heath (Lab)
My Lords, the noble Lord, Lord Patel, made some very interesting points, and I am interested in hearing my noble friend the Minister’s response to his amendments. I doubt I have had as many emails as the noble Lord, in view of his expertise in the whole area of medical training and development, particularly at postgraduate level, but it is hard not to feel sympathetic to both sides of the argument. I feel for those doctors trained overseas who thought they were on a pathway to being accepted for specialty training in this country and have had the rules of the game changed half way through.
Equally, though, as the noble Lord, Lord Patel, pointed out, we have the ridiculous situation of growing competition from overseas doctors while UK-trained doctors are finding it very hard to get specialist training. This goes to the wider question about this country’s overreliance on doctors from overseas, and the current recruitment from Africa gives me particular concern about the ethics of this process.
Baroness McIntosh of Pickering (Con)
My Lords, I will speak in support of the amendment in the name of the noble Lord, Lord Patel; I thank him for the background research he has done on the amendment. The Minister will be aware that I work for the Dispensing Doctors’ Association. My father and brother were GPs and my uncle was a surgeon; I could not stand the sight of blood, so for the greater good I went into the legal profession instead.
The Minister and the noble Baroness, Lady Blake, sitting beside her, know of my interest in this subject, particularly in relation to junior doctors in training. As we have heard, they do not have a sufficient number of specialty job vacancies offered to them, and they have no security of tenure. They are of an age—probably in their late 20s and early 30s—when they would hope to put down roots, form relationships and start families. It is particularly key that we look after them.
I had one point of difference from the noble Lord, Lord Patel: I thought the consultants were quite well rewarded in their pay round. I hope they will support the junior doctors in their pay round, because it is very important that the profession sticks together in that regard. I agree with the noble Lord that it is very unfortunate if they feel they have to go on strike, which obviously disadvantages patients, hospitals and other staff.
When the Minister responds to the debate, can she explain to me what there is in the Bill, if we do not adopt this amendment, to cover the specific set of circumstances that the noble Lord has identified? If there is nothing in the Bill, will she come forward at Third Reading with something that covers these points? This exercises a number of us very deeply. We have to give the right message, particularly to young, male, white doctors, who may otherwise leave the profession. In general practice, a number of partners are leaving and going to work in Australia, New Zealand and Canada after they have completed their training and possibly after five or 10 years of experience. For the future of the profession at every level, we need to take this set of circumstances very seriously.
Baroness Finlay of Llandaff (CB)
My Lords, I declare an interest as a UK graduate and as a pro-chancellor of Cardiff University, which has a very large medical school.
The ethics issues raised by the noble Lord, Lord Hunt of Kings Heath, are really important when we look at the Bill. What is our ethical role in attracting people—literally—and pulling them from places that have a terrible shortage of any medical provision whatever?
Another aspect that my noble friend Lord Patel brought out so clearly is the problem of career progression. I hope that, in summing up, the Minister will reassure us that the Bill is step one in sorting out the medical career progression for people in this country. Only this weekend, I heard of a large teaching hospital that has two consultant posts coming up, for which there were 28 appointable applicants, many of whom are already consultants. There is a real bottleneck for trainees who have gone right through their training programme and done all their exams. Broadly, there are two ways of progressing: run-through training, which provides some security, and training at a postgraduate level, where they have to reapply before they move on. The problems of geography for young people, or for parents with children who are settled, are absolutely massive.
I have been worried that the pay story hides huge problems and unhappiness, particularly in relation to the lack of teams in the way that training has been organised. I am referring not to Teams on the internet but to clinical teams where people know that they belong, where they know the person they can contact and where there is longer continuity. There has been a fault by the medical royal colleges—I hold my hand up, having been involved in some curricula in palliative medicine—in that we have overstepped different bits of experience and undervalued the importance of people coming through.
While I support these amendments from my noble friend Lord Patel, it is important to remember that some on international medical training programmes have no, or almost no, communications skills training or training in medical ethics. In fact, there are some where they have no clinical experience of any note until they pass their almost totally theoretical exams and then they have to gain all the clinical experience later. I am not passing any judgment on the quality of their medicine later on, and they may have a better scientific foundation, but we are not comparing like with like in the process.
I hope that the Minister will be able to assure us that Oriel, as an appointments and selection process, will have a much more subtle way of looking at the experience that people have and not just crude categories, because it will be important that we do not select away excellence in the name of the medical school that somebody graduated from. There is a spectrum of quality in every medical school output cohort. There are some who are superb, and there are some who, frankly, might have done better not getting into medicine in the first place—it may be a small number—but among graduates from other medical schools there will be people with superb experience and who turn out to be excellent. We see some of those in very senior positions in medicine across the UK.
The prioritisation message needs to be subtle, and it needs to look at the full employment history from graduation, including applicants’ NHS experience and the quality of their work during that. Apparently, the system can automatically calculate a lot of this, drawing on GMC data as well. There is a lot of work to be done by this system in relation to the data held by the GMC, and there is a lot of work to be done by the royal colleges.
Lord Stevens of Birmingham (CB)
My Lords, I declare my interest as chair of King’s College London. I think that there is a welcome consensus that the UK should aim for self-sufficiency in the production of new doctors through medical school, specialty training and into the NHS. In fairness, the last Government deserve credit for having taken the decision to expand medical school undergraduate intake to put us on that path. It was also not unreasonable, as a temporary measure, to make use of selective international recruitment while those new doctors came through the system, not least as the independent Migration Advisory Committee reported at the time that, in respect of doctors,
“there is sufficient and overwhelming evidence of a UK-wide shortage”.
Given that it takes perhaps 15 years for new medical students to come into independent clinical practice, telling patients to hang on for 15 years while that intake fed through the system would not have been good, certainly for patients.
However, the issue now is that, clearly, there needs to be better prioritisation during the transitional system. We spent a lot of time in Committee discussing the pros and cons of what that transitional prioritisation might look like, but one question that has not yet been completely resolved, which would aid the House in assessing the proposals that the noble Lord, Lord Patel, has put before us, is whether we could have a clear answer from the Minister as to what the increase in the pipeline and in the availability of specialty training places is going to be for the current year and over the next three years. As she pointed out to us in correspondence during recess last week, the NHS 10-year plan that the Government published last July talked about an additional 1,000 specialty training places over three years. However, the Secretary of State for Health and Social Care put on the table the proposition of not 1,000 but 4,000 additional specialty training places over three years, of which an additional 1,000 would become available in this coming year. That is what was put on the table in the discussion with the BMA on 10 December. Given that it is only a few months until these posts are filled, presumably the Minister must know the answer to the question: exactly how many additional specialty training places will we get for the year ahead so as to reduce the prioritisation problems with whichever criteria the Bill puts forth?
Baroness Gerada (CB)
My Lords, as probably the only person in this Chamber who has headed up a royal college not once but twice—the Royal College of General Practitioners—I feel the urge just to defend them and correct what is been said three times in this Chamber. The royal colleges set the standards and the curriculum; they do not oversee workforce planning, funding, or what the actual training looks like once you get into an organisation. I have to correct those speakers by saying that that is not the job of the Royal College of GPs. I do not disagree that there needs to be reform; absolutely, it is a complete mess—
Lord Hunt of Kings Heath (Lab)
My Lords, does the noble Baroness accept that the royal colleges certainly can give moral leadership? I also refer her back to the last junior doctors dispute, about 10 or 11 years ago. As she will remember, the Academy of Medical Royal Colleges, I think it was, set up a group to look at all these issues, and the outcome of that was very disappointing in terms of tangible results in improving the situation.
Baroness Gerada (CB)
I thank the noble Lord very much. I have to also tell your Lordships that for the last 20 years I have led what is called the practitioner health programme, which has looked after the mental health of the medical workforce—I no longer lead it. To date, about 40,000, mainly doctors, have passed through that service, most with mental health issues relating to burnout, depression and anxiety, and some with a new diagnosis which I call NHS-itis.
I know about the endless reviews that were done. It is not just the Academy of Medical Royal Colleges, Health Education England, the General Medical Council and the CQC; many of the individual royal colleges looked at the issues of the decline in mental health. Some of these have been raised here, around firms, loss of control, training and the intensity of the workload. Fundamentally, we do not make it easy for any of these doctors—and, by the way, we do not make it easy for the international medical graduates either, who have always fared worse. I agree with the noble Lord that there are solutions, so we do not need another review. The answer is blowing in the wind—we have the solutions—and I am very happy to discuss that at a further time.
Lord Clement-Jones (LD)
My Lords, we ought to thank the noble Lord, Lord Patel, for having stimulated such an interesting and important conversation about how terrible our workforce planning in the NHS has been to date, and we have had some very wise words around the House on that subject. It is clearly not fit for purpose, and that is why we are where we are.
On these Benches, we have consistently accepted the Government’s central premise for the Bill: that where the British taxpayer invests heavily in training a doctor at a UK medical school, there is a logic in prioritising that graduate for employment to ensure a return on that public investment. However, although we sympathise with the desire of the noble Lord, Lord Patel, to ensure that UK graduates are prioritised—indeed, a lot of that derives from the fact that our workforce planning system is not fit for purpose—we must be careful not to make the legislation so rigid that it removes any flexibility for the system to function effectively, as we will argue in later groups.
By creating strict statutory tiering that places UK graduates above all other priority categories in every instance, we risk creating a system that cannot respond to realities on the ground. We have received correspondence from many doctors, as I am sure almost every other noble Lord in this House today has done, warning that absolute exclusion or rigid tiering could leave rotas empty in hard-to-fill specialties such as psychiatry and general practice, which rely heavily on international talent.
Prioritisation is a necessary tool for workforce planning but we must ensure that it does not become a blockade that damages the wider delivery of NHS services. As the noble Lord, Lord Stevens of Birmingham, said, we need answers about the future of workforce planning. What will the numbers be for training places? The Government need to answer that as we go through this Bill.
Earl Howe (Con)
My Lords, I too am grateful to the noble Lord, Lord Patel, for leading the debate on his amendments, which seek to establish a new prioritisation hierarchy that puts UK medical graduates first, ahead of those in the priority group who are not UK medical graduates. I should have prefaced my speech by reminding the House of my interest as an honorary fellow of the Royal College of Physicians.
We debated this proposal in Committee, when other noble Lords, including my noble friend Lady Coffey, tabled amendments that sought to introduce a different prioritisation hierarchy. I understand fully the case that the noble Lord is making and I agree that UK medical graduates should have a much fairer crack of the whip in access to medical specialty training places. Fairness has been our primary concern throughout our scrutiny of this Bill. However, I agree also with the noble Lord, Lord Hunt of Kings Heath. The Government have had some hard choices to make.
In an ideal world, where the House had been given more time to consider these matters in the round, we might have been able to improve on the approach that Ministers are taking. For example, there is surely a place for guidance to make clear that the prioritisation process should incorporate considerations of medical and academic excellence, a point that the noble Baroness, Lady Finlay, has consistently made.
I am grateful to the noble Lord, Lord Stevens of Birmingham, for putting the decisions made by the last Government into their proper context. However, given where we are, we accept that Ministers have introduced this as urgent legislation with a specific purpose. In that context, having accepted that the Government’s approach will have the effect that they are seeking to achieve, we are satisfied that the Minister’s proposed method of prioritisation is acceptable.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am most grateful to noble Lords across the House for their considered contributions to this group of amendments and to the noble Lord, Lord Patel, for his introduction to this group. I have a third reason to be grateful—namely, for the understanding of the challenge that this Government are facing and the need to take action. I do not take that for granted. We are not able to support the amendments tabled by the noble Lord, Lord Patel, and I will go through the reasons.
In answer to the noble Baroness, Lady McIntosh, the Bill already sets clear priority groups without any further ranking within them. This is a binary system: applicants are either prioritised or they are not. It might be helpful to your Lordships House to say that the priority groups set out in the Bill have been agreed across the four Governments of the nation. They are best placed to support moving to what we all want—a sustainable workforce to meet the health needs of this population.
As I emphasised in Committee and at Second Reading, prioritisation does not mean exclusion. Non-prioritised graduates will still be able to apply, and they will be offered places if vacancies remain after prioritised applicants have received offers. For specialty training, there are likely to be opportunities in general practice, core psychiatry and internal medicine, which, historically, attract fewer applicants from the groups that we are prioritising for 2026.
Alongside UK graduates, the Bill prioritises graduates from Ireland—this reflects, as I have spoken of before in this Chamber, the special nature of our relationship with Ireland—along with graduates from Iceland, Liechtenstein, Norway and Switzerland, which reflects our obligations under international trade agreements with the European Free Trade Association countries to treat their graduates no less favourably. The amendments would mean that we would not be honouring these arrangements as we would be prioritising UK medical graduates over applicants from these countries.
The agreements with EFTA countries precede this Government. The agreement for Iceland, Norway and Liechtenstein was made in July 2021, and for Switzerland in 2019. The bottleneck issues that this Bill is designed to address were primarily driven by the removal of the resident labour market test in 2020. I know noble Lords will understand the need to uphold these international obligations, albeit we receive very low numbers of applicants from EFTA countries. As I noted in my recent letter to the noble Lord, Lord Mohammed, and to give noble Lords some idea of scale, there are a total of two applicants from EFTA countries for foundation and specialty training in 2026.
For specialty training, the amendments would mean we would be prioritising UK medical graduates over applicants with significant NHS experience. That would undermine the effective delivery of our policy intention, for which there is much sympathy in this Chamber, to prioritise applicants with significant experience working in the NHS. The Government have rightly committed to prioritising those who have made a considerable contribution to our health service because they better understand how the health service works and how to meet the needs of the UK population.
The noble Lord, Lord Patel, asked how many more students in the priority group would be able to enter specialty training. I will be pleased to write to the noble Lord on that matter.
My noble friend Lord Hunt and the noble Baroness, Lady Finlay, called for improvement of the broader approach to medical training, and that is something with which I would definitely concur. We have published phase 1 of the medical training review, which identifies the key challenges and the areas for improvement across postgraduate medical training, as noble Lords are inquiring about, and asks what is working well. Phase 2 of this work is already under way, and will focus on exploring those issues and developing options for change.
The noble Baroness, Lady Finlay, asked that I give an assurance that Oriel would, as an appointment process tool, have what she described as a more subtle way of looking at NHS experience. I can confirm that we will be engaging with stakeholders on what the best definition is and what is most appropriate for NHS experience. That will then allow us to update the system.
The noble Baroness, Lady Finlay, asked about merit-based selection and made a valid point about the quality of applicants. I assure your Lordships’ House that the Bill does not replace in any way a merit-based selection. Existing recruitment processes for foundation and specialty training already assess applicants against rigorous, merit-based criteria, including competence, performance and suitability for training, all of which I know are of concern, and rightly so, to the noble Baroness. The Bill sits alongside that process, not instead of that process.
The noble Lords, Lord Stevens and Lord Clement-Jones, asked about specialty training places. In the 10-year health plan, which the noble Lord, Lord Stevens, referred to, our commitment is to create 1,000 new specialty training posts over the next three years, focusing—importantly, in my view—on specialties where there is the greatest need. The Bill will not delay this process. There are some programmes and regions already at capacity for delivering properly supervised training posts. Expanding that training capacity will therefore need to be done gradually to ensure that placements remain of the high quality that we need and that appropriate supervision is in place to support it.
I hope that I have dealt with the main questions raised. For these reasons, I hope the noble Lord will withdraw his amendment.
Lord Patel (CB)
My Lords, I thank the Minister for her comments, and I thank the other noble Lords who spoke. I take the points that the noble Lord, Lord Hunt, made, which are quite important: there needs to be much wider review of the whole issue of medical training and workforce planning, which are linked together. I hope the review that NHS England carried out, published in October 2025, the more recent update on 18 January 2026, which was on the first “diagnostic” phase of the medical training, and the other phases to come will promote that review of medical training, and I hope the Government will back that.
I think the noble Lord, Lord Clement-Jones, made a similar comment in Committee that we should not prioritise UK medical graduates above others because the others may, and do, provide us with good service and care. I accepted that, and how could I not? In my own department, we regularly—on a yearly basis—took overseas doctors for training in United Kingdom. Some of them remained in this country, and others held high positions overseas. The fact is that 30% of core and specialty training slots go to international medical graduates; 70% go to the UK graduates. That is not a small number but quite a significant number of overall training positions. None the less, I accept that we need international medical graduates to come here and study and work here.
I thank noble Lords for the other comments made. The noble Lord, Lord Stevens of Birmingham, asked a very cogent question. I know that the Government say that there will be 1,000 new posts, but that is over three years, so it might be three years hence that we get those. In the meantime, we have a problem with UK medical graduates, and I will single that out, because I hope that the Bill will help with the process of more UK graduates getting the jobs. I thank the noble Earl, Lord Howe; he was stronger in his support last time than this time, but I can understand why.
I had no intention of putting my amendments to the vote. I had hoped that the Minister would accept them, but she has made it quite clear that she will not. I wish the Bill to be concluded speedily, because it is urgent, and I hope the prioritisation in the Bill will help UK graduates. On that basis, I beg leave to withdraw.
Lord Mohammed of Tinsley
Member’s explanatory statement
This amendment postpones the implementation of the medical specialty training prioritisation requirements by one year, moving the effective date for the mandated offer sequence from 2026 to 2027.
Lord Mohammed of Tinsley (LD)
My Lords, both amendments in this group are in my name. I start by saying that, despite the fact that we have had a short break since we discussed this previously, we have all had a lot of emails and commentary on the Bill as it has been going through your Lordships’ House. One point that people have queried, particularly around Amendment 3, is this: “Why is Lord Mohammed doing this? He must have some declarations of interest. He must have some personal gain to do what he is doing”.
For the record, I have three children. One works for Northern rail; the second, despite our best efforts, his mother’s in particular, to get him to go to medical school—we failed—went on to become a paramedic, and at the moment he is absolutely loving it. So it is highly unlikely that this Bill will affect him, and my daughter is not studying medicine or anything related. Therefore, the purpose of and the motive for me moving this amendment are around fairness and equity.
This would be a modest postponement. In rejecting this policy, we are not doing so outright. It is a necessary safeguard to ensure fairness for those who have already applied under the rules that existed when the current application cycle opened. As we heard in Committee, the core purpose of the Bill is to prioritise graduates with strong links to the UK, and NHS experience, as the noble Baroness, Lady Finlay, said earlier. It has broad support and is rooted in legitimate concerns about the balance between health, workforce supply and demand. However, the Government’s own planning documents indicate that for the 2026 recruitment, prioritisation is applied only at the offer stage because shortlisting has already occurred and the posts need to be filled by August; in other words, the legislation would apply part way through an active application cycle.
It is this timing that gives rise to the compelling fairness concerns at the heart of my amendments. Medical applicants make decisions in advance—far in advance. They invest years of study, financial cost and personal sacrifices based on published criteria. To change the criteria mid-application, with potential effects on eligibility, shortlisting, scoring or final offers, risks penalising those who complied fully with the rules as they stood when they applied. They cannot rewind their applications. They cannot be judged against a different standard. This is not theoretical. I have been contacted directly, as have many Members of your Lordships’ House, by candidates who face exactly this prospect under the current system. The core principle of procedural fairness and legitimate expectation is well established. Legislation, however well motivated, should not disadvantage applicants who acted in good faith. It should not reshuffle the deck once the cards have already been dealt.
A delay until 2027 would allow for clarity and proper stakeholder engagement and would ensure that no doctor is unfairly caught between two regimes. I emphasise that my amendment would not delay the policy indefinitely nor dilute its intention. It would simply align implementation with a natural application cycle. Therefore, I really hope that the Minister responds favourably.
Amendment 7 would replace the Government’s proposed immigration status criteria in the prioritisation framework with a test based on completion of
“at least two years of training or employment in a medical capacity within the National Health Service”.
The intent of the Bill to prioritise those who have strong links with UK medical training and the health service is not controversial, but to use indefinite leave to remain and other immigration categories as proxies for NHS experience is deeply problematic for me—and, I am sure, for many others. It risks both unfair outcomes and loss of clinical value for patients. In Committee, we heard detailed arguments about the unsuitability of immigration status as a measure of meaningful NHS experience, not least because it does not reflect who actually worked, trained or contributed here in the UK.
Under the Government’s current drafting, international medical graduates with indefinite leave to remain, settled status or citizenship would be prioritised irrespective of whether they have ever worked in the NHS—experience counts only if it fits within residency categories. Yet many doctors who arrived earlier on shorter visas have worked for years in the NHS, delivering front-line care throughout the pandemic pressures and workforce shortages. Their contribution is real, sustained and beneficial.
The British Medical Association has repeatedly emphasised that specialty training prioritisation should reflect clinical experience in the NHS, not simply legal residency status. The BMA has set out its position that international medical graduates who are GMC-registered and practising in the NHS and have at least two years’ experience should be prioritised.
This amendment aligns with that evidence-based and professionally grounded approach. Two years’ experience is clear, objective and legitimate, and a demonstrated threshold of contribution that is far more meaningful than a stamp in your passport. It would recognise those who have already invested in the UK system, who understand our clinical pathways and workforce needs, and who have delivered care for our patients. Critically, it would also avoid the injustice noted in Committee by several noble Lords about the category for either arbitrarily including or excluding applicants with negligible NHS ties. Doctors who arrive with ILR but have not delivered NHS care should not be automatically advantaged ahead of colleagues with years of service here. That simply cannot be justified on the grounds of fairness or workforce planning. Nor would the amendment prejudice the aim of prioritising UK medical graduates. It would supplement the Bill with additional criteria that would strengthen how NHS experience is recognised, supporting, not undermining, the long-term sustainability of the training pipeline.
The amendment strikes the right balance between policy ambitions and practical fairness. It would honour people’s contributions, support retention and strengthen the NHS workforce. I urge noble Lords to support it, and I hope the Minister will speak in favour of it.
Baroness Finlay of Llandaff (CB)
My Lords, I will go back to the question of Oriel and the prioritisation processes. It collects a full employment history from graduation and requires applicants to confirm whether each post was paid NHS experience. I hope the Minister will be able to recognise that some have worked in a voluntary capacity before they were able to get paid employment in the NHS, and that some people, in trying to build up their criteria for eligibility to apply, have worked in non-medical posts in order to gain the background NHS experience that they need.
I have been sent a copy of a response that was sent by the Department of Health and Social Care to a query about specified immigration status, which states:
“In 2026 the Government is using these immigration statuses as a proxy to capture applicants who it believes will be most likely to have significant experience of working in the health service in the UK”.
It goes on to state that that prioritisation
“will be applied at the offer stage because shortlisting is already underway”,
which, of course, creates a lot of problems for people. I can see that there are difficulties in postponing this, because all the applicants are already in such a state of turmoil that to have a second year of turmoil may not be helpful to them in any sense.
There was a worrying sentence at the end of the second paragraph, saying that the Government
“will be aiming to have regulations in place for the autumn 2026 application round (subject to parliamentary timetable)”.
I hope the Minister will be able to assure us, given that this has been emergency legislation, that the regulations will be treated with a similar degree of urgency to remove any uncertainty for the next round of applicants.
Lord Clement-Jones (LD)
My Lords, I offer my strongest support to Amendments 3 and 7 in the name of my noble friend Lord Mohammed of Tinsley. These amendments address the single biggest injustice in the Bill: the decision to implement major changes mid-cycle for 2026 using the blunt instrument of indefinite leave to remain as a proxy for commitment. In Committee, the Minister defended this decision by arguing that assessing actual NHS experience for 2026 was “not operationally feasible” and would require
“manual attention to thousands of applications”.—[Official Report, 12/2/26; col. 387.]
Since that debate, we have received categorical evidence from doctors currently using the system that contradicts this assertion. Multiple applicants have provided proof that the Oriel recruitment platform already captures granular data on NHS experience. The application form explicitly asks candidates to confirm whether they have more than six months’ experience in the NHS. It also captures their current visa status. The digital data field exists.
Earl Howe (Con)
My Lords, with these amendments, the noble Lord, Lord Mohammed, has reprised proposals he made, and which we debated, in Committee. In Committee, the Minister emphasised a point that I must say resonated particularly strongly with me. She pointed out that the delay proposed in Amendment 3 sets the Government back in their timetable to address the bottlenecks in medical training. Although I acknowledge all that the noble Lord said about fairness, I must accept that a delay of a year would set the Government back significantly in their plans. Given our support for the main principle underpinning the Bill, we cannot, I am afraid, support that amendment.
However, I reiterate that prioritisation is only part of the solution to the problem we have been talking about. It is a logical and sensible step, but the bottlenecks in medical training, which are having such a pernicious effect on the future opportunities of young doctors, will not be ameliorated until the number of training places is increased significantly. The Minister’s answer in the previous group to the question about training places posed by the noble Lord, Lord Stevens of Birmingham, was helpful. However, can she go any further and indicate whether the Government consider that the additional training places which have already been announced are likely to be sufficient, or is there a possibility that more may be announced in the coming months?
The noble Lord, Lord Mohammed, made a strong case for Amendment 7, and I endorse the powerful comments made not only by him but by the noble Lord, Lord Clement-Jones. Can the Minister provide us with further information on the Oriel system? There is a sort of fog surrounding this subject.
When we last debated this issue, I was surprised that the Minister was unable to give clarity on the number of individuals who have demonstrated an established commitment to the NHS but do not have leave to remain. It seems to me essential that we have clarity on the number of doctors that this amendment would affect. Has she had the opportunity to look into this in more detail between Committee and Report? If we are not able to get greater clarity on the issue today, will the Minister at least give a commitment to look at any cases where a doctor has demonstrated that commitment but does not have indefinite leave to remain, so that we can ensure that any injustices that may arise as a result of this emergency legislation are resolved swiftly at ministerial level?
Baroness Merron (Lab)
I am grateful to noble Lords on all sides of the House for their contributions today. I turn first to Amendment 3, tabled by the noble Lord, Lord Mohammed. As I explained in Committee, this is not an amendment that we are able to support. As has been emphasised, including today, a key aim of this Bill is to address the severe bottlenecks in medical training that have built up over recent years. These pressures are having real consequences, evidenced most starkly, I believe, through the most recent industrial action, where concerns about stalled career progression and training opportunities have featured and continue to feature heavily.
The noble Lord, Lord Mohammed, rightly spoke about the concerns of applicants mid-cycle, and I do recognise the concerns about this group and the impact on them, particularly where applicants did not know how prioritisation might affect them. But, although I absolutely understand the concerns, which we have discussed, these have been carefully considered and, at the end of it all, we have to make decisions about what it is we are trying to do. There will be people who are affected in ways that none of us would have chosen, but it has not been possible to make a change in legislation, particularly at this pace, without some effect on some groups. So, yes, it is a choice, and it is one that we have made. But I acknowledge of course the impact on those who are in the middle of a cycle of application.
With regard to the proposal in the amendment, I can only endorse the comments by the noble Lord Earl, Lord Howe, that another year of inaction would only deepen the frustration felt by UK-trained doctors and further destabilise the workforce. I do not think that is something that any of us want to see. So, we do believe that applying prioritisation to the 2026 intake is both necessary and justified. If we wait, as this amendment suggests, until 2027, it is projected that competition ratios will have risen even further. That would mean more UK graduates unable to progress their careers on time, with greater risk to the long-term sustainability of the NHS workforce, and protecting the long-term sustainability of the NHS workforce, protecting patients and protecting patient care and services is what this Bill is all about. That is why we are not able to accept another year’s delay, although I understand why the noble Lord put his amendment forward.
In addition, there is a difficulty in terms of the drafting in respect of this amendment, because it would create two clauses related to the prioritisation of applicants to specialty training programmes for 2027, and each would have a different approach to prioritisation. I am sure that the noble Lord would not want to create operational confusion or undermine legal certainty, but I thought it important to point that out.
I turn to Amendment 7, also tabled by the noble Lord, Lord Mohammed. First, following our conversation earlier—I am grateful for the noble Lord’s flexibility in that regard—I want to reassure him and your Lordships’ House that we are absolutely committed to recognising those who have worked in the NHS for a significant period. There is a very good reason for this: as well as it being the right thing to do, those individuals are much more likely to stay in the National Health Service for the long term, and they are much better equipped to understand how the health service works and how to meet the needs of the UK population. Again, that is a core driver in this Bill. It is our intention to prioritise those with significant NHS experience for specialty training. However, we are unable to support Amendment 7, for a number of reasons. I appreciate that the amendment was changed, but I want to refer at this stage to the points made by the noble Lord, Lord Clement-Jones; I discussed these matters with him earlier today.
While the NHS Oriel recruitment system holds some information about an applicant’s NHS experience, it cannot be used consistently or fairly for the 2026 round. The data has been collected on the basis that it would be checked by employers before appointment, not for retrospective automated assessment. It is indeed the case that applicants enter their employment history on Oriel as free text, but with no consistent format. Yes, there is a tick-box to indicate NHS experience, but I have to emphasise that it is self-declared—and that is the problem. There is no mechanism for verification to confirm that the employer listed is an NHS organisation, or any other relevant detail. That is why I spoke about this in Committee: it would require a manual review of tens of thousands of applications. That means a high risk of error, potentially delaying offers and start dates: again, nothing that any of us would wish to do. It would of course be destabilising for applicants and trusts, so it is not operationally feasible and nor would it be fair.
The noble Earl, Lord Howe, asked for more information on the Oriel system. I would welcome speaking to him at great length about it as, having looked into it in a practical sense, I can absolutely see the limitations. In my letter to the noble Lord, Lord Clement-Jones, which I have placed in the Library, more detail has been provided on the system, which may be of help to the noble Earl, Lord Howe. But if the noble Earl would like a more in-depth acquaintance with the Oriel system, he and other noble Lords are most welcome to benefit, as I have done.
The noble Baroness, Lady Finlay, spoke of voluntary experience as a possibility for being NHS-significant experience, and I understand why she raises this. On this point and also to the point about the amendment, there is currently no agreed threshold for what constitutes significant NHS experience. The fact is that views on this differ widely, as evidenced today by the noble Baroness. That is why we have committed to full engagement on this issue for future years, rather than rushing through the changes for 2026. Once we have agreed the parameters around experience, the Oriel system will be updated to ensure that data is collected in a consistent, verifiable format—that is the key—to support fair assessment in future recruitment rounds. Our aim is to have this in place in time for the next specialty training round, which will open for applications in autumn 2026.
For the current recruitment round, the Bill uses a set of carefully chosen specified immigration statuses, as this is a practical and proportionate proxy for identifying applicants most likely to have significant NHS experience. After careful consideration, we have concluded that this is the best approach for the 2026 recruitment round.
On the question from the noble Earl, Lord Howe, about the potential for additional training places and the likelihood that the ones I referred to earlier will be sufficient, we are keeping the numbers under review, as we always do. The noble Earl asked me to look at particular cases, and I am always happy to do that. We should bear in mind that it is often difficult to comment on very specific individual cases, but I am pleased to look at the broad point that he makes.
On the basis of the reasons I have outlined, I hope the noble Lord will withdraw his amendment.
Lord Mohammed of Tinsley (LD)
My Lords, I thank everyone in your Lordships’ House for their contributions on this group. I also place on record my thanks to the Minister, not only for speaking to me earlier today but for her letter, which she referred to earlier, and for speaking to us before this legislation was debated in your Lordships’ House. That has been very useful, and I appreciate the Minister giving us her time despite her busy diary.
On the amendments, I have heard the opinion and mood of the House, particularly from the noble Earl, Lord Howe. I therefore beg leave to withdraw Amendment 3. I will keep a watching brief on Amendment 7, given the discussion we had earlier outside the Chamber.
(2A) A person is within this subsection if—(a) they have been granted protection status in accordance with rules made under section 3(2) of the Immigration Act 1971,(b) they have been granted limited leave to enter or remain in the United Kingdom by virtue of Appendix Hong Kong British National (Overseas) of rules made under section 3(2) of the Immigration Act 1971, or(c) they have, as part of a safe and legal humanitarian immigration route, leave to enter or remain in the United Kingdom in accordance with rules made under section 3(2) of the Immigration Act 1971 or leave on a discretionary basis outside of rules.”Member’s explanatory statement
This amendment would add people who have been recognised as in need of international protection, who have arrived as a Hong Kong British National, or have arrived on a safe and legal humanitarian programme to the priority group.
Baroness Lister of Burtersett (Lab)
My Lords, Amendment 11 would add to the list of priority groups people who have been recognised as in need of international protection, who have arrived as a Hong Kong British national or who have arrived on a safe and legal humanitarian route. I will speak simply to this amendment, but I have some sympathy for the amendments in the name of the noble Baroness, Lady Gerada.
I apologise for popping up at this late stage of the Bill’s passage. This issue was brought to my attention by the Refugee Council, which recently spotted that, as it stands, the Bill will exclude those recognised as refugees from prioritisation for medical training posts. This will potentially make it harder for people with medical backgrounds who have been displaced and given protection in the UK to contribute fully to the NHS. This resonates with me because my father, as a young man with a medical qualification, came to the UK in the 1930s as an early refugee from Nazi Germany. He was able to requalify at Glasgow University and, after the war, eventually went on to have a long career as a medical officer in Manchester in what was then the DHSS. As such, he contributed to British society in a way that would now be difficult for medically qualified refugees.
Programmes such as the Refugee Council’s Building Bridges programme support qualified refugee doctors and other health professionals to utilise their skills and experience in the UK. These programmes are based on close collaboration between charities and the NHS. This is beneficial for the refugees themselves, as well as for the UK. That support can include helping refugees to pass the necessary language requirements and get professional registration in the UK. Some refugees will also progress to accessing medical training posts. This has included foundation programmes specifically designed to support refugee doctors into the NHS workforce.
During Second Reading in the other place, the Secretary of State said that the UK
“must break our over-reliance on international recruitment”.—[Official Report, Commons, 27/1/26; col. 803.]
This amendment does not run counter to that aim. Refugees have not come to the UK because they have been recruited. First and foremost, they have sought protection and have been given it. My amendment would simply ensure that those refugees who are also doctors would be able to put their medical backgrounds to good use and continue to develop their expertise for the benefit of the wider community, as well as for themselves.
At the same time as the Bill is progressing through Parliament, the Government are proposing significant changes to settlement for refugees as part of the earned settlement plans. Ministers have said that these changes are supposed to incentivise integration and ensure that settlement is earned. Ensuring that refugee doctors are not placed at a disadvantage because of this Bill would help the Government meet those aims.
At Second Reading, my noble friend the Minister explained:
“Internationally trained doctors with significant NHS experience will continue to be prioritised for specialty training, recognising the service that they have given. This year, immigration status will be used as a practical proxy for NHS experience in order to allow prioritisation to begin swiftly. For following years, we have taken powers in regulations to enable us to refine this approach in consultation with key partners. I have been asked by noble Lords what this means for those with refugee status. This status is not a stand-alone priority group, although refugees will be prioritised for specialty training in 2026 if they fall within another priority category, such as holding indefinite leave to remain or having completed the foundation programme. Refugees who do not fall within a prioritised group may still apply for specialty training posts and the Bill will not change their eligibility to apply for locally employed doctors’ roles”.—[Official Report, 4/2/26; col. 1648.]
The noble Lord, Lord Patel, responded positively with particular reference to Ukrainian refugees. I am not sure that my noble friend’s response was quite as reassuring as he perhaps thought, especially as Ukrainians who have arrived on the Ukrainian scheme will not be in any of the priority groups. If I understand the proposals correctly—this relates to the previous amendment—indefinite leave to remain is being used for places on specialty programmes in 2026 as a quick proxy for recognising doctors who have been trained abroad but who have been employed within the NHS for some time. It is not such a useful proxy for anyone who, like those on the Ukrainian schemes, have no route to settlement or who, under the proposed earned settlement changes, could have to wait 10 years, or even longer, to qualify for indefinite leave to remain.
My amendment also addresses the impact of the Bill on doctors who have come to the UK as part of the Hong Kong BNO visa scheme. As with other refugee doctors, they have sought safety in the UK. Indeed, the scheme is frequently described by the Government as a safe and legal route. The case for their inclusion has been put to me eloquently in an email from an anaesthetic registrar who is a BNO visa holder and is currently working in the NHS. Like many colleagues in a similar position, he migrated to the UK for political reasons before completing his training and now regards the UK as his permanent home, where he wishes to dedicate his career to the NHS. They argue that
“deprioritisation to the point of exclusion would leave us without any pathway to complete training, despite our qualifications and NHS contributions, effectively ending specialist careers for a group formally invited to settle here”.
They also point out that BNO doctors in the NHS form a small, finite cohort. Their main argument is that,
“unlike many other International Medical Graduates who can return home to complete training, those of us on the BNO scheme face unique barriers. Due to the political situation in Hong Kong, returning is not realistic nor possible for many of us. The UK is now our only place to practise medicine and pursue specialist training”.
Although their situation is not quite the same, the argument also applies to other displaced persons covered by this amendment.
At a time when the Government are making it much more difficult to achieve refugee status, should they not at the very least ensure that those who are so recognised and who are medically qualified are able to requalify and use their medical expertise to the benefit of our society? I hope my noble friend will be able to accept this amendment, but I suspect she will not. At the very least, I ask her to give a commitment to further consultation with a view to giving serious consideration to including the groups specified in the amendment, even if only in modified form, in the regulations to which she referred at Second Reading and which were mentioned earlier today. I beg to move.
Baroness Gerada (CB)
My Lords, I speak to Amendments 12, 13 and 15 in my name and that of the noble Lord, Lord Mendelsohn. I repeat my conflicts of interest: I am of Maltese heritage, I am a doctor and I am co-chair of the APPG. My amendments are narrow, they are practical and they respond directly to the concerns raised by the Minister in Committee. I respect the Minister and am grateful for the time that she has given me, for her letter and for engaging seriously with this issue.
I fully accept that we must find a solution to the difficulties faced by UK medical graduates, as so eloquently pointed out by the noble Lord, Lord Patel. In doing so, however, we must ensure that we do not unfairly disadvantage a small, specific group of students, do not strain valued relationships with an EU member state and Commonwealth partner or inadvertently undermine a long-standing transnational higher education commitment. That is the purpose of my amendments.
This is not about opening floodgates, nor is it about creating a new route for offshore medical schools. I am speaking here about just two long-established UK universities with overseas campuses: Queen Mary University of London in Malta and Newcastle University in Malaysia. They are the only two that, upon Royal Assent, will meet the criteria for delivering UK primary medical qualifications overseas—the same curriculum, the same examinations, the same degree and, until now, the same eligibility for the UK foundation programme. Historically, there was a third, City St George’s, which is now teaching its final cohort of seven students in Cyprus; that arrangement is closing. In reality, therefore, we are speaking about two mature, well-governed partnerships with capped, predictable numbers of no more than 190 students per year.
Let me address Malta, which I obviously know best. Since 2009, Queen Mary has operated a British medical school in Malta on the understanding that its graduates would be treated in the same way as its London cohort for entry into the UK foundation programme. That reassurance was reaffirmed as recently as 2024. Each year, about 90 students enrol at the university. Many of them are UK nationals, often with a clear intention of serving in the NHS. They are students such as Michael, who comes from Essex; he is a final-year medical student who worked as a nurse during the pandemic before deciding to train as a doctor at QMUL Malta. He is not a rich kid but someone who has dedicated his life to working in the NHS, and has worked, saved and borrowed money to achieve his passion of becoming a doctor. What can he hope for now? If we imply that a UK degree somehow becomes less UK because a lecture theatre is in Malta rather than Whitechapel, we send an unfortunate signal not only to those students but to a close education and historic partner.
The Minister has quite properly raised concerns about NHS exposure and it is true that most clinical placements take place in Malta, but almost all the students undertake NHS attachments. The health challenges they face are strikingly similar to ours—much more so, I would attest, than the health challenges in Iceland, Liechtenstein or Norway. Non-communicable diseases dominate: diabetes, cardiovascular disease and obesity. There is a growing burden of mental illness, especially among children and young people. Its population is ageing and its society is increasingly diverse. The weather may be warmer, but the medicine is not fundamentally different.
This is not merely an assertion. QMUL now has four completed cohorts—147 graduates who have transitioned safely into the NHS and are performing exceptionally well. Why would they not? More than half of them are UK nationals. All are fluent in English, and all have been trained to practise in the NHS. These doctors or students seek no advantage. They only ask not to be disadvantaged because the campus of the UK university is overseas. The numerical impact on domestic graduates would be negligible. The Government’s target competition ratio of two applicants per foundation place would still be met.
Baroness Finlay of Llandaff (CB)
My Lords, I speak in support of these amendments, so ably introduced by the noble Baroness, Lady Lister of Burtersett, and my noble friend Lady Gerada, who have outlined the very distinct and different problems for these groups. The Newcastle curriculum is one that I know more about than the other, but it appears to be identical. There are problems for those graduates as they feel that, because of geography, their qualification is effectively second-rate rather than of equal status. That becomes particularly important when we go back to the point I made earlier about recruiting for excellence for our NHS and for people to work here.
My other point is about asylum seeking and refugee doctors—and I am most grateful to the Minister for having had such an open door, both for face-to-face consultation and telephone conversations, which have been helpful in clarifying issues. There are currently eight schemes in the UK which are coming together to co-ordinate and meet the needs of asylum seeking and refugee doctors. This group is different to many others who have come here to train because many were working in their home countries and gained great clinical experience. Their experience in trauma, in particular, can be very useful in major accidents, as they have often managed trauma in really difficult situations. When they come here, however, they need, in effect, to retrain from the beginning, and that takes a huge commitment.
I asked about working as a care assistant deliberately because I know of a Ukrainian refugee doctor who is currently working in that role and has been almost from the time she arrived here, despite being a very senior consultant paediatrician in Ukraine. She has to work as a care assistant to be able to pass all the exams and stages she needs to get through. In her summing up, therefore, it would be very helpful if the Minister can tell us whether she knows how many such doctors there are and what level their experience is; if she cannot today, perhaps she could write to us with that.
Looking forward to future-proofing, I can see the difficulty—though I find it hard to accept—over both Newcastle and Queen Mary curricula. In Committee, we also had the point raised about Bahrain, where the curriculum is, in effect, identical to the Irish-based qualifications. Clause 4(3)(b) of the Bill states that the person within that subsection
“did not spend all or a majority of their time training for that qualification outside Ireland”.
Therefore, I hope the Minister can provide us with firm reassurance that this Bill is future-proofed. The Bahrain curriculum will not be easy to change so that students spend 51% or more of their time in Ireland. If this is not carefully monitored, however, there is a potential danger over the years ahead that another medical school could open an offshore curriculum which was 51% versus 49%, which would mean that it came in under this Bill as a prioritisation. That would then disadvantage the two medical schools we have been debating and which my noble friend Lady Gerada has spoken about and argued for so powerfully today. I therefore hope that the future-proofing aspect will also be addressed in the Minister’s summing up.
Baroness Wolf of Dulwich (CB)
My Lords, I also support Amendments 12, 13 and 15, and will echo the points made about the general implications of the issues here. I declare an interest as an employee of King’s College London. What we are talking about here are, in effect, English medical degrees: that is what they are approved as, and it is what they are seen as by the world. We should pause and think very hard before we give the impression to the world that we do not take our own legislation and regulations seriously, because this really strikes at the heart of the reputation of our higher education system, which has been long earned and is still well deserved.
We are talking about courses of study that are delivered by an overseas campus but it is a medical school of a UK-registered institution. These courses are approved as identical to those delivered within the British Isles by the GMC, and they are completely compliant with the requirements of the Higher Education and Research Act, the Education Reform Act, the Further and Higher Education (Scotland) Act and the Higher Education (Northern Ireland) Order. It is a very small number of people to whom this matters a lot, but I think it is a major step to say they do not count. Therefore, I too hope the Minister will be able to work towards a resolution of this very distressing issue.
Lord Patel (CB)
My Lords, I might end up sounding like a broken record, but I hope it is still playing well. I will declare my interests, although they are probably irrelevant. I am an emeritus professor at the University of Dundee and have previously been its chancellor. I am a fellow of the several royal medical colleges, and I am associated with several universities in the United Kingdom that have medical schools.
I congratulate the noble Baroness, Lady Gerada, on her most eloquent and powerful argument for Queen Mary, Malta to be considered a special case—and she just about succeeded in doing so. Besides that, the broken record bit about me goes back to UK medical graduates. Some 7.6% of graduates of United Kingdom universities are overseas citizens, but they are all trained in the same curriculum and with the same degree as from UK universities. There are several universities that take these students; there are too many to list them all. The overseas campuses of UK universities of course have the same curriculum because the GMC has recognised the institution and therefore its curriculum. The GMC does not give recognition to any training programmes that do not have the same curriculum for graduates. Whether it is a campus or it is associated with the university, the curriculum is what the GMC approves and, in doing so, it therefore approves the institutio;n.
There are other UK university campuses overseas. Newcastle has 107 trainee doctors in Malaysia. I am told by the GMC that Barts London has a university association in Malta that has 69 graduates—and, as we have heard, Queen Mary in London has had a total of 147 graduates from there. Southampton medical school is approved for a medical course in Germany with 23 candidates. St George’s London, as we have heard, had quite a small number; I was told it was nine, but the noble Baroness, Lady Gerada, said it was seven. There are two more schools that are seeking GMC approval: Swansea in Mauritius and Exeter in Athens. I have no doubt that other medical schools will also jump on the same bandwagon and that, after today’s debate, they will make sure that their curriculum is similar to those followed in the UK so that the degrees from their overseas campuses are also recognised.
I have no objections to any of those—as I said, the noble Baroness, Lady Gerada, made a very strong case for Queen Mary in Malta—but I do point out that, if we add these all up, we will increase the priority groups that will challenge UK medical graduates further. That is the only case I am making.
Lord Hunt of Kings Heath (Lab)
My Lords, like the noble Lord, Lord Patel, I apologise for coming back to the substance of the debate on the first group.
We should pay tribute to the noble Baroness, Lady Gerada, for how she has approached these issues. Her amendments, which I agree with, are very tightly drawn to Malta and Newcastle. She has been engaged with my noble friend the Minister and has asked for certain assurances from her; I hope my noble friend will be able to respond to them.
This identifies the madness of the situation that we have. UK universities with campuses abroad often have students coming from the UK; they go over there to study in the hope that they can then come back to the NHS and apply for specialty training places. If ever one wanted a reason for why we need a fundamental, wholesale review and reform of the gamut of medical training, this is it.
I chided the noble Baroness, Lady Gerada, about the royal colleges’ leadership in this area, because the colleges should take leadership. Through her leadership of her college, and that of the noble Lord, Lord Patel, we have examples of the kind of leadership that we desperately need now from the medical royal colleges.
Lord Clement-Jones (LD)
My Lords, it is always a pleasure to follow the thoughtful contributions of the noble Lord, Lord Hunt of Kings Heath.
I give our strong support for Amendments 12, 13 and 15, which have been so convincingly spoken to by the noble Baroness, Lady Gerada, and indeed by the noble Baronesses, Lady Finlay of Llandaff and Lady Wolf of Dulwich. Like the noble Baroness, Lady Gerada, I thank the Minister for her engagement with us on this particular issue, despite the swift passage of the Bill and the rather disappointing response during those meetings.
As I have declared at previous stages, I am the former chair of the council of Queen Mary University of London. My concern is for many of the medical students at the Queen Mary Malta Campus and Newcastle’s Malaysia campus who are affected by the Bill. That is the most pressing issue at hand: the human cost of this legislation in its current form. Over the last few weeks, we have received deeply distressed correspondence from these medical students. Many of them are British citizens who went overseas to study, precisely because of the lack of medical school places here. These students enrolled in GMC-approved courses on the explicit, documented understanding that their degrees were completely identical to those delivered in London or Newcastle, and that they would enter the UK foundation programme on equal terms. To pull the rug from under them now—changing their status to international, mid-cycle, just as they prepare to graduate—is procedurally unfair and totally unacceptable. They made irreversible life and financial decisions based on over a decade of consistent UK Government practice. We cannot treat the futures of our UK-registered university students with such disregard.
In Committee and in her subsequent letter to Peers dated 20 February, the Minister set out her reasons for resisting the inclusion of these students. On these Benches, we have listened carefully. The amendments before the House have been entirely redrafted to address and dismantle every single one of those technical concerns.
First, the Minister argued that the Government cannot control the numbers from overseas campuses, fearing a loophole that would place financial pressure on the NHS and undermine workforce planning. We can fix this. Amendment 12 would explicitly restrict eligibility to
“an overseas campus of a … UK-registered institution that is extant on the day on which this Act is passed”.
The door is firmly shut to future creep. No university can open a new campus tomorrow and exploit this route in the way that the noble Lord, Lord Patel, described.
Further, to address the Minister’s specific fear of uncontrolled numbers, Amendments 13 and 15 would grant the Secretary of State a new statutory power to explicitly cap the maximum number of eligible persons from these campuses. With roughly 50 to 70 graduates a year from Malta and around 120 from Malaysia, we are talking about fewer than 200 students in a system of over 11,000 places. They represent zero threat to workforce planning and, with this amendment, the Government would hold the lever to control the volume. From our conversations, I know that the Minister believes that this would mean opening the door to Irish university campuses and a total of 300 students because of the Windsor agreement. I hope the Minister will explain why they need to be linked when she speaks directly to Amendment 12A, in the name of the noble Lord, Lord Darzi.
Secondly, the Minister argued in her letter that these students should be excluded because they lack familiarity with local epidemiology in UK clinical placements. With the greatest respect, that argument simply does not hold water either. As the noble Baroness, Lady Gerada, with her immense medical experience, has explained, the primary conditions driving NHS demand are fundamentally the same across these nations. Crucially, these students study exactly the same curriculum, take the same UK medical licensing assessment and graduate with the identical GMC-approved primary medical qualification as their peers in the UK. We have the evidence of four graduated cohorts from Malta and those of over 10 years in Malaysia, who have transitioned seamlessly and safely into NHS practice.
As we have discussed before, if the Government truly believe that these students lack clinical familiarity, how can they justify Clause 4 of their own Bill? The Bill prioritises graduates from Switzerland, Iceland, Norway and Liechtenstein. A graduate from Liechtenstein has no UK medical degree, has not sat the UK assessments and has no training in UK epidemiology. We are told that this is due to free trade agreements requiring us to recognise comparable qualifications. It is legally and diplomatically absurd to voluntarily prioritise comparable qualifications from the EEA while rejecting identical qualifications from our own UK public universities.
Thirdly, the Minister cites the need to protect British taxpayers’ investment. The students at Queen Mary in Malta and Newcastle University in Malaysia are self-funded. They provide the NHS with fully trained, UK-aligned doctors at zero educational cost to the public purse. Turning away a pipeline of debt-free, UK-trained doctors is economically illiterate and contradicts the Government’s own value-for-money logic.
Finally, as I said at Second Reading, we risk breaking a solemn international commitment. Since 2009, the UK and Malta have operated under a unique mutual recognition agreement regarding the foundation programme, which was explicitly renewed by the Department of Health as recently as 2024. To sever this now, even in spirit, damages our bilateral relations and actively sabotages the Department for Education’s own strategy to export British higher education globally.
These amendments are safe, narrow and pragmatic, as has been described. They offer the Government exactly what they ask for—control, caps and the closure of loopholes—they protect a tiny cohort of students from unacceptable mid-term uncertainty and they honour our international agreements. I strongly urge the Minister to accept this solution.
Lord Patel (CB)
My Lords, I apologise. I should have said that the noble Lord, Lord Darzi, emailed me at noon today to apologise that he could not be here because he had a patient to look after. However, I think the noble Baroness, Lady Finlay, covered his amendment adequately.
Lord Mohammed of Tinsley (LD)
My Lords, briefly, I offer our support from these Benches to Amendment 11, in the name of the noble Baroness, Lady Lister, and to the amendments in the name of the noble Baroness, Lady Gerada.
I want to talk about the amendment in the name of the noble Baroness, Lady Lister. I am sure that other noble Lords will have had an email from a woman from Ukraine, who set out her concerns. We as a nation have proudly welcomed and given safe sanctuary to people from Ukraine, predominantly women and children. However, because of the conflict in her country she has not been able to fulfil her dream of being a doctor; she has tried to navigate the system, through working as a care worker, and would like us to be able to support her.
I plead to the Minister: can we not have some flexibility, at least when it comes to specific circumstances? We have been so generous as a nation in welcoming those people, who, if they had their way, would be in their country. They want to continue building on the education that they had in their nation. I am sure that there will be others as well. Is there some flexibility? I hope that the Minister can comment on that.
On the amendments tabled by the noble Baroness, Lady Gerada, when we had this discussion before the Recess it was clear that we were asking for those two overseas medical schools. They are the only ones that are active now. The amendments are clear that no other schools would be allowed to open up and go through the loophole that some noble Lords have talked about. We are talking about very small numbers. However, those numbers are important because we have also had emails from British nationals who have gone to study abroad with an expectation. As I said on my amendments in the previous group, we are changing the rules for them mid-cycle. There must be some level of flexibility.
We want the Bill to go through, but we would like it to be a bit fairer than it is. I talked previously about the unintended consequences of pushing this though. A lot of the funding for these two campuses comes from overseas. It is not costing the UK taxpayer money, but it is a pipeline, as my noble friend Lord Clement-Jones said. Having listened to the noble Lord, Lord Forbes, and spoken to my noble friend Lord Shipley, I know that they very strongly support the overseas campus that Newcastle University has in Malaysia. I hope that the Minister supports those two universities. There are no others in these circumstances.
Earl Howe (Con)
My Lords, the amendments in this group seek to change the definition of the priority group. We debated the principle behind the amendments tabled by the noble Baroness, Lady Gerada, and the noble Lord, Lord Darzi, in Committee. I shall come back to the amendment tabled by the noble Baroness, Lady Gerada, in a moment.
Meanwhile, the amendment tabled by the noble Baroness, Lady Lister, seeks to include a new group of people who should be prioritised for medical specialty training places. We have not, as she said, debated this precise issue before. She argued the case very powerfully. However, we need to come back to the object of the Bill, which is to resolve the specific problem of UK medical graduates having insufficient priority in accessing medical specialty training in UK workforce planning. Our prime focus should be on those young UK doctors who have put so much effort into their studies and who now want to progress further in the NHS.
I appreciate the force of everything that the noble Baroness, Lady Lister, said. I observed earlier that we are not living in an ideal world. However, for the reasons that I have given, I am not convinced that including an additional group—in this case, those who have come to the UK from Afghanistan, Ukraine, Syria or Hong Kong—will necessarily improve the Bill’s effectiveness in resolving the problem that it is designed to address. Those doctors are not, and surely cannot be, part of the NHS’s workforce planning framework.
That said, I think we can all agree that, where an individual comes to the UK through a safe and legal route as a legitimate refugee and has skills to offer our country, we should welcome them offering those skills. It would therefore be helpful to know from the Minister what support her department is giving and will give to medically trained people who have come to the UK legally and who wish to serve in the NHS.
I will say some brief but important things about the amendment from the noble Baroness, Lady Gerada, without, I hope, repeating what has been said. The merits of her case were ones which she powerfully presented in Committee, and she has done so again today.
I want to highlight three key points. First, QMUL’s campus on Malta and Newcastle University’s campus in Malaysia are not “foreign institutions”. Yes, they may be physically located abroad but, constitutionally, both are UK institutions and the qualifications they award are UK qualifications based on a UK-prescribed medical curriculum. Doctors have made career plans based on that long understanding. Therefore, badging graduates from those overseas campuses as international medical graduates, which is the implication behind the Government’s position, does them a grave injustice. In my submission, they are not international medical graduates in the sense that we normally understand the term—a point well made by the noble Baroness, Lady Finlay.
Baroness Merron (Lab)
My Lords, I am most grateful to noble Lords from across the House for their thoughtful contributions in this group. The noble Earl, Lord Howe, reminded us to come back to the prime focus in respect of Amendment 11, which I will start with. It is about supporting and being fair to UK medical graduates in whom we have invested, but that is also a group from whom we seek so much, and we are grateful to them. It is also about providing safe and appropriate care.
I appreciate the intention behind Amendment 11, tabled by my noble friend Lady Lister, but the Government are unable to support it, for the reasons I will outline. The Bill, as noble Lords will be familiar with, prioritises applicants based on certain specific immigration statuses for specialty training in 2026. These statuses have been carefully chosen for the reason that I have said a number of times: as a practical and proportionate proxy for applicants who are most likely to have significant NHS experience. I reiterate, as I have said a number of times, that the Bill is not about exclusion of any groups or individuals but about prioritisation.
Referring to the request by my noble friend Lady Lister, which was emphasised by the noble Lord, Lord Mohammed, perhaps I could make one point to remind your Lordships’ House. For 2027 onwards, those statuses will not automatically apply. Instead, there will be the power to make regulations to capture and prioritise persons with significant NHS experience based on other criteria or by reference to immigration statuses. I reassure my noble friend that we have already committed, and do so once again, to a proper engagement process—subject to the Bill’s passage, of course—to ensure that any future definition is fair, evidence-based and deliverable.
Amendment 11 would prioritise groups with different immigration statuses which are not an appropriate proxy for significant NHS experience. This is not consistent with the aims of the Bill. The amendment would also have the effect of permanently prioritising applicants on the basis of immigration status for foundation and specialty training. The applicants with the immigration statuses listed in the amendment who are not otherwise prioritised are—as I have already said, but it bears repeating—not excluded from applying for foundation or specialty training. They may still be offered a post, if there are places remaining, once all prioritised applicants have been allocated posts. They also remain eligible to apply for locally employed doctor roles. On this basis, I hope my noble friend will feel able to withdraw her amendment.
I turn now to Amendments 12, 13 and 15, tabled by the noble Baroness, Lady Gerada. I appreciate the intention behind these amendments, as many of us do, and I am most grateful to the noble Baroness for her work in bringing these amendments back in the way that she has on Report, having heard the arguments previously in Committee. I appreciate her work on them, both inside this Chamber and outside, and the way in which she made her case so clearly and powerfully, as other noble Lords have said. I know the noble Baroness is aware, as I emphasised in my letter that I sent out to Peers, that the Government are unable to support these amendments.
Let me explain to your Lordships’ House why this is the case. The Bill rightly prioritises doctors for foundation and specialty training based on where they are trained. It also prioritises internationally trained doctors with significant NHS experience for specialty training. We are doing this because these doctors are more likely to work in the NHS in the long term and to be better equipped to deliver healthcare that is tailored to the UK’s population, because they will better understand the UK’s health system and epidemiology.
On my noble friend Lord Hunt’s point, which I believe he also spoke to in the previous group, while assessments and course learning at overseas campuses may well be the same—I accept that—as in UK-based medical schools, students will not have undertaken the same number of clinical placements in the NHS in the United Kingdom.
I note that the noble Baroness, Lady Gerada, argued in her email to all Peers—or to a number of Peers, I am not quite sure which—that her amendment would not widen eligibility for prioritisation beyond the Government’s intentions. This is not the case. To reiterate, the Bill intends to prioritise home-grown doctors and put them at the front of the queue for training posts. It is unashamed, for the reasons that I have explained and noble Lords understand. Doctors who have trained here and undertaken their placements in our hospitals and health settings will have more familiarity with the NHS and the needs of the patients they serve than a doctor who has studied the same curriculum but not in the UK.
However, the Bill recognises that this experience can be gained without spending the entirety of one’s degree in the UK. However, the line has to be drawn somewhere and, where the majority of a degree has been studied outside the UK, it is right that those graduates are not prioritised equally alongside UK-trained medical graduates.
To pick up the point about future-proofing that the noble Baroness, Lady Finlay, raised, we recognise the risks of this creating a loophole in the legislation if medical schools purposefully change their curriculum to ensure that their graduates come from within the priority status. However, as we discussed earlier today, this risk would exist at whatever threshold we set. I can, however, assure the noble Baroness that we will continue to monitor the data carefully in future years, for all the important reasons that the noble Baroness said.
The Bill prioritises all graduates of UK medical schools who have studied for their degree in this country. That is the right thing to do for our health system, because we recognise that these doctors are well prepared to work in that system and are more likely to stay. It is also right and fair to do this for graduates of our medical schools. It treats all graduates as equals, regardless of where they are from.
As the noble Lord, Lord Patel, noted, prioritising graduates from overseas campuses would also undermine—these are my words, not the noble Lord’s—our aim of greater social mobility and access into medicine. We need dramatically to improve access to this profession for those from disadvantaged backgrounds across our communities in order that our medical practitioners can be more representative and serve the communities from where they come. The campuses that we are speaking of are commercial ventures and students are generally self-funded. Including these graduates in the priority group would undoubtedly undermine the efforts of the Bill to support home-grown talent.
I will make a number of points to deal with the points that the noble Lord, Lord Clement-Jones, raised. I understand that the proposed amendments seek to restrict future eligibility by prioritising only those campuses that are extant on the day the Act is passed, and also to create a power that would enable us to limit the number of eligible applications under this provision. However, the establishment and operation of these overseas campuses sit outside the UK Government’s workforce planning and commissioning decisions. We have previously set out that we expect that all eligible prioritised applicants for the foundation programme in 2026 will get a place. So, accepting these amendments, even with the suggestion of capping the numbers that could be prioritised from these campuses, would mean we would have to fund more foundation programme posts than we need.
There has been talk—not just in the Chamber, but outside—about figures. Let me clarify that current UK foundation programme applications for 2026 show almost 300 applicants from overseas campuses of UK and Ireland medical schools. This is a significant number and to prioritise all of this group would require substantial additional expenditure for these posts. A rough estimate is around £25 million over two years. This is funding which, if it went in this direction, could not be spent on other priorities, including increasing specialty training places, which I know is of great interest to noble Lords.
In addition, the proposed amendments would not have any effect on overseas campuses of Republic of Ireland medical schools, so would conflict with provisions in the rest of the Bill, which treat Ireland graduates on the same basis as UK graduates, reflecting the unique relationship between the two countries.
Baroness Lister of Burtersett (Lab)
My Lords, I am grateful to the noble Baroness, Lady Finlay of Llandaff, and the noble Lord, Lord Mohammed of Tinsley, for their support for Amendment 11. I am also grateful to the noble Earl, Lord Howe—I thought his response was very fair.
There was clearly very strong support for the noble Baroness, Lady Gerada, who made a very good case for why what she was asking for was very limited, but clearly it is not something that the Government feel able to support.
I take some comfort from what my noble friend said with regard to future engagement, particularly with regard to refugees and what she said at the very end in response to the noble Earl, Lord Howe. I emphasise that I really hope that this process of engagement will include the groups working with refugee doctors so perhaps there may be hope that—if not this year, then in future years—their needs may be recognised, and similarly that the case made today by the noble Baroness, Lady Gerada, will be taken into account when this engagement process starts.
Perhaps my noble friend could write to us and give us more of an idea about what this engagement process will involve, when it will take place, who will be engaged and so forth. But with that, I beg leave to withdraw the amendment.
Lord Mohammed of Tinsley
“(1) Regulations under this Act are subject to the affirmative procedure.”Member's explanatory statement
This amendment ensures that all regulations under this Act are subject to the affirmative resolution procedure.
Lord Mohammed of Tinsley (LD)
My Lords, Amendment 14 would ensure that all regulations under the Bill are subject to the affirmative resolution procedure—or, in simple terms, that both Houses of Parliament get to have a say in and have a vote on any changes that a future Minister or Government make. This is not a narrow technical point; it goes to the heart of parliamentary accountability and to the fair and transparent governance of medical training policy.
The Bill confers broad powers to Ministers to determine key aspects of how prioritisation will operate. These include potentially definitions for eligibility, scoring frameworks, exemptions, transitional arrangements and other detailed rules that will shape the careers of tens of thousands of doctors. In Committee, noble Lords expressed concerns about the breadth of delegated powers in the Bill and the limited parliamentary oversight of these powers. In Committee, it was evident from the debate that Members of your Lordships’ House share the view that regulatory decision-making powers are vast and open-ended, yet the Bill envisages only the negative procedure for most regulations, meaning that the regulations can come into force unless actively annulled.
This falls short of the level of scrutiny appropriate for measures of such significance. It is precisely because of the impact of this legislation on individuals’ careers and NHS workforce planning that the affirmative resolution procedure is the right standard. Ministers should be required to lay each statutory instrument before both Houses and obtain explicit parliamentary approval before they can take effect. This would give the House the opportunity not merely to debate but to approve or reject the detailed rules that give effect to the policy, ensuring that changes are made not by default or through omissions but by the conscious decisions of Parliament.
Medical training policy is not static. It will evolve in response to workforce needs, technical standards and educational practices. There is nothing wrong with working with flexibility. There is something wrong with flexibility exercised without open scrutiny. Doctors plan years ahead; they make life choices on the basis of published criteria. To allow Ministers to adjust those criteria by regulation without positive endorsement by this Parliament risks unpredictability and unfairness.
The use of the affirmative resolution procedure does not prevent Governments acting. It simply ensures that Parliament is properly informed and engaged, strengthening trust in the process and respecting this House’s role in scrutinising public policy. Given the far-reaching nature of these measures that could be set in regulation, the affirmative resolution procedure is not just desirable but necessary. For these reasons, I hope that noble Lords will back my amendment.
The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)
My Lords, I should advise the House that if this amendment is agreed to, I cannot call Amendment 15 by reason of pre-emption.
Lord Kamall (Con)
My Lords, I thank the noble Lord, Lord Mohammed of Tinsley, for opening the debate on this group—and the numerous noble Lords who spoke to it.
I redeclare my interests. I am a professor of politics and international relations at St Mary’s University, Twickenham, where I teach a module on healthcare policy and strategy, and I have been helping with its new medical school. I also work with the Vinson Centre for the Public Understanding of Economics and Entrepreneurship at the University of Buckingham, which has a medical school, although I have no direct connection with the medical school there. I hope I have touched on all potential conflicts.
Amendment 14, from the noble Lord, and Amendment 16, in my name, were debated in Committee, so I do not intend to repeat the arguments that were made then. However, I think it would be helpful if we reminded ourselves that we are dealing with emergency legislation. This is key. The Constitution Committee has warned against the Government’s overuse of emergency legislation, not least because when we legislate in this way we risk creating unintended consequences. We should be very careful and selective in using emergency legislation. In that context, it does not seem unreasonable that your Lordships’ House should be given an opportunity to scrutinise secondary legislation in more detail through the affirmative procedure. I hope the Minister will take on board the concerns about using the affirmative procedure rather than other procedure.
Turning to Amendment 16, I have retabled this amendment for debate today because I am afraid that I was not completely satisfied with the Minister’s response in Committee. I am sorry to say that but, at Second Reading, the Minister explained that the Government’s view is that commencement may not happen with Royal Assent because the changes introduced by the Bill are “a major undertaking” and
“there is a material consideration about whether it is even possible to proceed if the strikes are ongoing”.
However, in the same speech she explained that this is “emergency legislation” which is being brought forward
“as quickly as possible, rather than wait … another year to do so”.
On the one hand, this is a major undertaking that, in the words of the Minister,
“cannot be switched on overnight”.—[Official Report, 4/2/26; col. 1681.]
yet at the same time it is emergency legislation that cannot wait.
Baroness Merron (Lab)
My Lords, I am grateful to the noble Lords, Lord Kamall and Lord Mohammed, for their contributions in this group of amendments.
I turn first to Amendment 14, tabled by the noble Lord, Lord Mohammed. As I stated in Committee, we are unable to support this amendment. It might be helpful to your Lordships’ House if I am clear about our intention. As your Lordships are aware, the Bill sets out on its face the groups of people who are to be prioritised for specialty training from 2027 onwards. The delegated power about which we are speaking is limited to adding to this list by referring to the significant experience of working as a doctor in the health service or immigration status, so it is, in my view, tightly drawn.
Similarly, we have set out in the Bill the specialty training programmes excluded from the prioritisation scheme. Again, I give the reassurance that the delegated power about which we are speaking is limited to amending this list and gives necessary operational flexibility for future changes in recruitment, training and workforce needs—something that noble Lords raised in an earlier group.
As I hope noble Lords are aware, I am always supportive of parliamentary scrutiny. However, due to the very limited scope of these powers, we believe that the negative procedure is appropriate, not least as the regulations will not have the effect of excluding anyone from applying for a training post. I hope it is helpful to remind noble Lords that the Bill has been assessed by the Delegated Powers and Regulatory Reform Committee, and no suggestion was made that the negative procedure was inappropriate for such regulations. With that explanation, I therefore hope that the noble Lord will feel able to withdraw his amendment.
Turning to Amendment 16, tabled by the noble Lord, Lord Kamall, in Committee I spoke to why, as he said, we cannot support this amendment: because it removes an important element of operational flexibility. Let me say at the outset that I completely understand why the noble Lord has raised again the points he raised previously. He mentioned a tension; yes, in lots of ways there is a tension and that is what we are trying to manage.
As I stated previously, the commencement provision in the Bill is absolutely not a mechanism for delay. We want to proceed with this as soon as possible. That is the non-specific answer to the noble Lord’s very reasonable questions, but I think he will understand that not knowing the timetable on which I am commenting or the possibility of strike action means that I am not readily in a position to give exact answers; I wish I were. The main thing is that it is absolutely our intent to commence the Bill as soon as possible. That is why we are dealing with it on the planned timescale.
The commencement clause is a safeguard. It is to ensure that all the planning, capacity and systems are in place before the Act is brought into force, because it will be impossible to do it otherwise. Noble Lords will also appreciate—the noble Lord, Lord Kamall, raised this—that the question of whether it is possible to proceed if industrial action continues, given the strain that strikes put on the system, cannot be ignored.
Although preparations for the implementation of the Bill as introduced have been progressing and are undergoing quality assurance testing, should the Bill be amended it could impact on operational readiness that could delay offers and disrupt staffing preparations. We have to avoid such disruption; although we do not expect such issues to arise, it is important that we retain what we regard as a fail-safe provision.
Any Secretary of State would be right to take all the circumstances, including operational readiness, into account in deciding when the Act should come into force. I cannot restate often enough that the intention is to bring this in as soon as possible; that is what we all want to do and that is what we need to do. For the reasons I set out, I hope that the noble Lord will feel able to withdraw his amendment.
Lord Mohammed of Tinsley (LD)
I thank noble Lords who have contributed to the debate. Given what I have heard from the Minister, both in the Chamber and in my previous conversations with her, I beg leave to withdraw my amendment.