Lords Chamber

Monday 23rd February 2026

(began 2 hours, 9 minutes ago)

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14:37
None Portrait Oral questions: Findings of the Nature security assessment on global biodiversity loss, ecosystem collapse and national security, published on 20 January
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My My Lords, My Lords, I My Lords, I should My Lords, I should like My Lords, I should like to My Lords, I should like to notify
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None Portrait Oral questions: Findings of the Nature security assessment on global biodiversity loss, ecosystem collapse and national security, published on 20 January
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None Portrait Oral questions: Implementing the recommendations of the LGBT Veterans Independent Review, published in July 2023, with particular regard to the Financial Recognition Scheme
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Oral Question Lord Cashman. question. Standing in my name on the Order Paper. My Lords, can I just start answering this question
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None Portrait Oral questions: Communicating the purpose and value of the newly-introduced V-Levels to students, parents, and employers
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McNicol of West Kilbride. >> I beg leave to ask the question. >> Standing in my name on the Order Paper.

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Paper. Question. My Lords V-levels will deliver a
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Lord Stockwood Portrait Lord Stockwood, Minister of State (Department for Business and Trade) (Labour)
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Well, the noble Lord raises a number of challenging and fast moving issues here, so I'll try and moving issues here, so I'll try and respond as fully as I can. What's worth stating is that the UK secured that preferential deal last year, driven by the Prime Minister's direct engagement with President Trump and trying to give British businesses that certainty and competitive advantages, the ruling of the weekend does not affect our preferential treatment in key sectors like pharma, cars and steel that the noble Lord mentions.

The business secretary spoke to US Trade Representative Jameson Greer this weekend, making it clear our concerns about uncertainty and the degree of confidence in honour those agreements that we needed and had those reassurances. UK officials across Whitehall and Washington are engaging intensively with the US as we speak, and this will continue those discussions all of this week, at which time we can update the House. It's worth stating to my noble friend that we've always had a cool headed and pragmatic approach to trade deals, and whilst I wouldn't comment on other governments policies, we do have a competitive advantage globally in those sectors that we set out in the original negotiation, the biggest beneficiaries of this weekend's announcement are those trade barriers coming down for other countries.

But we still have the best deal globally, and we continue to negotiate to retain that preferential position.
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None Portrait House Adjourned During Pleasure
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My Lords, may I suggest a short
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15:34
None Portrait Legislation: Medical Training (Prioritisation) Bill – report stage
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Lords, I beg to move that this report be now received.
15:34
Lord Patel Portrait Lord Patel (Crossbench)
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The question is this report be now received as many of that opinion say content the contrary, opinion say content the contrary, not content. The contents have it in clause one, amendment one Lord Patel.

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Thank you, my Lords.

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I like to speak to my amendments listed in the Group one. My Lords, my amendment should be underpinned by the status of UK medical graduates. The the competition to get into medical schools in United get into medical schools in United Kingdom is one of the toughest of any countries. The ratio of success is about 4 to 1, with the highest A-level grades that are obtained, including many at A Stars. But requirements are higher than that at the completion.

On average. UK medical graduate has a loan of about £72,000 and it's important that we discuss this debate, this bill. In that context. I have reinserted my amendments that I had at Committee stage for two reasons. One, that the debate that we had at the Committee stage rightly maybe concentrated 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.

But the following debate, which we have all received many, many emails from both UK graduates and also international medical graduates, I have, presumably because I had amendments under my name, seem to receive many, many more from UK medical graduates and some of you may see a petition on the internet addressed to US Members of Lords to pass this bill unamended from UK medical graduates. And I gather that over 4500 names attached to that petition now.

So why are my amendments again? Most other countries my Lords, USA, Canada, New Zealand, Australia, Singapore and EU prioritise their graduates for further training and even employment. Data from GMC, NHS England, Royal Colleges, BMA professional journals and accept that there is variation in how the and also how this data could be interpreted. However, it does show that graduates from UK find it difficult to get into core and specialist training programmes for a variety of reasons increased output from medical schools and that will increase even more in future years.

Increase post visa 2019 from international medical graduates. The training slots have not increased and the workforce plan increased to accommodate more doctors. The UK doctors pay negotiations. One of the primary reasons they stated, was training as an issue. The second issue was working condition and the third issue was pay. Now I have said it publicly in this chamber before and I repeat it. I do not subscribe to any doctor at any time. Withdrawing their services from patients for no matter what reason.

So I 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, but that is no reason as far as I'm concerned, to withdraw services from patients. UK training of doctors is in three stages Foundation years one and two, core training and speciality including GP speciality training. GMC informs me that foundation one year training is available to all graduates who graduate from UK universities, although sometimes they find it difficult and the slots are not available till the last minute.

That usually 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 the surgery in Penzance, having qualified in Saint Andrews, so it was not a place I visited before, but I got through it. Foundation year two, the GMC says in 2024 reports that in 2023, 77% of doctors completing Foundation Year two did not or cannot enter core training. A lot of them, 13.14% had decided not to, I gather, had gone maybe overseas.

The international medical graduates whose primary medical qualification was overseas. In 2017, there were 47% registered with GMC. In 2023, there were 68% GMC report. In 2023, 40% of doctors entering speciality training are international medical graduates. Of course, it's important that we have opportunities for international medical graduates to come and train in United Kingdom and in fact have employment status in the NHS. But UK doctors should have a fair slot, sir, able to compete fairly.

UK doctors comment that after year five, Foundation year two to enter speciality training is like falling off a cliff that is difficult for them to get into specialist training. NHS England in the training information Medical Training (Prioritisation) Bill this bill at annexe three said to potential impact that the application totalled 21,000 from for about 10,000 posts of ratio of 2 to 1 in 2025. Round one 28,000 of Where Appointable, despite lower competition ratios, over 2000 Appointable UK grads, did not receive an offer.

In round one of 2025. The expectations, therefore, there will be 16,000 UK graduates, slight increase from last year applying for core and speciality training in 26,000 international medical graduates. Again, slight increase from last year. That is 42,000, although NHS England numbers are 47,000. There's always variation numbers for reasons I cannot explain, my Lord. The ratio nonetheless is 4 to 1 for 10,000 slots. Estimate, therefore, is in the prospect of 8000 UK graduates forced out of the current rotation year coming rotation year that may not have appointments with the passage of the bill, it will mean priority groups of doctors in the bill will apply also for these training slots.

Now, I could not find a number of what effect that would have, but maybe the noble Baroness, the Minister has numbers, or if the priority groups in the current bill were included, how many more doctors will be able to enter the specialist training? So the UK graduates, with the expansion of priority Group, will have further competition to to compete for the current bottlenecks. And I quote from a publication of NHS England with a foreword from both Doctor Powis and the and the Chief Medical Officer.

And the quote is the current bottlenecks in training do not benefit any anyone. While some competition has always been necessary part of medical training and career progression, the current ratios are making sensible career planning and assessment for and that is my words, UK doctors very difficult. I think that's why I put my amendments that I have. I know the later amendments will discuss about other graduates from other UK campuses being eligible in the priority group, but I'll refer to that later.

I beg to move.
15:44
Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Labour)
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Amendment proposed clause one, page one. Line four after must page one. Line four after must insert first. My Lords, I thought the noble Lord Patel made some very, very interesting points and I'll be interested in my noble friend's response to specific amendments. But like the noble Lord, I doubt if I've had as many emails as he has in view of his expertise in the whole area of medical training and development, particularly at postgraduate level. But my Lords, it's hard not to feel sympathetic to both sides of the argument.

And of course, my Lords, I feel for those doctors trained overseas who were on, they thought, on a pathway to being accepted for speciality training in this country and have now, if you like, had the rules of the game changed halfway through. But my Lords, equally we've got a situation as as my the noble Lord, Lord Patel pointed out, really a ridiculous situation of growing competition from overseas doctors. UK trained doctors finding it very, very hard to get specialist training.

My Lords, it also goes, I think, into a wider question about this country's overreliance on doctors from overseas and I must say, my Lords, the current recruitment from Africa is one that gives me particular concern in terms of the whole ethics of this process. And my Lords, I think we need to recognise what is the problem. And there's no question, isn't it, that the last government, as you know, my Lords, they wasted years trying to develop a workforce plan.

They eventually came up with a proposal to increase the number of medical training places. But of course, my Lords, it wasn't fully funded for the long term. Hence, my Lords, we had more medical training places, but the number of speciality training places did not keep pace with the actual number of medical undergraduate training places. And so, my Lords, we have this ludicrous situation of UK trained medical graduates funded by the state not being able to get a post.

As for speciality training and of course, like the noble Lord Patel, I don't. I've never prescribed to the view that just because you qualified as a UK trained medical doctor, you have an automatic right to go into speciality training. Clearly you have to have some bars and people have to get through those bars. But my Lords, to actually for the state itself to fund so many additional training places and then not being able to allow them to access speciality training is clearly ludicrous.

And so, my Lords, I do think the government, I'm afraid, had to do something. I think it's not it. It's had to make a hard choice here, and one which in the end, my Lords, I have to support. But I do think, my Lords, that this also poses real concerns about the whole medical training programme in this country. We've clearly got to bring an A line undergraduate medical training places with speciality training. But I think we also Lord Patel referred to the current dispute with resident doctors, and I agree with him in relation to the issue of pay.

But, my Lords, anyone who has met a newly trained doctor in the UK at the moment will know they're not treated right. They know that they're not given the right leadership. And my Lords, if you talk to more experienced doctors, they talk about the Old Firm system. They talk about the impact of the working time directive on training. They talk about the way partnerships can be broken up because doctors are sent to different parts of their deanery when they're in a relationship, and how difficult it is for them, particularly if they then have children.

And my Lords, you, we all hear about the lack of support for those doctors within NHS trust, a lack of sympathy by employers to some of the pressures they're under. And I think, my Lords, as I see it, the action the government are taking today is part of a general programme of trying to turn this around. And I would say, my Lords, that I do think the leadership of the profession has much to answer in terms of the way these resident junior doctors have been treated in the past.

It's about time the colleges actually took stepped up to the plate to actually sort some of these issues out in conjunction with the GMC, and I hope, my Lords, I don't pretend this is not easy. This is, I think, a difficult decision. It's a hard decision. And I do feel great sympathy with some of the doctors caught in the current situation. But my Lords, it's surely the right way to go. But I hope my noble friend will assure me that this is the foundation in which to improve our whole approach to medical training.
15:49
Baroness McIntosh of Pickering Portrait Baroness McIntosh of Pickering (Conservative)
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My Lords, I would like to speak in support of the amendment in the name of Lord Patel and thank him for the research he's done as background to this amendment. The noble Lady will be aware that I work for the Dispensing Doctors Association. My father and brother were GPS. My uncle was a surgeon. I couldn't stand the sight of blood for the greater good. I went to the law profession, the legal profession instead, the noble Lady and the lady alongside her know of my interest in this subject, particularly for junior doctors in training, who, as we've heard, don't have the number of job vacancies for speciality offered to them, but also have no security of tenure.

And they are sort of of an age, probably in the late 20s and early 30s, where they would be hoping to to put down roots, form relationships and start families. So it's particularly key that I think we look after them. I had one point of difference with the noble Lord Patel. I just say I thought the consultants were quite well rewarded in their pay round, and I hope that they will support the junior doctors in in their pay round, because I think it's very important that the profession stick together in this regard.

But I agree with them. It's very unfortunate if they feel that they have to go on on strike. And obviously patients, hospitals and other staff are disadvantaged in that way. Could the noble Lady, the Minister, will respond to the debate on this amendment, explain to me, if we're not to adopt this amendment, what there is in the bill to cover the specific set of circumstances that is identified by Lord Patel's amendment? And if there's nothing in the bill, would she come forward at Third Reading with something that covers these points? Because this is something that exercises a number of us very deeply to give the right message, particularly, may I say to to young male white doctors that I think may otherwise leave the procession profession.

And I know in general practice, a number of partners are leaving and going to work in in Australia, New Zealand and Canada after they've completed their training and possibly after 5 or 10 years experience. So I think for the future of the profession at every level, we do need to take this set of circumstances very seriously indeed.
15:52
Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (Crossbench)
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I must declare an interest as a UK graduate and also as Pro-Chancellor of Cardiff University, which has a very large medical school. I think the issues raised already over the ethics by the noble Lord, Lord Hunt of Kings Heath are really important when we look at this bill in terms of what is our ethical role in attracting people, literally attracting and pulling from places which have a terrible shortage of any medical provision whatsoever. And the other aspect which my noble friend Lord Patel brought out so clearly has been the problem of career progression altogether.

And I hope that in summing up the noble Lady, the Minister will be able to reassure us that this bill is step one in sorting out the medical career progress for people in this country. Only this weekend I heard of large teaching Hospital that has two consultant posts coming up for which they had 28 Appointable applicants, many of whom actually are already consultants. So there is a real bottleneck for trainees who've gone right through their training program, done all their exams.

And there are two ways of progressing. Broadly, there is run through training, which provides some security, and there's other training at a postgraduate level where they have to reapply before they move on. And the problems of geography for people who are young, who are parents, who have got children who are settled, are absolutely massive, I have worried that the pay story hides a huge amount of problem and unhappiness, particularly in relation to the lack of teams now in the way that training has been organised.

And I don't refer to internet teams, I must say, but clinical teams where people know that they belong, where they know the person who they can contact and where there is longer continuity. And I think the there has been a fault by the medical Royal Colleges, and I would hold up my hand in there, having been involved in some curriculum in palliative medicine, that we overstepped different bits of experience and undervalued the importance of people coming through. But in support of these amendments from my noble friend Lord Patel, I do think it's also important to remember that on international medical training programmes, some have no or almost no communication skills training, almost no or no training in medical ethics.

And in fact there are some where they have no clinical experience of of any note whatsoever until they pass. They're almost totally theoretical exams. And then they have to gain all the clinical experience later. Now, I'm not passing any judgement on the quality of their medicine later on, and they may actually have a better scientific foundation. But I do think we're not comparing like with like in the process. And the last point that I would like to make is that I hope that the noble Lady will be able to assure us that Oriel, as an appointments process 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 really important that we don't select away excellence in the name of the medical school that somebody graduated from, because there is a spectrum of quality in every medical school output cohort, there are some who are absolutely 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 there will be in those other graduates from other medical schools, people with absolutely superb experience and who turn out to be excellent. And we see some of those in very senior positions in medicine at the moment across the UK. So I think the prioritisation prioritisation message needs to be subtle, needs to look at the full employment history from graduation and including their NHS experience, but the quality of their work during that, and apparently the system can actually automatically calculate a lot of this drawing on GMC data as well.

So 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.
15:57
Lord Stevens of Birmingham Portrait Lord Stevens of Birmingham (Crossbench)
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My Lords, I declare my interest >> My Lords, I declare my interest as chair of a King's College London. I think there's a welcome consensus I think there's a welcome consensus that the UK should be aiming for self-sufficiency in the production self-sufficiency in the production of new doctors through medical school, through speciality training and into the NHS. And in fairness, I think the last government deserves credit for having taken the decision to expand medical school undergraduate intake to put us on that path, and it was also not unreasonable to, as a temporary measure, make use of selective international recruitment.

While those new doctors came through the system, not least as the Independent Migration Advisory Committee reported that at the time, in respect of doctors, quote, there is sufficient and overwhelming evidence of a UK wide shortage. Close quotes given 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 feeds through the system would not have been good, certainly for patients. However, the question now is that clearly there does need to be a better prioritisation during the transitional system, and we've spent a lot of time in committee discussing the pros and cons of what that transitional prioritisation might look like.

But one question I think that has not yet been completely resolved, that would aid the House in assessing the proposals that Lord Patel has put before us, is whether we could have a clear answer from the noble Baroness, the Minister, as to what is the increase in the pipeline, the increase in the availability of speciality training places going to be for the current year and over the next three years, as she has pointed out to us in correspondence last week, during recess, the long term, the NHS ten year plan that they published last July talked about an additional 1000 speciality training places over three years.

However, the Secretary of State for Health and Social Care put on the table the proposition of not 1000 but 4000 additional speciality training places over three years, of which an additional 1000 would become available in this coming year. That's what was put on the table in the discussion with the BMA on the 10th of December. Given this is only a few months until these posts are filled, presumably the Minister must know the answer to the question exactly how many speciality training places? Additionally, are we going to get for the year ahead so as to reduce the prioritisation problems with whichever criteria this act puts forth.

forth.
16:00
Baroness Gerada Portrait Baroness Gerada (Crossbench)
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As the probably the only person in this chamber that has headed up a Royal College not once but twice, the Royal College of General Practitioners. I feel the urge just to defend and correct what's been said twice. In fact, three times in this chamber, the Royal Colleges set the standards, the curriculum. They do not oversee workforce planning funding. They do not oversee what the actual training looks like. Once you get into an organisation, I have to correct the house and correct those speakers by saying that is the job that the that is not their job.

For the Royal College of GPS. I don't disagree that there needs to be

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reform. Absolutely. It's a mess. It's a complete mess and. Would give way. I mean, would

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Would give way. I mean, would you accept that the Royal Colleges certainly can give moral leadership? Secondly, I would refer her back to the last junior hospitals doctors dispute about 10 or 11 years ago. dispute about 10 or 11 years ago. She will remember, I think it was the Academy of Medical Royal Colleges set up a group to look at Colleges set up a group to look at all these issues, and it seemed to me, my Lords, the outcome of that

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was very disappointing in terms of tangible results in improving the situation. Thank you very much. I have to

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Thank you very much. I have to also tell you that I, for the last 20 years, have led what's called Practitioner Health Programme, Practitioner Health Programme, which has looked after the mental health of the medical workforce. And to date, I no longer lead it, And to date, I no longer lead it, but to date about 40,000, mainly doctors have passed through that service, most with mental health service, most with mental health issues relating to burnout, depression and anxiety, and some a new diagnosis which I call NHS itis.

I do know about this endless reviews that were done. It's not just the Academy, medical, Royal Colleges, Health Education England, the General Medical Council, CQC, many of the Royal Colleges looked at the issues of the decline in mental health and some of these have been raised here around firms, around loss of control, around your training, around the intensity of the workload. Fundamentally, we don't make it easy for any of these doctors. And by the way, we don't make it easy for the international medical graduates either, who have always fared worse.

So I agree with you. There are solutions that that are there that we don't need another review. The answer is blowing in the wind. We have them. But and I'm very happy to discuss that at a further time.
16:02
Lord Clement-Jones Portrait Lord Clement-Jones (Liberal Democrat)
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My Lords, I think we ought to thank Lord Patel for having stimulated such an interesting and important conversation about how terrible our workforce planning in the NHS has been to date, my Lords, and we've had some very wise words around the House on that subject. My Lords, it's clearly not fit for purpose and that's why we are where we are, my Lords, on these benches, we've 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.

But while we sympathise with the noble Lord Patel's desire to ensure UK graduates are prioritised, and indeed a lot of that derives from the the the fact that our workforce planning system is not fit for purpose. My Lords, 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 be arguing in later groups. My Lords, 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.

And my Lords, we've received correspondence as indeed I'm sure almost every other noble Lord in this House today that from many doctors warning that absolute exclusion or rigid tearing could leave rotas empty in hard to fill specialities like psychiatry and general practice, which rely heavily on international talent, prioritisation is a necessary tool for workforce planning, but, my Lords, we must ensure that it does not become a blockade that damages the wider delivery of NHS services.

And, my Lords, as the noble Lord Stevens of Birmingham, said we need answers about the future of workforce planning, you know, what are the numbers going to be, my Lords, for training places and I believe that the government really need to answer that as we go through this bill, my Lords.
16:05
Earl Howe Portrait Earl Howe (Conservative)
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My Lords, I too am grateful to the noble Lord, Lord Patel, for the noble Lord, Lord Patel, for leading this 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. And 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 at Committee stage and other noble Lords, including my noble friend Lady Coffey, had amendments that sought to introduce a different prioritisation hierarchy.

My Lords, I do understand fully the case that the noble Lord is making, and I do agree with him that UK medical graduates should have a much fairer crack of the whip in access to medical speciality training places. Indeed, fairness has been our primary concern throughout our scrutiny of this bill. However, I do 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, which is a point that the noble Baroness, Lady Findlay, has consistently made. May I say I'm 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 do accept that Ministers have introduced this as urgent legislation with a specific purpose.

And in that context, and 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.
16:07
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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My Lords are most grateful to noble Lords across the House for their considered contributions to this group of amendments, and grateful to the noble Lord, Lord Patel, for his introduction to this group. I have the third reason to be grateful, and that is for the understanding about the challenge that this government is facing and the need to take action, and that is certainly something that I don't take for granted. My Lords, we are not able to support the amendments tabled by the noble Lord Lord Patel.

If I can go through the reasons for that. Also, in answer to the noble Lady Baroness McIntosh, the bill does already set clear priority groups without any further ranking within these groups. This is a binary system, and applicants are either prioritised or they are not. It might be helpful to your Lordships House that I do say that the priority groups set out in the Bill have been agreed across the four governments of the nation. Those, I believe, are who are best placed to support moving to what we all want, which is a sustainable workforce, to meet the health needs of this population.

Again, as I emphasised in Committee stage and also in Second Reading prioritisation, my Lords, does not mean exclusion. Non prioritised graduates will still be able to apply and will be offered places if vacancies remain after prioritised. Applicants have received offers for speciality training. There are likely to be opportunities in general practice, course psychiatry and internal medicine, which historically attract fewer applicants from the groups that we are prioritising for 2026 and alongside UK graduates, the bill does prioritise graduates from Ireland.

This reflects, as I've spoken of before, in this chamber, the special nature of our relationship with Ireland, along with the graduates from Iceland, Liechtenstein, Norway and Switzerland, which reflects our obligations under international trade agreements with the European Free Trade Agreement. Countries to treat their graduates no less favourably. This amendment. The amendments would mean that we would not be honouring these arrangements, as it would mean we are prioritising UK medical graduates over applicants from these countries.

My Lords, the agreements with Efta countries do precede this government for Iceland, Norway and Liechtenstein, the agreement was made in July 2021 and Switzerland in 2019. And the bottleneck issues that this bill is designed to address were also primarily driven by the removal of the resident
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