Medical Training (Prioritisation) Bill

Baroness Finlay of Llandaff Excerpts

Committee stage & Report stage
Monday 23rd February 2026 Lords Chamber

[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?

--- Later in debate ---

[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.

--- Later in debate ---

I do not intend to divide the House today, as I agree with the principle of the Bill and do not wish to delay it. Instead, I invite the Minister to confirm from the Dispatch Box that she will work with colleagues across government, universities and interested parties to agree a clear mechanism, whether by guidance or memorandum, that secures consistency for Maltese doctors needing to finish their training. I also ask her to commit to reviewing the impact of this legislation on the small numbers of affected students, including the refugee doctors we have just heard about, while fully preserving the Government’s policy intent. I genuinely look forward to working with the Minister to get this right together. Thank you.

[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.