Medical Training (Prioritisation) Bill

Debate between Baroness Coffey and Lord Jackson of Peterborough

Committee stage
Thursday 12th February 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I have tabled Amendment 2. The clerks suggested changing the wording to what is now there. It is a probing amendment, and like those of the noble Lord, Lord Patel, it could be applied to other clauses as well. It is about the principle. My strong view is that we have opened up medical schools and made more placements because we want to make sure that we have an ongoing workforce. I am delighted to see the noble Lord, Lord Darzi, in his place. He will have done work not only for Health Secretary Wes Streeting recently but previously in making sure that we have a strong workforce pipeline.

I am conscious that many medical schools, by way of survival, by way of diversity, have opened up a number of places. Admittedly, this is still quite small compared with the number of UK citizens going to medical school. However, as the noble Lord, Lord Patel, said, we have a curious definition in this legislation—that a UK medical graduate is simply somebody who went to a UK medical school. I do not think that is what the public would think that this is about. From a lot of the emails, I do not think that it is what a lot of doctors appreciate either—although I appreciate that it is the position of the BMA, which does not want to differentiate in that regard.

We have young people taking on debt by investing in their own education and several billion pounds being put in by the UK Government, by the UK taxpayer, to have this pipeline. Therefore, it is vital to have what my amendment seeks—a set prioritisation in this legislation and not, as the Minister said the other day, a “just one group and then no more” kind of prioritisation. It is vital that UK citizens are given priority.

It is important to look at some of the analysis. It is not the case that all training posts could be filled by UK citizens who have trained to be doctors—far from it. We would not have GPs coming through. According to the 2024 analysis, only about half of the GPs going on the ST1 or CT1 were from UK medical schools. There is a whole series of issues, and we are seeing this in different elements including psychiatry and paediatrics—very few UK medical students, it seems, want to do paediatrics. I could go on with the series, but the point is clear: this is not about excluding people from the rest of the world coming to work in this country or to fill key roles in the NHS; it is about ensuring that our investment is prioritised on UK citizens.

There is a certain peculiarity, which will come up in other groups, about what then happens with the Republic of Ireland and similar. I am not seeking to get into that debate; perhaps we will a bit later.

I want to get a sense of this from the Minister. One thing that is clear in the statistics, and which the Minister and the Department of Health should be seeking to understand more, is that for quite a wide range of the training courses UK students are turning down the opportunity, once they have been offered placements. Why is that? For general practice, I think that only 57% are accepting. I am conscious that people might get posted around the country, but that needs careful scrutiny as well.

I do not wish to suggest in any way that we are not welcoming people from different parts of the world, but it should go back to trying to make sure that we are addressing particular gaps in our NHS workforce, now and in the future, not squeezing people out, and recognising the work that has been done to increase the potential numbers in home-grown talent.

Those of us who spoke at Second Reading have, in the last week, had a lot of emails coming in. I completely understand that there are different stories. For a brief time, when I was Health Secretary, a by-line suggested that I thought everybody should disappear to Australia—far from it. We cannot stop people leaving this country to go to Australia or elsewhere in the world, but we should be making sure that the reason they are choosing to go elsewhere is not because they cannot get a training place here when they have been deemed appointable. Ideally, they would be offered a role. That is something we can fix with this legislation. I hope the Government will rethink their approach to this during the passage of the Bill.

I apologise to the Committee that I will not be here to deal with my amendment later on, but I know that the Front Bench will do so. The time is pressing to get this right. I had not realised quite how soon a variety of decisions need to be made: I believe they need to be made before, or certainly within a few days of, Easter. It is critical that the Government think again. I am sure that, with encouragement from the Committee and from very distinguished medical practitioners, current and past, they will do so. That is why I commend my amendment to the Committee.

[Lord Jackson of Peterborough (Con)]

My Lords, I am delighted to have the opportunity to support my noble friend in her excellent amendment. Broadly speaking, this is a very welcome Bill. I congratulate the Government on bringing it forward to address what is becoming an acute issue, but it could be better. My remarks fall into two separate parts: there is the philosophical issue and there are the practical, evidence-based matters, which I will elucidate in the course of my remarks.

First, it has to be said that British taxpayers fund medical education through universities and the NHS, and we should be thinking much more about the value for money that those taxpayers receive. Prioritising British citizens would ensure that the investment benefits the domestic healthcare system and would, I think, reduce the risk of brain drain, where trained doctors emigrate after completing training. Training costs are substantial—estimated at £200,000 to £500,000 per doctor—and British citizens would be more likely to remain and practise in the UK long term. There is a case that they perhaps provide better value for public investment in medical education.

The wider philosophical issue, as alluded to by the Nuffield Trust, is around the fact that, in recruiting international medical graduates, the NHS has a negative impact on the domestic healthcare sector and staffing shortages in many countries abroad, particularly in Africa and Asia and poorer countries generally. That point has been made over many years. There were issues too about cultural familiarity, language proficiency, better understanding of local healthcare practices and patient expectations, and easier integration into multidisciplinary medical teams.

Specialty training, competition ratios and bottlenecks have reached breaking point. Preliminary information for the 2025 specialty training application cycle is concerning. This year, there are over 33,000 applicants for just under 13,000 training posts. This means that up to 20,000 doctors will be left out of specialty training this August. Even if you are not directly affected, that is a public health and public policy issue.

Crime and Policing Bill

Debate between Baroness Coffey and Lord Jackson of Peterborough

Committee stage
Monday 2nd February 2026 Lords Chamber

[Lord Jackson of Peterborough (Con)]

I am very grateful for that guidance, and I apologise for starting to accept what I am sure would have been a sparkling intervention from the noble Baroness, Lady Bennett of Manor Castle.

There are huge gaps in our understanding, particularly in relation to complications, but I will not repeat the points I made on my previous amendments. Suffice to say, there is a pressing need for a more comprehensive and robust system of data collection. My noble friend Lord Moylan’s Bill, which is currently awaiting Report, seeks to address this deficiency by ensuring that complications are more accurately reported. It would be remiss to proceed with Clause 191 without first seeking to understand the consequences for the recording and monitoring of abortion outside a clinical setting, particularly when we know that the present framework fails to capture the true scale of complications.

Finally, it is deeply regrettable that we are being asked to approve the most far-reaching change to abortion law since 1967 without the public having first been consulted. A change of such moral, legal and societal consequence warrants proper consultation, yet the public have been afforded no such opportunity.

Whichever side of the debate one may be on, we can surely agree that this is a matter that should not be pursued without proper consultation and consideration on its likely impact. I therefore urge noble Lords to support my amendment. I beg to move.

[Baroness Coffey (Con)]

My Lords, I support my noble friend’s Amendment 562, particularly his proposed new subsection (13)(e). I did not hear from the Minister earlier about what they are going to do once Clause 191 goes ahead—assuming it does; we will decide on Report whether or not that will happen. I do not think that the Minister will answer that today.

Amendment 562 would require the Government to give some proper consideration to how this is going to work in practice before it is enacted. For that reason, it is a sensible way to get a bit of breathing space to open up what we are walking into and, for those where potential crimes are committed, given that one person in the arrangement has been decriminalised, what is going to happen to the people who have facilitated what could be a crime. That is why I support Amendment 562 at this stage.

Border Security, Asylum and Immigration Bill

Debate between Baroness Coffey and Lord Jackson of Peterborough

Committee stage
Thursday 10th July 2025 Lords Chamber

[Lord Jackson of Peterborough (Con)]

The European Court of Human Rights is not recognised as a traditional court of jurists as one would recognise, for instance, the US Supreme Court. Many of the people representing their countries are from NGOs who have vested interests in different areas. It is not comparable to our own Supreme Court, the US Supreme Court and many others. I stand to be corrected.

This is the debate we had during the discussions and deliberations on the safety of Rwanda Act. The erroneous notion that international law is sovereign over the UK Parliament, and that we cannot pass laws contrary to international treaties such as the ECHR, is pernicious and hugely undermines the faith and trust the electorate have in our governance. Such a notion was explicitly refuted in a Supreme Court ruling in 2021.

Real demonstrable damage is being done by such mischaracterisation and errors. The excellent report for the Centre for Policy Studies authored by my noble friend Lord Lilley, recently published, highlights that the proportion of asylum claims granted first time jumped from 25% in 2010 to 67% in 2023. We have to ask ourselves why that is the case. Why are we so out of step with so many other countries such as France, Italy, Spain and Germany? Some 42,000 asylum seekers are awaiting appeal outcomes, with 40% citing human rights grounds.

This Government have instead doubled down on lawfare, on the rule of lawyers and not the rule of law. Today the newspapers report that our Attorney-General has apparently appointed himself as Deputy Prime Minister with an effective veto over all government policy and a “snitch clause”, encouraging civil servants to dob in Ministers who fall foul of the Attorney-General’s zealous, unbalanced and damaging interpretation of international law. This extends to vetoing potential domestic legislation. It will not end well.

To finish, this Government had a great opportunity to consolidate and build on the work we had done in government, and we would have cheered them on and wished them well. It is a matter of great regret for the future of our country, for people who are looking to government to protect the safety and security of our borders, that they were not able to do that.

[Baroness Coffey (Con)]

My Lords, I support my noble friends in opposing this clause. While I will try to avoid repeating what my noble friends have already said, to take a starting point, I did speak in the debate at the other end on this because it was important that, as has already been somewhat alluded to, this turned out to be quite a significant deterrent.

I appreciate that the Minister may disagree with my interpretation, but he will remember that when this started happening and became law, people started moving to Ireland, to Dublin. People left this country because they were concerned about being caught up in the process of being sent to Rwanda. People could see it with their own eyes. In 2022 the number of crossings meant that 45,000 people came to our shores through small boats, then it started to fall when the Prime Minister at the time announced that. Once there was legal wrangling, all of a sudden the number of people coming across on illegal crossings started to rise again. The numbers cannot be refuted.

I appreciate that this was in the Labour Party’s Change manifesto for government, which estimated that it would save £75 million a year by scrapping this policy. It also anticipated that it would save, I think, a few hundred million pounds more by ending hotels. That has not happened either.

Nevertheless, in the first half of this year, we have seen 20,000 people coming to these shores. That is a significant uplift and, with no deterrent, there seems to be no change in the trend. I hope that what the Prime Minister has announced while we have been debating this amendment will be successful. I will not repeat the questions from my noble friend Lord Harper.

It is critical to come back to aspects of the constitutional arrangement, which is why we ended up where we were. We had had the Nationality and Borders Act 2022, then the Illegal Migration Act 2023. I am not going to debate that, because we will come on to it later in Committee. The High Court having ruled in favour of the then Government, the Court of Appeal and then five members of the Supreme Court spoke unanimously. I think it was perfectly valid for the UK Government, who were responsible for international relations, to try to correct how Rwanda had been maligned by those five judges. Yes, that was also considering representations made by lawyers and the UN High Commissioner for Refugees, but nevertheless, as I think I referred to previously, Rwanda is a prominent member of the Commonwealth. It is a nation that joined the Commonwealth because of values. The Commonwealth does not let just anybody in. Also, Rwanda had just recently held the presidency of the Commonwealth. That in itself is no mean feat. So it was perfectly valid of the Government. As we know, if judges come up with a decision that Parliament does not like, the recourse is for Parliament to then put in place a new law. That is why I was more than happy to support that legislation at the time.

I respect that this is a manifesto commitment, but it feels very tokenistic. As my noble friend Lord Horam pointed out, the scheme in Australia involved a number of factors, not only the offshoring and processing but the turn away policy—how the Australian navy worked with boats—but nevertheless it was clear that the Government were not going to accept illegal criminal activity. We all know that the smugglers do not care whether people live or die as they push them out into the very dangerous channel. This is just one line in a campaign, and I think the Government will come to regret not having something effective in this regard. As I say, we will come on to the Illegal Migration Act later.

I encourage the Government to think carefully about what happened and to recognise that every time they undermine the deterrent, unfortunately, the number of people handing over thousands of pounds to smugglers will just increase. I am sure nobody in this Committee wants to see that.

Employment Rights Bill

Debate between Baroness Coffey and Lord Jackson of Peterborough

Committee stage
Wednesday 18th June 2025 Lords Chamber

[Lord Jackson of Peterborough (Con)]

My Lords, I wish to speak on the issue of the labour market enforcement strategy in support of Amendment 274 to which I have appended my name and to build on the excellent remarks of my noble friend Lord Hunt of Wirral and the specific points raised by my noble friend Lady Lawlor. For transparency, I declare that I have been a member of the Chartered Institute of Personnel and Development for more than 20 years. The CIPD estimates that the People Skills HR support service which it has mooted, working with ACAS, would cost about £13 million under the new regime when this Bill becomes an Act. We already know, following on from my noble friend’s comments, that the cumulative cost of the existing bodies doing similar work, with analogous workstreams, is about £40 million.

Amendment 274 is important because in this country we have a strange anomaly. Unusually for an advanced country, we generally do not put the architecture of scrutiny and oversight in primary legislation. I want to know how this agency is going to be accountable in terms of the costs, who it employs, its policies et cetera. No doubt the Minister will say, “Well, once it becomes an Act, there will be what was the Business Select Committee, or there might be the National Audit Office, or there might be the Public Accounts Committee”. But we are being asked to sign a blank cheque for this without knowing how precisely this agency is going to operate and, most fundamentally, at what cost. We have not seen a detailed impact assessment focusing on the work of this body. On that basis, I ask the Minister specifically how he sees the process of accountability working and whether there will be any work by his department, and Ministers more generally, to work out what the costs are likely to be.

I accept at face value that this Government are committed to reducing the regulatory burden, particularly on small and medium-sized enterprises. I am sure the noble Lord, Lord Leong, will bend the Minister’s ear on that, having come from the background that he came from as a champion of small businesses from the Labour side. It is therefore not unreasonable for us to ask what the cost will be and how we will be able to hold this agency to account once it is established.

[Baroness Coffey (Con)]

My Lords, Amendments 277 and 328, which I expect the noble Lord, Lord Goddard of Stockport, to speak to shortly, are an interesting element. Amendment 277 talks about the review of the fair work agency. Considering that a number of questions have come up about this, that is a fair assessment, given that there is still a considerable amount of consultation to be done. Amendment 328 would basically strip out the commencement of any part of the Act until that review has been done and

“a Minister of the Crown has tabled a motion in both Houses of Parliament for debate … and the review has been approved by a resolution”—

not just regulations.

The reason I say this is that I continue to assert that some of the powers here are going to be novel. Even if the Equality Act 2006 may give powers to the EHRC, it has never used them to institute legal proceedings, only as an intervener or for judicial review, rather than taking on individual cases; I am conscious that there is a consultation there. The amendment from the Liberal Democrats is an interesting way to think about how we are looking at the details of what the new agency is going to do.

Employment Rights Bill

Debate between Baroness Coffey and Lord Jackson of Peterborough

Committee stage
Tuesday 10th June 2025 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I thank the noble Lord, Lord Hendy, for bringing this into our debate but, candidly, his Amendment 240 is truly extraordinary. The only success Flying Pickets had was a number one in 1983 with the single “Only You”—and, by the way, that was a copy from the great band Yazoo. The idea that we would go back to flying pickets is just extraordinary.

Some 45 years on, no sensible Labour Peer has put this forward until tonight. I genuinely find it astonishing that we are here still debating the idea that it is democracy for a strike to be called somewhere else all of a sudden and for you to go off somewhere else for a dispute you are not part of.

While I appreciate the erudite speech we have heard tonight, going back to the real substance and principle of this, this is an important Bill. I do not agree with a lot of it, but I find it extraordinary that we are going back in time when this country actually needs to move forward in modern industrial relations. I regret the amendments that have been tabled today.

[Lord Jackson of Peterborough (Con)]

My Lords, I rise to speak against this amendment very briefly. I agree wholly with my noble friend Lady Coffey. I also agree that the speech by the noble Lord, Lord Hendy, was very persuasive, compelling, detailed and comprehensive, but completely wrong. It would be a disaster for our country if we were to go back to the era of Saltley coke works, Grunwick, the disaster inflicted on the automotive industry, flying pickets and the closed shop.

Employment Rights Bill

Debate between Baroness Coffey and Lord Jackson of Peterborough

Committee stage
Thursday 5th June 2025 Lords Chamber

[Lord Jackson of Peterborough (Con)]

Does my noble friend agree that our very serious concerns about this clause would be assuaged were the Government to have properly followed Cabinet Office protocols and updated expeditiously the impact assessments, which are normally present in Bills of this size and magnitude?

[Baroness Coffey (Con)]

I agree with my noble friend. I have tried to get deposited in the Library, or sent through some other form of communication to all Peers, a response I have received from the Secretary of State on this matter. By the way, I have still not received a reply from the Cabinet Secretary, who is supposed to uphold Cabinet Office guidelines. In essence, the answer came back: “We’ll do a full impact assessment once the Bill is completed”. We know that industry is looking for that. We have no idea when these regulations will be introduced; I assume that they could already have started the consultation. It is important that the Secretary of State—I am trying to remember; I do not have a photographic memory—basically said, “We haven’t really changed that much”. That is where we are. I will continue to make the point. My noble friend is right and reminds me to chase the Cabinet Secretary.