Medical Training (Prioritisation) Bill

Alex McIntyre Excerpts

Tuesday 27th January 2026 Commons Chamber

[Wes Streeting]

That is a fair question from the Chair of the Health and Social Care Committee. We are taking longer than I would have liked with the workforce plan. I hope it reassures the hon. Member and the House that we have taken more time because that is what the royal colleges, trade unions, and clinical and NHS leaders asked us to do. Their strong urging was to get it right, rather than rush according to a political timetable, which I thought was a fair challenge. It will be published this spring.

[Alex McIntyre (Gloucester) (Lab)]

I welcome this legislation. Does the Secretary of State agree with me that the fact that the Government have listened to the concerns of resident doctors about training places, and have acted at pace to bring forward the legislation, shows that we as a Government are committed to fixing the problems left behind by the Conservative Government? Does he agree that the BMA should consider that when thinking about going forward with any potential further action?

[Wes Streeting]

I agree with my hon. Friend. For context, I say to members of the BMA and resident doctors that to bring forward legislation in this way and at this pace is not easy. We have a packed legislative programme. The clock is ticking on getting everything through that we want to get through in the time that we have available, and I am grateful to the business managers in both Houses for facilitating the Bill. Cross-party support is going to be important, particularly in the other place, where we have lots of expertise to draw on, including from Cross-Bench peers.

We have introduced the legislation because fundamentally we agree with the case that the BMA and resident doctors have been making. In our discussions with BMA representatives, immediately prior to the last round of industrial action and since, it has been very clear that when it comes to jobs, we are not that far apart. We recognise the problems and we are working together to address the solution. On pay, there remains a gap between the expectations of the BMA and what the Government can afford. All I ask of resident doctors and their BMA representatives is some understanding and a bit of give and take about the range of pressures on the Government and the national health service, many of which require funding, which is why there are choices and trade-offs.

I hope that the BMA representatives know and have noticed that, regardless of the fact that we remain in dispute on these issues and have had a number of rounds of industrial action, I have not slammed the door in their faces and stopped talking—we have continued with good-natured and constructive talks—and I have not thrown my toys out of the pram either, and said “Right, we will not proceed with this Bill.” We have continued to work to enact solutions that we think are good for resident doctors, and therefore good for patients and good for the NHS. I hope that this will be the spirit in which we can work together.

The goal is to be in a place, particularly with the BMA and resident doctors although this applies to other groups in the workforce too, where we can work together and make progress outside disputes, so that we can gather around tables as partners, rather than as opponents. That will take some gear shifting from where we have been to where we want to be, but I know that both the Government and the BMA have entered the new year in that spirit, so we will continue to make progress.

Having stressed the urgency of the legislation, I want to address the commencement clause included in the Bill, which has already been raised. First and foremost, it is there as a failsafe. We are running to an extremely tight deadline. I do not want to be in a position where a law is enacted and we are unable to implement it in a timely and orderly fashion. Secondly, there is a material consideration about whether it is even possible to proceed if strikes are ongoing, because of the pressure that they put on resources and the disruption that is caused operationally, particularly among the people I require to help me deliver the measures in the Bill. Of course, I am keeping my options open. We are in a good place with the BMA, and we have entered the latest round of talks in good spirit, but we do not yet have an agreement on their disputes and we are waiting for the outcome of their ballot, so I am not going to do anything now that unnecessarily makes it harder to end the strikes.

The Opposition amendment to remove the commencement clause is designed to make industrial action more likely, not less likely. It tries to bind my hands and make this job even more difficult. It looks like political gameplaying, at a time when we are trying to save the NHS, and it looks like party interest before national interest. I hope that the Conservatives will consider whether their amendment is really necessary.

British taxpayers spend £4 billion training medics every year. We treat them poorly, place obstacles in their way and make them fearful for their futures. We are forcing young people, who should be the future of our NHS, to work abroad, in the private sector or to quit the profession entirely. It is time that we protect our investment and our home-grown talent. This Bill will ensure a sustainable workforce, cut our reliance on foreign labour, halve competition for places and give home-grown talent a path to become the next generation of NHS doctors. I commend this Bill to the House.

--- Later in debate ---

[Stuart Andrew (Daventry) (Con)]

Let me start by saying at the outset that—

[Alex McIntyre]

You are not defecting?

[Stuart Andrew]

No, I am most definitely not defecting.

In the spirit of being constructive, I will start by saying that the Opposition support the principle behind the Bill. Doctors trained in Britain and funded by the taxpayer should have a fair, clear and consistent route to progress in our NHS. Britain trains some of the best doctors in the world, yet too many are leaving—not because they want to, but because they cannot access the training places they need. That wastes talent, damages morale, and ultimately affects patient care. However, support in principle is not a blank cheque; the Bill must work in practice, not just look good in a headline. We should also be honest about why we are here. Much of what is in the Bill has been promised by the Government since their election in plans, reviews and ministerial statements, and the fact that it is only being brought forward now suggests that this is catching up, not leading.

The first test is delivery. We cannot solve a shortage by changing the queue. Unless the Government deliver the 4,000 new specialist training places that they have promised, including the 1,000 places that are needed early, the Bill will not fix the bottlenecks; it will simply shift frustration from one group of doctors to another. That is why we are proposing constructive amendments to the Bill that we believe are workable and fair.

The next test is clarity. The real impact of this Bill will be determined by the rules that sit beneath it—who qualifies, how experience is assessed, and how decisions can be challenged. We welcome the focus on foundation training; prioritising UK and Irish graduates for foundation training is sensible, as it strengthens the pipeline and improves workforce planning. However, it will only work if there are enough placements and the system is transparent. That is why amendment 8 would clarify that a UK foundation programme must mean a programme in which the majority of training takes place in the United Kingdom. That is a necessary safeguard against loopholes.

Amendment 9 would ensure that from 2027, British citizens on UK foundation programmes are prioritised in a meaningful way. Prioritisation must apply not only at the final offer stage, but at interview, which is where selection decisions are often made. The amendment addresses many of the points that Labour Members have been raising, so I encourage them to support amendment 9 when we divide on it.

We are also concerned about doctors serving overseas with the armed forces. I was pleased to hear the Secretary of State talk about them, since they certainly should not be penalised because part of their training takes place abroad on service. As such, amendment 10 would expand the definition of a UK medical graduate to include those undertaking placements as part of an armed forces posting outside of the British Isles. I hope the Secretary of State will consider accepting that amendment to give reassurance to our armed forces, which I know is something he cares about. These are practical changes that would improve fairness and operability, and we hope the Government will adopt them.

We also support new clause 2, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), which would make clear that once priority groups are established, training places should be allocated on merit. That allocation should be based on academic achievement and clinical performance, rather than a lottery or a computer-generated ranking divorced from real performance. Again, I hope the Government will seriously consider the new clause. When the Minister for Secondary Care sums up, will she put on record that merit will remain central to selection?

Another issue that cannot be ignored is the impact on medical schools, especially those that rely on international students. New clause 3 would require an annual report to Parliament on the number of international students at UK medical schools and the financial consequences flowing from the Bill’s provisions. International students pay higher fees and help sustain our universities. If those numbers fall, what funding model would replace them? When she sums up, will the Minister for Secondary Care outline what assessment has been made of the impact on medical school finances? How many international places do the Government expect to fund in future, and on what basis?

The Bill cannot stand in isolation. Workforce planning depends on more than allocating training posts; it requires enough trainers and clinical supervisors, viable rotas that support learning and facilities that make training possible. The revised NHS workforce plan must set out how those needs will be met, and how the extra training places will be staffed and supported. With NHS England set to be abolished in April 2027, we need to hear from the Government who will lead workforce planning and accountability thereafter.

Our approach is straightforward. We will support measures that are fair and practical, that strengthen patient care and that respect staff. We will press the Government where we feel that proposals are rushed, underfunded or left vague. Backing doctors means giving them a route to progress and ensuring that the system is properly planned and properly resourced. I repeat that, in principle, we support the Bill. We want doctors trained in Britain to build their careers in the national health service.

That brings me to enactment. As we have heard, the Government propose that the Bill should take effect when the Secretary of State decides, rather than on the date of Royal Assent. When he said that he wanted to introduce this Bill, and that it would be urgent, I said that we encourage that and support it. However, if this Bill is truly urgent, and if Ministers want it to affect this recruitment round, why would they not commence it immediately? The Secretary of State should not be playing politics with people’s jobs. It is not right for doctors, including those not involved in industrial action, to be treated as bargaining chips, and it is not right for Parliament to be treated in this way to give him the tools that he needs because he did the first set of negotiations so badly. Will the Government support amendment 1, so that the Bill takes effect on Royal Assent? Will they commit to enacting the Bill as quickly as possible?

When does the Secretary of State intend to commence the Bill? If the Minister for Secondary Care cannot give the House a date today, what makes the Bill so urgent that it needs to be pushed through Parliament in a single day? Will the Government proceed with this legislation, even if no agreement is reached with the BMA? If industrial action is paused, will the Government still honour their commitment to prioritise UK medical graduates?

Many doctors took industrial action because they felt that their career progression was blocked. This Bill could play a part in rebuilding that trust, but that will only happen if Ministers deliver, publish the detail and follow through. They must be straight with the House. If this Bill is urgent, it should commence on Royal Assent. If implementation takes time, the Government should publish a timetable and the steps required to deliver it. To do anything else, frankly, would be discourteous to Parliament.