Medical Training (Prioritisation) Bill

Baroness Finlay of Llandaff Excerpts

2nd reading & Committee stage
Wednesday 4th February 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my recent observer role with the Medical Schools Council, and as a pro-chancellor at Cardiff University, which, of course, has a medical school. The Bill aims to address a problem that has been brewing for years—but some medical graduates will unintentionally suffer, and we must consider them.

Specific groups have already been mentioned by the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, but they warrant reiterating. First, there are medical graduates from established overseas branch campuses of UK universities. That is not only Malta; Newcastle has already been spoken of, and there are others. There are also UK citizens studying medicine in the EU in good faith, always intending to work in the NHS, and international graduates unable to receive specialist training in their own country, who come here before returning to develop key specialist services in their home country. There are also those who relied on the published recruitment framework in good faith for years, and made irreversible decisions—relocating families, investing time and money, filling rota gaps and sustaining NHS services through Covid—never expecting specialty training to be rewritten while applications were already in progress. Would a separate tier, after the current priorities but ahead of those with no UK connection, provide a solution?

As has been said, a few UK medical schools deliver their degrees from established branch campuses abroad, by fully accredited programmes regulated by the General Medical Council. They follow the UK curriculum, and are taught and assessed in English to identical academic and clinical standards. These students graduate with a UK medical degree and will have passed the UK medical licensing assessment. They often apply to work in the NHS and transition smoothly into clinical practice, benefiting the NHS. These graduates have applied for UK training posts under one set of rules, but face different rules with limited options. Should these UK medical graduates not be prioritised over graduates from non-UK universities across the world?

There is a wider significance, as has already been alluded to. The Government’s international education strategy states the importance of universities seeking global opportunities, such as developing branch campuses. To avoid opening the floodgates, do the Government envisage capping UK healthcare degrees delivered offshore? This year, there were over 25,500 UK applicants for just over 10,000 UK medical school places. Selection at 18 years old is difficult. Each year, having invested in years of their schooling, we reject highly capable home applicants who would be excellent doctors. Many of them choose to study abroad, determined to return to work in the NHS. Should they be required to pass the UK medical licensing assessment, so that UK citizens studying in the EU after school are not left stranded?

For postgraduate trainees who applied through the previous recruitment framework and are currently working in the NHS, with several years’ experience, would recognising service from Covid onwards be considered in the eligibility in the current round? Where is the expansion of specialty training posts and academic posts for some of these graduates?

Lastly, all UK health expertise benefits international development. Many countries lack their own training expertise, and historically the UK has trained specialists to go back to develop services in their home countries. This altruism improves global health and creates opportunities for the NHS, universities and pharmaceutical and tech companies to gain international contracts. Without routes for overseas doctors to train here, our international partners will look elsewhere.

The Bill apparently aims to secure a reliable supply of doctors for the future, ensuring that those with a UK medical link are more likely to progress to current consultant roles and continue their careers in the NHS. Will international medical student places here be further limited? Otherwise, the Bill could mean that UK students forced to train overseas through limited home student places will not be prioritised, whereas international medical students at UK medical schools will. In passing the Bill with speed, we must avoid penalising our own graduates, jeopardising international partnerships, or appearing hostile to international excellence or unreliable by suddenly changing the rules. Will the Minister consider widening the priority group or adding other tiers to recognise the importance of medical graduates?

Medical Training (Prioritisation) Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I support the amendments in the name of the noble Lord, Lord Stevens of Birmingham, to which I have added my name. I am not going to repeat much of what he said, but I support it because when, in 2026, both the UK and overseas graduates are further down the process of applying—and some have even been asked to come for interview—they will now not be able to continue. That seems morally and ethically wrong, so I support the amendments. I also support the amendment in the name of the noble Earl, Lord Howe. He made his points very strongly.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my role as a pro-chancellor of Cardiff University, and that I have until recently been an observer on the Medical Schools Council; I am still in touch with it.

This group of amendments seems incredibly important for our international reputation for fairness and consistency in what we commit to, but also in wanting excellence in our NHS. Therefore, there needs to be a sophisticated way of prioritising. One of those important areas is the contribution to the NHS, especially during Covid and major events, when some have gone way above what is normally expected and come back from holiday or maternity leave, or whatever, to deal with a major incident, while others have perhaps not always been quite so flexible.

We certainly have a crisis and must deal with it, so this is not in any way to say that we should not be doing this, but the timing is the worry. I will come on to the other degrees in the next group. Can the Minister explain whether the Oriel system itself is a block to incorporating the flexibility that these amendments ask for? There is a real worry among some that the Oriel system is a rate-limiting step, rather than being flexible enough to be rapidly reprogrammed appropriately to allow the intention of these amendments to be incorporated at great speed, and therefore redress the accusation of unfairness.

[Lord Clement-Jones (LD)]

My Lords, I offer our strong support for Amendments 9, 11, 24 and 25 in the name of the noble Lord, Lord Stevens of Birmingham, and Amendments 5 and 10 in the name of my noble friend Lord Mohammed. I thank the noble Earl, Lord Howe, for his Amendment 4, because it, in essence, sets the theme of this group, which is the dashing of legitimate interests for this year, which a number of noble Lords explored.

Before I address the specific mechanics of these amendments, we need to thank the noble Lord, Lord Stevens, and other noble Lords who highlighted at Second Reading the whole question of the protracted failure in long-term workforce planning. For years, we have seen a disconnect between the number of medical school places and the number of specialty training posts. There is a bottleneck of our own making: 12 applications for one post is a disaster. My late wife trained in the 1970s and became a registrar at Barts. I have no recollection of it being anything like on this scale, and we risk dashing the expectations of many of those currently in training.

As the noble Lord, Lord Stevens, noted at Second Reading, the Bill does not widen the bottleneck; it simply reshuffles the queue. Although we on these Benches accept the principle that UK graduates should not face unemployment after taxpayer investment, we must ensure that, in correcting one failure, we do not commit a second failure of fairness against those have served our NHS in good faith.

These amendments address one of the greatest injustices in this Bill: the decision to implement major changes mid-cycle for 2026, using the blunt instrument of indefinite leave to remain as a proxy for experience. The Government claim that assessing actual NHS experience is “not operationally feasible” for the 2026 rounds. Since Second Reading, we have received compelling evidence to the contrary. As my noble friend says, we have heard from doctors currently using the system who confirm that the Oriel recruitment platform already captures data on “months of NHS experience”. The question is there; the data exists. The claim that this cannot be done is a choice, not an administrative necessity.

By refusing to use this data, Clause 2 creates a perverse experience gap. It excludes doctors who have served on our NHS front lines for two or three years but who have not yet reached the five-year threshold for settlement. We have received hundreds of emails detailing the human cost of this decision. We heard from a mother who lived apart from her one year-old child for seven months to study the MSRA exam, only to find the rules changing days after she sat it. We heard from a neurosurgery SHO with two years of NHS service, who notes that this mid-cycle change renders his sunk costs unrecoverable. We have heard from a British citizen whose wife, a doctor on a spousal visa, is deprioritised, despite being a permanent resident.

Amendments 9 and 11 offer the Government a lifeline. They are permissive—my noble friend’s amendments mandate the Government. The bottom line is that the Secretary of State should use the data we know Oriel possesses to prioritise those with significant NHS experience in 2026, just as they intend to do in 2027. To reject this is to choose administrative convenience over natural justice.

I see the amendments at this stage as a probing opportunity. We need the Minister to explain in specific, technical detail why the existing Oriel data fields regarding employment history cannot be used to filter applicants for this cycle. If the Minister cannot provide a satisfactory technical explanation today, and if the Government resist this flexible approach, we will be forced to conclude that this is a choice, not a necessity. In that event, we may well need to return to it on Report.

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[Lord Forbes of Newcastle (Lab)]

My Lords, I must begin my contribution to this debate with two formalities. First, I declare that I am an honorary member of the court of Newcastle University. In fact, I am a recent recipient of an honorary doctorate from Newcastle University—although I must stress that I in no way compare an honorary doctorate in civil law with the range of national and international medical expertise in the Chamber this afternoon.

I also apologise to the Committee for tabling the probing amendment in my name without speaking at Second Reading. I hope that your Lordships will excuse my inexperience in the procedures of the House and be assured that there was no intended discourtesy to the Committee on my part by this inadvertent breach of procedure. Previous contributions to the debate have demonstrated that I may have got off somewhat lightly in terms of email traffic by not speaking at Second Reading; I have no doubt that there will be more email traffic to come on this subject.

I congratulate the Government on bringing this Bill forward and acknowledge the legitimacy of its core purpose. Prioritising doctors trained in the United Kingdom for foundation and specialty training is a necessary, reasonable and understandable aim, particularly given the sustained workforce pressures in certain parts of the NHS.

I was motivated to table this amendment by a number of representations that I received from concerned students who had been studying at the NUMed campus in Malaysia, which I had the great privilege of visiting shortly after it opened about 10 years ago. Many graduates of the NUMed Malaysia campus have gone on to serve with great distinction in the NHS. As the noble Baroness, Lady Gerada, said, the numbers are very small, but their impact on our National Health Service is very great. That sense of pride in the NUMed campus is felt deeply by Newcastle University, which is how I know and have been contacted about this issue. However, in a number of the representations that I have received, there has been a mistaken interpretation that the intent of the legislation is to exclude rather than prioritise. I wish to comment on these points in the debate on this group.

I was very surprised to see figures demonstrating that, in some specialties, competition ratios for specialty training have now exceeded 20 applicants per post, making the urgency of the Bill ever more apparent. I listened very carefully to the debate and have been greatly reassured by my noble friend the Minister’s assurances, particularly on the prioritisation of UK students rather than the exclusion of overseas students, and the intention of the Bill to smooth out bottlenecks in medical training and focus on homegrown talent as a priority. This does not mean denying the NHS appropriate international talent when it is appropriate to deploy it. I am also very reassured by my noble friend the Minister’s reassurances on the concerns about unintended consequences being addressed by subsequent regulation and review.

The Government have expressed a clear intent to continue to engage with relevant UK universities with international campuses to further explain the intention of the Bill and the way that it will operate in practice, and to support them as they adjust to the Bill’s very legitimate and important requirements as it progresses towards enactment.

[Baroness Finlay of Llandaff (CB)]

My Lords, it was with great pleasure that I added my name to the amendment so nobly introduced by the noble Lord, Lord Forbes of Newcastle. I am most appreciative to my noble friend Lady Gerada for the way that she introduced this whole group, because she flagged up very clearly that Malta and Newcastle are different from other places.

I also reassure the noble Lord, Lord Darzi, that my probing amendment was simply to probe. I was worried that the Bill’s wording could inadvertently leave UK-based universities unable to develop other outreach campuses, but not Irish medical schools and universities, and that those graduates could then be included in the future. I wanted to make sure that we had a level playing field, but I accept that the wording is clumsy and does not work.

I think the key word in the amendment that the noble Lord, Lord Forbes of Newcastle, tabled is “extant”, when it says that the

“medical school … is extant on the day on which this Act is passed”.

That would allow those schools currently in place, particularly Malta-Newcastle and, if the Government are so minded, the RCSI in Bahrain, to be able to be included because those degrees are taught to the same curriculum and examined at the same level, and those taking it undertake the medical licensing exam and prescribing exam—which I know is changing, but it will still be important that there is a completely level playing field. It would stop the mushrooming that could occur from other universities.

The word “extant” is really important, and I hope that the Minister will be able to take it on board and that it is completely compatible with the compelling case made by my noble friend Lady Gerada.

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[Baroness Merron (Lab)]

The noble Lord kindly raised this with me before, and I did test it out. I am grateful that he has given thought to this, because it is an important point. However, I am advised that, unfortunately, the solution that he has come up with would not deal with all the concerns we have and would still give us difficulty. The noble Lord talked about the thin end of the wedge, and I fear that we are still in the same place. I am happy to write to the noble Lord, and to make that letter available, to explain further detail. I am grateful that he has given consideration to a solution for what is undoubtedly an issue.

[Baroness Finlay of Llandaff (CB)]

I understand the comments that the Minister has made to my noble friend Lord Stevens. Would she consider wording in the primary legislation that expands on the fact that the campus must be extant and includes that the number of students studying medicine for the UK degree must be the same as when the Bill passes? That would provide rigid guidelines in primary legislation and would not rely on another body, where a quota could possibly be negotiated.

[Baroness Merron (Lab)]

Again, I understand that the noble Baroness is coming forward with a solution and I appreciate her thoughts. I always reflect on what is said, but my initial reflection is that that does not deal with the fact that we already have a number of people. I asked this very question about continuing to prioritise them. It is significant even currently and that is part of the problem, although I understand what she is suggesting.

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[Baroness Merron (Lab)]

My noble friend is right about the pace of change, and many of the changes we cannot even imagine as we discuss this today. We keep the impact of legislation under review, and the Bill will be no different to any other Bill in that regard.

[Baroness Finlay of Llandaff (CB)]

I do not want to put the Minister too much on the spot now, so could she clarify in her letter whether Clause 4(3)(b) means that the Bahrain campus is within the allocation for prioritised places, whether any other Irish campuses are, and how the limit would be held on other campuses developed from Ireland, given that the response we have had seems to exclude Malta and Newcastle?

[Baroness Merron (Lab)]

I am happy to set it out in a letter, but I can say immediately that graduates of the Royal College of Surgeons in Ireland’s Bahrain campus are not necessarily prioritised just because part of their programme takes place in Ireland. The Bill is clear that prioritisation applies to graduates of Irish medical schools who complete the majority of their medical education in Ireland, but I am happy to add to that in my letter.