Junior Doctors’ Foundation Programme

Debate between Caroline Johnson and Stephen Kinnock

Wednesday 22nd April 2026 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a real pleasure to serve under your chairship, Mrs Barker. I congratulate and thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this vital debate, and all the hon. Members who have contributed. I pay tribute to my hon. Friend’s significant and distinguished career and experience in our NHS. I take the opportunity to thank resident doctors up and down the country for the vital contribution they make to our NHS and to treating the patients it serves.

As my hon. Friend said in his opening speech, the UK foundation programme is a central part of the pathway to becoming a doctor, bridging the gap between medical school and specialty or general practice training in the NHS. It supports newly qualified doctors to develop the clinical and professional skills needed to deliver safe and effective care, preparing them for progression into core, specialty or general practice training. Resident doctors who currently work in the NHS have made it clear that they have concerns and frustrations with their training experience. We are committed to listening to and addressing that and to improving the training pathway for the medical workforce, for the benefit of NHS services and patients.

Through phase 1 of the medical training review we conducted extensive engagement to ensure that doctors, patients and NHS leaders had the opportunity to describe what works well in medical education and training and what needs to improve to meet the needs of both resident doctors and patients. The phase 1 diagnostic report was published last year and made 11 recommendations centred on four key priorities: more flexible training; removing the divide between service and training; ending the damaging recruitment bottlenecks and rewarding teams where doctors feel valued.

The implementation team, led by Dame Jane Dacre, who has been appointed as the independent chair for this work, will now work with doctors, the General Medical Council, the Medical Schools Council, royal colleges and other bodies to drive this much-needed change.

[Dr Johnson]

Could the Minister highlight the timing of that in relation to the workforce plan, and when that will be published?

[Stephen Kinnock]

The workforce plan will be published this spring, so there is not too long to wait. It has taken a little longer than we initially hoped, but we think it is really important to ensure that it is anchored in very solid engagement with our partners and stakeholders.

Earlier this year, the Government delivered fast-track legislation to put UK medical graduates at the front of the queue for foundation and specialty training places, reducing uncertainty and ensuring that they can progress to full registration as doctors. We have confirmed that all eligible UK medical graduates will be offered a place on the foundation programme this year. Of course, our fast-track legislation seeks to rectify the unforgivably reckless and damaging decision made by the previous Government to remove the resident labour market test after Brexit, which in many ways is the root cause of the mess created by the neglect and incompetence of the previous Government over 14 years.

I turn now to the process for allocating places to applicants for the UK foundation programme and the steps the Government are taking to improve it. We recognise that the location a foundation doctor is assigned for training has both professional and personal impacts. The four UK Health Departments determine the number of places available each year based on workforce planning across the continuum of postgraduate medical education and training. Applicants are allocated across the UK using a nationally applied preference informed allocation system, which has been extensively commented on in the debate.

The PIA system was introduced in 2024, following extensive engagement with the four UK statutory education bodies, medical students and key stakeholders. The move to the new system aimed to address concerns that the previous system was unfair and stressful for applicants and that there was a lack of standardisation within and across schools. It is worth mentioning that the consultation on the PIA system received over 14,500 responses, 66% of which favoured a move to the PIA option against the status quo. There were 106 organisations among those 14,500 responses. It was an extensive consultation with fairly conclusive feedback on the change that was required.

[Stephen Kinnock]

It is worth highlighting that around 82% of applicants get their first preference. That is a significant improvement—it was 71% in 2023. We are taking steps in the right direction, but we would love to get to 100%. It is difficult to get to 100% of anything in a large and complex system, but that is our aspiration. Of course, those who do not get their first place are welcome to re-engage with the system, and efforts are made to ensure they get their preference, although we do not always succeed in that process. I will take the hon. Member’s question away and discuss it with my colleague the Minister of State for Health—she leads on this portfolio, although she was not available for this debate—and we will write to him with further clarifications on the important point he makes.

The introduction of the PIA was broadly supported by stakeholders, and I am pleased that we have seen an improvement under this system in the number of students allocated their first preference programme. As I said, 82% of applicants to this year’s foundation programme were allocated their first preference, up from 71% in 2023. However, we are committed to ensuring that the system remains fit for purpose. NHS England will conduct a review to ensure that it is still working for applicants. The timelines of that review will be confirmed in due course.

Furthermore, although some individuals may want to move away from their university area for foundation training, some need greater certainty, for a range of reasons, about their foundation placements. In the last two years, we have supported a portion of students in three UK medical schools by allocating them to foundation programmes in their local area. Last Friday we went further, announcing that we will work with medical schools and foundation schools to extend that support to trainees across the country from disadvantaged backgrounds. Providing a post close to where they live will mean more stability for trainees and will support employers in developing a local workforce.

I would like to say a final word on the PIA. I think we all accept that it is not perfect—it is very difficult to have a perfect system—but I take issue with the characterisation by some Members in the debate that it is a random system. We do not agree with that characterisation. We are clear that the system in place is enabling people to clearly articulate their first preference, and in the overwhelming majority of cases they are getting their first preference. That does not feel like a random system to us, but we absolutely accept that it is not perfect, and there is always room for improvement.

Let me turn to rotations. We recognise the importance of stability for doctors in training and the impact that frequent relocations can have on wellbeing, retention and workforce planning. Following the 2024 resident doctors agreement, the Department of Health and Social Care conducted a review of rotational training and found that rotations can provide valuable breadth of experience. However, we know that in some cases they can disrupt learning, wellbeing, team integration and patient care. To tackle that, NHS England is developing pilots under the medical education and training review to test longer placements and more flexible arrangements for less-than-full-time trainees. The evaluation of those pilots will inform future policy decisions on placement length and continuity benefits.

I turn now to the wider working conditions for resident doctors. It is essential that we create a supportive environment for doctors throughout their training that looks after their health and wellbeing. NHS England’s resident doctors’ working lives programme continues to implement several measures aimed at supporting resident doctors, encouraging them to stay in training and the NHS and reducing overall attrition. That includes measures such as the less-than-full-time training options to allow trainees to continue to work in the service and progress with their training on a reduced working pattern where that is beneficial for their personal circumstances.

We have made significant progress over the past year to improve the working lives of resident doctors, including agreeing an improved exception reporting system, which will ensure that doctors are compensated fairly for additional work, and rationalising statutory and mandatory training to reduce unnecessary burden and repetition.

[Dr Johnson]

The Minister talked about less-than-full-time training, which has obviously had an impact on the number of doctors we need. The Secretary of State said before the general election that if Labour was elected, it would double the number of medical school places. Is that still the Government’s intention?

[Stephen Kinnock]

Yes, that is the Government’s intention. Obviously, we have had some challenges in April around our hope that we could create 1,000 additional places. We have not been able to do that, unfortunately, because of the reckless decision of the BMA to go back out on strike. The absorption of huge capacity, as well as operational issues, has meant that we have not been able to do that.

--- Later in debate ---

[Dr Johnson]

I thank the Minister for that answer, but I believe that it relates to postgraduate training places. I was asking whether it is still the intention to double the number of medical school places?

[Stephen Kinnock]

Sorry; I misunderstood the question. Yes, it is still our intention to double the number of medical school places.

The Government remain committed to publishing a 10-year workforce plan this spring to set out how we will create a workforce ready to deliver the transformed service that we set out in the 10-year health plan. The 10-year workforce plan will ensure that the NHS has the right people, in the right places, with the right skills to care for patients when they need it.

NHS staff told us through the 10-year health plan engagement that they are crying out for change. The workforce plan will set out how we deliver that change by making sure staff are better treated and have better training, more fulfilling roles and hope for the future.

I thank all hon. Members for taking part in this important debate.

--- Later in debate ---

[Stephen Kinnock]

The short answer is yes, absolutely—our door is always open. We have to find a constructive way through this. I accept that it is not always just about pay; it is also about broader terms and conditions—exactly the things we have been debating today. That is why I was so excited by the fast-track legislation we brought forward specifically to address the bottlenecks and the impact of the disgraceful decision under the previous Government to remove the resident labour market test. We are seeking to fix all those problems, and we need a constructive partner on the other side of the table to do that. We are starting to see in opinion polls that public support for the action taken by the BMA and resident doctors is eroding quite seriously, and I hope they take that into account before they make their next decisions.

[Dr Caroline Johnson]

As a doctor, I feel uncomfortable with the morality of going on strike and leaving patients to suffer in order to get more money for oneself. I think the morality of the strikes is outrageous. However, does the Minister regret the repealing of the minimum service levels legislation, which could have enabled the Government to put in firmer boundaries around the strikes to prevent harm to patients? Will the Government consider banning doctors from striking altogether, as a Conservative Government would, in the same way that people in the Army and the police are banned from striking?

[Stephen Kinnock]

The hon. Lady’s point about morality is important and interesting, but people also have to be able to put bread on the table, pay the mortgage or rent, and feed and clothe their kids. Morality is fine, but it does not put bread on the table. The two things are very important.

On the retrograde steps the Conservative party is proposing around industrial relations, that is just not what the Labour party is about. The Labour party is about constructive, positive industrial relations and respect. It is about treating the workforce and unions with the respect they deserve and finding a constructive solution. We do not want to move to some kind of police state, where we restrict the rights of trade unions. We see the right to organise and go on strike as a fundamental right of citizens in our country, and it would be a retrograde step to remove it. It is pretty extraordinary to hear that suggested by the Conservative party when we live in a liberal democracy. So the answer to the hon. Lady’s question is no. I believe we will find a way through this dispute. It will be hard going—it will be two steps forward and one step back, I am sure—but in the end I believe we will get there.

[Dr Johnson]

I thank the Minister for being extremely generous with his time. He says the Government will not consider removing the right of doctors to strike, but he seems to be going further and suggesting that doing so would be wrong in principle. Do the Government therefore intend to allow the right to strike for those who are currently not allowed to, such as the police and armed forces?

[Stephen Kinnock]

We have those restrictions on the right to strike in the police and the armed forces for obvious reasons of national security. I think that is a very different issue; our critical national infrastructure must be protected, and there cannot be any dispute about that.

We are dealing with a workforce whose pay and conditions had clearly been neglected. The previous Government used the moral argument the hon. Lady was trying to make as leverage to keep pay and conditions down, which I would say is a deeply immoral position to take. The right to be a member of a trade union and to go on strike is relevant to certain sectors of our labour market, and that right, where it exists, should be protected; where it does not exist, that is a completely different debate.

I thank all Members for taking part in this important debate. The Government are taking important steps, and we remain committed to improving the working lives and prospects of resident doctors, and to ensuring an effective foundation programme.

Oral Answers to Questions

Debate between Caroline Johnson and Stephen Kinnock

Tuesday 17th June 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Last health questions, I asked about delays to crucial medications in A&E and the Secretary of State said he was interested to hear more, but his office said he would delegate it to a Minister and we still have not been offered a date, so could I encourage him to look into that, please? The U-turn on winter fuel will help the elderly to stay warm and healthy this winter, but another way to help elderly people would be to protect them from the respiratory syncytial virus. Will the Government extend the vaccination to the over-80s?

[Stephen Kinnock]

I thank the hon. Lady for that question, but I did not quite catch the word she used. The virus was called? [Interruption.] Oh—RSV, yes. We are certainly looking at increasing the coverage of the RSV vaccination. I do not have the statistics to hand at the moment, but I would be happy to write to her on that point.

[Dr Johnson]

Many of those on waiting lists are elderly and have chronic conditions; rather than seeing consultants at regular intervals, which may coincide with them being relatively well, they are often kept on open appointments so that they can call when they are ill. This is efficient and responsive care. Is the Minister aware that this provision is being stopped in some areas in order to improve figures? I will quote from a letter about an elderly patient:

“I regret cannot keep him on my waiting list under the open appointment”

for treatment, and,

“I have explained the politics of everything and where we are at.”

Being re-referred to a GP each time is expensive and a waste of time. Can the Minister explain why doctors are being asked to make decisions for political reasons, instead of clinical ones?

Terminally Ill Adults (End of Life) Bill

Debate between Caroline Johnson and Stephen Kinnock

Report stage
Friday 13th June 2025 Commons Chamber

[Stephen Kinnock]

I can confirm that it is absolutely the policy intent of the sponsor for that to be a backstop. The Government are working on that basis to ensure that it is a backstop and not a target.

Amendment 42 seeks to remove the four-year backstop. Although that is a matter for Members to decide, we note that if both that amendment and amendment 94, tabled by my hon. Friend the Member for Spen Valley, were accepted, nobody would have the power to commence reserve provisions in Wales. That would create major workability concerns for the service in Wales.

[Dr Johnson]

The advocates of the Bill talk about the point of choice and autonomy in the decision about when and where a person will die. Can the Minister confirm whether we have enough doctors to provide a service for people to die at home at the time of their choosing?

[Stephen Kinnock]

I refer the hon. Lady to the impact assessment, which is of course not a forecast but a set of scenarios. In it, detail is given on expected numbers and the capacity of the system to deal with the service.

Amendments 13 and 82 to 85 relate to the appointment of the voluntary assisted dying commissioner and panel members. The amendments would put the process for the appointments out of kilter with standard practice for public or non-judicial appointments and could significantly limit the pool of individuals available. Amendment 86 would give the panel the same powers, privileges and authority as the High Court, which are significant in scope and are set out across different court rules and legislation. It is unclear how those would apply to panels in practice. They may be unworkable given that the panel is not designed to be a court.

New clause 4 and amendment 28 would put various responsibilities on the chief medical officers for England and Wales. Imposing duties in primary legislation on an individual civil servant may cause difficulties in the future if the role does not exist or if the title changes. It is usual practice for duties in primary legislation to be conferred on the Secretary of State, who may decide to delegate to the chief medical officer.

I would like to briefly respond to a number of questions directly asked of the Government. The hon. Member for South Antrim (Robin Swann) asked about medicines regulation in Northern Ireland. The amendments will not affect the application of EU law; they will instead ensure coherence between the different legislative frameworks. The sponsor will lead engagement with the devolved Governments, supported by officials.

The hon. Member for Richmond Park (Sarah Olney) asked about the equality impact assessment. The EQIA considers the nine protected characteristics alongside socioeconomic background, geography and mental health. The hon. Member for West Worcestershire (Dame Harriett Baldwin) asked about the Suicide Act and advertising. I can confirm that encouraging or facilitating suicide will remain a crime under the Suicide Act. On advertising, new clause 14, if passed, would oblige the Secretary of State to make regulations prohibiting certain forms of advertising that promote voluntary assisted dying services. The exemptions to that, which may be provided under subsection (2), will not cut across the criminal offences elsewhere in the Bill or in the Suicide Act.

I hope that those observations were helpful to Members in their consideration of the technical workability of the amendments that we have debated today.

NHS Dentistry: South-west

Debate between Caroline Johnson and Stephen Kinnock

Tuesday 12th November 2024 Westminster Hall

[Stephen Kinnock]

As the hon. Gentleman will understand, we are in a sequence: we have the Budget, then the complex negotiations around the spending review. We cannot engage in meaningful, formal discussions and negotiations until we are clear on what exactly the financial envelope is. We are working at pace on that. However, we have been meeting informally to sketch it out, so I would say that the scope of the negotiations is agreed. The formal negotiations will really start only once we have the detailed budget in place.

We will listen to the sector and learn from the best practice to improve our workforce and deliver more care. For example, the integrated care boards in the south-west are applying their delegated powers to increase the availability of NHS dentistry across the region through other targeted recruitment and retention activities. That includes work on a regional level to attract new applicants through increased access to postgraduate bursaries, exploring the potential for apprenticeships and supporting international dental graduates.

There are two dental schools in the south-west: Bristol Dental School, and Peninsula Dental School in Plymouth. I recently had the pleasure of visiting Bristol Dental School and seeing the excellent work that they are doing there, training the next generation of dental professionals, supporting NHS provision by treating local patients, and reaching underserved populations through outreach programmes. I also know that Peninsula Dental School, which first took on students in 2007, is doing the same for Plymouth and its surrounding areas.

I would also like to pay tribute to Patricia Miller of NHS Dorset, Lesley Haig of the Health Sciences University and council leader Millie Earl for working so constructively with my hon. Friend the Member for Bournemouth East (Tom Hayes) on improving oral health in his constituency.

A number of hon. Members have rightly highlighted the importance of prevention, and we are working around the clock to end the appalling tooth decay that is blighting our children. We will work with local authorities and the NHS to introduce supervised toothbrushing for three to five-year-olds in our most deprived communities, getting them into healthy habits for life and protecting their teeth from decay. We will set out plans in due course, but it is clear that to maximise our return on investment, we need to be targeting those plans at children in the most disadvantaged communities. In addition to that scheme, the measures that we are taking to reduce sugar consumption will also have a positive effect on improving children’s oral health.

Separate from the national schemes, I was pleased to note that NHS Devon integrated care board has committed £900,000 per annum for three years to support further cohorts of children for supervised toothbrushing, fluoride varnish and Open Wide Step Inside, with a new fluoride varnish scheme due to go live in September 2025. Open Wide Step Inside is a local scheme in which a dental outreach team, run by the Peninsula Dental Social Enterprise, goes into schools to deliver 45-minute oral health education lessons across Devon and Cornwall. It is a truly commendable scheme.

The steps we take in NHS dentistry will feed into the wider work we are doing to fix our broken NHS. We have committed to three strategic shifts: from hospital to community, from sickness to prevention and from analogue to digital. Our 10-year plan will set out how we deliver those shifts to ensure that the NHS is fit for the future.

[Dr Johnson]

The Minister has iterated the problem, and he has spoken warm words about listening, talking and working with people. However, he has said little that is concrete, except about things that were happening already, either locally or as a result of the previous Government. With a minute left to answer all the questions he has been asked, can he commit to answering in writing those he does not have time to answer in the remaining minutes?

[Stephen Kinnock]

The first thing I will say is that I am not going to take any lectures from any Conservative Member about the state of our dental system. What brass neck we see from that party, both in the Chamber and in this place—lecturing us, given the disgraceful state of our NHS and the fact that the biggest cause of five to nine-year-olds going to hospital is to have their rotten teeth removed! I will not be taking any lectures on that from the Conservative party. Of course, I am more than happy to answer the hon. Lady’s detailed questions, many of which I feel I have already answered in my preceding comments. I will not take any more interventions from her because I need to finish shortly.

Our 10-year plan will set out how we deliver these shifts to ensure the NHS is fit for the future. To develop the plan, we must have a meaningful conversation with the public and those who work in the health system. We are going to conduct a range of engagement activities, bringing in views from the public, the health and care workforce, national and local stakeholders, system leaders and parliamentarians. I urge hon. Members from across the House to please get involved in this consultation—the largest in the history of the NHS—at change.nhs.uk. I urge them to make their voices heard in their constituencies, through the deliberative events.

Children’s Hospices: Funding

Debate between Caroline Johnson and Stephen Kinnock

Wednesday 30th October 2024 Westminster Hall

[Stephen Kinnock]

The right hon. Lady is absolutely right: funding that is earmarked for palliative care must go to palliative care. There is statutory guidance from the NHS, and it is vital that we continue to liaise with ICBs from the centre, to ensure that the allocated funding goes where it needs to go. If she is aware of cases in which that funding is not going where it should go, she should make representations; I am happy to receive a letter from her on the issue.

The amount of funding that each charitable hospice receives varies both within and between ICB areas. That funding will vary depending on demand in an ICB area, but will also depend on the totality and type of palliative and end of life care provision from both NHS and non-NHS services, including charitable hospices, in each ICB area. There are inequalities in access to hospice services, especially for those living in rural or socio- economically deprived areas. That is why including hospices as part of a system-wide approach is so important.

I understand that charitable hospices value their independence and autonomy, which allow them the freedom to provide services beyond the statutory offer, which is one of the wonderful parts of hospice care. That independence also gives a sense of shared purpose, in which the community cares for the hospice, and in turn the hospice cares for the community and is something to be cherished. That is indicative of the compassion that is found in hospices and communities all over the country.

In addition to ICB funding, at a national level, NHS England has supported palliative and end of life care for children and young people through the children and young people’s hospice grant, totalling £25 million in ’23-24. While ’23-24 marked the final year of the grant in its previous format, in ’24-25 NHS England continued to provide £25 million of funding for children and young people’s hospices. A prevalence-based model is used for that funding, which supports the move away from a traditional model of bed-based funding, better reflecting population needs. In ’24-25, that funding was transacted by ICBs on behalf of NHS England for the first time, rather than being centrally administered. I am aware that the shift to an ICB-transacted model for ’24-25 has not been as smooth a transition as we in the Department certainly would have hoped. We are working closely with NHS England to resolve any remaining issues with the ’24-25 funding, and to learn from what did not work so well this year.

We, alongside NHS England, absolutely recognise the importance of sustainable funding for the palliative and end of life care sector, including hospices, and we will consider the future of children’s hospice funding in the context of Budget discussions. I have absolutely heard the representations by hon. Members on both sides of the Chamber today about the need for the Government to maintain the £25-million grant, and I assure hon. Members that I am working very closely with NHS England to get that confirmed as a matter of urgency.

[Dr Johnson]

The Minister talked about maintaining the grant, but does he recognise that many hon. Members have also raised the increasing costs that hospices are facing? Will he look to not just maintain the grant but increase it?

[Stephen Kinnock]

We are certainly looking at all those issues in the round, including ensuring that the grant is sustainable and that there is a real-terms financial input to the system. We are working on that as a matter of urgency. I totally recognise and understand why the sector needs certainty and stability; it is very difficult for hospices not to be sure what is happening after this in-year position.

The 2010s were a lost decade for our health and care services, which now too often are not there when we need them. That is also true for hospice care, where we see a postcode lottery for services across the country and variation in quality and access. Hon. Members will know that we have committed to developing a 10-year plan to deliver an NHS and care system that is fit for the future, by driving three shifts in the way that care and health services are delivered.

We will be carefully considering policies, including those that impact children with palliative and end of life care needs, with input from the public, patients, health staff and our stakeholders as we develop the plan over the coming months. That engagement process was formally launched last week, and I strongly encourage the sector, including hospice providers, service providers and their families, and indeed every parliamentarian in this Chamber, to engage with that process: please go on to change.nhs.uk and make your voice heard. That will allow us to fully understand what is not working as well as it should, what the solutions are, and where the opportunities are for the future.

One of the three strategic shifts that our 10-year health plan will deliver is the Government’s determination to shift more healthcare out of hospitals and into the community. Community health teams play a vital role in supporting children and young people with complex health and care needs to live as well as possible, providing proactive care and preventing exacerbations and hospital admissions where possible. That shift from hospital to community includes our commitment to roll out neighbourhood health services to ensure that patients and their families receive personalised care in the most appropriate setting in their community, and indeed as close as possible to home. Palliative and end of life care services, including hospices, will have a major role to play in the fundamental shift from hospital to community, and in shaping that shift.

Additionally, the Department, through the National Institute for Health and Care Research, is investing £3 million in a new policy research unit in palliative and end of life care. That unit launched in January 2024 and will build the evidence base on all-age palliative and end of life care, with a specific focus on inequalities. In closing, I thank once again the hon. Member for Liverpool West Derby for securing this vital debate on children’s hospice funding. I again express my heartfelt thanks to all those who support children, young people and their loved ones when they need them most.