Medical Training (Prioritisation) Bill

Lord Kamall Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

Moved by

[Lord Kamall]

22: After Clause 5, insert the following new Clause—
“Review: provision of medical training places(1) Within six months of the day on which this Act is passed, the Secretary of State must undertake a review of the impact of this Act on the provision of medical training places as part of the UK Foundation Programme and UK specialty training programmes as defined by section 5 of this Act.(2) The review under subsection (1) must include assessment of the impact of this Act on—(a) the take-up of places on the UK Foundation Programme and UK specialty training programmes in each calendar year from 2010 to 2025, and(b) the total number of valid applications to the UK Foundation Programme and UK specialty training programmes in each calendar year from 2010 to 2025.(3) In undertaking the review under subsection (1), the Secretary of State must consider the number of unsuccessful applicants or successful applicants who decide not to take up their training place.(4) Within two months of the completion of the review under subsection 1, the Secretary of State must publish a report including the findings of the review and lay a copy of the report before both Houses of Parliament.”Member’s explanatory statement
This amendment would require the Secretary of State to undertake a review of the adequacy of provision of medical training places and publish a report detailing the findings of that review.

[Lord Kamall (Con)]

My Lords, in speaking for the first time in Committee, I refer to my interests as a professor of politics and international relations at St Mary’s University, Twickenham, where I teach an MBA module on healthcare policy and strategy, and where I also co-operate with the school of medicine, which will start accepting students later this year. I also work as an honorary fellow at the Vinson Centre for the Public Understanding of Economics and Entrepreneurship at the University of Buckingham, which also has a medical school but with which I have no direct connection.

I tabled Amendment 22 to facilitate a wider debate on the level of provision of medical training places and its impact on the outcomes for doctors and, by extension, patients, as well as the need for regular review. We all agree that the NHS and other health providers need highly qualified staff if they are to deliver the quality care that people expect of them, but that means that policymakers should seek to establish an education system that encourages young people to see the benefits of medicine as a career path, supports those going through medical training every step of the way and removes barriers to those who want to be doctors. As my noble friend Lord Howe said earlier, currently, too many young doctors reach the point at which they need to secure a medical specialty training place but find themselves disappointed, either because they are unable to access a training place or because the training place they are able to secure does not meet their needs.

A 2023 study by Tomas Ferreira on the career intentions of medical students found that many medical students finishing their foundation programme do not intend to take up medical specialty training places. The report says

“we report an increase in intention to not take up specialty posts immediately after the Foundation Programme, with an increase from 6.75% … of first-year students to 35.98% … of final year students. A contributing factor to this scenario could be a significant increase in competition ratios for specialty training posts, partly due to increasing medical student places and no corresponding increase in the number of training posts available”.

The lack of specialty training places to retain those medical students within the NHS is a challenge that the Government and we all face—something, I concede, we realised perhaps too late when we were in government. If the issue is not tackled, we will continue to see talented young doctors who might otherwise prefer to stay in the UK and work within the NHS, and maybe other health providers, leaving the UK to complete their training elsewhere.

The Government have announced their offer to the BMA to expand specialty training posts by 4,000, with 1,000 of them brought forward this year. That expansion in training places is welcome and necessary. I ask the Minister to confirm whether there will be any delay in their delivery and whether they will be delivered this year.

In May last year, I tabled a series of Written Questions on resident doctor medical training places, and the responses showed that very small numbers of training places are available in some regions. For example, in 2024, just one medical oncology specialist training stage 3 post was offered in the whole of the north-east region. The figure for the Wessex region was two places. For the earlier specialist training stage 1 posts in gynaecology, the Wessex region had just 11 places in 2024, while the whole of the south-west region had just 16 of those places. Can the Minister say whether those numbers are meeting the needs of those regions and whether there is a gap? What are the key factors that restrict the number of training places that can be offered in those regions?

The overall number of training places is probably the most important challenge young doctors face, but there are other considerations that affect talent retention. The geographical distribution of training places is also something that we all know needs attention. Last month, the Government announced that they will introduce new training places targeted at trusts with the biggest workforce gaps, prioritising rural and coastal areas, where patients currently struggle the most. We welcome that. That is good news. But, in designing this policy, I ask the Minister what assessment the Government have made of the number of medical students who actually want to train in these rural areas and whether that is a factor in some UK medical graduates choosing to go abroad or is irrelevant.

In response to concerns from the BMA about the challenge of doctors having to cover the upfront cost of their training, the Government have offered cost-related measures in their offer to the BMA, including reimbursement of exam fees. I ask the Minister for a little transparency and to give the Committee more detail on how reimbursement would work if the BMA were to accept that offer.

I hope that the Minister is able to answer these questions, either today or later in writing. I assure her that we look forward to working constructively with the Government as they face up to these workforce challenges. I beg to move.

[Lord Stevens of Birmingham (CB)]

My Lords, to help the Committee to assess the need for this further report that the noble Lord, Lord Kamall, just set out, it would be helpful if we could hear from the Minister when the Government will produce their replacement long-term workforce plan for the 2023 edition, which itself was deemed to be long term but ended up having a half-life of less than two years. How imminent is that and will it deal with the sorts of points that the noble Lord, Lord Kamall, rightly brings to our attention? When will we see the follow-on to the excellent Medical Training Review: Phase 1 Diagnostic Report, authored by the Chief Medical Officer and the previous National Medical Director of NHS England, published in October, which sets out these issues extremely well? The clue is in the title: it is the diagnosis. But when do we get the prescription? When does the treatment begin?

In a sense, the problem that we are dealing with through the Bill—again, as the noble Lord, Lord Kamall, just set out for us—owes its antecedents to the disconnect between the provision of NHS services and the ability to make smart, long-term workforce decisions. Unfortunately, for the period 2012 to 2022, those decisions on medical training were outwith the NHS and in effect were being controlled by the Treasury, which was constantly saying no to Health Ministers who were at the time trying to bring forward constructive solutions. Indeed, it was only when a former Secretary of State for Health became Chancellor that the situation was unblocked and we got the medical school expansion. Perhaps that is an inspiring example for the current Health Secretary—I do not know; perhaps he aspires higher. The fact is that we need that whole-government engagement on these kinds of questions to bring coherence and deal with these problems at root. Therefore, in responding to the noble Lord, Lord Kamall, any light that the Minister can shed on when precisely we will have line of sight to these sorts of questions would be, I think, of great benefit to the Committee.

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With that, I hope that the noble Lord, Lord Kamall, feels able to withdraw his amendment.

[Lord Kamall (Con)]

My Lords, I am grateful to all noble Lords who spoke on this amendment. I recognise the answer that the Minister gave about the impact report that the Government have announced. I will reflect carefully on whether what I intended with this amendment aligns with that impact report. If this is just a problem of synchronisation of when data is available with the report then, if the impact report that the Minister mentions does not provide information, perhaps we could find an amendment. We could look at syncing that data to make sure that it is a meaningful report that meets both our needs. Obviously, I will need to do a careful review, but at this stage I beg leave to withdraw the amendment.

Amendment 22 withdrawn.

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Moved by

[Lord Kamall]

26: Clause 8, page 6, line 23, leave out from “force” to the end of line 24 and insert “one month after the day on which it is passed.”
Member's explanatory statement
This amendment brings the Act into force one month after it is passed.

[Lord Kamall (Con)]

My Lords, in the absence of my noble friend Lady Coffey, who is not in her place, I hope it is acceptable if I move Amendment 26 and speak to Amendment 27. Both amendments seek to bring forward the commencement of the Bill rather than leaving its provisions to be implemented by regulations.

The Government say they need the Bill to pass as soon as possible but then refuse to commit to a date for commencement. Given that there is no date for implementation, noble Lords will rightly ask: what is the hurry with this Bill? There is a fundamental constitutional point here. Emergency legislation should be avoided as far as possible and, where it is necessary, it should be delivered urgently. In this case, we have been asked to fast-track the Bill without there being any apparent urgency to implement it.

The Minister sought to partly address this concern at Second Reading. Could she please explain exactly why the training allocation system will be unable to cope with the changed prioritisation arrangements introduced by the Bill if the BMA continues with its strike action during the coming months? What factors would frustrate the rollout? Would it be systems? Would it be the availability of officials? Would it be the ability of trusts and institutions to engage with the Department of Health and Social Care in a timely way? Or are there other reasons that noble Lords should be aware of? I hope this gives the Minister the opportunity to explain some of those reasons.

While we agree with the principle of giving UK graduates priority, and many noble Lords across the Committee have said this, we should take the time to have a proper debate on whether any other students should also be prioritised and in what order. We should have a debate to consider and debate questions such as: while qualifications may be similar, whether graduates from overseas branches of UK universities really do have similar experience to those who studied in the UK and worked in the NHS, or whether the country in which they studied has a patient profile similar to the UK, and whether in fact any of these distinctions are actually important. Another possible question that we should be looking at is whether historical prioritisation is still valid for today’s world, and whether it is worth while or too much effort to revisit some international agreements.

Instead of this much more considered debate, the Government tell us that they need to get the Bill on the statute book as soon as possible, but they are not forthcoming—perhaps not transparent—when it comes to implementation. Given this lack of clarity, I must say that there is a suspicion that the timing of the Bill and the Government’s rush to get it on to the statute book may appear to be not entirely unconnected with negotiations with the BMA resident doctors.

Whatever our politics and whichever Bench we sit on, legislation should be about making the lives of British people better. Although this Bill has the potential to help British citizens who are graduates of UK medical schools, the lack of transparency on implementation gives the impression that this legislation is more about giving the Secretary of State a negotiating chip in discussions with the BMA. I gently suggest that this is not a good enough reason for rushing such legislation, which is why my noble friend and I tabled these amendments. I look forward to hearing the Minister’s response.

[Lord Clement-Jones (LD)]

My Lords, I will speak to Amendments 26 and 27 on commencement, proposed by the noble Lord, Lord Kamall. I confess that we are conflicted on these. This brings us back to the tension at the heart of the Bill. We have UK graduates urging immediate implementation to resolve their uncertainty; conversely, we have international medical graduates asking for delay or transition because the rules are changing mid-cycle. If the Government eventually accept the amendments in group 2, providing a fair transitional arrangement for those with NHS experience, then immediate commencement becomes less punitive. However, if they persist with the blunt ILR proxy for 2026 then rushing to commencement simply accelerates an injustice.

I urge the Minister to clarify when precisely the regulations for the 2026 cycle will be laid if this Bill passes and whether they will include the transitional protections we have argued for. I am somewhat pessimistic on that. Certainty is needed, but it must not come at the expense of fairness.

In that context, as we are at the end of Committee, I must ask the Minister to confirm that she is going to meet the cross-party group of those of us who have spoken at Second Reading and in Committee before Report takes place. I have kept my diary free for the Monday before Report and I know that the noble Baroness, Lady Gerada, mentioned that earlier. We would all welcome a face-to-face meeting with the Minister. She talked about us being co-operative, and we all realise the Government’s desire for speed, particularly in the context of the industrial dispute, but, quite frankly, it takes two to tango.

[Baroness Merron (Lab)]

I am grateful for the noble Lord’s advice in his last comment.

I thank noble Lords for their contributions. The noble Lord, Lord Kamall, spoke about what I am going to call the tension between emergency legislation and the commencement clause. I will start on that point. I hope he is aware that our intent is, of course, to commence the Bill as soon as we possibly can, subject to its passage through Parliament. That is why I am so grateful to noble Lords and to Parliament more broadly—both Houses—that they have agreed to expedite the progress of this Bill.

I will come back on to this later in a bit more detail but, as I have already stated, there is a genuine question about operational feasibility, if strikes are ongoing, due to the strain that they put on the system. I am sure everybody in your Lordships’ Chamber would understand that. I will now refer to the amendments, and I have some other points to answer some of the questions that were raised.

Amendment 26, tabled by the noble Baroness, Lady Coffey, and spoken to by the noble Lord, Lord Kamall, and Amendment 23, tabled by the noble Lord, Lord Mohammed, and spoken to by the noble Lord, Lord Clement-Jones, relate to the date upon which the Act comes into force. Both would remove the provision that allows the Secretary of State to appoint the commencement date.

We cannot accept these amendments, as they remove an important element—and I emphasise this point—of operational flexibility, should it be needed. The commencement provision within the Bill is not a mechanism for delay. It is, we believe, a necessary safeguard to ensure that systems planning and operational capacity are in place before the Act is brought into force. Noble Lords will also appreciate that it is a material question, as referred to by the noble Lord, Lord Kamall, about how possible it is to proceed if industrial action continues, given the strain that strikes put on the system.

It is our intention to commence the Bill as soon as we are able, but it is essential that the Secretary of State is able to take all the circumstances, including operational readiness, into account when deciding when the Act should come into force. I think that it is honest to say this. Amendment 26 also seeks to require the Act to come into force one month after it is passed. Specialty training offers must be made from March. Delaying commencement by even one month would leave insufficient time to implement prioritisation for this year’s application round. In short, fixing a commencement date one month after Royal Assent, as Amendment 26 suggests, would create a situation where the Bill comes into force too late to tackle the bottleneck problem that we seek to resolve—the one that it is designed to remedy for the 2026 year—while also removing our ability to commence the Act only when systems are ready to deliver it effectively.

On the comments about industrial action made by the noble Lord, Lord Kamall, I reconfirm that the Government have been in intensive and constructive discussions with the BMA resident doctors committee since the start of the new year. The aim is to try to bring an end to the damaging cycle of strikes, and to avoid what is undoubtedly further, unnecessary disruption for patients and NHS staff. We continue to hope that those talks result in an agreement that works for everyone, so that there will be no more strike action by resident doctors in 2026.

With regard to the noble Lord’s request for more detail on operational readiness, I know he understands that introducing reforms to such a large-scale recruitment process is a big undertaking. We do not want the risk of creating errors that could lead to further uncertainty for organisations, for educators and, most importantly, for our trainees. An effective commencement demands clear processes for delivery across the health system. The reality is that industrial action will put this at risk because it is a diversion of resources, as it always is.

The noble Lord, Lord Clement-Jones, asked about further engagement. I have already had engagement with a number of noble Lords, including both Front Benches. If it is possible to do so before Report, I will write again. Time is extremely short, so while I am always glad to do so, if the noble Lord will allow me to look at that in a practical sense, I will be pleased to. With that, I hope that the noble Lord will withdraw the amendment.

[Lord Kamall (Con)]

I thank the noble Baroness for that considered response to the discussions. I thank all noble Lords who have spoken, not only to this group of amendments, but today. I also thank the staff for being here to look after us while we stay to this hour.

I should perhaps clarify for the noble Lord, Lord Clement-Jones, that when I laid the amendment it was with the amendment from my noble friend Lord Howe in mind. If we can address some of the perceived injustices or unfairness in the system, we should implement as soon as possible. I was not seeking to create a tension there.

I am grateful to the Minister for explaining that there are operational issues. I think that it would help the Government, and help this Bill to go forward, if the Minister were able to explain in a letter to noble Lords some of those operational issues, because sometimes it may be that we think that it is quite easy. I know, having been in government, that there are a number of issues. I can see that the Minister is looking forward to spending her Recess formulating that letter with her officials. The noble Lord, Lord Mohammed, talked earlier about a holiday, but I do not think that Ministers ever get a holiday. I am giving the Minister a challenge during the Recess to explain some of the operational challenges that lead to the Government not being able to accept this amendment to implement the Bill as soon as possible.

With that, I thank the Minister for her response. I thank all noble Lords who have spoken today and I beg leave to withdraw the amendment.

Amendment 26 withdrawn.