Medical Training (Prioritisation) Bill

Lord Mohammed of Tinsley Excerpts

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

[Lord Mohammed of Tinsley (LD)]

My Lords, I thank noble Lords across the Chamber for their contributions, and in particular the noble Lords, Lord Roe and Lord Duvall, for their fantastic maiden speeches. I look forward to working alongside both noble Lords in taking forward this and other Bills. I was particularly interested to hear about the journey that the noble Lord, Lord Duvall, took here; I also worked with young people in a youth centre, and I have military history on both my mum’s side and my dad’s side of the family, spanning the First World War and the Second World War—although I confess that my mum’s uncle was not really sure where he was when he came to Europe to fight in the First World War.

I start by acknowledging, as my noble friend Lord Clement-Jones did, that I support the broad objectives of this legislation. As we have heard from other noble Lords, it is entirely reasonable for the United Kingdom to seek to ensure that our investment in medical education strengthens the NHS workforce and benefits patients here at home. Prioritising those who have trained and worked within our NHS is a legitimate aim. However, the way that principle is delivered matters greatly.

My first concern relates to the breadth of ministerial discretion in the Bill. It has not been covered by others, but it is really important. As drafted, the Bill will allow future changes on prioritisation to be made with limited parliamentary oversight. Decisions about who is prioritised for medical training places are not just technical adjustments; they shape careers, determine workforce supply and directly affect patients. Such decisions should therefore be subject to proper scrutiny and democratic accountability. This House has a principal responsibility to ensure that powers of this significance are exercised transparently and proportionately.

Many noble Lords have raised concerns about the timing of the Bill. As it makes its way through the legislative process, final-year students have seen their foundation training allocations paused. Thousands of graduates now face waiting until the last minute to discover where they will be working later this summer, potentially having to move across the country, as we have heard, with little notice. That uncertainty is deeply unsettling for graduates at the very start of their careers.

As we have heard from many noble Lords, including the noble Earl, Lord Howe, and the noble Lord, Lord Patel, the intention to introduce new prioritisation rules part way through the 2026 specialty training cycle also risks causing real harm. More broadly, we must be clear-eyed about the workforce challenges and what this Bill can and cannot deliver. On its own, it will not resolve the problem, which is the critical shortage of training places, as we heard earlier. The noble Lord, Lord Stevens of Birmingham, talked about it as the bottleneck. Without a significant expansion in this, there is a real risk of this being only a partial fix. Indeed, in many respects, this feels like closing the stable door after the horse has bolted.

In recent years, the number of domestic undergraduate medical school places has expanded, while at the same time the GMC has registered a large number of overseas graduates. Staff-grade jobs that were difficult to fill even five years ago are now inundated with applications, and the appetite among NHS employers to actively recruit candidates overseas has already disappeared. All of this sits against the background of a highly restrictive government cap on the number of medical and dental students that UK universities are permitted to train—caps to which international partners are not subject. Because of these constraints, medical schools have developed partnerships with overseas institutions and Governments to help cover the increasing cost of teaching UK students. Therefore, I ask the Government to reflect carefully on any unintended reputational damage the Bill may cause to UK’s medical education sector and to those international relationships, as we heard from the noble Baroness, Lady Hollins, and others.

Malta has been mentioned, but I will not mention it further. My noble friend Lord Clement-Jones and the noble Baroness, Lady Gerada, both made that point forcefully.

I want to mention the emails that we have had from Newcastle, but there are also other universities out there that have partnership arrangements with Malaysia in particular, and I just want to talk about Nottingham and Southampton. I know that, in the past, the university that I attended, the University of Sheffield, also had that working relationship where the first two years of the medical degree were done in Malaysia and then the students came across here.

I am also concerned about the wider workforce consequences and shortages not confined to one area of medicine. Radiology has been mentioned, but mental health services and other specialties are already under intense strain, with evidence that professional bodies are linking workforce gaps directly to potential patient safety concerns, particularly in the cancer care area. Any reforms of training prioritisation must therefore be accompanied by a clear and ongoing assessment of their impact across specialties.

At the same time, the Government are hastily implementing the Leng review without adequate consultation, which risks placing additional long-term pressures on resident doctors during their postgraduate training through an unanticipated reduction in the number of medical associate professionals supporting doctors in their clinical workloads.

Finally, I wish to raise a fundamental question about the Government’s chosen mechanism for prioritisation. The Bill places significant weight on immigration status, as we have heard from other noble Lords, particularly indefinite leave to remain. I struggle to understand why this is the most appropriate or effective measure. The NHS, as we have heard, already has a robust system in place through the Oriel recruitment platform, which records where doctors have trained, how long they have worked in the NHS and their progression through the system. That data speaks directly to commitment, experience and contribution to our health service.

Prioritising doctors on the basis of time worked in the NHS, clinical excellence and demonstrable service to patients would seem far more closely aligned to the Bill’s stated purpose than relying on immigration status, which, as we heard, with the recent changes potentially coming through as well, is shaped by factors beyond an individual’s control. Therefore, I urge the Government to explain why they have chosen this route and whether they have fully considered the unintended consequences for recruitment, retention and morale within the medical workforce.

The Bill seeks to address real challenges and its objectives are worthy. I just want to pick up on the point that the noble Baroness, Lady Coffey, raised about the grouping of applicants from around the world in just one group. It is only right and proper that, if we are scrutinising the Bill, we see data that I am sure the NHS holds about the origin of some of those students. To succeed, the Bill has to be fair and transparent and firmly rooted in the realities of the NHS workforce. Above all, it must sit alongside a serious commitment to expand training and capacity. I hope that the Government will reflect carefully on the issues that we have raised in your Lordships’ Chamber tonight as the Bill progresses through the House.

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[Baroness Merron (Lab)]

As I said at the outset, I will endeavour to answer all questions, but where I do not have an answer, particularly where I want to look at them in closer detail, I will be very pleased to write, of course, as always.

Still turning to Malta—which is a pleasure—let me say straight away that we do have a long-standing partnership with Malta on healthcare. It is valued and it will continue. Doctors who are training in Malta will still come to the UK, as they do now, to gain NHS experience to support their training, for example through fellowship schemes. This is not affected by the Bill.

As I discussed with the noble Baroness just yesterday, senior officials in my department have met with the High Commissioner of Malta to the United Kingdom in order to assure him of this. But it is important to prioritise in order to ensure a sustainable workforce that meets its health needs. Again, that is at the core of the Bill. Malta has its own foundation school. This is not part of the UK foundation programme: it is affiliated with the UK foundation programme office which administers the UK programme. That means—this point has been made to me—the Malta Foundation School delivers the same curriculum and offers the same education and training as the UK foundation programme. The Bill will not impact this affiliation or the other ways in which work carries on closely with the Government of Malta when it comes to health.

The noble Earl, Lord Howe, also made the point that he believed small numbers of students were impacted. I have referred to the 300 applicants from overseas campuses. I hope it is understood that that is why there is a significance there.

If there are other matters that I have not addressed to the satisfaction of the noble Baroness, Lady Gerada, I will be very pleased to review this, because I suspect there were some more points to address. I will be very pleased to write to her to give her comfort in this regard.

I move on now to the impact on doctors who were part way through the application process—a point spoken to by noble Lords, Lord Patel, Lord Mohammed, Lord Clement-Jones, and other noble Lords. As I stated earlier, delaying implementation of the Bill until next year, which would be required if we were to respond as requested, would mean another full year where we are not tackling the issue of bottlenecks in medical training. It seemed to me that the feeling in the House was that we did need to do that.

I understand the discomfort of noble Lords around this. It is important that I recognise that, but it is also important to recognise when introducing legislation that sometimes it will not work perfectly for everybody. This is about prioritisation, not about exclusion.

Following that point, the noble Lord, Lord Stevens, the noble Baroness, Lady Coffey, and the noble Earl, Lord Effingham, asked about emergency legislation. They asked: why now? As the Health Secretary set out in the other place, he has listened to resident doctors and their concerns about a system that does not work for them. He agreed to bring forward that emergency legislation as quickly as possible, rather than wait—this is key for a number of the points raised—another year to do so.

The noble Earl, Lord Howe, and the noble Baroness, Lady Coffey, asked about the Bill’s commencement and why it will not commence at Royal Assent—that is a very fair question. We are introducing reforms for a large-scale recruitment process. I know that noble Lords will understand what a major undertaking this is. We do not want to create errors or more uncertainty. To make sure that it is effective in commencement, we must have clear processes for delivery across the health system, and I am sure that all noble Lords appreciate that these elements cannot be switched on overnight. As the Secretary of State said in the other place, there is a material consideration about whether it is even possible to proceed if the strikes are ongoing. He is concerned—I share this concern, as I am sure all noble Lords do—about the disruption that strikes cause and the pressure they put on resources, which would make it so much harder operationally to deliver the measures in the Bill.

[Lord Mohammed of Tinsley (LD)]

I will press the point I made earlier about uncertainty. Not having a commencement date creates a lot of uncertainty for the current batch of students, who are really worried about whether they will they gain a place and, more importantly, where. I want to impress this issue on the Minister; it was raised by the Russell group medical school admissions head with me personally.

[Baroness Merron (Lab)]

I completely understand the point about uncertainty. Uncertainty exists in the current system, and uncertainty may transfer for different reasons. We are keen to get on with this. I am just indicating some of the circumstances—strike action—that would cause difficulty for us in terms of commencement. I hope we can proceed. I think the noble Lord will understand exactly what I am saying.

The noble Baroness, Lady Coffey, asked about the release of more granular detail. I draw noble Lords’ attention to the fact that NHS England already publishes a wide range of recruitment data, including data on country of qualification and nationality groups. It will publish further granular data when possible and monitor the implementation of the Bill, should it pass—that, for me, is the most important point. If the noble Baroness is referring to other information, she is very welcome to raise that with me.

I am of course very happy to meet with my noble friend Lord Stevenson. In general, the 10-year health plan commits to working with professional regulators and educational institutions over the next three years to overhaul education and training curricula.

To answer the question from the noble Baroness, Lady Coffey, on prioritisation, if I can put it in my language: you either are or are not prioritised. There are no tiers of priorities within priorities; it is as it is written in the Bill.

The noble Lord, Lord Mohammed, asked about the impact of prioritisation on harder-to-fill specialties. This approach will not negatively impact recruitment. In fact, it will ensure that priority groups are considered first, while keeping the door open for when we need people. I think it will help get people into the areas in which we need them, because it will direct people to where we do not have sufficient applicants.

At its heart, the Bill is about the UK-trained medical graduates on whom the NHS heavily relies. We are grateful for their skill, commitment and professionalism. It is our responsibility to ensure they are trained, supported and treated well at work. This is a more sustainable and considered approach to the allocation of medical training places. A number of noble Lords said that this is a problem that has been around for years. We are grasping the proverbial nettle. The Bill is a measured step towards the goals of clarity, fairness and opportunity. It will not, on its own, resolve everything—I am fully aware of that—but it will help us with a pressing problem. With that, I beg to move.

Medical Training (Prioritisation) Bill

Lord Mohammed of Tinsley Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

That leaves UK graduates in a unique position globally, due to having no recruitment programme that will prioritise them. The UK graduates worst affected, if action is not taken, will be those who are limited in their ability to emigrate—those with young families, disabilities, caring responsibilities or low heritage family wealth. We cannot sustain a policy of uncontrolled and exponential growth of specialty training applicants every year. That is why I am pleased to support the amendment in the name of my noble friend.

[Lord Mohammed of Tinsley (LD)]

My Lords, I want to speak briefly to the amendments proposed by the noble Lord, Lord Patel, and the noble Baroness, Lady Coffey. The noble Lord, Lord Patel, mentioned that 7% of undergraduates who take medical degrees in the UK are from overseas. I briefly mentioned last week my conversations with the head of admissions at a Russell group medical school. An important point that I did not have time to raise then, but is appropriate to raise now, is the significant amount of money that that 7% contribute not only to that medical school but in additional payments to the local trust.

I wanted to make your Lordships’ House aware of that, but I also want the Minister to talk about the consequences if we accepted the amendment of the noble Baroness, Lady Coffey, and just had British citizens as opposed to the British graduates the noble Lord Patel talked about. What impact would there be? We have held our tuition fees static for a while in this country, while those overseas students have been paying a phenomenal amount. I am just worried that we might throw the baby out with the bath water. The unintended consequence of making some of those courses unviable is a serious concern, and I think it appropriate to raise it at this point.

[Lord Winston (Lab)]

My Lords, I too am a little bit concerned about unintended consequences. It is a real pleasure to see my noble friend Lord Darzi in his place, because I hope he will have comments on this issue.

I trained as a clinical academic. Indeed, we know that clinical academics have had a unique value to the health service. They work part-time in the health service with a reduced salary and do research at the same time. I am very concerned that many of the clinical academics we have had at Imperial College, for example, have been from overseas. They were medically qualified elsewhere but had not yet been in Britain and were still junior doctors, in a sense. I am really concerned that there are many such people who come to Britain, do a postdoctoral degree such as a PhD and, in the meantime, keep their medical skills flowing, as I did myself. I was seven years in this situation with the Wellcome Trust. I remember it very well. I was overseas but at least knew that I could come back to Britain. But I was a British subject—that was easy.

There are so many of these people. To give just one example, Professor Jan Brosens at Warwick University is undoubtedly one of the key people who have contributed massively to female health, particularly on implantation of the ovum and in his magnificent work on endometriosis. He came as a junior doctor from Belgium, from Leuven University, to what was then Hammersmith Hospital, which is now, of course, Imperial College. Now, he is a very distinguished professor at Warwick University with a very large team. His recruitment made a very big difference to the whole field. His is not an isolated example; there are many such people I can think of. I hope the noble Baroness can suggest some way of dealing with this problem of unusually good graduates from elsewhere, who may not be British citizens, perhaps, in the current priorities, but who would really be deserving of serious consideration for certain specialty jobs. Not to do that would be a great loss to the health service.

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[Lord Mohammed of Tinsley (LD)]

Can I ask about applications from overseas? I know from the paperwork that has been shared online that everybody has been grouped together as the rest of the world. With the applications that we have had this time and last year, it might be helpful to share the data of the breakdown by each country rather than just lumping it all together as the rest of the world. Then we could see how many applications there are from the nations that we have an international agreement with.

[Baroness Merron (Lab)]

I shall be very pleased to do that.

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[Earl Howe (Con)]

My Lords, I begin by making it clear that this is very much a probing amendment, for reasons which I shall explain. Across all the many representations I have received on the provisions of this Bill—from UK medical graduates; UK citizens studying medicine abroad; non-UK citizens studying abroad; some in the middle of their degree course; some who have finished their degrees, and some who have commenced but not completed a UK foundation programme—there is one issue that rises to the surface. It is an issue that is most easily encapsulated in the phrase “legitimate expectations”.

Quite justifiably, in my view, individuals who have embarked on the long and costly journey that is required of them in order to gain a GMC-approved medical qualification and who have found themselves suddenly deprioritised by one or other provision within this Bill have questioned the fairness of the dividing lines that the Government have chosen to draw in such summary fashion. Medical graduates—many of them British citizens—who have demonstrated both commitment and excellence and who have adhered in good faith to every step of the process laid down under existing rules are now being told that their trust in the system counts for nothing and that, all of a sudden, their legitimate expectations have been overridden.

Noble Lords will note that my amendment relates specifically to the 2026 UK foundation programme. It suggests that a graduate who has already received a written offer of a place on a foundation programme should be able to rely on the validity of that offer. In reality, I understand that, with very few exceptions if any, applicants to the 2026 UK foundation programme have not yet received formal written offers of employment. However, the formal process began last summer. Eligibility applications were completed last July and foundation programme applications in September. Since then, there have been mandatory UKFP-related deadlines, including the national clinical assessment—NCA—in November and PLAB 1 in December. In other words, the process is active, sequential and consequential, notwithstanding as yet the absence of formal written offers.

To take the case of a medical graduate in February 2026 who finds themselves prospectively deprioritised in the way that I have described, in the Government’s view, at what point on that graduate’s journey does the principle of legitimate expectations kick in? How fair is it to say to a talented and high-achieving graduate that, despite their passing through all the existing procedural hoops, they now need to lower their expectations quite dramatically and accept that they are no longer in that part of the queue for a medical qualification which, in good faith, they previously worked to join?

In summary, my amendment is intended to pose a somewhat broader question than its literal wording would suggest. What do the Government have to say to that cohort of soon-to-be deprioritised graduates who have committed time, effort and money to pursuing their goal? Is there any room for movement? I beg to move.

[Lord Mohammed of Tinsley (LD)]

My Lords, I speak to the amendments in this group in my name—Amendments 5 and 10—and to Amendments 9, 11, 24 and 25 in the name of the noble Lord, Lord Stevens of Birmingham, which I have also signed.

I follow up the point that the noble Earl, Lord Howe, talked about in terms of the fairness for those people who went into the application process last summer. They started this process with the expectation of getting a confirmation any time now and being able to prepare. That is why my Amendment 5 proposes to postpone the implementation of this speciality training prioritisation for this year’s intake, so that those people who are applying for 2027 know that we are changing the rules, rather than telling those people who applied last summer that we have changed the rules. Let me be clear from the outset: this amendment does not seek to undermine the principle of the objectives of this Bill on medical training; rather, it seeks to ensure that these objectives are implemented fairly, coherently and without unintended harm to the very trainees upon whom our healthcare system depends.

The central issue for us here has always been timing. As the Bill currently stands, these changes would be introduced during an active application cycle. This raises serious concerns about procedural fairness and legitimate expectations. Applicants have made life-altering decisions—academic, financial and personal—based on a set of rules that existed last summer when they applied. To change these rules mid-cycle, in my opinion, is not merely inconvenient but fundamentally unjust. Like many others, I have been contacted by affected medical students who have articulated their concerns around the criteria. They noted that they had complied fully with all the requirements enforced at the time of application, only to find themselves potentially excluded by the change that has now been imposed. Without transitional protections, the Bill would disadvantage applicants who acted in good faith, followed the guidance provided and had every reasonable expectation that the rules would not be rewritten half way through the process. This is not about isolated grievance; it reflects a systematic risk inherent in rushed implementation.

Medicine is a profession that demands long-term planning, with years of study, examination, placement and significant personal sacrifice. When Parliament alters the conditions of progression without adequate notice or transition, it destabilises that planning and erodes trust in the system. My amendment therefore offers a modest but proportionate and sensible solution: a one-year delay that would allow for clarity in communications and proper preparation. It would give institutions time to adjust their process, regulators time to issue clear guidance and applicants time to make informed decisions so that people who will be applying this summer know what the criteria are. Crucially it would also align with the principles of this House, which has long upheld fairness, legal certainty and an avoidance of disadvantage. We should be especially mindful of these principles when legislating in areas that directly affect access to professional training and career progression.

There is also the practical consideration. Disruption of the current application cycle risks creating gaps, appeals and bottlenecks that could ultimately harm workforce planning in the NHS. At a time when staffing pressures are already acute, we should really be wary of reforms that may have unintended consequences and might deter capable candidates. My amendment would not delay the reforms indefinitely, but simply ensure that reforms are done properly. By supporting this amendment, we would send a clear message that, while we are committed to improving medical training pathways, we are equally committed to treating applicants fairly and honouring the rules under which they apply.

We have heard about the immigration status mentioned earlier and the criteria on which that is based. With my Amendment 10, I would like to raise with the Minister the alternative option, given that the Government are also seeking to change the rules around indefinite leave to remain. My understanding is that there is a better option. The NHS has its own recruitment platform, the Oriel system, which is able to demonstrate professional commitment to the NHS. In doing so, it shifts the focus from legal residence status to actual service, contributions and engagement with our health system.

The NHS does not run, as we heard earlier, on immigration categories. It runs on people who turn up to shifts, who trained within its system, who understand its pressures and who have committed themselves to caring for patients day in, day out. The Oriel registration is not just a symbolic tactic; it is a gateway through which NHS recruitment, training and workforce planning operates. It is a clear, objective indicator that an individual is already participating in or seeking to participate in the NHS.

Similarly, the concept of professional commitment to the NHS allows for a broader and fairer assessment of contributions. It recognises work undertaken in the NHS trust, clinical placements, foundation training, research, teaching and other forms of service that directly benefit patients and institutions. This approach reflects reality far more accurately than a single immigration milestone, which may have little bearing on an individual’s clinical engagement or future commitments or intentions.

There is also a serious risk of equality issues at stake. Many doctors who have trained in the UK, worked in NHS hospitals, paid taxes and served our communities for years do not yet hold indefinite leave to remain, due to the structures and lengths of immigration pathways. To divert these such individuals despite their proven service risks sending a deeply damaging message that contribution is secondary to paperwork. At a time when the NHS remains heavily reliant on international medical students, we should be careful not to erect barriers that discourage retention or undermine morale. These clinicians are not temporary stopgaps; they are integral members of our workforce. Many intend to build long-term careers here and many already have.

From a practical standpoint, this amendment also improves administrative clarity. Assessing our registration and documenting NHS experience is straightforward, verifiable and directly relevant to workforce needs. By contrast, tying prioritisation to immigration status risks complexity, inconsistencies and unintended exclusion. If the aim of the Bill is to strengthen medical training and to support the NHS workforce, our criteria must align with that goal. This amendment ensures that prioritisation is based on what truly matters: demonstrated commitment to the NHS and the work that it exists to do. Therefore, I urge noble Lords to support both my amendments.

[Lord Stevens of Birmingham (CB)]

My Lords, I repeat my declarations of interest from Second Reading as chair of King’s College London and chair of Cancer Research UK, and as an honorary fellow of the Royal College of Physicians and the Royal College of General Practitioners. I am going to speak to my Amendments 9, 11, 24 and 25. I am most grateful to my co-signatories: the noble Earl, Lord Howe, and the noble Lords, Lord Mohammed of Tinsley and Lord Patel.

The Government, in my opinion rightly, want to prioritise for specialty training doctors who, among other things, have significant prior experience working in the NHS. They propose in the Bill that that would be an explicit criterion to be taken into account from 2027. So the principle is clear. The practice for 2026, however, is said in the impact assessment to be such that they cannot use that criterion for the current cycle. So, instead, a series of proxies are proposed which, in the words of the impact assessment, would

“capture applicants who we believe are most likely to have NHS experience”.

This set of amendments, which should be an easy pill for the Government to swallow, would simply give them the ability to apply in 2026 the same criterion relative to work experience in the NHS that they propose from 2027 onwards. I recognise that there may still be some discussions, as we just heard from the noble Lord, Lord Mohammed of Tinsley, about the executability of that criterion, using the Oriel system or other mechanisms. These amendments would not require the Government to bring forward their 2027 approach but simply permit them to do so if, in the weeks between now and 5 March, for example, if that is the deadline for when Royal Assent is required, it becomes clear to them that the modest enabling work on the computer software, estimated at £100,000, can be put in place if that were needed.

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[Lord Stevens of Birmingham (CB)]

My Lords, I speak in support of the thrust of the amendments in this group. I start by acknowledging the concern that I think is animating the Government on this point, which is that they do not want to see a thin end of a wedge that opens up substantially with a lot of newly created international programmes that then end up further displacing UK-trained graduates and undermining the ability to effectively plan the medical workforce of the future.

Fortunately, however, none of these amendments actually constitutes the thin end of the wedge—there is no wedge. As we have just heard, these amendments grandfather the current, very modest arrangements at QMUL Malta and Newcastle University, which are so numerically small, with a couple of hundred students relative to 12,800 for the other training programmes. So those are not the programmes that have caused the problem that the Bill is seeking to address, nor should they therefore be collateral damage as the Bill progresses.

As discussed at Second Reading, particularly in respect of Malta we have a long-standing relationship, and we have a series of diplomatic and other ties of bilateral agreement that the British Government and the Maltese within the last 12 months have renewed, which are of continuing and considerable significance to us, including on defence, security and other aspects. So the Government would be well advised not to throw the baby out with the bathwater and to take seriously the concerns that these amendments represent.

[Lord Mohammed of Tinsley (LD)]

I shall speak to the Amendments 15, 16 and 19 to add my support to the amendments on the issue of Malta from the noble Baroness, Lady Gerada, as well as Amendment 17 from the noble Lord, Lord Forbes, and Amendment 20 from the noble Earl, Lord Howe.

Given that we have had a substantial discussion on Malta, particularly from the noble Baroness, Lady Gerada, and the noble Lord, Lord Clement-Jones, I shall speak more towards Newcastle, forging the northern alliance that we may have—and more importantly because my mentor, the noble Lord, Lord Shipley, who cannot be here, made a particular point of visiting my office to say, “You are going to be speaking on Newcastle on Thursday, aren’t you?” So here we go.

The amendment from the noble Lord, Lord Forbes, would ensure that graduates from overseas campuses, and United Kingdom medical schools in particular, are treated fairly and consistently. I think that the amendment is precise and proportionate. It applies three conditions: first, that the primary medical qualification is awarded by a United Kingdom medical school—in this case Newcastle, but there will be others; and, secondly, that the qualification is obtained through study at an overseas campus that existed at the point of this Act being passed. The noble Baroness talked about potential creep when we discussed this last week in terms of other institutions being able to take advantage and open that back door. With this very timely amendment from the noble Lord, Lord Forbes, it is very clear that—

[Lord Stevens of Birmingham (CB)]

Is it the noble Lord’s understanding that there would be the opportunity for creep as is currently set out in the Bill? For example, if Queen Mary University of London wished to establish a medical school in Liechtenstein, which currently lacks one, it would be able to do so with an unlimited number of places. All those new students would then be passported into the NHS.

[Lord Mohammed of Tinsley (LD)]

The noble Lord, Lord Stevens, has given people ideas. Possibly, this could happen, yes.

Thirdly, both courses and study for the convocation are approved by the GMC as being equivalent to the UK medical qualification. This is not about lowering standards or creating a new route through the back door. On the contrary, this is about recognising the standards that already exist and are regulated by the GMC. The GMC is determined that these courses are equivalent in content assessment and outcome. It is difficult to justify why we should exclude them, given the numbers that we heard about earlier.

Universities such as Newcastle—and there may be others as well—rely heavily on this partnership. These programmes have not just happened overnight. They have existed for some time. They are run by UK institutions, aligned with UK curricula and assessed identically to UK standards and subjects. Graduates receive UK-awarded degrees, not foreign substitutes. Such programmes contribute to the NHS. Only yesterday, we heard from Newcastle University that they have had up to 150 students on their Malaysian campus. As we heard earlier, some of those students have come back to the United Kingdom and, in particular, have served for many years as GPs when we have had an acute shortage. We need to take heed of that contribution and also the long-standing relationships that exist both with Newcastle and Queen Mary.

We are only asking for a very small change. We are not asking for tens of thousands of students to come here. We are asking for a small number through long-established partnerships that have existed and stood the test of time. We are asking the Minister for some flexibility. This is being heard from all sides of your Lordships’ House. We are about to go on a holiday. I hope that the Minister will take this time to reflect on our debate and come back on Report with government amendments that we can all support. I look forward to the debate that we are going to have in less than a fortnight’s time.

[Earl Howe (Con)]

My Lords, I shall speak to my Amendments 20 and 21 and in support of the other amendments in this group.

My amendments are intended to work together and to return us to one of the salient themes of our debates at Second Reading, a theme which has been persuasively developed today by the noble Baroness, Lady Gerada, the noble Lord, Lord Forbes, and other speakers. At the heart of their concerns is why the Government have chosen to adopt a definition that threatens to undermine high-quality workforce capacity in the NHS, that jeopardises the sustainability of medical education delivered overseas by UK institutions, and that runs completely counter to the Government’s stated ambitions on promoting British standards of education internationally.

The Bill prioritises graduates based on strict geographic criteria, rather than on the provenance of their qualifications. UK academic institutions such as Queen Mary University of London and Newcastle University have campuses respectively on Malta and in Malaysia which train doctors to GMC-approved standards, using the same curriculum and the same assessments as those employed on their campuses in the UK.

The noble Baroness, Lady Gerada, has eloquently made the case for Maltese-trained students. I can add little to that. The noble Lords, Lord Clement-Jones, Lord Mendelsohn, and Lord Forbes have also spoken very powerfully on the same theme. The amendments of the noble Baroness, Lady Gerada, speak of the two qualifications—in other words that gained in Malta and that gained in London—as being identical in character. The amendment from the noble Lord, Lord Forbes, uses the word “equivalent”. I would go further by saying that the degree issued by the Queen Mary University of London Malta campus is not merely equivalent to a UK degree: it is a UK degree.

Not only that, but Queen Mary University is able to state that cohorts of its students trained in Malta frequently outperform their contemporaries who have studied and trained on the London campus. The intervention from the noble Lord, Lord Winston, has confirmed that that is not an isolated claim. The same claim could be made of many graduates of Newcastle University’s campus in Malaysia. These are excellent doctors, so there is not an issue of quality here.

Nor should there be an issue around numbers. In total, as we have heard, the number of these overseas-trained graduates is modest in comparison to the overall NHS training intake in a given year. The numbers really ought to be treated as de minimis. We have heard from Ministers that, if they were to flex the rules in the way that I and others are proposing, there would be no way for them in the future to control the total numbers of eligible applicants from these sources. My question is: why? It would seem perfectly possible to grant Ministers a power to cap total numbers at a figure corresponding to recent experience. It would then be up to the relevant universities concerned to collaborate year by year to ensure that the cap was not exceeded. That is what my Amendment 21 is intended to do.

Finally, we return to the issue of legitimate expectations. For all the reasons that I have given, students trained on overseas campuses of UK institutions have never dreamed of questioning whether the status of their qualification would differ in the slightest from the status of the qualification gained by their student colleagues in London. They are, in consequence, not to put too fine a point in it, appalled that, through this Bill, they are suddenly to be regarded as less deserving of a medical career in the NHS. I ask the Minister to think again.

--- Later in debate ---

Moved by

[Lord Mohammed of Tinsley]

23: Clause 7, page 4, line 39, leave out subsections (1) to (4) and insert—
“(1) Regulations under this Act are subject to the affirmative resolution procedure.”

[Lord Mohammed of Tinsley (LD)]

My Lords, I know that it is late, but it is important that I move this amendment, which seeks for all regulations that are made under the Bill are subject to affirmative resolution procedures. In simple terms, after the Bill is passed, we would have a vote in both Houses on any changes made to allocation of spaces. This amendment goes to the heart of parliamentary accountability.

The Bill as currently drafted grants Ministers broad regulation-making powers, including the ability to amend key operational aspects of medical training with limited parliamentary oversight. My concerns are not with the intentions of the current Minister or the present Government but with the precedent that this sets. Delegated powers once granted outlive individual Ministers or Governments.

Medical training is an area where stability and predictability are essential. Doctors and medical students plan years in advance—sometimes decades. They make decisions about education, location, finances and family life based on the rules that Parliament sets. If those rules can be altered by secondary legislation without a positive vote in both Houses, we risk creating uncertainty and undermining confidence in the system.

The affirmative resolution procedure would provide a necessary safeguard. It ensures transparency, debate and accountability. It allows Parliament to examine whether proposed changes are proportionate, evidence-based and aligned with the original intent of an Act. Importantly, in this case, it would give affected shareholders—medical students, trainees, regulators and the NHS workforce—the assurance that changes will not be made without democratic consent and accountability.

This House has repeatedly expressed concerns about the expansion of executive powers through delegated legislation, particularly in areas with significant policy impacts. The Delegated Powers and Regulatory Reform Committee has, on numerous occasions, warned against the inappropriate use of negative or minimal scrutiny procedures where primary legislation confers wider discretion. My amendment responds directly to those concerns.

There is also a practical benefit. Requiring affirmative approvals encourages better policy-making. Ministers can explain, justify and defend their proposals in open debate. That process often improves the quality of regulations, identifies unintended consequences and builds broader support for necessary reforms.

This amendment would not prevent future Governments adapting the medical training system. It would simply ensure that, when they do so, they do so with Parliament, not without it and not by going around it. It would preserve flexibility while embedding accountability. At a time when trust in politics and political institutions is fragile, Parliament must demonstrate that significant changes to professional regulations are made openly and responsibly. Requiring a positive resolution in both Houses is a modest but important step in that direction. I therefore commend this amendment to your Lordships’ House.

[Earl Howe (Con)]

My Lords, I am grateful to the noble Lord, Lord Mohammed, for his amendment and his very helpful introduction. From these Benches, we have consistently raised our concerns about the downsides of emergency legislation. The Constitution Committee chairman, my noble friend Lord Strathclyde, wrote in his letter to the Minister that the Constitution Committee has

“repeatedly raised concerns about the fast-tracking of legislation, highlighting in particular the need to ensure that effective parliamentary scrutiny is maintained”.

We are all of us, I hope, doing our utmost in the short time available to scrutinise the Bill fully, but, with such a short period of time available, we cannot discount the possibility that this legislation will have unintended consequences. The noble Lord, Lord Clement-Jones, posited one particular example in his speech during the last debate.

It is true that the Delegated Powers and Regulatory Reform Committee has not brought anything in the Bill to the attention of the House. However, in the light of the fact that the Bill has been fast-tracked through Parliament, there is, I believe, a case for making all regulations under this Act subject to the affirmative procedure, allowing for additional future scrutiny. Like the noble Lord, Lord Mohammed, I look forward to hearing the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am grateful not just for this brief debate but for the efforts of noble Lords to expedite this legislation. I acknowledge the short timeframe—it is not as short as in the other place but, nevertheless, noble Lords have been most co-operative, and I value that.

Amendment 23, tabled by the noble Lord, Lord Mohammed, seeks to require that all regulations made under the Act are subject to the affirmative procedure. This is an amendment we are not able to accept. To reiterate our intention, the Bill sets out the groups of people who are to be prioritised for specialty training from 2027 onwards. I reassure the noble Lord that the delegated power is limited to adding to this list by reference to significant experience working as a doctor in the health service or immigration status.

Similarly, we have set out in the Bill specialty training programmes excluded from the prioritisation scheme. The delegated power is limited to amend this list, and it gives necessary operational flexibility to respond to future changes in recruitment, training and workforce needs—something that I know noble Lords are very attuned to the need for.

I am sympathetic to the desire for parliamentary scrutiny and I always try to ensure that it is provided but, because of the limited scope of these powers, we believe that the negative procedure is appropriate. As the noble Earl, Lord Howe, just referred to, the Bill has been assessed by the Delegated Powers and Regulatory Reform Committee, and no suggestion has been made that the negative procedure was inappropriate for this regulation.

I have spoken in a previous group to why we are dealing with emergency legislation. I hear what is said about the downsides, but we have to balance that with the scale of the problem and the urgency that it demands. That is why we decided to introduce emergency legislation.

The noble Earl spoke about the Constitutional Committee letter. We will be responding formally to the committee to address its concern. With that, I hope the noble Lord feels able to withdraw his amendment.

[Lord Mohammed of Tinsley (LD)]

I thank the Minister for that timely response. I particularly welcome the support of the noble Earl, Lord Howe, for the principle that I was trying to establish. However, on this occasion, I beg leave to withdraw the amendment.

Amendment 23 withdrawn.