Medical Training (Prioritisation) Bill

Wes Streeting Excerpts

Tuesday 27th January 2026 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

I beg to move, That the Bill be now read a Second time.

I begin by thanking the Leader of the House, the Chief Whip, their counterparts in the other place, colleagues in my Department and in the NHS, the Bill team and parliamentary counsel, who have moved mountains to prepare this Bill in double-quick time. I once again place on the record my sincere thanks to my counterparts in the Governments of Wales, Scotland and Northern Ireland—as well as the respective Secretaries of State for those nations—for the spirit in which, regardless of party, they have helped us to bring the Bill forward. Last but by no means least, I am enormously grateful to Jackie Baillie, Labour’s deputy leader in Holyrood, for her wise counsel.

The NHS is on the road to recovery, not least because of the herculean efforts and dedication of NHS leaders and frontline staff who, even in the depths of winter, are delivering outstanding episodes of care, hour after hour and day after day. Among the encouraging signs of year-on-year improvement are waiting lists falling at their fastest rate in three years—down more than 300,000 under Labour—and quicker ambulance response times, shorter waits in A&E and speedier cancer diagnoses for more people. December was the busiest month in NHS history for 999 calls, but despite that, and regardless of industrial action and winter pressures, ambulances arrived at heart attack and stroke patients nearly 15 minutes faster compared with last year.

The progress we are seeing is a reminder that nothing positive for the people who use the NHS ever happens without the people who work in our NHS. Our investment and modernisation are starting to restore confidence and renew belief among frontline staff; with that, hope, optimism and ambition are returning too. That is why, outside of the pandemic, staff retention is at its highest in a decade and vacancies are at their lowest since records began in 2017. There is lots done, but, as we know, there is so much more to do.

I will always be honest about the state of our national health service—what is going well and where we need to improve. There is no sugar coating the fact that staff morale is still too low, and the way that some of our NHS workforce is still treated and the conditions in which too many of them still work are nothing short of a national disgrace. Not only is it a stain on our NHS, but it shames us as a country when those who care for us in our hour of need suffer bullying, harassment and racist abuse; have nowhere to rest, go to the toilet or get changed; cannot get a hot meal on a night shift; have limited flexible working options; must book holiday a year in advance; need to log in seven times just to use a PC; spend time form-filling rather than looking after patients; and face basic errors with pay and contracts. Before Christmas, I had a doctor in my constituency advice surgery in tears as she described the way she had been treated by a previous employer. This is no way to treat the people who kept us going when everything else stopped, so we are taking action.

Trusts are now implementing the 10-point plan for resident doctors and my Department, together with NHS England, is developing new staff standards to create better working practices and better conditions.

We have awarded above-inflation pay rises to everyone working in the NHS for this year and last year, which is beginning to recover the pay erosions seen under the last Government. We have begun 2026 with constructive talks with the British Medical Association’s resident doctors committee, as we seek to broker industrial peace. I have also told NHS leaders that they need to step up when it comes to the conditions that their staff face. They cannot expect the Secretary of State to micromanage availability of hot food in their canteen, for example.

However, there are workforce problems that only Government can solve. We have known for years that the treatment of resident doctors is often totally unacceptable and that the very real fears about their futures are wholly justified. Every time I have met a resident doctor, either formally or informally, they have told me without fail how their careers are blocked because there are far too many applicants for training places. Not only do I think that they have a legitimate grievance, but I agree with them.

[Dr Kieran Mullan (Bexhill and Battle) (Con)]

The Secretary of State is essentially talking about postgraduate training. I wonder what thought he has given to new clause 2 in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). I have spoken to students who worked really hard all the way through medical school to get the best exam results and perform highly but then ended up in an allocation system that pays no attention whatsoever to that. Merit has been entirely removed from the system. I think it was wrong for us to make that change. Does he have any sympathy for returning to a merit-based system?

[Wes Streeting]

I certainly do have sympathy with that argument. We have begun to move the system in the right direction in terms of giving applicants greater preference in placements, but it is not lost on me that the system of rotations, placements and jobs means doctors are moved around the country and families are uprooted. The frictional cost of relocating from one place to another is a challenge that resident doctors in particular face. I do not think that an amendment to the Bill is the right vehicle in which to address that issue, but I am sympathetic to the arguments that the hon. Member makes, and I am sure he will make them again during this afternoon’s proceedings. We will take his arguments seriously and look to work together with the BMA and others to act to improve the experience of training, rotations and jobs.

UK graduates used to compete among themselves for foundation and specialty roles. Now they are competing against the world, because of the visa and immigration changes made by the Conservative Government post Brexit. The situation is compounded by the previous Administration’s total lack of workforce planning, which saw more students going to medical school without the number of specialty training places being increased. That is why we see the training bottlenecks that resident doctors face today.

[Several hon. Members rose—]

--- Later in debate ---

[Wes Streeting]

I will give way to the hon. Member for Henley and Thame (Freddie van Mierlo) and then to my hon. Friend the Member for Hitchin (Alistair Strathern).

[Freddie van Mierlo (Henley and Thame) (LD)]

A constituent of mine is studying medicine at Queen Mary University of London but at a campus in Malta. Students at the Malta campus complete the same General Medical Council-approved curriculum, assessments and licensed exams as London-based students, and graduates hold a UK primary qualification. He was given a formal guarantee that he would be at no disadvantage if he chose to study at the Malta campus. Can the Secretary of State reassure me that graduates like my constituent will be prioritised on the NHS foundation medical training programme?

[Wes Streeting]

Students studying in Malta will not be prioritised in the Bill, but they will still be able to make applications. Queen Mary University’s Malta website is clear that Queen Mary does not administer the UK foundation programme and cannot control whether or on what basis applicants are accepted into the programme, and no one is guaranteed a post on qualification.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Will the Secretary of State give way?

[Wes Streeting]

I will make some progress because, with respect, I have not yet set out the measures that we are to debate today. Let me take the intervention from my hon. Friend the Member for Hitchin, then I will set out the Government’s rationale and take further interventions.

[Alistair Strathern (Hitchin) (Lab)]

I wonder if the Secretary of State shares my residents’ utter disbelief that the last Government created a system where thousands of UK medical graduates, educated at the cost of billions to the UK taxpayer, were suddenly forced to compete with overseas students, pushing many abroad for their careers and losing a big talent pool that should be powering our NHS and getting it back on its feet.

[Wes Streeting]

That is right. I have to say, many of my counterparts around the world cannot fathom how we ended up in this situation in the first place. They certainly do not do as we have been doing, investing so much in their home-grown talent only to then see that talent compete on equal terms with anyone from anywhere else in the world.

Let me set out why we need this Bill. There are workforce problems that only Government can solve. We know that the treatment of resident doctors has been totally unacceptable for years and we see the training bottlenecks that resident doctors face today. In 2019, there were around 12,000 applicants for 9,000 specialty training places. This year, that has soared to nearly 40,000 applicants for 10,000 places, with nearly twice as many overseas-trained applicants as UK-trained ones. As a result, we now have the ridiculous state of affairs where UK medical graduates, whose training British taxpayers fund to the tune of £4 billion a year and who want to carve out a career in their NHS, are either being lost abroad or to the private sector. If we do not deal with that, the scale of the issue and the resentment it causes will just get worse. More taxpayers’ money will be wasted, more British medics will turn their backs on the NHS, and patients and our NHS will ultimately suffer.

[Seamus Logan (Aberdeenshire North and Moray East) (SNP)]

The Secretary of State knows that the SNP believes that this is a pragmatic Bill that will have a net-positive outcome for the health service in Scotland. We welcome the Bill and are glad to support it. However, there are specialty fields, such as general practice, which have a high number of international graduates. Because of Government policy, there are significant challenges in supporting the retention of some individuals. For example, the new requirement for settled status is 10 years with some exceptions, whereas training programmes are often only three years long. I am sure that the Secretary of State does not want the UK to be a hostile environment for our vital overseas medical staff. Will he therefore make representations to the Home Office so that it is aware of the anomaly?

[Wes Streeting]

I will say two things to the hon. Gentleman. This Bill does not in any way detract from the fundamental point that the NHS has always been an overseas recruiter and we have always been fortunate to draw on global talent from around the world who come and give through their service, their taxes and their wider contribution to the national health service and our country. We will continue to welcome that and people will continue to be free to apply. In future, they will apply on terms that are fairer to our own, home-grown talent.

There is nothing in what the Home Secretary proposes that will stop people who come through our universities and have the skills that we need to contribute to our health and care system applying for jobs and settling and making the UK their home. The Bill supports the Home Secretary to reduce an over-reliance on overseas talent and labour, which contributes to levels of net migration that even bleeding-heart liberals like me can see are too high. That is the issue that the Home Secretary seeks to deal with.

[Kevin Bonavia (Stevenage) (Lab)]

My right hon. Friend is right that we need to deal with this pressing problem and I support the aims of the Bill. However, as he can imagine, as the only current Member of this House with Maltese heritage, I have had representations from all quarters, both in the UK and in Malta, about the impact on Malta of this. Our two countries have a special health relationship, including the affiliation of the UK foundation programme with the Maltese equivalent. I understand that now may not be the time to have Malta in the priority group, but I note that there is a power in clause 4(6) that allows the Secretary of State to amend that in future. Is that something that my right hon. Friend will think about reviewing in future?

[Wes Streeting]

My hon. Friend is right about the measures in the Bill. He is also right about the importance of our relationship with Malta, which is long-standing and deep, and this Government place enormous value on that. We will, of course, keep the workings of the measures in the Bill under review. He is also right to say that the Bill provides flexibility to the Secretary of State to adjust, as our needs may demand.

[Dr Murrison]

The Bill is basically a good one, and we all share the intent to encourage home-grown talent to remain in our national health service, so could the Health Secretary explain why he appears to have set his face against British students who for various reasons train at, for example, St George’s in Cyprus or St George’s in Grenada and who then want to come back and practise in our national health service? They want to come back and practise at home. Amendment 9 would deal with that conundrum. Why will he not support it?

[Wes Streeting]

We set UK medical school places based on future health system needs. We cannot control how many places the overseas campus universities create, whether they are UK-based universities or not. Prioritising those graduates in the way that the right hon. Gentleman suggests would undermine sustainable workforce planning. It would also undermine social mobility and fair access. Those campuses are commercial ventures; they receive no public funding and students are generally self-funded. The nature of prioritisation is that we set priorities, and these are the priorities that this Government are setting out. We must break our over-reliance on international recruitment.

As I have said, I am proud of the fact that the NHS is an international employer, and it is no coincidence that the Empire Windrush landed on these shores in 1948, the very year our NHS was founded. We are lucky that we have people from around the world who come and work in our health and care service. Since Brexit, however, under the last Government, we have begun to see something much more corrosive, with the NHS poaching staff from countries on the World Health Organisation’s red list because their own shortages of medical practitioners are so severe. The continued plundering of doctors from countries that desperately need them while we have an army of talented and willing recruits who cannot get jobs is morally unacceptable. If some Opposition Members want to defend that record and dismiss the morality argument, I would point out that that position is naive on economic grounds. Competition for medical staff has never been fiercer. The World Health Organisation estimates a shortfall of 11 million health workers by 2030. Shoring up our own workforce will limit our exposure to such global pressures without depriving other countries of their own home-grown talent.

[Ben Coleman (Chelsea and Fulham) (Lab)]

I congratulate my right hon. Friend on his excellent speech and the strong points that he is delivering. I associate myself with the remarks of my hon. Friend the Member for Stevenage (Kevin Bonavia) about Malta. As a member of the Health and Social Care Committee, I have also been approached by Queen Mary University. It seems to me that we should be approaching this with a sense of fairness, and if students have entered into a GMC-recognised course with the expectation of having priority access for foundation status, we should accept that those who are currently in training still enjoy that, even if we change the rules for people who enter those courses in the future. Is that something that my right hon. Friend will consider?

[Wes Streeting]

As I have said, the position we have set out is founded on fairness. The basis on which people have applied to these universities has made it clear that the universities cannot guarantee places and that overseas applicants studying at UK universities’ overseas campuses can still apply. There is nothing to prevent those people from applying, but when it comes to prioritisation, we are prioritising UK-trained medical graduates from UK-based universities who have undertaken their training here in the UK. I think that is the right priority to draw.

[Anneliese Dodds (Oxford East) (Lab/Co-op)]

rose—

[Gregory Stafford (Farnham and Bordon) (Con)]

rose—

[Wes Streeting]

I will take an intervention from the hon. Gentleman. I will come to my right hon. Friend in a moment.

[Gregory Stafford]

The Secretary of State mentioned the need for more medical staff across the world and, of course, in this country as well. At the general election, he pledged to double the number of medical school places by 2030. Is that still a commitment, and how far has he got with it?

[Wes Streeting]

With respect, I think the hon. Gentleman has got his chronology slightly wrong. As shadow Health Secretary, I proposed that we should double the number of undergraduate medical school places. That policy was poached by the then Conservative Government, who made modest progress with it. We then came into government, looked at their long-term workforce plan and concluded that it was not a particularly long-term workforce plan, and we are revising it as we speak. The number of medical school places will be determined by future need. We will publish our long-term workforce plan in the not-too-distant future.

[Alison Bennett (Mid Sussex) (LD)]

rose—

[Wes Streeting]

I will give way to the hon. Lady and then to my right hon. Friend the Member for Oxford East (Anneliese Dodds).

[Alison Bennett]

The Secretary of State rightly notes that there is international competition for healthcare talent. On Friday, I met Dr Osoba, a GP who trains future GPs. She told me how disheartening it is to train future GPs whose intention is to leave the UK. What is the Secretary of State doing to ensure that British-trained medics stay working in the NHS?

[Wes Streeting]

The hon. Member puts her finger right on the issue at the heart of the Bill. That is exactly the challenge we want it to address. The Bill is not a panacea—it does not solve all the problems—but reducing competition for specialty places from around four to one to less than two to one, as the Bill will do, will make it far more likely that people who have undertaken their training here in the UK will stay here and contribute to our national health service. Of course, there is much more to do on career structure, pay and conditions, but we will go as fast as we can and as far as the country can afford. We recognise that we need to keep the great people we have invested in, because doing so is in their interest and in our national interest.

[Anneliese Dodds]

My question relates to exactly that issue. The Secretary of State will be aware, because I have written to his Department about it a number of times, that many disabled medics face a particular challenge. They may have had to take time out of their training because of a medical condition. They are told that they can obtain a certificate of readiness to enter specialty training and go into a training specialism, but the computer says no and NHS England is not sorting this out. Will he please get a personal grip on this and fix it for my constituents?

[Wes Streeting]

I am certainly aware of my right hon. Friend’s concerns. I can give her that assurance and will report back to her on progress.

Without action to prioritise UK medics, we will also make it tougher than it already is for those from working-class backgrounds like mine to become doctors—or, for that matter, to even consider a career in medicine. The odds are already stacked against them: they are less likely to know doctors, their teachers may be less familiar with how to help students into medical school, they will have fewer opportunities to do work experience, and fewer people in their lives will tell them that they should aim high and reach for the stars. The result is that only 5% of medical school entrants are from lower-income working-class backgrounds. Someone’s background should not be a barrier to becoming a doctor, so our job—especially as a Labour Government committed to social justice—is not just to ensure that a few kids like me beat the odds, but to change the odds for every child in this country so that they can go as far as their talents will take them.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

It is vital that we address this issue to ensure that UK-trained doctors are prioritised for vacancies over international applicants—the Secretary of State is making important points about that. We need those places to be opened up for UK medics immediately, so will he explain why the Bill will not come into force immediately after Royal Assent but instead includes provision for it to come into force

“on such day or days as the Secretary of State may by regulations appoint”?

[Wes Streeting]

It is important that the Bill is workable. A number of factors may well interrupt our ability to move at the pace at which I want to open up those places. One of those factors is the ongoing risk of industrial action. We know that the BMA is balloting for further industrial action at the moment. We respect the process that it is undertaking, and we are not closing the door to discussions while it does so. However, we are clear that that is a further disruption risk. I hope that we will be in a position to open up a new application round very shortly for current applicants, but that will depend on our ability to expedite the passage of the Bill through both Houses, and to ensure that the system is ready to implement it. That is why bringing forward the Bill on this timescale has been particularly important.

[Dr Murrison]

I am grateful to the Health Secretary; he is being generous with his time. Is he saying that he intends to use this as some sort of lever or bargaining chip in his discussion with the BMA?

[Wes Streeting]

I am clear that this is about whether the system will be ready to implement the measures in the Bill. I must say that I view the Conservatives’ amendment on this issue with a degree of cynicism. Not so long ago, they were accusing me of being too kind to resident doctors when it came to making changes to pay or conditions without something in return. They seem to have completely changed their position. I am sure that that is not remotely cynical and is for entirely noble reasons, but I will wait for the shadow Health Secretary, the right hon. Member for Daventry (Stuart Andrew), to make his case. Let’s just say that I am not entirely convinced.

The Bill implements the commitment in our 10-year plan for health to put home-grown talent at the front of the queue for medical training posts. Starting this year, it prioritises graduates from UK medical schools and other priority groups over applicants from overseas during the current application round and in all subsequent years. For the UK foundation programme, the Bill requires that places are allocated to UK medical graduates and those in a priority group before they are allocated to other eligible applicants.

For specialty training, the Bill effectively reduces the competition for places from around four to one, where it is today, to less than two to one. That is a really important point for resident doctors to hear, not least because in the debate we had on the Government’s previous offer to the BMA, that point was lost amid some of the broader and, frankly, more contested arguments between the Government and the BMA around pay. It is not just the provision of additional training posts that reduces the competition ratio; it is also the measures in this Bill. I hope that that message is heard clearly by resident doctors as they think about their own futures immediately or in the coming years. For posts starting this year, there must be prioritisation at the offer stage, and for training posts starting from 2027, prioritisation will apply at both the shortlisting and offer stages.

In the 10-year plan, we committed to prioritising international applicants with significant NHS experience for specialty places in recognition of the contribution they have made to our nation’s health. This year, we will use immigration status as a proxy for determining those who are eligible, so that we can introduce prioritisation as soon as possible. From next year, under the terms of the Bill, we will set out in regulations how we are defining significant NHS experience.

[Dr Simon Opher (Stroud) (Lab)]

Will the Secretary of State give way?

[Wes Streeting]

I give way to my hon. Friend with significant NHS experience.

[Dr Opher]

I commend the speed with which my right hon. Friend has brought this legislation to Parliament. I have been a GP trainer for 25 years. Fifty per cent of GP trainees are international medical graduates, and there has been some disquiet from them. Will he reassure our international medical graduates that they are welcome and treasured in the health service?

[Wes Streeting]

My hon. Friend is absolutely right about the contribution that international medical graduates make, and I have no doubt that that will continue to be the case for many years to come. I hope it is clear to those going through medical school or aspiring to a career in medicine that, in terms of the future of healthcare in this country, general practice is where it’s at. We are looking to shift the centre of gravity in the NHS out of hospital and into the community, with care closer to people’s homes and, indeed, in people’s homes, with GPs as leaders of a neighbourhood health service. I hope that gives encouragement to GPs serving today about the future of their profession, about which they care enormously. I also hope that that message resonates with people who are thinking about a career in medicine, when they think about what kind of career that might be.

[Sarah Pochin (Runcorn and Helsby) (Reform)]

I recently spoke to a doctor in my constituency who was concerned about resident doctors going abroad to get a training place in their chosen specialty. We in Reform welcome this Bill. Can the Secretary of State make a commitment that we will prioritise our own UK-trained resident doctors ahead of those trained abroad, and will he assure me that the Bill will help UK-trained resident doctors to secure a training post in their chosen specialty?

[Wes Streeting]

I can give the hon. Member that assurance—that is exactly what the Bill does. Madam Deputy Speaker, I cannot, however, resist the enormous temptation to say that while I welcome the support of the hon. Member and her party, I hope that her party’s position will not change now that it has adopted so many of the formerly Conservative culprits who landed us with this system in the first place. Whether it is the former Home Secretary, the right hon. and learned Member for Fareham and Waterlooville (Suella Braverman), or the former Immigration Minister, the right hon. Member for Newark (Robert Jenrick), I am afraid that Reform looks rather more like the Conservative party that the country rejected at the last election, which I am sure will not be lost on people when they go to the ballot box in May—[Interruption.] As my hon. Friend the Minister for Care says from a sedentary position, Reform UK are increasingly the teal Tories—it is certainly the most successful recycling project currently taking place in the House of Commons. Anyway, that was totally self-indulgent, and very churlish given that the hon. Member for Runcorn and Helsby (Sarah Pochin) is supporting the Bill, so I will slap myself on the wrist and get back to the serious matters at hand.

As we set out these changes, it is important to note that they will have no impact on doctors working in the armed forces, who will continue to be a priority, and neither does the Bill exclude international talent, as people will still be able to apply for roles and continue to bring new and vital skills to our NHS. The principle here is home-grown talent. It is not about where students are born; it is about where they are trained. What the Bill does is return us to the fair terms on which those home-grown medics competed before Brexit.

[Robin Swann (South Antrim) (UUP)]

I welcome the Secretary of State’s approach to the Bill, and how he has worked across all devolved Administrations. May I seek his assurance that medical students who reside in Northern Ireland, who identify as Irish and who study in an Irish institution in the Republic of Ireland will not be excluded from coming back to work in the national health service in Northern Ireland, where we very much need all the talent we can get?

[Wes Streeting]

I absolutely give the hon. Member that assurance—the Bill covers medical graduates from the UK and Ireland, for very obvious reasons. I welcome the broad support that the Bill appears to have across the House, because for the changes to benefit applicants in the current round—for posts starting this August—it must achieve Royal Assent by 5 March. Any delay will risk vacancies in August and disrupt planning in NHS trusts, which rely on their new trainees to deliver frontline care. Doctors also need sufficient time to find somewhere to live, sort childcare and arrange other aspects of their lives before their posts start. I am grateful that Parliament has agreed to expedite the Bill’s progress, and confident that we will be able to work at pace with our majority in this House, and with cross-party support in the other place.

[Layla Moran (Oxford West and Abingdon) (LD)]

I sense that the Secretary of State is about to reach the end of his remarks. We are keen to start the debate, but it would be helpful to get clarity on one thing before we begin. When will we see the workforce plan? It has been delayed a couple of times. We wrote to the Department in November asking for an explanation as to why it has been delayed and when we can expect it. Can the Secretary of State give us some clarity, because that is the context in which the narrow technical measure that we are discussing needs to happen?

[Wes Streeting]

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

[Alex McIntyre (Gloucester) (Lab)]

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

[Wes Streeting]

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

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

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

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

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

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

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