Lord Lansley (Con)

My Lords, I am very grateful for the opportunity to raise this important issue. Although it will be a short debate, this is not an unimportant subject for us to discuss. It is also very timely, coming just a fortnight after the Government’s publication of Fit for the Future and the 10-year plan. I will refer to that in some detail a little later, but it is timely for us to look at the Government’s statements in that plan and how they are to be delivered. This autumn, something approaching 24,000 young people will go to medical school. They are among the most intelligent, passionate and motivated young people. Among many of them, there is an understanding that it is a competitive profession and that they will have to fight for their places: 24,000 of them might seek medical school places but only around 9,000 or 10,000 will achieve that. From the outset, it is a competitive situation. However, we do not want to make that competition a career-frustrating experience—something that does not enable them, having achieved their initial medical qualifications, to set out on their career. We want them to be able to see that through to a more successful conclusion. One of the central issues is that, once upon a time, there was an expectation that there was a flow from initial medical school into foundation-year training and that, following foundation-year training, the substantial majority of people would go into some form of speciality training. This is not an assumption that we can make to the same extent now, when the proportion going into speciality training straight out of foundation year 2 has gone down from something like three-quarters to only just over one-third. What we want is to follow through on the expectation that we can make a substantial contribution to meeting our own medical workforce requirements and, potentially, make some contribution internationally. The worldwide demand for doctors is rising. The World Economic Forum has estimated a global shortfall of 10 million doctors by 2030, so the fact that we are increasing the number of doctors and medical school places in this country should be welcomed, frankly, whether or not we subsequently employ all those young people in our own National Health Service. If they go somewhere else or work in other parts of the world, fine—so be it. We have always drawn on other parts of the world for our medical services here, so we should be comfortable with that future possibility. Indeed, the number of international medical graduates coming to this country has substantially increased, particularly after the 2020 revision of the shortage occupations list and the resident labour market test no longer applying. This has led to a substantial increase in the number of international medical graduates. We need to focus on that issue, alongside medical training, in some of our discussions this afternoon. When it comes to the relationships between the increasing numbers of medical school places, my noble friend may like to recall the successful expansion of medical school places over the past two decades; it happened before, while and after I was the Secretary of State, and it continues to this day. In 2023, the long-term workforce plan set an ambition—not just an ambition but a promise, I think—that there would be 15,000 medical school places by 2031. We are not far off track on that, but I am not entirely sure whether that continues to be the Government’s intention. However, the ratio for those applying to specialty training from medical school and foundation years has significantly deteriorated. In a number of specialties, we have seen substantial numbers of additional young medical graduates coming through after finishing their foundation year—for some specialties the number has doubled or even tripled—but the number of posts available for them in speciality training has in many cases hardly increased at all. Overall, there has been something like a 34% increase in medical school places but only a 9% increase in speciality training available. Noble Lords do not need me to remind them that the ratio of applications to places in some specialities is severely distorted. When looking at the numbers, you have to do some work to establish to what extent there are unique applications as well as the total number of applications, but, even so, overall there are more than twice as many applications for specialty posts than we have places available. In some specialties, the ratio is significantly higher. The Government’s report Fit for the Future made a number of important points, on which I think we all agree. As they put it, the Government wish to “tackle bottlenecks in medical training pathways”. One of the central ways they plan to do this is by working “to prioritise UK medical graduates for foundation training, and to prioritise UK medical graduates and other doctors who have worked in the NHS for a significant period, for specialty training”. We need to know a bit more about what is intended by this reference to “other doctors who have worked in the NHS for a significant period”. Are we talking about six months, a year, two years or five years? Making specialty training less accessible to international medical graduates will have a significant impact on the likelihood of their coming to this country to work in our NHS. We are not wholly reliant on that and should not be, but we need to know what the implications are. It could mean literally tens of thousands fewer doctors available in five or 10 years’ time. The Government also committed to 1,000 new specialty training posts over the next three years. I want to be sure that I understand this. Will they increase the annual supply of specialty training places by 1,000, which would be something like a 20% to 25% increase, or add 300 or so each year over three years? That would not be quite what we are looking for. I hope I will be assured that it will be a 20% or 25% increase in the number of places available. The Chris Whitty and Stephen Powis review of medical training is continuing and we expect to see the Government’s long-term workforce plan in the latter part of this year. I hope it will include greater detail about the expectations for the requirements for consultant posts and the consultant workforce in future years, specialty by specialty. I hope we will see more detail on the extent to which the Government expect UK graduates to remain in the NHS, and perhaps some incentives for them to do so, so that we do not rely as heavily as we have done in the past on international medical graduates. I hope that the review of medical training and the Government’s workforce plan will use the independent sector more, which supplies something like 10% of treatments overall and should supply a significant proportion of the training support available. I hope we will see more on supporting professional activities written into consultant job plans, because we cannot deliver the increase in specialty training that we are looking for without more of that being available. I hope that where the Government say that they want to work with the GMC to get a streamlined pathway to consultant status, that means that, in addition to the specialty training places, those who go into locum and locally employed doctor status can also find their way, through certificates of eligibility or experience, to becoming consultants in due course. I also hope that, overall, the workforce plan that we will see later this year gives us many more of the answers that we are looking for to enable us to deliver this improvement in the consultant workforce in future.