Lord Patel (CB)

My Lords, I will speak to my amendments listed in group one. My amendments should be underpinned by the status of UK medical graduates. The competition to get into medical schools in the United Kingdom is one of the toughest of any country. The ratio of success is about 4:1, with the highest A-level grades obtained, including many at A*, but requirements are higher than that. At completion, on average, a UK medical graduate has a loan of about £72,000, and it is important that we debate this Bill in that context. I have retabled my amendments from Committee for two reasons. The first is that the debate that we had in Committee concentrated—rightly, maybe—more on international medical graduates or graduates from UK university campuses and not so much on the UK medical school graduates, who seem to be losing out on getting training posts. We have all received many emails from UK graduates and international medical graduates. I, presumably because I had amendments in my name, seemed to receive many more from UK medical graduates. Some noble Lords may have seen a petition on the internet addressed to us, Members of the House of Lords, to pass this Bill unamended, from UK medical graduates. I gather that there are over 4,500 names attached to that petition now. So why am I putting forward these amendments again? Most other countries—the USA, Canada, New Zealand, Australia, Singapore and the EU—prioritise their graduates for further training and even employment. Data from the GMC, NHS England, the royal colleges, the BMA and professional journals shows—I accept there is variation, including in how the data could be interpreted—that graduates from the UK find it difficult to get into core and specialist training programmes, for a variety of reasons. They include: increased output from medical schools, which will increase even more in future years; an increase in post-2019 visas for international medical graduates; and training slots have not increased, with the workforce plan increased to accommodate more doctors. In the UK doctors’ pay negotiations, one of the primary reasons that they gave was that training was an issue. A second issue was working conditions and a third was pay. I have said publicly in this Chamber before, and I repeat now, that I do not subscribe to any doctor at any time withdrawing their services from patients, for no matter what reason. I therefore do not agree with junior doctors going on strike. Despite the fact that they may have a legitimate reason to complain about their training issues, it is still no reason, as far as I am concerned, to withdraw services from patients. UK training of doctors has three stages: foundation years 1 and 2; core training; and specialty training, including GP training. The GMC informs me that foundation year one training is available to all graduates who graduate from UK universities, although sometimes they find it difficult as the slots are not available until the last minute. Usually, that ought not to be a problem. In my case, it was two weeks before I had to start the job that I secured a position to do surgery in Penzance, having qualified in St Andrews. It was not a place that I had visited before, but I got through it. In a 2024 report, the GMC says that, in 2023, 77% of doctors completing foundation year 2 did not or could not enter core training. A lot of them, around 13%, had decided not to, I gather, and may have gone overseas. In 2017, international medical graduates whose primary medical qualification was overseas were 47% of those registered with the GMC; in 2023, this was 68%. The 2023 GMC report said that 40% of doctors entering specialty training were international medical graduates. It is important that we have opportunities for international medical graduates to come to train in the United Kingdom and have employment status in the NHS. But UK doctors should have a fair shot at being able to compete fairly. UK doctors comment that, after foundation year 2, entering specialty training is like falling off a cliff; it is difficult for them to get into specialist training. NHS England, in annex 3 of its briefing on the Medical Training (Prioritisation) Bill, says that the potential impact will be an application total of 21,000 for about 10,000 posts, a ratio of 2:1. In 2025 round 1, 28,000 of the 80,000 applications were deemed appointable, according to that document. On competition, annex 4 says that, despite lower competition ratios, over 2,000 appointable UK graduates did not receive an offer in round 1 of 2025. The expectation, therefore, is that there will be 16,000 UK graduates, a slight increase from last year, applying for core and specialty training, and 26,000 international medical graduates, also a slight increase from last year. That is 42,000, although the NHS England number is 47,000. There is always a variation in the numbers, for reasons I cannot explain. Nonetheless, the ratio is 4:1 for 10,000 slots. The estimate is that 8,000 UK graduates may be forced out of the coming rotation year as they may not have appointments. The passage of the Bill will mean that priority groups of doctors will also apply for these training slots. I could not find a number for what effect that will have, but maybe the Minister has numbers on how many more doctors will be able to enter specialist training if the priority groups in the Bill are included. So UK graduates, with the expansion of priority groups, will have further competition. An NHS England publication, with a foreword from Dr Powis and the Chief Medical Officer, says that “the current bottlenecks in training do not benefit anyone; while some competition has always been a necessary part of medical training and career progression … the current ratios are making sensible career planning and assessment” for, in my words, UK doctors “very difficult”. That is why I put my amendment where I have. I know the later amendments will discuss graduates from other UK campuses being eligible for the priority group, but I will refer to that later. I beg to move.