Baroness Finlay of Llandaff (CB)

My Lords, I declare an interest as a UK graduate and as a pro-chancellor of Cardiff University, which has a very large medical school. The ethics issues raised by the noble Lord, Lord Hunt of Kings Heath, are really important when we look at the Bill. What is our ethical role in attracting people—literally—and pulling them from places that have a terrible shortage of any medical provision whatever? Another aspect that my noble friend Lord Patel brought out so clearly is the problem of career progression. I hope that, in summing up, the Minister will reassure us that the Bill is step one in sorting out the medical career progression for people in this country. Only this weekend, I heard of a large teaching hospital that has two consultant posts coming up, for which there were 28 appointable applicants, many of whom are already consultants. There is a real bottleneck for trainees who have gone right through their training programme and done all their exams. Broadly, there are two ways of progressing: run-through training, which provides some security, and training at a postgraduate level, where they have to reapply before they move on. The problems of geography for young people, or for parents with children who are settled, are absolutely massive. I have been worried that the pay story hides huge problems and unhappiness, particularly in relation to the lack of teams in the way that training has been organised. I am referring not to Teams on the internet but to clinical teams where people know that they belong, where they know the person they can contact and where there is longer continuity. There has been a fault by the medical royal colleges—I hold my hand up, having been involved in some curricula in palliative medicine—in that we have overstepped different bits of experience and undervalued the importance of people coming through. While I support these amendments from my noble friend Lord Patel, it is important to remember that some on international medical training programmes have no, or almost no, communications skills training or training in medical ethics. In fact, there are some where they have no clinical experience of any note until they pass their almost totally theoretical exams and then they have to gain all the clinical experience later. I am not passing any judgment on the quality of their medicine later on, and they may have a better scientific foundation, but we are not comparing like with like in the process. I hope that the Minister will be able to assure us that Oriel, as an appointments and selection process, will have a much more subtle way of looking at the experience that people have and not just crude categories, because it will be important that we do not select away excellence in the name of the medical school that somebody graduated from. There is a spectrum of quality in every medical school output cohort. There are some who are superb, and there are some who, frankly, might have done better not getting into medicine in the first place—it may be a small number—but among graduates from other medical schools there will be people with superb experience and who turn out to be excellent. We see some of those in very senior positions in medicine across the UK. The prioritisation message needs to be subtle, and it needs to look at the full employment history from graduation, including applicants’ NHS experience and the quality of their work during that. Apparently, the system can automatically calculate a lot of this, drawing on GMC data as well. There is a lot of work to be done by this system in relation to the data held by the GMC, and there is a lot of work to be done by the royal colleges.