Contribution
My Lords, I speak to Amendments 12, 13 and 15 in my name and that of the noble Lord, Lord Mendelsohn. I repeat my conflicts of interest: I am of Maltese heritage, I am a doctor and I am co-chair of the APPG. My amendments are narrow, they are practical and they respond directly to the concerns raised by the Minister in Committee. I respect the Minister and am grateful for the time that she has given me, for her letter and for engaging seriously with this issue.
I fully accept that we must find a solution to the difficulties faced by UK medical graduates, as so eloquently pointed out by the noble Lord, Lord Patel. In doing so, however, we must ensure that we do not unfairly disadvantage a small, specific group of students, do not strain valued relationships with an EU member state and Commonwealth partner or inadvertently undermine a long-standing transnational higher education commitment. That is the purpose of my amendments.
This is not about opening floodgates, nor is it about creating a new route for offshore medical schools. I am speaking here about just two long-established UK universities with overseas campuses: Queen Mary University of London in Malta and Newcastle University in Malaysia. They are the only two that, upon Royal Assent, will meet the criteria for delivering UK primary medical qualifications overseas—the same curriculum, the same examinations, the same degree and, until now, the same eligibility for the UK foundation programme. Historically, there was a third, City St George’s, which is now teaching its final cohort of seven students in Cyprus; that arrangement is closing. In reality, therefore, we are speaking about two mature, well-governed partnerships with capped, predictable numbers of no more than 190 students per year.
Let me address Malta, which I obviously know best. Since 2009, Queen Mary has operated a British medical school in Malta on the understanding that its graduates would be treated in the same way as its London cohort for entry into the UK foundation programme. That reassurance was reaffirmed as recently as 2024. Each year, about 90 students enrol at the university. Many of them are UK nationals, often with a clear intention of serving in the NHS. They are students such as Michael, who comes from Essex; he is a final-year medical student who worked as a nurse during the pandemic before deciding to train as a doctor at QMUL Malta. He is not a rich kid but someone who has dedicated his life to working in the NHS, and has worked, saved and borrowed money to achieve his passion of becoming a doctor. What can he hope for now? If we imply that a UK degree somehow becomes less UK because a lecture theatre is in Malta rather than Whitechapel, we send an unfortunate signal not only to those students but to a close education and historic partner.
The Minister has quite properly raised concerns about NHS exposure and it is true that most clinical placements take place in Malta, but almost all the students undertake NHS attachments. The health challenges they face are strikingly similar to ours—much more so, I would attest, than the health challenges in Iceland, Liechtenstein or Norway. Non-communicable diseases dominate: diabetes, cardiovascular disease and obesity. There is a growing burden of mental illness, especially among children and young people. Its population is ageing and its society is increasingly diverse. The weather may be warmer, but the medicine is not fundamentally different.
This is not merely an assertion. QMUL now has four completed cohorts—147 graduates who have transitioned safely into the NHS and are performing exceptionally well. Why would they not? More than half of them are UK nationals. All are fluent in English, and all have been trained to practise in the NHS. These doctors or students seek no advantage. They only ask not to be disadvantaged because the campus of the UK university is overseas. The numerical impact on domestic graduates would be negligible. The Government’s target competition ratio of two applicants per foundation place would still be met.