Baroness Merron (Lab)

My Lords, I am most grateful to noble Lords from across the House for their thoughtful contributions in this group. The noble Earl, Lord Howe, reminded us to come back to the prime focus in respect of Amendment 11, which I will start with. It is about supporting and being fair to UK medical graduates in whom we have invested, but that is also a group from whom we seek so much, and we are grateful to them. It is also about providing safe and appropriate care. I appreciate the intention behind Amendment 11, tabled by my noble friend Lady Lister, but the Government are unable to support it, for the reasons I will outline. The Bill, as noble Lords will be familiar with, prioritises applicants based on certain specific immigration statuses for specialty training in 2026. These statuses have been carefully chosen for the reason that I have said a number of times: as a practical and proportionate proxy for applicants who are most likely to have significant NHS experience. I reiterate, as I have said a number of times, that the Bill is not about exclusion of any groups or individuals but about prioritisation. Referring to the request by my noble friend Lady Lister, which was emphasised by the noble Lord, Lord Mohammed, perhaps I could make one point to remind your Lordships’ House. For 2027 onwards, those statuses will not automatically apply. Instead, there will be the power to make regulations to capture and prioritise persons with significant NHS experience based on other criteria or by reference to immigration statuses. I reassure my noble friend that we have already committed, and do so once again, to a proper engagement process—subject to the Bill’s passage, of course—to ensure that any future definition is fair, evidence-based and deliverable. Amendment 11 would prioritise groups with different immigration statuses which are not an appropriate proxy for significant NHS experience. This is not consistent with the aims of the Bill. The amendment would also have the effect of permanently prioritising applicants on the basis of immigration status for foundation and specialty training. The applicants with the immigration statuses listed in the amendment who are not otherwise prioritised are—as I have already said, but it bears repeating—not excluded from applying for foundation or specialty training. They may still be offered a post, if there are places remaining, once all prioritised applicants have been allocated posts. They also remain eligible to apply for locally employed doctor roles. On this basis, I hope my noble friend will feel able to withdraw her amendment. I turn now to Amendments 12, 13 and 15, tabled by the noble Baroness, Lady Gerada. I appreciate the intention behind these amendments, as many of us do, and I am most grateful to the noble Baroness for her work in bringing these amendments back in the way that she has on Report, having heard the arguments previously in Committee. I appreciate her work on them, both inside this Chamber and outside, and the way in which she made her case so clearly and powerfully, as other noble Lords have said. I know the noble Baroness is aware, as I emphasised in my letter that I sent out to Peers, that the Government are unable to support these amendments. Let me explain to your Lordships’ House why this is the case. The Bill rightly prioritises doctors for foundation and specialty training based on where they are trained. It also prioritises internationally trained doctors with significant NHS experience for specialty training. We are doing this because these doctors are more likely to work in the NHS in the long term and to be better equipped to deliver healthcare that is tailored to the UK’s population, because they will better understand the UK’s health system and epidemiology. On my noble friend Lord Hunt’s point, which I believe he also spoke to in the previous group, while assessments and course learning at overseas campuses may well be the same—I accept that—as in UK-based medical schools, students will not have undertaken the same number of clinical placements in the NHS in the United Kingdom. I note that the noble Baroness, Lady Gerada, argued in her email to all Peers—or to a number of Peers, I am not quite sure which—that her amendment would not widen eligibility for prioritisation beyond the Government’s intentions. This is not the case. To reiterate, the Bill intends to prioritise home-grown doctors and put them at the front of the queue for training posts. It is unashamed, for the reasons that I have explained and noble Lords understand. Doctors who have trained here and undertaken their placements in our hospitals and health settings will have more familiarity with the NHS and the needs of the patients they serve than a doctor who has studied the same curriculum but not in the UK. However, the Bill recognises that this experience can be gained without spending the entirety of one’s degree in the UK. However, the line has to be drawn somewhere and, where the majority of a degree has been studied outside the UK, it is right that those graduates are not prioritised equally alongside UK-trained medical graduates. To pick up the point about future-proofing that the noble Baroness, Lady Finlay, raised, we recognise the risks of this creating a loophole in the legislation if medical schools purposefully change their curriculum to ensure that their graduates come from within the priority status. However, as we discussed earlier today, this risk would exist at whatever threshold we set. I can, however, assure the noble Baroness that we will continue to monitor the data carefully in future years, for all the important reasons that the noble Baroness said. The Bill prioritises all graduates of UK medical schools who have studied for their degree in this country. That is the right thing to do for our health system, because we recognise that these doctors are well prepared to work in that system and are more likely to stay. It is also right and fair to do this for graduates of our medical schools. It treats all graduates as equals, regardless of where they are from. As the noble Lord, Lord Patel, noted, prioritising graduates from overseas campuses would also undermine—these are my words, not the noble Lord’s—our aim of greater social mobility and access into medicine. We need dramatically to improve access to this profession for those from disadvantaged backgrounds across our communities in order that our medical practitioners can be more representative and serve the communities from where they come. The campuses that we are speaking of are commercial ventures and students are generally self-funded. Including these graduates in the priority group would undoubtedly undermine the efforts of the Bill to support home-grown talent. I will make a number of points to deal with the points that the noble Lord, Lord Clement-Jones, raised. I understand that the proposed amendments seek to restrict future eligibility by prioritising only those campuses that are extant on the day the Act is passed, and also to create a power that would enable us to limit the number of eligible applications under this provision. However, the establishment and operation of these overseas campuses sit outside the UK Government’s workforce planning and commissioning decisions. We have previously set out that we expect that all eligible prioritised applicants for the foundation programme in 2026 will get a place. So, accepting these amendments, even with the suggestion of capping the numbers that could be prioritised from these campuses, would mean we would have to fund more foundation programme posts than we need. There has been talk—not just in the Chamber, but outside—about figures. Let me clarify that current UK foundation programme applications for 2026 show almost 300 applicants from overseas campuses of UK and Ireland medical schools. This is a significant number and to prioritise all of this group would require substantial additional expenditure for these posts. A rough estimate is around £25 million over two years. This is funding which, if it went in this direction, could not be spent on other priorities, including increasing specialty training places, which I know is of great interest to noble Lords. In addition, the proposed amendments would not have any effect on overseas campuses of Republic of Ireland medical schools, so would conflict with provisions in the rest of the Bill, which treat Ireland graduates on the same basis as UK graduates, reflecting the unique relationship between the two countries.