Baroness Merron (Lab)

As I always do, I will seek to engage in sufficient time before Report. I will not promise the beginning of next week, but we all know the deadlines that noble Lords are working to and I am very respectful of that. Amendment 17 could create the loophole I have referred to and risks existing international overseas campuses expanding their intakes further. I am grateful that noble Lords acknowledge the concern and are considering how to deal with it. That would be outside any UK workforce planning. Amendment 21 would provide a regulation-making power to limit the number of applicants who could be prioritised from these overseas campuses. Going back to my earlier comments, it is not clear how such a requirement would be implemented effectively and fairly in practice but, in any event, it would not provide an appropriate safeguard for UK workforce planning. The Bill rightly prioritises those whose education and placements the UK taxpayer has supported, who are most likely to work in the NHS in the long term—I emphasise this point—and are better equipped to deliver healthcare tailored to the UK’s population because they understand the UK’s epidemiology. However, I hope my noble friend Lord Forbes and the noble Lord, Lord Mohammed, will take back to the university that graduates from international overseas campuses are not excluded and will continue to be able to apply to the foundation programme and specialty training. Amendment 18 tabled by the noble Baroness, Lady Finlay, relates to the prioritisation of medical graduates from institutions in Ireland. The Government cannot accept this amendment, and I thought her own assessment of it was most honest and helpful. Throughout the development of this Bill, we have been clear that graduates from the Republic of Ireland are prioritised on the same basis as UK medical graduates. This reflects the long-standing and unique relationship between our countries, including the arrangements under the common travel area, which supports reciprocal rights of movement and employment. It also ensures coherence in workforce planning across both jurisdictions, where medical education and training pathways have been closely aligned for many years. Introducing different criteria for graduates from the Republic of Ireland, as this amendment proposes, would risk disrupting those shared arrangements. It could also create an uncertainty in the provision of postgraduate training in Ireland. Amendment 19, tabled by the noble Baroness, Lady Gerada, seeks to add Malta to the list of prioritised countries set out in Clause 4. This would require that those who hold a primary medical qualification from any institution in Malta, irrespective of their nationality, are prioritised for foundation and specialty training. I address this particularly to my noble friend Lord Mendelsohn, to whom I listened closely, as I did to the noble Baroness, but we cannot accept this amendment. I refer particularly to the European Free Trade Association countries, as they have been mentioned a number of times, including by my noble friend Lord Mendelsohn, the noble Lord, Lord Clement-Jones, and others. Those countries listed in Clause 4 are those with which the UK has signed agreements that include offering parity of access to the workforce. I have looked back at when those agreements were made: for the EFTA countries of Iceland, Norway and Liechtenstein, the agreement was made in July 2021, and Switzerland was in 2019. I make these points because they certainly precede this Government. In practice, as I have said before, not all these countries will have eligible applicants in any case. The 1975 UK-Malta reciprocal healthcare convention will continue and is not affected by the Bill. I emphasise that that agreement is wholly related to reciprocal access to healthcare, not access to training or employment related to medical training. I hope it is helpful to say that the Bill includes a power to amend the list of countries in Clause 4 to reflect any future international agreements that the UK may enter into. As I have also stated previously, the Government set UK medical school places based on future health system needs. I emphasise that there is no disrespect intended here and we very much value the long-standing partnership with Malta on healthcare, and that will continue to be valued. However, prioritising international graduates would undermine our ability to keep foundation training numbers aligned with the NHS workforce that we are planning for and manage those bottlenecks in specialty training, about which there is concern across the Committee. This is about focusing on patient care and ensuring that those whose education and experience best prepares them to practice safely and effectively in the NHS are the ones who are prioritised. For specialty training, prioritising these individuals would not support our aim to prioritise doctors with significant NHS experience who understand how the health service works and how to meet the needs of the UK population. I reassure the Committee that this Bill will not affect existing fellowship arrangements with Malta, and the affiliation of the UK foundation programme and Malta foundation programme, to which the noble Baroness, Lady Gerada, referred, will still stand. Senior officials in my department have met with the high commissioner of Malta to the United Kingdom to assure him of this and last week I received a positive letter of acknowledgement from the Health Minister in Malta. To be absolutely clear, individuals with a primary medical qualification from Malta will still be able to apply for foundation and specialty training places, and they will be considered for any places that are left after prioritisation. But it would still be the case that it would be at odds with the aim of the Bill for them to be prioritised for these places. For the reasons I have set out, I hope the noble Baroness will feel able to withdraw her amendment.