Contribution
I welcome the Government bringing forward this legislation, and not just in response to the significant concerns that doctors currently have about access to training places, but as an important part of a reset, with a longer-term approach, to ensure that we have an NHS workforce that is fit for the future.
I am going to go off script and respond to some comments that the shadow Secretary of State, the right hon. Member for Daventry (Stuart Andrew), made. He rightly pointed out that the Bill is about prioritisation, not immediate capacity. However, in week one or two of NHS manager school, one of the core techniques that is taught is about capacity and demand modelling. A fundamental assumption about the capacity of our workforce going forward is retention—how long they will work over the course of their careers. The GMC is absolutely clear that an international medical graduate will, on average, work for a shorter period of time in the UK than a UK medical graduate—they are more likely to leave.
I suggest that it is entirely sensible that the Government are bringing in the legislation now, in advance of their NHS workforce planning, because the Bill fixes a core assumption of that plan. To give an example, I have managed cancer waiting lists and, knowing that I have a list of patients I am responsible for, feared that the lower gastrointestinal oncologist who is getting on will announce their retirement without a clear succession plan, as lower GI oncologists are in short supply. This Bill is not just the right thing to do but provides the absolute clarity around medical capacity that will allow the Government to do the proper demand work that is necessary to build the NHS of the future.
Turning to the immediate situation, I have heard the views clearly expressed by medical graduates in Sunderland and across the country about the bottlenecks they face when trying to secure foundation and specialty training places. Many are left in prolonged periods of uncertainty, unable to progress despite years of study.
When we talk about trainees, we risk giving the impression that the contribution made by these talented young people will all be in the future, but of course, in reality, people in training positions provide a huge contribution of direct service to the NHS today, forming the core of the medical workforce in hospitals up and down the country. When I was an NHS operational manager, I had to get to know the new rotation of core, foundation and specialty training doctors every time as they rotated around. Meeting those inspiring and motivated young people was not just a lovely thing to do but a hugely important one, as the day-to-day care of the patients in the specialties I was responsible for was largely provided by the people on those training courses.
That experience also highlighted to me how, over a decade under the previous Government, there was a total failure to put in place a proper care framework for those foundation and specialty doctors, which left UK-trained doctors competing in increasingly crowded pools. We have heard some of the numbers already from the Secretary of State: in 2025, there were more than 30,000 doctors competing for just 9,500 training posts. That is not a system that shows proper regard for the commitment of medical graduates or for their wellbeing, let alone a system that is designed to meet the future needs of the country or the NHS. We invest hundreds of thousands of pounds training each medical student, but too often we fail to retain them. That represents a loss not only of talent, but of public investment.
However, I think it is important, as others have done, to put on the record our recognition of the enormous benefit brought by medical professionals who have chosen to come to the United Kingdom and dedicate their careers to the NHS. I know that will continue even after this legislation is passed. As I always say, healthcare is a team sport, and in my experience, when a team is working together under significant operational pressure, the commitment of everyone in going the extra mile, no matter which country they trained in and what nationality they are, is always exemplary. That is the case throughout the NHS that I know.
The contribution of international medical and wider clinical staff to our NHS is invaluable, and it must never be diminished or forgotten. I know that will continue. It is important, therefore, that the discussion of the Bill is not interpreted as a slight on their contribution or commitment.
In aggregate, as I have said, the GMC has been clear that while international graduates are essential to the functioning of our health services, they are statistically more likely to leave the UK workforce within six years of joining compared with those who train here. That reality makes clear the risk of overreliance on a system that is unpredictable and, ultimately, unsustainable. This Bill is about balance, not exclusion; it is about ensuring that the significant public investment we are making in training doctors in this country translates into a stable and sustainable workforce for the years ahead.