Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): I welcome from the Department of Health Mr Phil Rogers, director of workforce policy; Professor Lourda Geoghegan, deputy chief medical officer; and Mr Chris Wilkinson from the workforce policy directorate.

Before I ask you to make some opening remarks, I want to put on record the Committee's disappointment at the delay in laying the legislative consent motion (LCM). It will not give the Committee and, therefore, the Assembly the opportunity to scrutinise the LCM as they should. We are aware that the Scottish and Welsh Committees considered the issue a number of weeks ago, but we were not given that opportunity. I want to put that on record. That is disappointing, as it is important legislation, and we have questions to ask about it. We have a job to do, and the Assembly has a job to do. That requires getting things in a timely fashion, and that has not been the case in this instance. I just want that recorded.

I will hand over to you to make some remarks.

Mr Phil Rodgers (Department of Health): Thank you, Chair. To reflect on what you have just said, I will open by repeating the apology for the lack of time afforded to properly scrutinise the Bill. The Minister has written to the Committee on that. We are conscious of our obligations to provide members with full and timely briefing. We informed the Clerk immediately on receipt of Executive approval of the LCM and the expedited passage of the Bill at Westminster. Royal Assent is expected in early March, so there is limited engagement time in general on it. The LCM, as you know, is due for debate on the Floor of the Assembly on Tuesday.

The Bill introduces a UK-wide duty on all providers of medical training to prioritise applications from medical schools in the UK and Ireland, but it applies to devolved Health and Social Care (HSC) matters, so that necessitates an LCM to extend the provisions of the Bill going through Westminster to Northern Ireland.

The policy aim of the Bill is to ensure that there is an employment pathway for UK and Irish graduates into UK medical training programmes. The Bill aims to implement the UK Government's commitment set out in its 10-year health plan for England to prioritise UK medical graduates for foundation training places and UK medical graduates and other doctors with significant NHS experience for speciality training places.

The Bill also includes provisions to prioritise others in a priority group. That includes graduates of Irish medical schools and of countries with which the UK has agreements regarding recognising professional qualifications and providing no less favourable access to practice. It would be possible to add to the list of countries to take into account any future agreements that will be signed. At the moment, it reflects agreements with the European Free Trade Association (EFTA), so it includes countries such as Norway and Switzerland.

Each UK nation is committed to supporting and developing a sustainable domestic supply of doctors, recognising that medicine is a global profession and that the movement of doctors from the UK to other nations and vice versa is sometimes desirable and, indeed, necessary.

The LCM asks the Assembly to endorse the amendments' extension to Northern Ireland for provisions within its legislative competence. Approving the LCM will ensure UK-wide consistency and will enhance career pathways for UK and Irish graduates, protect UK-wide recruitment practices and ensure that medical foundation training places are sufficient for the output of all local higher education institutions. Without it, Northern Ireland would face increased competition for training places from international applicants and would probably have to withdraw from national recruitment. Most training places and training programmes are recruited on a UK-wide basis. That would place a significant administrative and financial burden on the NI Medical and Dental Training Agency (NIMDTA).

International staff will, of course, always play an important role in Health and Social Care. We recruit doctors from abroad when there is already a substantial pool of eligible applicants who have trained in the UK or are already employed in the NHS or HSC. Those doctors are more likely to work in HSC for longer and be better equipped to deliver healthcare that is tailored to Northern Ireland's population because they better understand local UK/Irish epidemiology.

The Bill will ensure a sustainable medical workforce that can meet the health needs of the population and will mean that we are less reliant on an unpredictable global labour market and can make best use of the substantial taxpayer investment that goes into medical training. It will also reduce competition for places and give home-grown talent a path to become the next generation of NHS or HSC doctors. Internationally trained doctors will continue to make a contribution to the health service. The Bill aims to prioritise internationally trained doctors who have significant NHS experience for training posts in the future, so we are excluding no one from applying for training positions.

As I say, if we do not make the legislation, the number of applicants will continue to grow and the current bottlenecks in speciality training for UK and Irish graduates will worsen. To prevent that escalation and ensure that the changes take effect for the current application round for posts starting in 2026, the UK Government have asked Parliament to expedite the progress of the Bill, with the aim of achieving Royal Assent by 5 March.

We are happy to take questions.

The Chairperson (Mr McGuigan): OK. It is a prioritisation Bill. Your paper states that, in some cases, the number of applicants is twice the number of places for particular courses across the water. How are applicants prioritised at the minute? The Bill will prioritise them on the basis of their passport, but how are they prioritised at the minute?

Mr Chris Wilkinson (Department of Health): It is simply by application.

The Chairperson (Mr McGuigan): The best people get it.

Mr Rodgers: At this moment in time, yes. It is qualitative rather than being based on demographics.

The Chairperson (Mr McGuigan): So, under the legislation, will the quality of applicants reduce?

Mr Rodgers: The quality standards will still apply. We will still expect to appoint the best graduates from the eligible pools. We are not saying that those in the prioritised pool will fill every vacancy. That is why international medical graduates (IMGs) are still welcome to apply. If there are vacancies after those in the priority pools have been considered, those vacancies will be filled through the IMG route.

The Chairperson (Mr McGuigan): OK. Our health service in the North relies heavily on people from outside these islands. In what way did the Department here shape the Bill? Did it shape it? Were aspects of the Bill shaped in such a way as to suit our scenario in the North?

Mr Rodgers: Chris will pick up on some of the detail. We had significant engagement with colleagues in the Department of Health and Social Care (DHSC) and with the other devolved Administrations on shaping the objectives and content of the Bill.

Mr Wilkinson: During the conversations, we were keen to point out the Northern Ireland-specific needs, in that we have our section 75 obligations and we want free movement across the border for employment. We were also keen to get Republic of Ireland graduates included in the priority groups.

We see the Bill as an opportunity to look not just at the posts that are regularly filled but the harder-to-fill posts. There is an opportunity here to look at applications from international medical graduates or even at those in our priority pools in order to fill harder-to-fill posts. If our graduates look at their most favoured post and a harder-to-fill post for their second preference, they are more or less guaranteed to get a training post where they want it.

The Chairperson (Mr McGuigan): OK. You have answered one of my questions about section 75 compliance, so that is good. My question was not about cross-border graduates; it was more about the international medical workforce coming here.

I have two more questions. What engagement has the Department had with stakeholders here? Every week, we meet some section of the health service that tells us that there is a workforce problem. Will the Bill help our current workforce problem. If so, how?

Mr Rodgers: Do you want to talk about the engagement piece?

Mr Wilkinson: Certainly. That work was set out in September or October of last year. At that stage, it was envisaged that a public consultation would be taken forward on a UK-wide basis. That changed in late November when the focus became taking it through as emergency legislation, partly, we understand, in response to British Medical Association (BMA) concerns about how UK and Republic of Ireland graduates were being frozen out of speciality training because of the volume of international medical applicants. That took away from our ability to engage proactively with key stakeholders here or across the UK. There was some discussion with the BMA. We had limited discussion with the General Medical Council (GMC) on aspects of the Bill and how they will apply. We do not anticipate that we will cut off international medical recruitment at all. We are still saying that there will be opportunities; it is just that the opportunities will be different.

The Chairperson (Mr McGuigan): OK. How will it help our workforce?

Mr Rodgers: That is the point. We do not see the Bill as cutting off opportunities for international medical graduates. As you outlined, the pool of international medical graduates who work in HSC play a vital role. What the Bill does is give priority to UK and Irish graduates and, as Chris said, alternative opportunities for international graduates, such as the locally employed registrar route that a lot of trusts now undertake rather than directly through the NIMDTA training pathways. We hope that it will have a positive impact on the number of graduates that we employ. The Bill will give priority to local graduates in the NIMDTA training pathways.

Professor Lourda Geoghegan (Department of Health): To conclude on that piece, future provisions of the Bill will also take account of doctors who have significant NHS/HSC experience, even if they did not graduate in the UK or Ireland. The specifics of those provisions are yet to be worked through. However, what you may see in a number of years is some locally employed doctors with attractive amounts of time — two, three or four years — being supported to get the relevant NHS/HSC experience so that they become eligible for a priority pool. We could work with our locally employed doctors to make them attractive in order to prepare for prioritisation.

The Chairperson (Mr McGuigan): I totally understand the premise of the Bill. However, we rely heavily on international doctors, and I am concerned that the Bill may have a negative impact in that scenario while trying to do something positive in another scenario.

Professor Geoghegan: There is a commitment from all Administrations to monitor and watch closely what happens once the Bill becomes law. It will probably take a couple of years to get a sense of what is going on. There is a commitment to be careful in monitoring what happens. The important thing is that we continue to engage all the time with our international medical graduates, because they are hugely important, to make sure that they understand that this is not about their relative lack of importance.

The Chairperson (Mr McGuigan): Fair enough.

Mr McGrath: This is probably an academic conversation, because, if we did not bring in the legislation and everywhere else did, we would end up being the back door that everybody comes through, and that would create problems down the line. We are almost hamstrung into approving it, because everywhere else is approving it.

We talk about those who graduate from a UK or Irish university. If 50% of the people offered places at Queen's are from overseas, they will be eligible to apply and get priority for those posts. Therefore, it is not about priority for locally based people who apply and go to university; it is just about whoever goes to those universities. The spirit of it is about employing local people so that they do not have to go overseas to get employment. The idea is to create employment here for people from here who want to be medics. Does that not put an onus on the university to cap the number of people from overseas on their courses? Otherwise it is an even further academic exercise.

Mr Rodgers: It would be, but it is important to recognise that the GMC is putting significant controls on the number of international students in any university.

Mr McGrath: What is that cap, roughly?

Mr Wilkinson: Currently, in Queen's, we allow an intake of 20 per year.

Mr McGrath: Out of?

Mr Wilkinson: That is out of 242 home students. "Home" is the UK or the Republic of Ireland. We allow 20 places for international students.

Mr McGrath: So, if there are 220 places and 20 places for overseas students, 200 local people will be eligible to go on to foundation training. They will get priority over people who trained in China, America or South America who come over and want to use our foundation training.

Mr Rodgers: For UU, there are seven places out of 77. It is about 10%.

Professor Geoghegan: You raise an important point, which is not, strictly speaking, what the Bill is about, but it is about widening participation.

We have two medical schools that run very different programmes and whose student intake is different. With the postgraduate course in the University of Ulster, it is about seeing now, as the years progress and we are turning out graduates, what that means for our local service because it is a postgraduate course. Quite a lot of the postgraduate medical courses are about attracting local people to create for the local service.

We are having a lot of conversations with Queen's about diversification and widening participation so that we can make the medical intake more representative of the communities in which the university is located. The university is keen to do something further in that regard.

Mr McGrath: I am a bit surprised that it is not part of the criteria already. Do we have figures for graduates from the UK and Ireland who apply for courses and get turned down but somebody from overseas applies and gets the training? It is taxpayers' money that is paying for people from overseas to come to train. Do we keep a record of how many of them at the end of their training go back to where they are from? Is a pathway kept?

There is also the suggestion that we train lots of local people who then go to Australia to practise. Some people have concerns that we are, in effect, funding training for the Australian medical service, which is an easy remark to make but is not the truth. However, the principle is there.

Mr Rodgers: I am not sure whether we have any figures.

Mr Wilkinson: We have some. For the UK foundation programme applications for 2026, there were almost 300 applications from overseas campuses, of whom 152 were UK nationals.

In the overall application process, that is not an insignificant number. You are right that it is difficult for us to track a different career pathway. We have to ask the GMC at different points who is registered with it and where their primary medical qualification came from. It is even more difficult to track if they drop off where they have gone to.

Mr McGrath: This legislation might help to introduce some of that.

Professor Geoghegan: There is no system to track over the long term longitudinally, but that question has been asked in other forums. It is probably likely that research will be done. You can tell for various cohorts. You can tell that, five years ago, X graduated and now we have X in the system. However, there is nothing following people around so that you get a real sense of when people drop off and when they come back. It is probably likely that some national work will be done on a longitudinal basis to answer some of those questions.

Mr Donnelly: My question is similar to what Colin was asking and the Chair mentioned. You mentioned harder-to-fill posts: what are those posts?

Mr Wilkinson: Some specialties are less attractive to the doctors of the future than others. Currently, we have problems in general practice and psychiatry.

Professor Geoghegan: It can be for a range of reasons. It can reflect location, geography, length of training programme, rotas that are run, services that are well established or services that are new. A lot of factors will influence whether a training programme or post is attractive.

The changing nature of the graduates also has an influence. Many of our younger cohorts do not necessarily want a post that requires a seven-days-a-week commitment; they may want fewer than five days or something tech-enabled. Lots of factors influence whether a training programme is attractive.

Mr Donnelly: Building on what the Chair said, could the specialities where there are already issues become even less likely to be filled from overseas applications? If there are only those applications, will they be, in effect, directed towards those specialities?

Professor Geoghegan: If anything, it will probably increase. If a cohort applies from the UK and Ireland, goes into a priority pool and meets the quality criteria, they will go into posts. You could have a cohort from overseas, for want of better terminology, who know that, if they do two or three years or however the significant HSC experience is described, they will be eligible to go into the priority pool. That could make those doctors interested in coming to any post. It could make the posts that are now considered less attractive more attractive to those doctors, because it would give them a way to get experience.

Mr Rodgers: As Lourda said, we will continue to monitor that and keep it under review. It will be interesting to see what happens. It will take two or three years to play out.

Mr Donnelly: OK. Thank you.

Mrs Dodds: One of the issues that have been brought to me this year in particular, more than any other year, is that of young medical graduates who cannot get jobs in Northern Ireland because their access to speciality training is being taken up by overseas graduates — so they say. Is there any data on the number of local graduates who wish for a job but cannot get one? Is there anything that can help us with that?

Professor Geoghegan: That is part of the very scenario that the Bill is to address.

Mrs Dodds: What is the data? I do not think that the issue has been raised with me before, but, this year, a number of young people contacted me who were graduating but could not get posts — are they F1 posts? — to start their training.

Mr Rodgers: I am just looking for the numbers here, sorry.

Mrs Dodds: I am happy for you to write to the Committee with them, because we are pushed for time.

Mr Rodgers: In 2024, there were 65 international medical graduates on the GP programme and 252 on the specialist programme, which means higher speciality training. I am not sure that that answers your question, though. That is how many international medical graduates we had in 2024.

Mrs Dodds: Vis-à-vis people who have trained in the UK or Ireland.

Mr Rodgers: Overall, we have about 8,000 — no, that cannot be right; sorry. That is UK-wide. We will write to you. Finding a figure in a table can be a bit tricky sometimes.

Mr McGrath: We would love to have 8,000 training places.

The Chairperson (Mr McGuigan): We do not want to put you under pressure. We will get that question answered via a letter. Thank you very much.

Professor Geoghegan: Apologies again for the timeline.

Mr Rodgers: Yes, apologies for the timeline.

The Chairperson (Mr McGuigan): No bother.