Britain’s resident doctors have just spent six days on picket lines. On Wednesday, April 22 I will lead a Westminster Hall debate on the Foundation Programme and its role in supporting and retaining our resident doctors. My argument will be a simple one: if we want to reset this Government’s relationship with the profession, we must begin at the foundations.
The Foundation Programme application process is causing consternation. Our young doctors are unhappy – unhappy with a system that does not make them feel valued – and I understand why. From the very beginning of their careers, they are made to feel like numbers on a spreadsheet rather than people.
The Medical Students’ Insight into Foundation Training (MEDSIFT) study, published in the Postgraduate Medical Journal last November, found that 51.6% of students surveyed felt the current “preference-informed allocation” system was unfair; 76.3% said they had lost control of their application; and 46.3% reported a negative effect on their physical or mental health. Most strikingly, close to half were considering a career outside the NHS altogether.
When I began training – a very long time ago now – the system looked quite different. Rather than the randomised ballot of today, which can assign a newly-qualified doctor to a hospital anywhere in the country, medical students spent their first year out of university training in a hospital associated with their medical school. This was an ideal system in many ways. Students knew the hospital, knew the clinical teams, and would recognise among the staff many of their own peers. The arrangement eased the difficult transition from the safety of university to the harsh realities of hospital practice, and gave new doctors the pastoral support of colleagues and friends to fall back on.
Right now, at the most vulnerable point in a young doctor’s career, just as they are thrust into the real world, we treat our new doctors with blind apathy – sending many far from their homes, far from supportive family and friends, far from their familiar environments and routines. The UK Foundation Programme Office’s 2026 figures show 10,810 graduates allocated to foundation schools; and while 82.3% received their first preference, the minority who do not can find themselves packing up their lives for a city in which they know no one. As I put it in the Commons last month, it is a crazy foundation lottery that sends a doctor from Norwich to Belfast and a doctor from Belfast to Norwich.
Recent reform has exemplified the adage of throwing the baby out with the bathwater. Students rightly objected to the old Situational Judgement Test – a stressful national exam of questionable validity, with a documented score gap that disadvantaged candidates from ethnic minority backgrounds. But what they were given in its place was not a fairer assessment; it was a random number generator. Even the Medical Training Review led by Professor Sir Stephen Powis and Professor Sir Chris Whitty last autumn found– after drawing on more than 8,000 submissions, including over 6,000 resident doctors – that postgraduate training is in urgent need of modernisation.
Medicine is one of the most rewarding careers a person can undertake. The NHS was my only employer until I was elected to parliament age 66. It is sometimes described as the nearest thing we have in our increasingly secular country to a national religion. This Labour Government shall continue to fight for it: to ensure free and equitable access to high-quality care, against opposition threats of privatisation in all its different flavours. But if we are to revitalise our NHS and build a truly robust and enduring service, we must begin at the foundations.
My proposal is straightforward: return to a firm-based model in which the first-year placement is arranged by medical schools, with each new doctor placed alongside peers they already know and consultants who have taught them. I do not believe this would be particularly expensive; in fact, I suspect it may cost less than the current centralised system.
We have already passed the Medical Training (Prioritisation) Act to give UK graduates their rightful priority for training places. Wednesday’s debate is an opportunity to take the next step. We owe our young doctors – and the patients who depend on them – no less than the fair, well-supported start they deserve. That would go a very long way towards resetting this Government’s relationship with the profession, and towards ending these damaging rolling strikes.
