Rt Hon Lord Lilley

    Lord Lilley:

    My Lords, I will focus on Amendments 82 and 93, and particularly their implications for reviewing the need, or otherwise, to recruit nurses and doctors from overseas. I am grateful to the noble Lord, Lord Patel, and the noble Baroness, Lady Jones, for tabling them.

    I suspect, however, that these amendments are based on the common fallacy that the NHS needs to recruit doctors and nurses overseas because supposedly not enough British people want to do these jobs. That is simply untrue. The latest year for which UCAS figures are available is 2019; I apologise to the House for giving out-of-date figures at Second Reading. The most recent figures show that 53,000 young British people applied to train as nurses last year, of whom 20,250 were turned away—that is 43% of applicants, or nearly half of those who applied. UCAS unfortunately does not produce figures on the same basis for those seeking to train as doctors, but it is clear that an even higher proportion of those who apply to medical school are turned away.

    This is a double scandal. First, it means that tens of thousands of young Brits who aspire to serve their country as doctors or nurses are refused that chance and have to pursue less attractive options. Secondly, we have to recruit tens of thousands of doctors and nurses from abroad, mostly from countries that are far poorer, have fewer medical staff per head of population, and can ill afford to train people who then migrate to the United Kingdom.

    This double scandal is compounded by the way this issue is excluded from the national debate. Why do we allow this situation to persist? We allow effectively unlimited numbers of students to study every subject from art history to zoology. The only subjects where places are numerically restricted are medicine, where they are formally restricted, and nursing, where they are de facto restricted.

    I will pass over the political reasons why it may have seemed wise to advocates of mass immigration to invoke the needs of the NHS and nurses and doctors to sanctify their cause. The other reason is nakedly economic: we found it cheaper, in the short term, to employ people trained at the expense of foreign taxpayers, rather than pay to train our own citizens. At the same time, relying on nurses and other health workers from abroad, on whom many other noble Lords have focused, helps to keep wages low. What a paradox it is that many noble Lords who have spoken today and railed against the level of inequality in our country pursue a policy whose prime justification, as they have made clear today, is that it depresses the wages of the lowest-paid people in this country and keeps them below what economists call the domestic market clearing rate—the rate at which we could meet our needs from our own employees.

    I was at first minded to support these amendments, but, on looking more closely, I note that one thing the reports that they call on the Government to produce do not cover is the scope for training more of those aspiring to become nurses and doctors in the UK, so that we can end the plundering of foreign health services. That is a very significant omission and shows that there is a blind spot in this discussion, which I hope we will not perpetuate in future debates.