Concerns about the impact a Bill making its way through the House of Lords in the United Kingdom could have on the training and specialisation of Maltese doctors in the UK have been raised in the House of Lords.

The Bill relates to the prioritisation of graduates from medical schools in the United Kingdom and certain other persons for places on medical training programmes. Concerns about the impact on Maltese doctors, as well as students attending the Queen Mary University of London campus in Malta, were raised during a second reading debate in the House of Lords last week.

Some members of the House also referred to a letter sent by Malta's Health Minister, Jo-Etienne Abela, in which he aired his concerns about the proposed legislation and its impact.

Information on the House of Lords Website explains that the proposed Medical Training (Prioritisation) Bill would, for foundation placements, prioritise UK and Ireland medical graduates and graduates from priority list countries. For offers for specialty training posts in 2026, it would prioritise UK and Ireland medical graduates, as well as graduates from priority countries; those who completed foundation training or a relevant earlier stage of training in the UK; and those with certain immigration statuses. For offers and interviews for specialty training posts from 2027 onwards, it would prioritise UK and Ireland medical graduates; graduates from priority countries; those who completed foundation training or a relevant earlier stage of training in the UK; and those with significant NHS experience, to be defined in regulations.

"Priority list countries are Norway, Liechtenstein and Switzerland, due to international agreements which include recognition of professional qualifications and access to professions." Malta is not listed in the priority list.

Speaking in the House of Lords, Parliamentary Under-Secretary of State, Department of Health and Social Care, Baroness Merron, said that the Medical Training (Prioritisation) Bill gives effect to the UK Government's commitment to place UK-trained doctors and other defined priority groups at the front of the queue for medical training posts. "It does so while continuing to allow internationally trained doctors to apply for and contribute to the NHS. Let me emphasise that the Bill is about prioritisation. It is not about excluding people."

She said that she had listened to colleagues expressing concerns regarding the treatment of applicants graduating in Malta. "The UK's long-standing partnership with Malta on healthcare is valued and will continue. Doctors training in Malta will still be able to come to the UK to gain NHS experience to support their training, for example through fellowship schemes. These arrangements are not affected by the Bill. However, as I stated earlier, for recruitment to specialty training places in the UK, the Government assess that it is important to prioritise to ensure a sustainable workforce that meets health needs."

But concerns about the Bills' effect on Malta continued to be raised by members of the House of Lords during the second reading.

Baroness Gerada, who is of Maltese heritage, said that Malta's Health Minister had written a letter to the UK government's health team about the impact the Bill would have on Malta.

She quoted from the Maltese minister's letter: "Whilst acknowledging the supreme interest of 'home-grown' graduates, this development raises serious concerns for this Ministry and the people of Malta. Aside from risking to undermine two centuries of proud tradition and the dissolution of a strong bilateral relationship in healthcare, this strategy puts the training and specialisation of Maltese graduates in jeopardy."

Baroness Gerada highlighted that Malta has a long and historic relationship with the United Kingdom. She said that for nearly 200 years, since the first Maltese doctor received their licence to practise from the Royal College of Surgeons, British and Maltese medicine have grown side by side: "the same language, the same exams and, for many years, the same training programme."

She said that each year around 50 doctors complete their specialty training in the NHS, under a special arrangement under which the Maltese Government covers 70% of their salary, "with a contractual agreement that these doctors return to Malta. It is a so-called finishing school; they come here to do parts of the training that they cannot get in Malta, such as for sickle cell in haematology. It is a win-win. The NHS gets talented, skilled doctors, often working in hard-to-fill non-training grade posts, at very little cost to the UK NHS."

She also mentioned the campus in Malta of the UK-based medical school, Queen Mary University of London (QMUL). "QMUL has delivered an integrated training programme, awarding an MBBS degree that is academically and regulatorily identical to the UK London programme," she said.

The diversity of the campus in Malta mirrors that of the UK, she said.

"Their training is aligned to NHS principles and practice. Nearly 80% of them do part of their training in a UK NHS hospital. Of course they understand the NHS-nearly 70% of these students are British nationals or have indefinite leave to remain in the UK. Deprioritising these doctors risks abandoning a small, committed cohort without a fallback, simply because they choose to fund their own training. This seems unfair."

Earl Howe also mentioned QMUL, saying that the programme it runs is sustained by a long-standing UK-Malta agreement, first established in 2009 and reviewed as recently as 2024. "That agreement sits within a broader context of deep and enduring ties between the two countries' health systems and approaches to medical education. Undermining it risks significant and long-lasting repercussions for the UK-Malta relationship. I understand that the Government of Malta have written to the Secretary of State to raise these concerns-so far, I understand, without a response."

He said that the UK minister had referred to the Maltese concern, "but I believe it is an issue we shall want to pursue in Committee in greater depth. The concern is multifaceted because, in the scheme of things, what the Bill does to Maltese doctors looks completely unnecessary. The numbers involved are tiny. The Maltese example demonstrates that the Bill as drafted risks causing disproportionate harm to well-established international partnerships, seemingly not as a matter of policy intent but as a consequence of legislation being rushed through Parliament."

Lord Clement-Jones was another to mention the QMUL Malta situation.

He referred to a letter a UK minister had sent "which argued that these graduates should not be prioritised because they may lack familiarity with local epidemiology and NHS systems." Lord Clement-Jones said that this does not hold water as these students follow the same NHS-aligned curriculum as Queen Mary students in the UK.

He said that in the Bill, the Government is rightly prioritising graduates from Ireland, but mentioned that it also prioritises graduates from Switzerland, Norway, Iceland and Liechtenstein. "A graduate from Liechtenstein has no UK medical degree, has not sat the UK medical licensing assessment and has no training in UK epidemiology. Yet, under the Bill, they will be prioritised over a Queen Mary in Malta student who holds a UK degree and has been specifically prepared for the NHS. This is a manifest absurdity."

He also says that since 2009, the UK and Malta have operated under a unique mutual recognition agreement regarding the foundation programme itself. "Malta is the only country in the world with this status. By unilaterally demoting these graduates, we are, in effect, tearing up a long-standing agreement with a Commonwealth partner - one that Malta's own Minister for Health describes as having served both countries for over two centuries."

He went on to say that for Queen Mary in Malta, the solution is a minor amendment to Clause 4 to recognise its UK degree, "or the inclusion of Malta in the priority list, honouring our 2009 agreement."