Race Matters

Nuturing the Nation – the Asian contribution of the NHS

Migration to the UK is an enduring and contentious political issue. Within the public sector, and particularly the NHS, the relationship between the health sector and Asian minority ethnic groups is more complex and historical than widely assumed. The recent debate surrounding the poor examination results of international medical graduates and UK born BME students sitting the MRCGP highlights that there continue to be issues to address.

Asian workers are and have historically been an essential part of the NHS and Nurturing the Nation is a book, which celebrates the many social, legislative, and employment related obstacles they have overcome to have been able to form such an integral part of the NHS. The book is based on interviews with 40 NHS workers ranging in ages from 43 – 88 who  left their homes and families in countries including India, Pakistan, Kenya, Uganda, Malaysia, Singapore, Trinidad and Mauritius to travel to the UK.  

In 1963, Britain publicised a call for overseas trained doctors to work within the then expanding UK health service and 18,000 doctors from Pakistan and India responded.  By 1971 over 30% of doctors working in the NHS in England had been recruited from abroad.  Current figures suggest that 7% of the NHS workforce describe themselves as Asian, or Asian British and 17% of all clinicians are from a minority ethnic background.

Nurturing the Nation celebrates their contribution while also noting the racism which affected not only their abilities to access suitable employment or progress in their careers, but also the ease of finding the most basic necessities such as housing.

Although initially welcomed in the 1960s Asian NHS workers were not spread evenly across the workforce and many began to experience numerous employment difficulties.  For example, between 1961 and 1975 Asian doctors were berated by their White British counterparts in letters published in the British Medical Journal about the problems patients had understanding their accents.  And while Asian doctors began to find work very easily in the specialties of genito-urinary and geriatric medicine, and also as GPs in the more deprived areas within the UK, this was precisely because British born doctors rejected these vacancies considering them undesirable.  Some Asian doctors reported finding it difficult to pass medical examinations in the UK, and the numbers who have found themselves in front of Fitness to Practice panels has been disproportionate to their numbers in the workforce.

The migration journeys of those seeking work within the UK health service were further hampered by legislative attempts to control immigration throughout the 1960s and 1970s and restrictions, introduced in 1972, to the ability of those born in India to gain full registration as doctors.

Our interviewees however have each in their own way overcome the challenges that working in a foreign country can bring and have achieved highly – many have been awarded with OBEs and MBEs, have been founding members of key organisations or have gone on to hold highly regarded posts either locally or within the Department of Health, the BMA and GMC.

It is testament to all of those we spoke to, that even for those who have retired, they remain committed in their pursuit of helping others and that for many, having seen other world health systems, believe that the NHS is one of the best, and wish it to remain so.

Read Nurturing the Nation here.

This article first appeared in the Health Service Journal.
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