Written by:
Kathryn Zacharek

The Importance of Re-Writing Migrant Workers Back into the History of the NHS

Read time:
6 minutes

PhD student, Kathryn Zacharek explores the importance of rewriting the role of migrants in the NHS.

When we think about migrants in relation to the NHS, what is the first thing that springs to mind? Unfortunately, preceding and post-Brexit the focus of most mainstream narratives has been framed around the ubiquitous concept of “health tourism”. This refers to the idea that people travel deliberately to the UK to seek free treatment for a pre-existing condition, and as a result, drain precious NHS resources. Furthermore, this is a problem that has been mobilised politically. In 2019, ex- Health Secretary Matt Hancock announced an additional £1 million in funding to expand the team of experts responsible for recovering the costs for treating overseas visitors. The government’s justifications for such actions can be summed up in the often-repeated refrain that the “NHS is a national, not international health service”.  

This is exactly where the problem lies. Since its inception the NHS has always been an international health service, but not in the way we might imagine it. The popular perception of the NHS as a “British” institution is understood in the typically restrictive white sense, rather than inclusive sense. This has a huge impact not only on public perceptions but the organisations overall self–image.  

In the 1950s-60s, nurses from Ireland and the Caribbean were essential to the expansion of NHS services across the country. This pattern was then repeated in the early 2000s with nurses from India, the African continent and the Philippines moving to the UK. Likewise, doctors from South Asia have played an integral part in developing and improving general practice, particularly in the field of psychiatry. With regards to EU migrants, right up until 2016, year on year the percentage of healthcare workers trained abroad then moving to staff local trusts was continuously rising, and by 2019 one in five GPs had gained their qualifications outside of the UK.  

The point I am trying to make here is that ever since the NHS was founded staffing levels have been fundamentally reliant on overseas medical workers. Yet, political and organisational histories pay scant attention to migrants. This, in turn, will soon have disastrous consequences on healthcare as we know it. Since the Brexit referendum, there has been a sharp drop in overseas applications across all healthcare roles. This, along with the staffing crisis in the fallout of the Covid-19 pandemic means that the future of the NHS looks uncertain.  

Worryingly since 2017, the NHS has been utilised to serve a new political project. Under the government, Hostile Environment immigration policies, access to healthcare has become restricted for some people. NHS England has introduced regulations for ID checks for all patients accessing most non-emergency care. This includes, but is not limited, to cancer treatment and paediatricians. Trusts are forced to charge upfront for those who cannot provide documentation proving their eligibility for access to treatment. Naturally, this impacts people of colour and migrant workers the most. Thankfully, there has been resistance to these legislations and readers can help by supporting Docs Not Cops. They are a campaign group consisting of NHS professionals and patients who believe that healthcare is a right and not a privilege; actively fighting against racism and xenophobia becoming a part of daily NHS practices with their Patients Not Passports activism.

In summation, the persistence of racism and discrimination can only be supported by a history that marginalises the role which migrants have played and makes them an easy target to scapegoat as the root cause of societal ills. Thinking back to the idea of “health tourism”, the irony of this argument is that most people who fall under this category are in fact British ‘ex-pats’ who live overseas and return to the UK for their medical needs. Therefore, if we are to have an informed debate about immigration, we need to accept the many ways in which modern Britain has been shaped by the work of migrants. This must be the foundation for any constructive national conversation on the subject.    

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