The NHS: Nationalised or Nationalist?
As one of LUU’s Liberation Coordinators, I had the opportunity to attend the third annual conference organised by CTDC (Centre for Transnational Development and Collaboration) and Kohl: Journal for Bodily and Gender Research, which took place at Birkbeck University of London last week. The conference was titled ‘Decolonising Knowledge around Gender and Sexuality’, and brought together academics, practitioners and students to discuss decolonising discourses in the field. Discussing everything from the decolonisation of feminist pedagogy to the intersections of gender, sexuality and migration, one presentation in particular really stuck out for me: ‘Coloniality in the NHS’.
The NHS, despite being celebrated as a typically ‘British’ service, is staffed by a large numbers of migrant workers. 26% of UK registered doctors were trained outside the UK, the vast majority of them from India and Pakistan, yet migrants have increasingly limited access to NHS healthcare.
At the end of 2016, over 65.6 million people worldwide were forcibly displaced, many originating from war-torn countries such as Syria, Afghanistan, and Somalia. Most of these migrants and refugees were received by countries in the Middle East and Northern Africa, and about 1.2 million arrived in Europe during that period, with the UK receiving 38,517 asylum applications. About half of those seeking asylum in the UK were granted refugee status, giving them the same legal rights to free healthcare as British citizens.
Not all migrants share the same access to healthcare, however. According to a 2009 report from the London School of Economics (LSE), there are as many as 863,000 undocumented migrants in the UK, constituting around 1% of the population. Many of these migrants live in fear that their immigration status will be discovered. Since 2015, NHS service providers must request the immigration status of patients, and so considerations regarding nationality are brought into a healthcare setting that once prided itself on providing treatment without discrimination and regardless of a person’s ability to pay. Not only does requesting medical staff to scrutinise the immigration status of patients make medical encounters more prone to unconscious racial bias or more overt racial discrimination, but it also places new political obligations on medical staff, who become part of the broader government mechanisms of border control.
This is especially detrimental for pregnant migrant women, who due to fear of deportation and the lack of affordable healthcare for migrants, are unlikely to access NHS services when they really need them. It would cost a migrant woman who does not have indefinite leave to remain up to £7000 for standard maternity care. Her only other option is an abortion, which costs a whopping £1353. If she is unable to pay for her maternity care or abortion, and acquires a debt of £500 or more for more than two months, then the Home Office will be contacted about her immigration status.
Not only does this have huge implications for the health of these women, as they are more likely to consider free-birthing or back-street abortions, but it also assumes that migrant women have easy access to contraception to avoid such circumstances, or that the context in which they became pregnant was consensual. Poor birth outcomes are already likely exacerbated by the stress and anxiety experienced during this process. The only hope for these women is a dangerous pregnancy complication in which the NHS will not charge them to give birth.
This hostile environment for immigration, in which the Government aims to crack-down on “health-tourism” in order to free funds for British citizens, is not only racist but a disingenuous consideration. The Department of Health’s research into the cost of providing services to visitors and immigrants in 2013 estimates a total cost of £2 billion per year at the top-end, of which a relatively small amount was returned through various charges. However, this total includes the use of the NHS by nationals of countries with which the UK has a reciprocal agreement. Within this total, ‘health tourism’, where people come to the UK with the express intent of using health services to which they were not entitled, was estimated to be only 0.05% of the annual NHS budget.
We must not forget that the NHS exists at the great expense of other communities. Britain’s colonial past played a strong role in utilising medical workers from the Global South in order to fill a gap in our workforce, and it is this legacy of imperialism to which the UK owes its wealth and makes the NHS possible. While I would argue that socialised healthcare is possible without such a legacy, the NHS we know today is unfortunately predicated on this context.
The National Health Service exists as a symbol of equality and fairness in this country. We should honour this proud tradition by putting the welfare of those in need first.
