The NHS and dog whistle politics

This article was first published by Open Democracy

The new Immigration Bill introduces hefty charges for migrants to use the NHS. It is a costly, wrong-headed insult to the migrants on whom the NHS has always relied.

My father was an immigrant. He came to London at the age of 10 from Bombay in 1927. Having trained as a doctor at Barts in the years running up to the Second World War, when war broke out, he joined the Royal Army Medical Corps. In the immediate post war years, he campaigned for Nye Bevan, helping win the argument amongst GPs that we should set up an NHS, and that it should be free for all. He spent the rest of his working life as a GP in Plumstead giving back what he had been given by this country.But if he had arrived today, if the current Immigration Bill goes through, he would have no entitlement to use the NHS he was going to spent his whole life serving.
Dr Roointon Boomla
Dr Roointon Boomla
Home Office ministers Theresa May and Mark Harper are responding to UKIP’s dog whistle. They talk tendentiously of the UK having “a national health service, not an international health service”. They propose charges of between £200 and £400 a year for all migrant workers, right up until they achieve permanent residence status in the UK. This takes at least five years. Ministers create the spectre of health and benefit tourists, illegal immigrants and spongers, to justify an attack on migrants. Mark Harper writes he will “clamp down on those from overseas who try to abuse our public services”.What is the cost of this abuse of the NHS, this problem that the new Immigration Bill is meant to solve? Last year the NHS says it spent £33 million treating foreign nationals. This is 0.03%, three hundredths of one percent, of the total NHS budget of £110 billion. To put it another way, just two hours of the annual NHS spending per year. This £33m compares with the £16.3 billion migrants and visitors contribute to the UK economy.Migrants form a large proportion of those working in health and social care. Many work at little above the minimum wage. These are the people Theresa May wishes to charge because she feels they do not already contribute to our country. And at the top end of the wage spectrum, one in three hospital consultants was trained overseas. We have a government that is parasitic on medical school training in countries much poorer than ours, but rather than say we are indebted to India, Pakistan, Nigeria and Egypt, it proposing a double robbery by introducing these charges.The harm is not simply financial. Charges will deter people from seeking treatment. If only those with their papers in order and who have paid their annual fees can register with the NHS, there will be a pool of the impoverished who dare not seek medical treatment when they are ill. This will undo years of work getting marginalised people to come forward for HIV testing. As a GP myself I know that stopping people coming to see me for routine care of their asthma will only result in those same people presenting in crisis and at greater expense in A&E. As Diane Abbott correctly points out, stigmatising foreigners accessing the NHS creates a public health risk. What price xenophobia?

But also we need to think how this will be enforced. To ensure visitors to the UK have paid their health tax, GPs will be forced to check ID and immigration status on all those who register on their lists.

Nye Bevan, the architect of the NHS, considered these issues. He named those who called for charges for foreign visitors “ill informed” or “deliberately mischievous”.

“How do we distinguish a visitor from a British citizen?” he wrote. “Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats, both must be classified. What began as an attempt to keep the Health Service for ourselves would become a nuisance to everybody.”

It is GPs who are likely to carry the burden of this policing. And I am certainly not prepared for my surgery staff to become the enforcement agency of the Home Office. For this to work, it is clear there would need to be a link up between NHS computer systems and those of the Home Office. This is sure to undermine confidence in the confidentiality of computerised patient records.

My father is now 96. He worked for the Royal Army Medical Corp and then the NHS from his early 20s till the age of 70. What right does immigration minister Mark Harper have to say those following in his footsteps do not contribute enough and are out to “abuse our public services”?

As Nye Bevan concluded on the same issue:

“The whole agitation has a nasty taste. Instead of rejoicing at the opportunity to practice a civilized principle, Conservatives have tried to exploit the most disreputable emotions in this among many other attempts to discredit socialized medicine.”