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Last week, Reform UK’s new MP Suela Braverman and party chair Zia Yusuf claimed high levels of immigration were putting unsustainable pressure on GP services and patients in the UK were struggling to get appointments. This follows new data released by the Center for Immigration Management, which suggests 752,000 migrants joined the GP register last year.
The Center for Migration Management, a think tank focused on reducing immigration in the UK, bases its claim on the Flag-4 GP register. This is a category that counts people whose previous address was outside the UK for more than three months, and is a group that includes returnees and new arrivals from the UK. While 752,000 Flag 4 registrations may seem large, it represents just over one in 10 of the approximately 6.5 million new GP registrations last year, a proportion that falls well short of the “unquenchable demand” envisaged by the reforms. The party continues to blame immigration for pressures on access to GPs, but it overlooks a central fact about the NHS workforce. More than 40% of doctors currently licensed to practice in the UK qualified overseas, and foreign graduates now make up the majority of new entrants to the medical register. A system that reformers claim is overwhelmed by immigrants is in fact largely supported by immigrants. However, rhetoric linking the GP shortage only to immigrant patients is becoming increasingly common.
These claims are echoed across Britain’s broader far right. Tommy Robinson, an anti-Muslim activist and former leader of the British Defense League, has repeatedly claimed that the NHS is “overwhelmed by the rest of the world” and has argued that healthcare is another border to protect. In this story, the NHS becomes the last national institution under siege by migrants. But the NHS is embedded in Britain’s self-consciousness. Designed to serve people from cradle to grave, almost every citizen relies on it at some point in their life, and despite current strains, emotional attachment to it remains strong. But unlike other parts of British life that politicians routinely blame for reshaping immigration, the NHS has always been linked to immigration, but not for the reasons currently being put forward.
The NHS was founded on an immigrant workforce, but no politician since its introduction has been able to fully appreciate this. In 1948, coinciding with the creation of the Medical Service, an exodus of British doctors began, with many leaving for countries such as the United States, Canada, and Australia, and Britain increasingly turning to its former colonies for a continued supply of labor. By 1971, around 31 per cent of NHS doctors in the UK were born and qualified overseas. Even Enoch Powell, widely known as the chief architect of Britain’s modern anti-immigration movement, called for and supported the recruitment of doctors from overseas when he was Minister of Health in the early 1960s. In a House of Lords debate in 1961, Lord Cohen of Birkenhead said that without young doctors from India and Pakistan, “the health service would have collapsed”. This completely ignores the influence of the Windrush generation and Irish immigrants who formed an important part of Britain’s post-war nursing workforce. This cognitive dissonance has been evident in recent governments as well. Take Priti Patel, former home secretary under Boris Johnson’s Conservative government, for example. He introduced health and care visas and oversaw a significant increase in the recruitment of overseas health workers during and after the pandemic to address labor shortages, while imposing some of the toughest immigration conditions in decades. Britain knows that its health service cannot function without immigrants, but it did not.
This is not a new argument. In the 2010s, successive Conservative governments oversaw years of austerity and historically low health service funding growth, while blaming immigration for the country’s woes. The NHS Immigration Surcharge was introduced in 2015 as the Immigration Health Surcharge, and migrants moving to the UK are forced to pay extra costs to access the NHS, despite paying for it through income tax and National Insurance. Currently, the surcharge is £1,035 ($1,405) per adult per year, which can easily add up to a fairly high expense for families moving to the UK. Immigrants therefore pay more to access the National Health Service. So why does Britain keep criticizing the stagnation of military services?
Redirection tactics are easier to use than dealing with the complexities of fixing the NHS. The service is so fragmented that it’s nearly impossible to determine where responsibility lies internally, or where to start when it comes to solving the many problems that lead to lower latency. But it’s easy to blame immigrants. It’s also specific. Images of A&E departments full of brown and black patients waiting to be seen regularly circulate on social media, with racist captions accusing them of being “foreigners” – even though they could very well be British nationals. None of these posts in any way consider that nearly half of the doctors currently practicing in the UK are qualified overseas. Rather, visible ethnic differences are enough to convince them that immigration is the cause of the NHS’s shortcomings. When politicians jump on this sentiment, the truth becomes irrelevant.
For example, the reform proposals do not take into account research from Oxford University’s Blavatnik School of Government that found that NHS waiting times are no longer longer in areas with high immigrant populations, and in some cases they may even be slightly shorter. Immigrants are often young and healthy and are therefore less likely to use GP services than the UK’s aging population. But explaining that to the British public is harder than adding it to the ever-growing list of blaming immigrants.
British politics is boiled down to two recurring debates: fixing the NHS and immigration. Immigration sparks heated debate, just as the NHS stirs the emotions of British politics. Combining the two creates a political firestorm that reformers believe will lead to electoral victory. This is a tactic used previously when the now infamous Vote Leave bus claimed the NHS would receive funds sent to the EU and would help the Vote Leave campaign win the Brexit referendum. It wins over voters, even if the numbers don’t stand up to scrutiny.
This is why Health Secretary Wes Streeting has introduced emergency legislation to prioritize British doctors in training posts over overseas doctors in a bid to “bring back our homegrown talent”, and why the Labor government has proposed tightening the social care worker visa route. The UK still faces a shortage of doctors, nurses and social care workers, but recent years have evidenced a notable shift in ideology. There is no longer a debate about the ‘good immigrants’ we need for the NHS. The policy is to block all immigration for short-term political gain. Perhaps when Britain frees itself from the idea that it is competing with immigrants for care, it will realize that immigration is care.
The views expressed in this article are the author’s own and do not necessarily reflect the editorial stance of Al Jazeera.
