Migrants in and out of the National Health Service

Mariri Niino, Lauren Brown and Zehui Qiu

Over the last year many of us have developed a renewed gratitude and appreciation for the UK’s NHS. Though many take the universality of the NHS for granted, it is in fact inaccessible to many people living in the UK. The key is in the name: the National Health Service. For some patients with irregular migration statuses or currently seeking asylum, there are regulations in place restricting free access to healthcare – even for those who work within the NHS. Hospitals have been required to be gatekeepers, forced to carry out immigration checks and impose up-front charges to so-called health tourists, A&E departments included. Yet common sense dictates that during an outbreak of an incredibly infectious disease, it is crucial that everyone can access healthcare.

Migrants’ access to the NHS

Many migrants avoid seeking healthcare due to fears of discriminatory treatment and the existence of language barriers and lack of digital resources to access the NHS. The hostile environment policies set in place since 2012 has only amplified existing barriers, especially during the pandemic – with almost half of all migrants surveyed by the Joint Council for the Welfare of Immigrants being too scared to access healthcare if they became sick. Migrants, especially those with BAME backgrounds have found themselves in uniquely precarious positions – with disproportionate rates of infection and mortality. In April last year, an undocumented immigrant from the Philippines was reported to have died from a coronavirus infection. Although having showed severe symptoms prior to his death, he was reluctant to approach the NHS because he was afraid that the hospitals would report him to immigration authorities or that he would have been charged for a treatment he could not afford.

Though the government may have suspended regulations and costs for COVID-19 treatment, only 20% of migrant respondents were even aware that treatment for coronavirus is exempt from charging. We should remember that these statistics might only be the tip of the iceberg – with many migrants’ precarious positions meaning they are unable, or unaware, of these surveys.

Treatment is only half of the battle too – vaccines are the other. Recently, the British government announced that undocumented migrants could register for a vaccine, without needing to worry about their undeclared migration status. However, higher vaccine hesitancy was found among ethnic minorities. This follows a long historical trend of lower vaccine uptake in black Caribbean and African and South Asian populations even before the pandemic. Again, this goes to show the salience of negative experiences of healthcare and mistrust of government and that proactive outreach would be necessary.

Ironically, it is often those who have contributed the most to the NHS that are finding themselves disadvantaged. Staff from BAME backgrounds are not only more exposed to health risks and harassment during the pandemic period, but also disadvantaged in senior representation and equal opportunities. Though it has reduced year-on-year, BAME staff still have a lower likelihood to access non-mandatory training and continuous professional development (CPD).

Migrants’ contribution to the NHS

A digital exhibition launched in October last year at the Migration Museum, “Heart of the Nation”, tells a riveting story about the contributions of immigrants to the NHS, which have largely been forgotten throughout its long history. Migrants have contributed immensely to the NHS ever since its inception in 1948, as can be seen in this infographic on the ethnicity of NHS staff. Its mission to make healthcare available for all required an unprecedented number of healthcare workers to fill positions. Consequently, in the same year, the British Nationality Act and the arrival of the Empire Windrush prompted the recruitment of medical migrants – mostly from its former colonies.

Even before the establishment of the NHS, the history of the healthcare system in the UK roots itself in the legacy of imperial history. Those who came to work in the NHS had been schooled in medical colleges set up by the British Empire starting in the 1830s. Many immigrants, who had never set foot in the UK, nevertheless grew up being familiar with and trained under the British healthcare system. Even after former colonies’ independence, these legacies have continued.

Following mass recruitment of British Commonwealth migrants to the NHS, negative reports on the risks of imported disease and infection began to circulate in the media and the general public. Politicians and medical professionals discredited immigrant workers by pointing to their perceived lack of language skills and lower standards of training.

Following this, popular media presented discriminatory imageries, further adding to the discrimination and racialization of BAME doctors and nurses. Paradoxically, migrant healthcare workers who provided essential services to the NHS were imagined as a threat to the very system they contributed to.

COVID-19 pandemic has highlighted the inequality between citizens and non-citizens under the NHS. During this particularly challenging time, we should not shy away from discussions on broader issues of social justice and healthcare. It is all the more important to pay attention to equal access to healthcare and inclusivity of migrant nurses and doctors who are working at the frontline of the NHS during this pandemic.