How NHS staff are fighting back against the ‘hostile environment’
With typical hyperbole and disregard for accuracy, the Daily Mail published a headline earlier this month claiming that MPs had ‘caved in’ to ‘left-wing doctors and scrap[ped] plans to stop ‘health tourists’ coming to Britain for treatment they're not entitled to’. Making no reference to the well documented harm caused by the policy, the piece focused instead on the alleged cost of so called ‘health tourists’ to the NHS, repeating a favourite refrain of a Government and media adept at directing the anger at enforced austerity towards migrants.
No mention either of Elfreda Spencer, Nasar Khan, Albert Thompson, Kelemua Mulat, Esayas Welday, Pauline Pennant, Beatrice, Saloum, Bhavani Espathi, and countless others who have died after being denied care or made destitute after receiving huge medical bills. Meanwhile the ‘left-wing doctors’ the Daily Mail reviles are in fact supported by the Academy of Medical Royal Colleges, who recently called for the policy to be scrapped. This follows evidence from the British Medical Association, the Equality and Human Rights Commission and Doctors of the World that demonstrate the harm these policies are causing, and calling into question the shaky economic rationale behind the policy.
Despite the claims made by the Daily Mail, the policy of charging migrants for NHS care has not been reversed. The article mentions the pausing of a pilot scheme run in 18 Trusts that required people to bring 2 forms of ID to their outpatient appointment. No evaluation of these pilots is available, though we know through freedom of information requests that of 8900 people checked only 50 were found to be eligible for charging. This method of ID checking is only one part of the Hostile Environment’s byzantine system of ID checks, pre attendance forms, and data sharing; an entire infrastructure of immigration enforcement that threatens the lives of migrants and the foundational principles of the NHS.
Charging Migrants in the NHS
Behind the ID checks and upfront charging sit dedicated teams of overseas visitor managers whose job it is to find and charge patients. The majority of those bearing the brunt of the policy are not so-called ‘health tourists’ but undocumented migrants, refused asylum seekers, and others caught up in the UK’s dysfunctional and discriminatory immigration system.
These are the people who are least likely to be able to pay and the most likely to be in insecure or low paid work. So instead of recovering costs, the policy in reality results in NHS Trusts selling patient debt to bailiffs who go on to harass people who cannot pay, causing considerable distress to destitute families. Others find themselves trapped outside of the NHS altogether, either too afraid to seek care when they need it, or denied treatment because they can not afford to pay upfront.
The Hostile Environment also precipitates a culture shift within the NHS, forcing staff to be complicit in policing and excluding patients and institutionalising racism until it becomes a normalised part of the daily routine. Entitlement, not need, is increasingly becoming the first thing people consider when someone seeks care; chip and pin machines are now a common sight on wards, and doctors are under pressure to consign their patients to untreated pain and even death if they don’t have the right documentation. Take the case of Salom, an anti-FGM campaigner who had been living undocumented in the UK for over 10 years. Salom was found to have 2 brain tumors and lung cancer after collapsing in the street, however he was denied treatment because he had not been able to regularise his residency in the UK. Even in the days leading up to his death he remained terrified he would be asked to leave the hospital because he could not pay.
Ominously, these policies continue to lay the groundwork for increasing privatisation of the NHS, legitimising the denial of care on the basis of arbitrary status and personal wealth.
But the Daily Mail is right about one thing – a nationwide campaign is now mobilising against these cruel policies. Under the banner of ‘Patients not Passports’, a broad and growing coalition of healthcare workers, trade unions, faith institutions, anti-austerity campaigns, migrant groups and racial justice organisations are uniting to stand up for migrants and the principle of equal treatment in the NHS. More than 400 of them met at the end of April to launch the campaign in London, reflecting the strong views of thousands of others now organising around the country.
Resisting the Hostile Environment
Every day, in wards up and down the country, doctors, nurses and administrative staff are asked to make impossible decisions about whether or not to treat ill patients. Those refusing to comply have been threatened by their Trusts, accused of ‘fraud’ and ‘bringing the Trust into disrepute’.
It is in the NHS – the country’s biggest employer – that the political values of the far right are being enacted in practical terms, finding their way into the most basic clinical decisions healthcare workers are asked to make. This is supported by an entire propaganda infrastructure, with official Government statements, posters in hospitals and staff training all reinforcing racial stereotypes (and also criminalising difference through other programmes, like PREVENT).
Given the harm to patients, the threat to the NHS, and the use of austerity to progress far right policies, what can we do – as healthcare workers, as communities, and as patients – to fight back against the the racist Hostile Environment?
The success of such a campaign will depend on mobilising everybody, from the management of NHS Trusts to patient engagement groups, from the staff working on the front line to the Royal Colleges that represent them, to engage with and advance opposition to these policies. We must force these institutions to break their silence. Those that work in the sector must be supported to challenge these policies in the ways that are possible for them in their workplace.
The hostile environment policy takes aim at one of the few institutions representing progressive political ideals, and is a direct attack on the equality and class solidarity the NHS embodies. This is why this fight is so pivotal in the struggle against institutional racism and the far right in Britain today – and the work of resisting these policies must include everybody.
Migrants Organise, Medact, and Docs Not Cops have been supporting groups to put these principles into action, and there are now growing campaigns in Liverpool, Bristol, Birmingham, Brighton, Cambridge, Glasgow, Swansea, and in four London Trusts. In Barts Health Trust in east London, healthcare workers have been collaborating with campaigners from Keep Our NHS Public and North East London Save Our NHS who have been pushing the Trust to stop charging patients. This has led to a picket at the Trusts AGM, a march from East London Mosque to deliver the community’s demands to the Trust Executive, and an inspiring meeting of healthcare workers sharing their experiences of being forced to charge patients under these regulations.
In Liverpool, hundreds of people have signed an open statement demanding their Trust stand up for the rights of patients and call on the Government to stop charging for NHS care. In Birmingham campaigns are building a powerful coalition of healthcare workers, community campaigners, faith groups, and people affected by charging, a campaign that emerged from the tragic death of community member Nasar Ullah Khan. Campaigners working in Homerton Trust in east London have been using the Local Council’s Health Scrutiny Board to pressure the Trust to stop using threatening pre-attendance forms that demand patients provide ID and consent to their data being given to the Home Office.
These campaigns are growing rapidly, now supported by the Patients Not Passports toolkit that contains the basic principles for how to advocate for patients, and how to create a vibrant, dynamic movement against the Hostile Environment in the NHS. The toolkit is accompanied by Medact’s briefing on charging – Patients Not Passports: Challenging healthcare charging in the NHS. It explains where NHS charging came from, deconstructs the racialised myths the Government have used to justify it, and provides a comprehensive evidence base to support opposition to the policy.
The campaign is open to all, and all will be needed in order to succeed. Here are some ways you can get involved.
1) Organise – people across the country are organising locally to call on Trusts to resist the charges. We can support you step by step to start a campaign where you are. For more information email JamesSkinner@medact.org or DocsNotCops@gmail.com. There might already be a campaign where you are, see below!
2) Share the Toolkit and the Briefing – These tools are made for everyone, help us get them out there by sharing them with your friends, colleagues, and on social media using #PatientsNotPassports
3) Stay in touch
● Email Docs Not Cops to join their mailing list
● Sign up to Medact’s Patients Not Passports mailing list to get updates about the campaigns happening around the country.
● Contact Migrants Organise – email Akram on firstname.lastname@example.org
● Follow @MigrantsOrg @Medact & @DocsNotCops on Twitter to stay in touch.