Winston Howard (not his real name) is in his early 70s and has lived in the UK since the age of two when his parents came over from Jamaica. He worked throughout his time in this country, initially as a caretaker.
Later in life he retrained and became a primary school teacher for 25 years. A glint of pride creeps into his voice when he speaks of his work life, pride in his legacy of teaching children and of paying his own way without any “need of handouts”.
Last week, Winston came into my clinic. Owing to a lifetime of wear and tear in his neck, Winston had compression on his spinal cord. Ten years ago, he had needed an operation to help deal with this when he started losing dexterity in both of his hands after which he had made a full recovery.
By the time I called Winston’s name in the waiting room, my clinic was already running half an hour late. The only person left in the harshly artificially lit room, Winston slowly got up from the chair – his hand initially missing the arm rest because of his reduced ability to coordinate his hands.
I noticed that his legs were barely able to support the weight of his thin physique even with the help of a Zimmer frame. With my help it took him five minutes to walk the 20-metre-long corridor to the clinic room. I was worried about him. Winston explained that over the last three years his arms and legs have gotten weaker and more uncoordinated. Things started this way 10 years ago, but did not then deteriorate to this disabling stage as Winston had seen a doctor and underwent his operation.
I turned the flickering computer screen toward Winston, and he exclaimed: “Well I don’t know what I’m looking at but all I know is that it doesn’t look good!” I agreed as I explained that just above where he had been operated 10 years ago, his ligaments had thickened and hardened – causing a critical pressure on his spinal cord.
A similar process to 10 years ago, but now much worse. Whenever someone hears bad news, there is always a silence – while the patient digests what can possibly be life-changing information and tries to marshal their thoughts to coherence. While Winston did this, one question occupied my thoughts – why had Winston waited so long for things to get so bad, especially given he had been through this once before? What could possibly have been happening over the last three years?
After we discussed Winston’s options, and we both agreed that surgery was the way forward, I asked precisely that question. A guttural sigh came from Winston: “It’s this hostile environment business. I’ve had so many friends affected by it and it scared me. I wasn’t born here but I’ve known no other country.
“My wife, God rest her soul, passed five years ago, and my kids have young children of their own, so everybody’s here. But I see all these people being shipped away, and our community’s full of stories of people being done up in hospital by this business” – he is referring to the immigration checks hospitals managers often carry out on patients – “and I got scared this would happen to me.
“It was only me nearly falling over onto my 7-year old granddaughter that convinced me that I should face that fear and deal with whatever may come. I just don’t want to be another Windrush victim.”
I tried to quell my raging anger at any system that would cause such an unnecessary level of fear in my patient.
Winston would rather risk paralysis from the neck down than go to a hospital for fear that he would be discharged to immigration detention and possibly deportation.
I briefly shared my familial experience of the hostile environment to let Winston know that I completely empathised with his feelings. Here sat Winston, a British citizen, who has contributed to society far more than many, paid his way as well as others – now being victimised by a government that should be acting in his interests rather than generating a Stalinesque culture of malignant fear.
The road to hell is paved with good intentions. Whatever the intentions of the architects of the hostile environment policy claim, the results are what any policy is judged upon.
As anyone who has been following recent events can see, the implementation of such a crass and implicitly racist immigration policy has cast a cloud over immigrants who should have nothing to fear.
Even after the Windrush scandal, the claim of lessons learnt rings hollow in the light of the recent chartered Titan Airways deportation flight to Jamaica, while the Home Office’s Windrush hardship fund had managed to help a grand total of one person.
The core principles of the NHS at its inception clearly stated:
- That it meets the needs of everyone
- That it be free at the point of delivery; and
- That it be based on clinical need, not the ability to pay
The use of an immigration policy to reduce the use of the NHS – especially those fully entitled to its care – is a strategy that could have stemmed from George Orwell’s Nineteen Eighty-Four.
Often in the immigration debate, nuances are ignored, and the quality of the debate simply descends to nativism which ignores the very simple lesson of history: no democratic nation has achieved development while continuing to have a closed immigration policy. The NHS wouldn’t exist without people exactly like Winston. The NHS workforce consists of 1.2 million people of which 12.7 per cent are immigrants as of June 2018.
This does not include second-generation immigrants like me, who would not be available for work without immigration occurring. That’s 144,000 people – the population of Oxford – from 102 nationalities.
Yet the hostile environment seeks to disenfranchise both NHS staff and patients, with its effects spreading in a way that cannot be reflected only by crude statistics. Winston represents a group of people who, due to fear of non-medical consequences, will delay (or decline) their presentation to health services and as a result will be less likely to recover. Nobody wins in this scenario.
Over the past 10 years, immigration policy has now become intertwined with the NHS in a way that can no longer be denied.
From the story of Albert Thompson being denied cancer treatment, to the lack of mental health provision for at risk patients in immigration detention the so called “upfront charging” of patients (which in reality often means patients being blindsided with a crippling life-ruining bill immediately prior to discharge), the checking of passports at outpatient receptions and the Home Office’s use of NHS data on patient debt to track down asylum seekers and migrants at their home address and arrest them, the confabulation of immigration and the NHS is undeniable.
Added to this, we now have the avoidance of healthcare due to unnecessary fear of deportation as exemplified by Winston.
Yet contrary to many ill-informed opinions, immigration is not a death knell for the NHS. A study by Oxford university, that looked at 125 million patient records, found that a 10-percentage-point increase in migrants led to reduction of waiting times by nine days for outpatient referrals, with no effect on waits for A&E or elective care.
Yet the NHS is weaponised as an arm of the immigration service.
The NHS is often held up as the exemplifier of British values. The current immigration policy wrapping its tentacles around the NHS will only act to toxify it.
Patients like Winston should see our team as people who are there to help them, not as uniformed border control agents waiting to deport them for no reason.
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