As a doctor, the Tories’ abuse of the NHS in the name of xenophobia makes me sick

If Johnson truly wants to help the service, he needs to look at investing in people – including immigrants – rather than just a handful of buildings

Dolin Bhagawati
Saturday 05 October 2019 16:44
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Priti Patel says she will 'end free movement once and for all'

We’ve witnessed a slew of pronouncements from the Conservative Party in the last week. Most of which served to demonstrate a simple unyielding truth: contrary to Boris Johnson’s bemusing claim that they are the “party of the NHS”, the party clearly doesn’t understand how and why the NHS survives and continues to be the jewel in the crown of British achievement.

From the flagship pledge of building 40 new hospitals (in reality, six hospitals) to the inflammatory rhetoric of Priti Patel’s gleeful anti-immigrant antipathy, the evidence demonstrates a pernicious misunderstanding of some of the basic truths about the NHS:

Firstly, the NHS survives because of its staff – of which there currently are too few. And secondly, the NHS has thrived because of immigrants, with frontline staff from 212 nationalities consistently working harder and longer considering the salaries they are paid.

This lack of understanding has led to the Conservative Party presiding over a worsening NHS staffing crisis, exacerbated by a decline in staff retention and tipping towards catastrophe with the exodus of staff over Brexit uncertainty.

Speaking at the Tory conference last week, Patel, the home secretary, illustrated her egregious ignorance regarding these issues by blithely declaring:

“My responsibility is to end the free movement of people once and for all. Instead we will introduce an Australian style points-based immigration system. One that attracts the brightest and best. This daughter of immigrants needs no lectures from the north London, metropolitan, liberal elite.”

It beggars belief that such statements are so replete with inaccuracy. Under Johnson, the government claims the elixir to the UK’s immigration issues is the points-based Australian immigration system. However, the UK’s immigration system is essentially already a points-based system and still fails to gauge healthcare staffing needs. The country is littered with examples, such as the case of Dr Mu Chun-Chiang – a doctor who has lived the majority of her life in the UK, working on an understaffed ward, yet is due to be deported by the Home Office, despite the ongoing and public medical shortage – which fulfill the criteria of any points-based system. Her decision was overturned only after public outcry. In addition to her case, there are the many European doctors being refused settled status, even in shortage areas and specialities, as well as cases from outside the EU such as Luke Ong and a number of others who were told to leave despite their public service.

Even those born and educated in the UK, such as myself, have not been exempt from this xenophobic lunacy. Meanwhile, the actual Australian points-based system has failed to address a crippling nursing shortage in Australia.

It seems that Johnson and Patel have not done their basic research into their immigration panacea, instead allowing the Home Office to deny visas to the brightest and best, but most importantly the needed.

The foundation of the misdirected immigration policy has origins in policy from Johnson’s old Etonian adversary, David Cameron. Cameron claimed that one just had to “look at the crowded doctors’ waiting rooms”, to see the problems with the NHS and immigration. As a doctor with a waiting room, such a statement from a former PM betrays the degree of prejudice among politicians who wish to claim liberal legacies.

The evidence also runs counter to this narrative – a study conducted by Oxford University looked at 125 million patient records and found that a 10 percentage-point increase in migrants leads to reduced waiting times of nine days for outpatient referrals, with no effect on waits for A&E or elective care. In the light of such a study, it’s important to remember that the same ignorance of evidence spawned the “hostile environment”. It was a policy born out of Cameron’s decision to appeal to xenophobia, and Theresa May’s zeal to implement it. It represents their true legacy and Patel, in her eagerness to please her political party, is clearly more than happy to champion it.

Johnson’s aforementioned plan to build “40 new hospitals” is an extension of the Conservative Party’s ignorance over the NHS. Johnson and Matt Hancock, the health secretary, initially doubled down on this pledge, and then rapidly changed tack, admitting to funding for only six. In many ways, approaches like these typify political thinking on the NHS: promise new shiny hospitals to the public in the hope that they’ll be distracted, while ignoring fundamental problems and failing to acknowledge any role in creating them. Chris Hopson (CEO of NHS providers and often a voice of reason on such NHS pronouncements), helpfully delineated the problems faced by NHS trusts with regards to their infrastructure. His words state the issue better than I can: “The NHS has been starved of capital since 2010. There’s a £6bn maintenance backlog, £3bn of it is safety critical. It’s not just these six hospitals who have crumbling, outdated infrastructure.”

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Further, under such proposals, what comfort would I, a surgeon, take from walking into a new, bright and shiny operating theatre with no anaesthetist, operating department practitioner, scrub nurse, theatre runner or surgical assistant available to actually help the patient?

Safe staffing levels are not just about media sound bites. They are a fundamental part of patient safety – as stated by the National Institute for Health and Care Excellence, the Royal College of Nursing and the Royal College of Physicians among many others.

And the solution to the problem of low levels of safe staffing is the same as it always has been for the NHS – the need for immigrant labour. From the Windrush generation to the south Asian doctors and nurses of the Sixties and Seventies and to the currently 13.1 per cent of NHS staff of a non-British nationality – without immigrant labour, the NHS will wither and die.

Even Enoch “Rivers of Blood” Powell recognised this basic truth during his time in government, yet our last three prime ministers have routinely refused to. If Johnson truly wants to help our NHS, he needs to look at investing in people rather than just the buildings. As for Patel, as a fellow child of immigrants I would humbly suggest that she look at the evidence rather than pandering to base xenophobic illogical instincts for precarious career advancement.

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