Last week, Reform UK’s newest MP, Suella Braverman, and the party’s chairman, Zia Yusuf, argued that high levels of migration are placing unsustainable pressure on GP services, leaving British patients struggling to get appointments. This follows new data released by the Centre for Migration Control, suggesting that 752,000 migrants joined the GP register last year.
The Centre for Migration Control, a think tank focused on reducing immigration in the United Kingdom, based its claim on Flag-4 GP registrations, a category that counts anyone whose previous address was outside the UK for three months or more – a group that can include returning British residents as well as new arrivals. The figure of 752,000 Flag-4 registrations may seem large, but it accounted for just more than one in 10 of the roughly 6.5 million new GP registrations last year, a share that falls well short of the “unquenchable demand” Reform portrays. While the party continues to blame immigration for GP access pressures, it overlooks a central fact about the NHS workforce: More than 40 percent of doctors currently licensed to practise in the UK qualified overseas, and international graduates now make up the majority of new entrants to the medical register. The system Reform claims is being overwhelmed by migrants is, in reality, heavily sustained by them. Yet rhetoric tying GP shortages solely to migrant patients is becoming more frequent.
These claims echo across the UK’s wider far right. Tommy Robinson, the anti-Islam activist and former leader of the English Defence League, has repeatedly claimed the NHS is being “swamped by the rest of the world”, framing healthcare as another border to be defended. In this telling, the NHS becomes the last national institution under siege from migration. Yet the NHS is woven into Britain’s sense of itself. Almost every citizen has relied on it at some point in their lives, as it was designed to serve people from cradle to grave, and the emotional attachment to it remains strong despite its present strains. But unlike other parts of British life that politicians routinely blame migrants for reshaping, the NHS has always been intertwined with migration – just not for the reasons now being invoked.
The NHS was built on migrant labour, something that no politician has quite come to grips with since it was introduced. In 1948, an exodus of British doctors began at the formation of the health service, with many leaving for countries such as the United States, Canada and Australia, and Britain increasingly looking to its former colonies for a continued workforce supply. By 1971, about 31 percent of NHS doctors in England were born and qualified overseas. Even Enoch Powell, widely regarded as the chief architect of Britain’s modern anti-immigration movement, called for and supported the recruitment of doctors from abroad during his time as minister of health in the early 1960s. In a 1961 House of Lords debate, Lord Cohen of Birkenhead stated that the “Health Service would have collapsed” had it not been for junior doctors from India and Pakistan. This is without even taking into account the effect of the Windrush generation or Irish migrants, who formed a significant part of the nursing workforce in post-war Britain. This cognitive dissonance was apparent even in recent governments. Take former Home Secretary Priti Patel, under Boris Johnson’s Conservative government, who enforced some of the harshest migration conditions in recent decades, yet also introduced the Health and Care Visa and oversaw a significant increase in the recruitment of overseas healthcare workers during and after the pandemic to meet workforce shortages. Britain knows its health service cannot function without migration, but it never has.
This is not a new debate. In the 2010s, successive Conservative governments, while overseeing years of austerity and historically low funding growth in the health service, blamed migrants for its woes. The NHS migrant surcharge was introduced in 2015 as the Immigration Health Surcharge, forcing migrants who move to Britain to pay additional costs to use the NHS, despite many also contributing through income tax and national insurance. Currently, the surcharge stands at 1,035 pounds ($1,405) per year per adult, which can easily rack up significantly higher costs for families relocating to Britain. Thus, migrants do pay more to use the National Health Service. So why does Britain continue to blame them for the faltering service time and again?
The redirection tactic is easier to use than dealing with the complexity of fixing the NHS. The service has become so fragmented that it is almost impossible to work out where exactly the blame should lie internally, or where to begin when trying to fix the numerous problems that lead to poor wait times. Blaming migrants, however, is easy. It is tangible, too. Images regularly circulate on social media of A&E departments filled with brown and Black patients waiting to be seen, with racist captions blaming “foreigners” for the wait – even though they could very easily be British nationals. None of those posts ever considers that close to half of doctors currently practising in the UK qualified overseas. Instead, visible ethnic differences are enough to convince them that immigration is the cause of the NHS’s faults. Politicians jump on this sentiment, and the truth becomes irrelevant.
Reform, for example, fails to take into account that research from the University of Oxford’s Blavatnik School of Government found that areas with more migrants do not experience longer NHS waiting times and, in some cases, even record slightly shorter waits. Migrants are often younger, healthier and therefore less likely to use GP services than Britain’s ageing population. Explaining that to the British public, however, is more complicated than adding it to the ever-growing list of things to blame immigrants for.
British politics has become encapsulated in two recurring debates – fixing the NHS, and migration. Just as the NHS stokes up emotion in British politics, migration causes a heated conversation. Combining the two creates a political firestorm that Reform believes will lead them to election victory – a tactic which has been used before, when the now infamous Vote Leave bus claimed the NHS would receive money going to the European Union, helping the Vote Leave campaign win the Brexit referendum. It wins voters, even if the figures do not stand up to scrutiny.
This is why, now, Health Secretary Wes Streeting has introduced fast-tracked legislation to prioritise British doctors in training posts over international ones, to “back homegrown talent”, and the Labour government has proposed tightening the social care worker visa route. Britain remains short of doctors, nurses and social care workers, but the last few years have proved a marked ideological shift. No longer is the debate about “good immigrants” who are needed in the NHS – the policy is to deter all migrants, for short-term political gain. Perhaps when Britain releases itself from the idea that it is competing with migrants for care, it will realise that migrants are the care.
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.