Treating xenophobics on the NHS?

Few issues today are as polarising as Brexit or the National Health Service (NHS).

This week saw Dr Phil Hammond become perhaps the first UK medic (and journalist) to lose his job, for daring to mention he might stand up for the NHS against hard Brexiteer, Jacob Rees-Mogg.

For many Mogg supporters, Brexit’s a win over foreign powers; the NHS, a luxury wasted on migrants.

For opponents, Brexit’s a win by Russian powers; the NHS, a necessity needing migrants.

It’s a fevered clash in a country that likes to think it keeps calm and carries on; but annually, still parades bad blood between Protestant and Catholic.

This Summer’s been heated. Claims that Brexit harms – by deterring EU staff, limiting supplies and disrupting research – are met by claims Brexit helps – by allowing more testing of foreign doctors, and more hours to train junior ones.

The world’s first Brexit

With each side arguing over foreign staff, it’s worth looking at what comedian Anuvab Pal has dubbed “the world’s first Brexit”.

In 1947, Britain quit India after almost two centuries. To that point, the Empire had run an Indian Medical Service and the General Medical Council (GMC) continued to recognise Indian medical degrees.

The next year, Britain created the NHS. Minister of Health, Nye Bevan was said to have met doctors’ objections by “stuffing their mouths with gold”. But with postwar austerity, how much gold can there have been to go round? Professor Aneez Esmail reports that:

The British Medical Association (BMA) was keen to pursue a policy that would severely restrict the rights of foreign medical students to practise in Britain…

In truth, Britain needed cheap workers to rebuild its economy and build its NHS. From the Caribbean, the Windrush generation answered the call. From India and South Asia, doctors came in numbers.

Their plight was recounted by Lord Taylor to the House of Lords in a debate on “The Shortage of Doctors” (29.11.61):

The whole of our hospital service would have collapsed had it not been for the enormous influx of junior doctors from India and Pakistan…They are coming here to learn, and they are going to the worst places to do it, where there is less supervision. They are acting as pairs of hands, usually with very incomplete and inadequate supervision…

Overseas doctors, though restricted by poor jobs and the old boys’ club, were still useful to contain costs (as ever, a pressing issue). Minister of Health, Enoch Powell, went so far as to complain:

The unnerving discovery every Minister of Health makes at or near the outset of his term in office is that the only subject he is ever destined to discuss with the medical profession is money.

Overseas doctors came cheap, with less risk they’d ever have to be paid as consultants. Esmail reports that Powell was “an architect of the policy of recruiting doctors from the Indian subcontinent”; stuffing the NHS with foreign doctors, not gold. Ironically, Powell later whipped up fear of immigration, saying:

…I am filled with foreboding. Like the Roman, I seem to see “the River Tiber foaming with much blood”.

But Powell’s views weren’t alien to UK medics. Esmail reports antipathy to foreign doctors in many letters to the British Medical Journal of that time.

Brexit Revisited

Brexit’s seeing the rise of similar hypocrisy and intolerance.

Remainers argue that Brexit hits retention and recruitment of EU staff, limits medical supplies and harms research. Certainly, the Mid Staffs inquiry laid bare the suffering that results from key shortages. And the world’s first Brexit shows how the NHS can be left to limp along with inadequate UK staffing. When junior doctors warn as much, they echo retired foreign medics who also covered in austere times.

Brexiteers respond that leaving the EU allows more intense training of junior doctors and harder testing of foreign ones.

Longer hours may or may not cause clinical harm. But the training claim looks like a way to work juniors harder to cover staffing gaps. These were plugged after the world’s first Brexit, but seem set to be reopened by the second. #BawaGarba has ignited fears about who’ll carry the can when these gaps cause disaster.

And stricter language testing presupposes an unaddressed hazard. Professor Esmail reports that only a few foreign doctors have material language issues, and most resolve within months of starting UK practice. Evidence of harm is limited to isolated cases. Despite this, the language claim gets recycled to excuse the GMC’s well known race gap (white doctors face fewer, lighter sanctions). Yet it’s older doctors, beyond language issues, who more often face GMC action.

The language claim seems a convenient fiction. If it were just about safety, the GMC would surely test surgeons’ eyesight with at least the vigour it tests foreigners’ vocabulary?

Conclusion

The history of the NHS proves the UK’s need for, and discomfort with, migrants. It’s as if imported doctors are to serve the NHS, but needn’t apply to run it.

Brexit pushes similar buttons, distracting from its key battle, over which elite runs Britain. Like imported colleagues, Dr Phil Hammond’s learnt this is a debate to which he’s not invited.