The NHS was first introduced as a health service which was available to all, no matter what your class, wealth or background; a body which doesn’t discriminate.
This founding principle of universal provision was the result of working class struggle. It is one of the things that sets the UK apart from other capitalist countries, like the US, where a privatised system means that quality healthcare is reserved for the wealthy. In such places, the ability to keep yourself and your family alive and healthy directly correlates with your pay-cheque.
It is the NHS’ lack of discrimination that defines its ethics. It provides health services for all. And it is a literal lifeline for the most vulnerable in our society.
However, according to a recent report by the Observer, three-quarters of NHS hospital trusts in England are using private debt firms to chase treatment costs for destitute asylum-seekers and migrants who have been unable to pay them.
According to the report, between 2016-18, 8,468 patient debts were referred to independent debt collector firms. These firms employed a variety of tactics, including intimidating phone calls, doorstep visits and property possession. Despite these methods, their success rate was slim, only managing to recover 7% of the unpaid debts.
These instances took place despite official guidance given by the Department of Health and Social Care, which state that NHS trusts can write off a debt if “it is clear that a person is destitute or genuinely without access to any funds”.
This is yet another demonstration of the Tory ‘hostile environment’ policy putting a strain on the already overstretched NHS, placing the healthcare system in a position in which morals must be compromised in order to stay afloat.
Continuing hostile policies
The ‘hostile environment’ phrase was denounced by Sajid Javid, the home secretary, upon taking over the role in the wake of the Windrush scandal.
But despite the fact that the phrase has been hushed throughout Westminster ever since, the policy itself has lived on. It continues to shape the practices of various service-providers, employers and individuals in Britain.
According to Theresa May, who introduced the policy while she was home secretary, the hostile environment was intended to make the UK so unwelcoming for illegal immigrants that they would “voluntarily leave”.
Before the Windrush scandal, the policy became progressively more extreme. ‘Operation Vaken’, for example, placed ‘go home’ vans and adverts in areas of the UK with large minority-ethnic communities.
The policy also introduced the 2014 Immigration Act, which requires several public services and groups to carry out ID checks on individuals, including landlords, employers, and the NHS.
All these approaches were aimed at targeting immigrants who were in the UK illegally. However, the policy resulted in mass-discrimination, impacting the lives of many migrants and their families who were legally residing, working, or settled in the UK.
For example, a report by the Joint Council for the Welfare of Immigrants (JCWI) found that 42% of landlords would be less likely to consider renting to someone without a passport since the scheme had been rolled out, while 27% were less willing to negotiate with anyone who had a ‘foreign-sounding’ accent or name.
Equally, another report by the charity SafeLives found that migrant and BME women were likely to stay silent 1.5 times longer than white-British women while living with an abusive partner. This was attributed to their concern that authorities would treat them with hostility if they reported their crimes. This was ultimately fuelled by the fact that police forces were sharing information about abuse victims with immigration authorities.
Now, with the policy apparently abolished, many service-providers are still unclear about how much they should be enforcing lingering discriminatory practices.
People before profit
In the health sector, several cases have come to light in which destitute and vulnerable asylum-seekers have been refused end of life and urgent care. In one instance this January, an Eritrean asylum-seeker with leukaemia was cut off from his treatment by an NHS trust because he could not produce the proper paperwork.
According to doctors who have come forward against these kinds of actions, hostile immigration policies go directly against their Hippocratic oath: ‘to treat the ill to the best of your ability’.
In this instance, NHS trusts have been forced into a position in which they must become an active part of the British capitalist state. They must sacrifice their ethics in favour of profit, and place money above people in their list of priorities.
Stop killing our NHS
The blame for such events cannot be placed on the NHS itself and those working in it. The healthcare system has received large cuts over the last decade, and the blame for this lies squarely with the Tories and their programme of austerity.
Since the Conservative government has been in power, spending in the public sector, including in health budgets, has been cut by up to 40%, according to the Institute For Fiscal Studies (IFS). This has resulted in the highest levels of austerity since the 1940’s.
In the public healthcare sector specifically, the IFS estimate that Tory spending was “substantially below” long-term trend growth, which between 1955 and 2016 averaged out to 4.1 per cent a year. By comparison, between the years 2009-10 and 2015-16 UK public health spending grew at an average of only 1.3 per cent per year.
Instead of blaming the NHS and its tireless staff of nurses, doctors, and other healthcare workers, we should fight for a Labour government that will end all these discriminatory policies and increase funding to the public health sector. This way, NHS trusts will not be forced to prioritise their financial needs over their ethical ones.
The NHS is something to be proud of. Despite the various cuts and bruises it has received over the last decade, it is still plodding onwards, offering help to millions of vulnerable people across the country every year.
For this reason, the labour movement needs to fight to put an end to hostile policies and budget cuts. Only in this way can we ensure that the NHS’ ability to continue fulfilling its role as an ethical service is no longer jeopardised - now and in the future.
This article was written by Luna Williams, a Labour supporter and socialist based in Manchester. Luna is the political correspondent for the Immigration Advice Service, a team of immigration lawyers that provides free immigration advice and application support for asylum seekers, trafficking victims and abuse victims.