This is a guest blog for the Patients Not Passports “No Borders in the NHS Week of Action”, by Keep Our NHS Public campaigner, Alia Butt. Patients Not Passports is the campaign to end migrant charging in the NHS.

The NHS is struggling to cope. With what will certainly be the worst winter crisis in its history on the way and a service already ravaged by the pandemic, it will be the poorest, most marginalised and migrants who will suffer – writes NHS Psychotherapist and activist with Keep Our NHS Public, Alia Butt

Today I was horrified to find that the Borough I work in is no longer taking on any more referrals from adults struggling with their mental health. That means that no-one in the area of Hackney will be offered one-to-one therapy of any kind. In fact, they will not even be put onto a waiting list. 

This is now the reality of the NHS. The Government is working to place the blame on health workers, introducing league tables for GPs and financial penalties for not offering enough face to face appointments. But why are they so keen to blame the workers for the faults of the system? 

The reality of the situation is that the crisis in the NHS has been moulded to scapegoat health workers and allow those responsible in private healthcare companies and the Government to look innocent. It is through this narrative that they justify introducing more and more neoliberal market logic into the NHS. The truth is perhaps all too harrowing.

The NHS has been destabilised over the years, through austerity and cuts that could have been avoided – whilst the government misuses taxpayers’ money to prop up the arms trade and big business. The NHS is a public health service designed to provide free healthcare to all, and the crisis should be a time for making that more of a possibility, yet over the pandemic we have seen privatisation rise exponentially, undermining our universal health service.

Privatisation both wastes money and also reduces service provision. People who are able to access support are being offered lower quality of care and this ultimately adds to loss of life and preventable suffering. It is the reason GPs are unable to offer more face-to-face appointments; it is the reason my Trust is no longer able to offer any more appointments for the millions of people struggling with their mental health, and it is the reason people are dying on trolleys waiting for beds. Whilst the pandemic has undoubtedly put the NHS under unprecedented strain, this was all happening before coronavirus was even a whisper on the grapevine.

Those who suffer most are those in society with less access to help elsewhere. Increasingly these people are also those who are expected to pay more despite having less. Undocumented migrants who live in this country are now charged at a cost of 150% to be able to access the NHS. They are required to pay upfront for care that is not deemed urgent, often leading to delays, denial of treatment, and in many cases death, because they could not pay. For those that can access treatment, they find themselves in debt to the NHS, which often acts as a barrier to being able to make applications to stay in the country, or leads NHS Trusts to send outsourced debt collectors after patients that cannot pay in the first place. In an attempt to make it incredibly difficult to stay and live in Britain, the Home Office introduced the Hostile Environment policy which is inhumane on many levels, including a stipulation to deport first and have a hearing later. But the additional charges to access the NHS result in many people not accessing healthcare and losing health and life. 

The logic of Hostile Environment immigration policies goes hand in hand with privatisation, both working to undermine the role of the NHS as a public service, available to all who need it, regardless of ability to pay or where a person is from. The Hostile Environment seeks to shift the culture of the NHS towards a focus on ‘entitlements’ – dividing people into those who are included and those who are not. It is a move away from a rights-based approach to care, a direct attack on the idea that we all deserve to live a healthy and happy life. For the provision of healthcare to be profitable, and therefore appealing to private companies, it is necessary to create a system in which some people are entitled to services and some are not. As we have seen from the cherry-picking practices of privately run ‘NHS’ services, or through the selective coverage offered on health insurance schemes elsewhere, the market has no interest in maintaining a health system that values universal coverage as a core principle. 

This is why the fight against the Hostile Environment is bound up with the fight against privatisation. Why both these battles are a struggle for the future of healthcare, for the universal principles of the NHS, and why we must resist every attempt to further erode foundations on which our health service is built.

The Health and Care Bill, introduced earlier this year, is worrying for a number of reasons. One particularly frightening concept is that private companies will be able to sit on the boards that decide how taxpayer money is spent, which will naturally mean more private companies will be contracted for services within the NHS. When we hear about the multiple crises in the NHS, we can link them directly to the Government closing essential services under the guise of austerity and then paying private companies millions – if not billions – of pounds to do a below-par job. These companies are inexperienced and uninterested in getting the most public benefit from this money, and therefore the service provided to the public is incredibly insufficient. 

Worse still, the workers often outsourced to private companies are treated incredibly badly. We are seeing some unions helping these workers win disputes around bullying, access to breaks and sickness benefits and – of course – pay, but these are fights over conditions that have worsened significantly as a result of outsourcing and for many workers conditions continue to deteriorate. Some outsourced workers are taking home 15% less than other NHS workers – who are already being paid far too little for the incredibly essential work they are doing so well. Given that migrant workers are often in more precarious situations and less able to access redress for bad treatment by their employers, it is often migrants that find employment in these outsourced roles and bear the burden of these poor conditions. And many of these migrant workers are still having to pay to access the NHS, as do their families. No person should have to pay for healthcare, but there is something particularly cruel about charging people to access the very service they are propping up with their blood, sweat and tears.

The cruelty shown to migrants, to the NHS and its workers is connected, and part of a broader picture of the government’s attack on working and vulnerable people. But there is a chance to hold those in power to account and pressure them into doing the right thing. 

Today is the second day of the #PatientsNotPassports week of action against the Hostile Environment. Today we remind ourselves that we are all fighting for the future of the NHS. 


SHARE Docs Not Cops video outlining what is happening to the NHS – 

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TAKE PART and join us for the rest of Patients Not Passports: No Borders in Healthcare Week of Action (October 23rd – 27th 2021)

You can find Alia Butt on Twitter here.